Detection Of Psychiatric Morbidity Research Articles

The prevalence and detection of psychiatric morbidity in patients with metastatic breast cancer.

This study monitored the prevalence and detection of psychiatric morbidity in 80 women newly diagnosed with metastatic breast cancer from diagnosis of metastatic disease over a 16-month period. Patients were interviewed at home every 8 weeks using the Hospital Anxiety and Depression Scale (HADS) and an interview schedule compiled by the author to monitor contact with members of the multidisciplinary team, demographic details, current treatment and sites of metastatic spread. One way analysis of variance (ANOVA) comparing the mean anxiety and depression scores at each interview demonstrated that there were no statistically significant differences in mood across the eight interviews, though there was a trend over the course of the eight interviews for mean anxiety and depression to decrease. Using the cut off scores suggested by the authors of the HADS, the scores were then categorized into case, borderline and normal. These analyses illustrated the relatively large proportion of patients who fell into the borderline and case ranges for anxiety and/or depression with, for example, 39% of women scoring in the case range for anxiety and 31% for depression at diagnosis of metastatic breast cancer. Detection of these mood problems was extremely low with referral to appropriate services not in evidence. The results of this study are consistent with those of other studies monitoring the psychological needs of women with breast cancer and the detection of mood disturbance. The clinical relevance of the results of the present study are discussed and future research avenues suggested.

Detection of psychiatric morbidity in gynecology patients by two brief screening methods.

Psychiatric morbidity was studied in 100 women attending gynecological outpatient and inpatient set-ups using two brief screening instruments: the General Health Questionnaire, 12 items, and the Present State Examination, ten short questions. Psychiatric morbidity was detected in 36% and was found to be higher in women with uterine prolapse and infections but not in those with menstrual irregularities (p < 0.001). The commonest psychiatric symptoms detected in this population were worrying (50%), aches and pains (51%), depression (50%) and disturbances of biological function (51%). The commonest diagnoses were neurotic depression (70%) and adjustment disorders (23%). The screening instruments used were found to be simple, sensitive, specific, with high identification indices and easy to administer.

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 morbidity and its effects on outcome in acute elderly medical admissions

AbstractThis study examines the point prevalence of psychiatric morbidity in patients admitted to acute geriatric care, the performance of screening questionnaries in detecting psychiatric morbidity and the relationship between psychiatric morbidity and outcome (in terms of length of hospital admission and mortality) after controlling for severity of physical illness. In a sample of 119 consecutive admissions, 65 (61%) of the 106 patients assessed had dementia, while nine (10%) of the 88 assessed had a diagnosis of depression and a further 35 (40%) significant depressive symptoms, and 22 (20%) of the 106 assessed had delirium. Screening with the Mini‐Mental State Examination had 81% sensitivity and 83% specificity for dementia. The Geriatric Depression Scale (GDS) had 74% sensitivity and 72% specificity for depressive symptoms; both the GDS and General Health Questionnaire had 100% sensitivity for depressive illness. Mortality was significantly higher in the delirious (62%) than in the non‐delirious (14%,p&gt;0.001) and in the severely demented (65%) than the mildly demented (29%) and non‐demented (15%,p&gt;0.001) subjects. For delirium this effect was found to be independent of the severity of physical illness. Patients with severe dementia had significantly longer hospital admissions (p&gt;0.02). No relationship was found between depression and outcome.

Detection of psychiatric morbidity in the primary medical care setting in Brazil

The aims of this study were a) to assess the ability of primary care doctors to make accurate ratings of psychiatric disturbance and b) to evaluate the use of a case-finding questionnaire in the detection of psychiatric morbidity. The estudy took place in three primary care clinics in the city of São Paulo, Brazil, during a six-month survey. A time sample of consecutive adult attenders were asked to complete a case-finding questionnaire for psychiatric disorders (the Self Report Questionnaire - SRQ) and a subsample were selected for a semi-structured psychiatric interview (the Clinical Interview Schedule - CIS). At the end of the consultation the primary care doctors were asked to assess, in a standardized way, the presence or absence of psychiatric disorder; these assessments were then compared with that ratings obtained in the psychiatric interview. A considerable proportion of minor psychiatric morbidity remained undetected by the three primary care doctors: the hidden morbidity ranged from 22% to 79%. When these were compared to those of the case-finding questionnaire, they were consistently lower, indicating that the use of these instruments can enhance the recognition of psychiatric disorders in primary care settings. Four strategies for adopting the questionnaire are described, and some of the clinical consequences of its use are discussed.

The detection of psychiatric morbidity and associated factors in patients with rheumatoid arthritis.

Eighty-six patients with a confirmed diagnosis of rheumatoid arthritis were surveyed to assess the extent of psychiatric morbidity as indicated by two screening questionnaires, the General Health Questionnaire and the Hospital Anxiety and Depression Scale. In addition to an investigation of the concordance of the screening questionnaires, a description of demographic characteristics and measures of disability were taken. Disability due to arthritis was indicated by measures of years of chronicity, pain, duration of morning stiffness, functional level, active treatment involvement, and presence of coexisting medical problems. The relationship of physical symptoms to level of psychiatric distress was investigated. Psychiatric cases were identified using recommended cut off scores on results of the screening questionnaires. GHQ cut off scores of 6/7 identified as "cases" 31.8% of the sample. HADS subscale cut off scores of 8/9 identified 21.4% of subjects with "anxiety" and 19.0% with "depression" scores in the morbid range. Nineteen percent of patients were found to have scores on both tests concurrently in the pathological range.