Conspicuous Psychiatric Morbidity Research Articles

The quality of life of HIV-infected women is associated with psychiatric morbidity

This study evaluated the effect of clinical, demographic and psychiatric factors on the health-related quality of life of 76 women with HIV infection seen in two HIV reference centres in Brazil. The generic questionnaire for evaluation of Health-Related Quality of Life (SF-36), the Hospital Anxiety and Depression Scale (HAD) and the Clinical Interview Schedule (CIS-R) were used. The statistical tests included the covariance analysis. The patients’ mean age was 37.4 years; 44.7% had less than 8 years of schooling. A total of 44.8% were asymptomatic, 28.9% symptomatic non-AIDS and 26.3% had AIDS. Most (77.6%) used two or three kinds of antiretrovirals; 36.8 and 30.3% achieved scores for anxiety and depression, respectively (HAD); and 48.7% for conspicuous psychiatric morbidity (CIS-R). The sub-group of the non-AIDS symptoms (clinical stage B) showed the worst quality of life. The variables which better explained the scoring variation on both the mental and physical components of the SF-36 were related to mental health. The more mental symptoms present, the worse the health-related quality of life. We must rethink care strategies in the area of mental health which are directed toward HIV+ patients, by virtue of the levels of mental symptoms found and the request for care which the research revealed.

A mental health prevalence survey in two developing towns of western region

A prevalence survey was done to find out the conspicuous psychiatric morbidity (CPM) in two rapidlydeveloping towns of western region by using Self – Rating Questionnaire (SRQ). Out of 894 people interviewed773 were selected for analysis. The CPM point prevalence rate of 35.4 % was found. The high prevalence ofCPM was most likely due to less stable social structure in the towns in transition.

The pathways to primary mental health care in high-density suburbs in Harare, Zimbabwe.

The pathways to care for mental illness are diverse and are dependent on sociocultural and economic factors. The objective of this study was to describe the pathways to primary care for patients with common mental disorders in Harare. One hundred and nine consecutive patients with conspicuous psychiatric morbidity identified by general nurses in three primary health care clinics (PHC) and by four traditional medical practitioners were interviewed with the Pathways to Care Schedule. Other than those patients with an acute illness, most patients consulted more than one care provider; three-quarters of those with a history of prior consultations had consulted both traditional and biomedical care providers. Biomedical care providers were the most common first care provider consulted; if this treatment failed, then patients tried other biomedical or traditional care providers. Different factors operated in the decision-making process in choosing between consulting biomedical and traditional care providers. Traditional care providers provided explanations more often than biomedical care providers; explanations given were most often spiritual. Injectable treatments were often prescribed for mental illness, especially by private general practitioners (GPs). Such treatments, and many oral treatments, were non-specific. Dissatisfaction with consultations was most commonly due to lack of symptomatic improvement. The costs of consultation were highest for private GPs, general hospitals and traditional healers; faith-healers, PHCs and hospital psychiatric departments were the cheapest.

A three-year follow-up of psychiatric morbidity in urban and rural primary care

Follow-up by examination of medical and psychiatric records was carried out on 357 patients with conspicuous psychiatric morbidity in two general practices three years after clinical and personality assessment using structured interview schedules. One practice was an inner-city urban one and the other was rural. Full follow-up data over the 3-year period was available for 301 patients (84.3%). After three years patients with personality disorder and those in the urban practice had greater morbidity, more contacts with all levels of the psychiatric service and more psychotropic drugs, particularly benzodiazepines. Despite this increased morbidity, the number of consultations with the general practitioner for psychiatric illness was no higher in the urban group and those for medical illness were significantly higher in the rural one. The implications of the findings are discussed with particular reference to developments in community psychiatric care.

5. Psychiatric morbidity in general practice

It is well known that the great majority of patients presenting psychiatric symptoms are treated by GPs rather than by specialist psychiatric personnel (Shepherdet al.1966). Goldberg & Huxley (1980) have proposed a model to describe psychiatric disorders and their care, consisting of five levels and four filters. Level 1 refers to psychiatric and emotional disorders in the community as a whole, and filter 1 represents the decision to, and act of, consulting a GP. Level 2 consists of all psychiatric morbidity that presents to GPs, although a proportion is not recognized as such (the hidden psychiatric morbidity – HPM). Filter 2 is thus the process of identification, and level 3 refers to the morbidity so identified (the conspicuous psychiatric morbidity – CPM). Filter 3 is the process of referral to the specialist psychiatric services, the patients of which are designated as level 4. A proportion of patients at this level will be admitted to hospital (i.e. will pass through filter 4) and reach level 5 (psychiatric in-patients).

