Detection Of Psychiatric Illness Research Articles

P9 Impact of neuropsychiatry screening in neurological inpatients: comparison with routine clinical practice

Objective To compare the rate of detection of psychiatric illness in routine clinical practice, with the prevalence of mental illness established, using a dedicated screening programme at a regional neuroscience centre; and to assess if the screening programme had any enduring impact on routine clinical practice after its completion. Method Consecutive admissions to a neurology ward in the 3-month period before (n=160) and after (n=158) a dedicated neuropsychiatric screening program was carried out were identified. Case notes were then reviewed to establish if symptoms of mental illness were identified by the treating neurologists and if patients were referred for neuropsychiatric assessment. Rates of detection of neuropsychiatric problems and rates of referral for treatment were compared with those identified during the screening programme. Results In routine clinical practice, over two 3-month study periods, psychiatric symptoms were identified in 23.7% of patients and only 10.6% received neuropsychiatric interventions. This is much lower as compared to rates identified (51.3%) and treated (51.3%) during dedicated screening. Detection of mood symptoms decreased from 14.7% pre-screening to 3.8% in the post-screening period. Conclusion Rate of detection and treatment of neuropsychiatric problems remains low in neurology inpatients in routine clinical practice. Neuropsychiatric Screening is effective but does not have sustained effect once it stops. Hence we suggest active ongoing screening should be incorporated into routine practice.

Impact of neuropsychiatry screening in neurological in-patients: comparison with routine clinical practice.

Earl J, Pop O, Jefferies K, Agrawal N. Impact of neuropsychiatry screening in neurological in-patients: comparison with routine clinical practiceBackground: It is now well recognised that the rate of psychiatric comorbidity is high in patients with neurological disorders. Psychiatric comorbidity has a significant impact on quality of life and often goes undetected in routine clinical practice.Objectives: To compare the rate of detection of psychiatric illness in routine clinical practice with the prevalence of mental illness established using a dedicated screening programme at a regional neuroscience centre and to assess if the screening programme had any enduring impact on routine clinical practice after its completion.Methods: Consecutive admissions to a neurology ward in the 3-month period before (n = 160) and after (n = 158) a dedicated neuropsychiatric screening programme was carried out were identified. Case notes were then reviewed to establish if symptoms of mental illness were identified by the treating neurologists and if patients were referred for neuropsychiatric assessment. Rates of detection of neuropsychiatric problems and rates of referral for treatment were compared with those identified during the screening programme.Results: In routine clinical practice, over two 3-month study periods, psychiatric symptoms were identified in 23.7% of patients and only 10.6% received neuropsychiatric interventions. This is much lower as compared with rates identified (51.3%) and treated (51.3%) during dedicated screening. Detection of mood symptoms decreased from 14.7% pre-screening to 3.8% in the post-screening period.Conclusion: Rate of detection and treatment of neuropsychiatric problems remain low in neurology in-patients in routine clinical practice. Neuropsychiatric screening is effective but does not have sustained effect once it stops. Hence we suggest that active ongoing screening should be incorporated into routine practice.

The role of satisfaction with occupational status, neuroticism, financial strain and categories of experience in predicting mental health in the unemployed

This study tests the contributions of the latent functions of employment (latent deprivation model; Jahoda, 1981: Jahoda, M. (1981). Work, employment and unemployment: Values theories and approaches in social research. American Psychologist, 36, 184–191), the manifest functions of employment (agency restriction model; Fryer, 1986: Fryer, D. M. (1986). Employment deprivation and personal agency during unemployment: A critical discussion of Jahoda’s explanation of the psychological effects of unemployment. Social Behaviour, 1, 3–23) and personality (trait neuroticism) in accounting for psychological distress in the unemployed. Eighty-one unemployed individuals were assessed on measures of psychological distress (GHQ-12; Goldberg, 1972: Goldberg, D. P. (1972). The detection of psychiatric illness by questionnaire. London: Oxford University Press), the latent functions of employment (activity, time structure, social contact, status, collective purpose), financial strain, trait neuroticism, and a measure of labour market satisfaction. It was shown that the latent functions of employment and financial strain were each able to contribute significantly to the prediction of psychological distress over and above that predicted by Neuroticism, which alone also contributed significantly to the prediction of distress. Results are related to the latent deprivation and agency restriction models of well-being and it is argued that temperament needs to be considered in any explanation of the negative psychological effects of unemployment.

Psychiatric training for family doctors: what do GP registrars want and can a brief course provide this?

About 40% of British General Practitioners (GPs) train formally in a psychiatric post as part of their general practice training, but such training may not fully meet the needs of future GPs. A specific course in psychiatry for family doctors has run in Manchester for more than a decade. Semi-structured interviews conducted with GP registrars before attending the Manchester course in psychiatry with questionnaire follow-up afterwards to ascertain (a) the training 'wants' of GP registrars and (b) whether the course was providing them. GP registrars most frequently wanted training in communication skills, how to access the resources that are available to GPs, the detection of psychiatric illness, drug treatment and the management of aggression. The course was successful in satisfying the first three but failed in the last two. There was trend for those who attended Manchester Medical School, which scored significantly higher on number of topics covered at undergraduate level, to perceive a greater need for training than those who attended other medical schools. However, there was no evidence to link self-perception of greater need with having already worked in general practice during postgraduate training. More attention needs to be paid to how to address the specific mental health skills training requirements of GP registrars both within the attachment in psychiatry and during the practice year. Preliminary research is required to devise teaching packages before they are entirely satisfactory for GP education.