Personality Disorder and Psychiatric Illness in General Practice

In a one-year prevalence study of conspicuous psychiatric morbidity in two group general practices, one urban and the other rural, personality disorder was diagnosed in 5.3% by the GP and in 5.6% by the psychiatrist, but this increased to 28% when personality disorder was assessed using a structured interview. The prevalence of personality disorder was higher in the urban practice than in the rural one but there was no consistent association between personality disorder and mental state disorder, with the exception of alcohol abuse and dependence. The high rate of personality disorder found using the interview schedule is likely to be a true finding, and failure to recognise this hidden morbidity is important in both general and psychiatric practice.

Psychotropic drug prescription in general practice in Italy: a two-week prevalence study.

A study on psychotropic drug monitoring was carried out in Verona over a 2-week period using information obtained during consultation with 3 GPs. Psychotropic drugs accounted for 23.4% and 24.3% of all prescriptions in men and women respectively. Benzodiazepines were the most frequently prescribed: 76% and 72% of all psychotropic prescriptions respectively in women and in men. No significant association between psychotropic drug prescription and age, sex, marital status and occupation was found in the present survey. In men only, those patients with higher educational level were more likely to receive a prescription for psychotropic drugs than those with a lower educational level. About 70% of men and 60.4% of women diagnosed by the GP as having a psychiatric problem were prescribed a psychotropic drug. However, the probability of a psychotropic being prescribed, when a psychiatric problem is identified by the GP, was significantly higher (p less than 0.05) in men than in women: odds ratio 39.37 and 16.33 respectively. Psychotropic drugs were prescribed in 35% of men and in about 48% of women in which a social problem was identified by the GP. Women were about 5 times more likely to receive a prescription than men: odds ratio 12 and 2.75 respectively. A significant influence of physical ill-health and educational level on psychotropic prescription emerged: both effects were independent of sex, psychiatric morbidity and social problems. Using a logistic regression analysis, an interactive effect between sex and conspicuous psychiatric morbidity and between sex and social problems was also found.

General practitioners' selection of patients for treatment in community psychiatric services.

In a Danish community psychiatric service the patients referred from general practitioners (GPs) to the community psychiatric service (CPS) are compared with matched individuals with conspicuous psychiatric morbidity treated in general practice only. The psychopathology of the referred patients is more severe, as estimated by two different methods. They make fewer social contacts and their work situations are unfavourable. It was found that to a great extent the GPs refer their patients with mental disorders to the CPS so that the 'filter' between the GP and the CPS is very permeable. Of the patients treated by the GPs only (the matched group), no more than 54% were assessed by a psychiatrist as psychiatric 'cases'. Psychopathology thus only partly determines the GPs' assessment of psychiatric 'caseness', in which social impairment plays an important part. The GPs diagnose more mental disorder than the psychiatrists, possibly because of an intimate acquaintance with the anamnesis.

The relationship between social functioning and psychiatric symptomatology in primary care

The relationship between social functioning measured by an interview schedule, psychiatric symptoms, alcohol abuse and personality was examined in 171 patients with conspicuous psychiatric morbidity seen in primary care. Social functioning was significantly better in older patients and in those with no alcohol abuse or personality disorder. A close relationship was shown between social functioning and psychiatric diagnosis, social impairment increasing with severity of disorder. This relationship was not obtained for depressive disorders in which social functioning was similar across all diagnostic groups. There was a high correlation between social functioning score and total psychiatric symptomatology, although social functioning appeared to be a more important determinant of referral to psychiatric services than Present State Examination (PSE) total score. The results support the view that social functioning measures can convey additional useful information to that of symptom measures, and might be of use in a multiaxial classification.

The diagnostic status of patients with conspicuous psychiatric morbidity in primary care.

A 7% one-year prevalence rate of conspicuous psychiatric morbidity was found in patients attending a single general practice. The nature of the morbidity was examined by a detailed assessment of mental state and personality, using interview schedules administered by a psychiatrist. Depressive disorders were presented by nearly half of the patients. The overall sex incidence of the disorders was equal, but alcohol abuse was more common in males. A personality disorder was present in 33.9% of all patients seen, although it was rarely diagnosed as the primary problem and was linked to the diagnosis of anxiety states, rather than depressive neurosis. These findings are discussed in relation to other epidemiological studies in primary care.

The two town study: a comparison of psychiatric illness in two contrasting Western Australian mining towns.

The results are presented of a survey of patients identified by their general practitioner as having conspicuous psychiatric morbidity, according to Kessel's (1960) Classification, during a three months general practice survey in two Western Australian towns, one Gynalla, a new expanding town in the Pilbara area and the other, Jaburoo, an established economically stagnant town in the South West. The findings show a higher general practice consultation attendance rate for both sexes, and a higher rate of psychiatric illness among females, in Jaburoo than in Gynalla. In Gynalla psychiatric cases among women formed a disproportionately high percentage of all general practice attendances. The implications of these findings are discussed.

Pathways of specialist referral of depressed patients from general practice.

Of patients with ‘conspicuous psychiatric morbidity’ in British general practice, 5 per cent annually are seen by psychiatrists, roughly equal numbers are referred to non-psychiatric specialists (Shepherd, Cooper, Brown and Kalton, 1966), and cross-referral rates are low (Mezey and Kellett, 1971). The clinical, as opposed to the social, reasons why so few patients are referred to psychiatrists must be inferred from the indirect evidence of epidemiological surveys (Shepherd et al., 1966), studies of patients already referred to an out-patients clinic (Kreitman, Sainsbury, Pearce and Costain, 1965), doctors' referral letters (Mowbray, Blair, Jubb and Clarke, 1961), and surveys of doctors' attitudes (Shepherd et al., 1966; Mezey and Kellett, 1971). Few studies of referral have been prospective (Kaeser and Cooper, 1971) and none has been by interview of patients before referral has taken place. Meanwhile, detailed clinical studies of psychiatric illness continue to focus almost exclusively on patients already in care of psychiatrists. It follows that more knowledge is needed of the clinical factors which lead to specialist referral; otherwise the significance of hospital-based studies for the wider context of psychiatry in general medical practice cannot be properly appreciated. This need is particularly acute with respect to the so-called minor affective disorders which are common in general practice but of which only a minority come to the notice of psychiatrists (Watts, 1966; Taylor and Chave, 1964).

Psychiatric morbidity in an out-of-hours deputizing service.

A survey undertaken on a consecutive series of 500 patients, visited by a doctor who was employed by a deputizing service providing out-of-hours medical attention, revealed a psychiatric morbidity of 8%. The distinction between the total psychiatric morbidity and the conspicuous psychiatric morbidity of a population is discussed, and reasons are suggested why the determined conspicuous psychiatric morbidity of 8% is low. The psychiatric conditions encountered in such a practice are described. The incidence of psychosis and of psychiatric problems in children was low. Alcoholic disorders were common and diverse in their clinical manifestations, and presented difficulties in diagnosis. Case studies of the alcoholic patients are included to illustrate these findings. Problems presented by drug-dependent patients are described. A descriptive impression is given of the type of patients with a psychiatric problem who seek the attention of a deputizing service.

LEVODOPA AND L-TRYPTOPHAN THERAPY IN PARKINSONISM

The therapeutic effects on parkinsonism of a combination either of L-dopa (levodopa) and L-tryptophan, or of levodopa and a placebo, were compared. The trial was carried out on forty parkinsonian patients. Psychological assessments before the trial revealed little conspicuous psychiatric morbidity, and, in particular, little depressive affect. " Validity ", a dimension of personality measured by the Marke-Nyman temperament scale, which is related to energy and drive, was lower than normal. Levodopa produced a striking improvement in the ratings of tremor, rigidity, akinesia, gait, and posture equally in patients treated with this compound alone or in combination with L-tryptophan. Tests of functional ability to do certain tasks tended to improve in all patients but showed a significant improvement only in patients treated by the combination of levodopa and L-tryptophan. There was no deterioration in the mental state in either treatment group, and the patients treated by the combination (but not by levodopa alone) showed a small but significant improvement in mood and drive. Cerebrospinal-fluid concentrations of homovanillic acid and 5-hydroxyindoleacetic acid were estimated in fourteen patients before treatment. The levels of both compounds were low before starting treatment, but there was no correlation between the pretreatment levels of these compounds and the baseline neurological and psychological scores, nor with the patients' subsequent response to treatment.

Psychiatric Illness in General Practice: A Detailed Study Using a New Method of Case Identification

A self-administered questionary (the General Health Questionnaire) aimed at detecting current psychiatric disturbance was given to 553 consecutive attenders to a general practitioner's surgery. A sample of 200 of these patients was given an independent assessment of their mental state by a psychiatrist using a standardized psychiatric interview. Over 90% of the patients were correctly classified as "well" or "ill" by the questionary, and the correlation between questionary score and the clinical assessment of severity of disturbance was found to be +0.80.The "conspicuous psychiatric morbidity" of a suburban general practice assessed by a general practitioner who was himself a psychiatrist and validated against independent psychiatric assessment was found to be 20%. "Hidden psychiatric morbidity" was found to account for one-third of all disturbed patients. These patients were similar to patients with "conspicuous illnesses" in terms both of degree of disturbance and the course of their illnesses at six-month follow-up, but were distinguished by their attitude to their illness and by usually presenting a physical symptom to the general practitioner.When 87 patients who had been assessed as psychiatric cases at the index consultation were called back for follow-up six months later, two-thirds of them were functioning in the normal range. Frequency of attendance at the surgery in the six months following index consultation was found to have only a modest relationship to severity of psychiatric disturbance.It is argued that minor affective illnesses and physical complaints often accompany each other and usually have a good prognosis.