Generalists neglect psychiatry

EDITOR,--The recent report by the Royal Colleges of Physicians and Psychiatrists highlighting the psychological care of medical patients emphasises the importance of general doctors being able to detect and assess the presence of common psychiatric disorders.1 2 Most patients with psychiatric illness are not seen by psychiatrists, with only just over a quarter of psychiatrically ill patients actually being diagnosed.3 There must therefore be an increased emphasis on the detection of psychiatric illness …

Patient satisfaction and the detection of psychiatric morbidity in general practice.

This study explores the relationship between the detection of psychiatric illness during general practice consultations and patient satisfaction. Psychiatric illness was defined as a score of greater than or equal to 3 on the 12-item General Health Questionnaire (GHQ-12). The hypothesis was that patient satisfaction would be higher after consultations during which psychiatric illness was correctly identified by the GP than after those during which it was 'missed'. Two hundred and twenty two patients attending seven doctors at one inner London practice participated. One hundred and ten patients (50%) scored greater than or equal to 3 on the GHQ-12. The GPs classified 76 of these 110 patients as having a psychiatric component to their illness and 34 as having an entirely physical illness. Only one significant difference in satisfaction was found between these two groups--patients in whom psychiatric illness was correctly identified reported more benefit from the consultation than patients in whom psychiatric illness was present but 'missed'. Possible explanations for the largely negative findings are discussed including the difficulties of measuring patient satisfaction and the distinction between detection and management of psychiatric illness in general practice.

The detection of psychiatric illness and psychological handicaps in a British pain clinic population

Ninety-seven successive patients attending the Newcastle Pain Relief Clinic completed a battery of psychiatric, psychological and pain questionnaires, and an extensive personal information form. All patients were seen by a physician who evaluated the extent of the pain arising from physical, psychiatric and psychological causes, and by a psychiatrist, who administered a structured interview schedule. Thirty-two percent of the patients had sufficient symptoms to be classified as psychiatric cases on the Present State Examination (PSE), a further 22% had minor neurotic symptoms and features of illness behaviour, 35% were categorized as organic, and 11% were unclassified. The Leeds General Depression Scale for Depression and Anxiety and the Beck Depression Inventory were the most effective of the psychiatric questionnaires used in separating the psychiatric patients from the remainder, and can be recommended as screening instruments for psychiatric illness in this population. Factors associated with a psychiatric diagnosis included female sex, larger number of present medications, greater reduction in activities compared to the period before the pain developed and increasing subjective pain from the onset of this.

Use of the Diagnostic Interview Schedule in patients with diabetes mellitus.

In routine clinical practice and in research interviews like the Diagnostic Interview Schedule (DIS), symptoms attributed to physical illness are excluded from contributing positively toward psychiatric diagnoses. The maximal rate of underdiagnosis which results from this diagnostic rule was determined in 114 patients with diabetes mellitus. When symptoms attributed to diabetes (total = 296, mean = 2.6 per patient) were discounted, 256 diagnoses were made. Eighteen additional diagnoses (a 6.7% increase) were appreciated when these excluded symptoms were considered as psychiatrically significant; however, only two of these new diagnoses were given to patients previously without a psychiatric diagnosis. The authors concluded that the DIS is sensitive in its detection of psychiatric illness in diabetes and perhaps other physical illnesses as well.

The detection of psychiatric illness and psychological handicaps in a british pain clinic population

Tyrer, S. P.*,1; Capon, M. N.*,1; Peterson, D. M.*,1; Charlton, J. E.2; Thompson, J. W.2 Author Information

Psychiatric illness detection: A comparison of osteopaths and M.D.s in private family practice

The detection of psychiatric illness is increasingly becoming the responsibility of non-psychiatric physicians. As part of a large scale epidemiological survey of psychiatric illness in a metropolitan area, primary care M.D.s and osteopaths were compared for their ability to detect psychiatric illness. Although neither group of physicians detected as much illness as patient self-assessments revealed, osteopaths detected significantly more psychiatric illness than M.D.s. When, however, physician and patient reports of illness were juxtaposed, to determine concordance, M.D.s and osteopaths showed similar degrees of overall accuracy. Osteopaths tended to detect more true positives, while M.D.s detected more true negatives. Different practice and social characteristics were not found to account for practice differences in physician rates of psychiatric illness detection. Osteopaths appeared to be performing at least as effectively as M.D.s in a first line of defence against mental illness.

The Detection of Psychiatric Illness by Questionnaire; A Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness.

The Detection of Psychiatric Illness by Questionnaire; A Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness.