Disorders In General Hospital Research Articles

Neuro-11: a new questionnaire for the assessment of somatic symptom disorder in general hospitals

BackgroundSomatic symptom disorder (SSD) commonly presents in general hospital settings, posing challenges for healthcare professionals lacking specialised psychiatric training. The Neuro-11 Neurosis Scale (Neuro-11) offers promise in screening and evaluating...

Reliability and validity of the brief psychosomatic symptom scale (BPSS) in patients from general hospitals

ObjectivesTo verify the Brief Psychosomatic Symptom Scale (BPSS) among patients with psychosomatic-related disorders in general hospitals and determine the threshold of BPSS. MethodsThe BPSS is a shortened 10-item version of the psychosomatic symptoms scale (PSSS). Data from 483 patients and 388 healthy controls were included for psychometric analyses. Internal consistency, construct validity, and factorial validity were verified. The threshold of BPSS in distinguishing psychosomatic patients from healthy controls were determined using receiver operating characteristic (ROC) curve analysis. The ROC curve of the BPSS was compared with that of the PSSS and patient health questionnaire-15 (PHQ-15) by using Venkatraman's method with 2000 times Monte-Carlo simulations. ResultsThe reliability of the BPSS was good with Cronbach's α of 0.831. BPSS was significantly correlated with PSSS (r = 0.886, P < 0.001), PHQ-15 (r = 0.752, P < 0.001), PHQ-9 (r = 0.757, P < 0.001) and GAD-7 (r = 0.715, P < 0.001), which indicated good construct validity. ROC analyses demonstrated that the AUC of the BPSS was comparable with that of PSSS. The gender-specific threshold of BPSS was determined as ≥8 in males and ≥ 9 in females. ConclusionsThe BPSS is a brief and validated instrument for screening common psychosomatic symptoms.

Detecting DSM-5 somatic symptom disorder in general hospitals in China: B-criteria instrument has better accuracy-A secondary analysis.

This study investigates the diagnostic accuracy of the PHQ-15, SSS-8, SSD-12 and Whitley 8 and their combination in detecting DSM-5 somatic symptom disorder in general hospitals. In our former multicenter cross-sectional study enrolling 699 outpatients from different departments in five cities in China, SCID-5 for SSD was administered to diagnose SSD and instruments including PHQ-15, SSS-8, SSD-12 and WI-8 were used to evaluate the SSD A and B criteria. In this secondary analysis study, we investigate which instrument or combination of instrument has best accuracy for detecting SSD in outpatients. Receiver operator curves were created, and area under the curve (AUC) analyses were assessed. The sensitivity and specificity were calculated for the optimal individual cut points. Data from n = 694 patients [38.6% male, mean age: 42.89 years (SD = 14.24)] were analyzed. A total of 33.9% of patients fulfilled the SSD criteria. Diagnostic accuracy was moderate or good for each questionnaire (PHQ-15: AUC = 0.72; 95% CI = 0.68-0.75; SSS-8: AUC = 0.73; 95% CI = 0.69-0.76; SSD-12: AUC = 0.84; 95% CI = 0.81-0.86; WI-8: AUC = 0.81; 95% CI = 0.78-0.84). SSD-12 and WI-8 were significantly better at predicting SSD diagnoses. Combining PHQ-15 or SSS-8 with SSD-12 or WI-8 showed similar diagnostic accuracy to SSD-12 or WI-8 alone (PHQ-15 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; PHQ-15 + WI-8: AUC = 0.82; 95% CI = 0.79-0.85; SSS-8 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; SSS-8 + WI-8: AUC = 0.82; 95% CI = 0.79-0.84). In the efficiency analysis, both SSD-12 and WI-8 showed good efficiency, SSD-12 slightly more efficient than WI-8; however, within the range of good sensitivity, the PHQ-15 and SSS-8 delivered rather poor specificity. For a priority of sensitivity over specificity, the cutoff points of ≥13 for SSD-12 (sensitivity and specificity = 80 and 72%) and ≥17 for WI-8 (sensitivity and specificity = 80 and 67%) are recommended. In general hospital settings, SSD-12 or WI-8 alone may be sufficient for detecting somatic symptom disorder, as effective as when combined with the PHQ-15 or SSS-8 for evaluating physical burden.

Improving the ability of neurology departments in general hospitals to treat neuropsychiatric disorders

Due to the "stigma" of psychiatric diseases, most patients with psychiatric diseases prefer to be treated in general hospitals or combined Chinese and Western medicine hospitals, while patients with internal diseases are mostly seen in neurology departments. At present, there are few neurologists in general hospitals in China who are capable of treating neuropsychiatric disorders, and they do not have enough experience in treating such disorders. In this paper, we present a review of the current status of neuropsychiatric and psychiatric disorders in general hospitals and Chinese and Western medicine hospitals, and propose recommendations to strengthen the capacity of neurology departments in general hospitals to treat neuropsychiatric disorders.

Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE

BackgroundPrevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders.MethodsWe employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data.ResultsThe continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003).ConclusionsThe findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.

Sleep Disorders in General Hospital: A Cross-Sectional Study in 253 Patients Hospitalized In Different Medical and Surgical Services

Introduction: Sleep is a fundamental physiological need. It is important to understand the prevalence of sleep disorders, especially in patients with a somatic disease. Method: The study had as scope patients admitted to the medical and surgical services of general hospital, during a period of one month. The approach used in this study is a qualitative approach, based on a semi-structured, concise, and clear questionnaire. Results: The main aim of this study was to estimate the frequency of sleep disorders and their management by somantician doctors in the Moulay Ismail military hospital. This present study has 2 important results; the first one, sleep disorders are common in patients with somatic pathology. The second one, and against the recognition and management of these disorders by health professionals is rare. Conclusion: It is essential to alert both public and health practitioners to this subject through public education campaigns creating awareness of the consequences of sleep disorders but also through adequate training of physicians for a better screening and treatments of insomnia problems.

Hypnotherapy for borderline psychic disorders in a multidisciplinary hospital

The increase in the number of patients with mental disorders in general hospitals with the shorter patient length of stay there requires diagnostic and therapeutic measures as soon as possible. Group hypnotic suggestive psychotherapy (HSPT) is an effective psychotherapeutic technique that is capable of covering a large number of patients in a short time. Objective: to evaluate the efficiency of short-term group HSPT in multidisciplinary hospital patients with borderline psychic disorders accompanying the underlying disease and to determine the impact of a single session of such therapy on the patients' condition. Patients and methods. A study group consisted of 78 patients who received HSPT; a control group included 37 patients who did not have such therapy. Treatment-induced changes in their mental state were evaluated using the Symptom Checklist-90-Revised questionnaire; the patients' current state was rated with the Mood and Feelings (health, activity, and mood) questionnaire, and the situational anxiety subtest of the integrative anxiety test (IAT-st). Results and discussion . The study group showed a more pronounced reduction in mental disorders, especially the symptoms of anxiety and depression, than that in the control group. A single HSPT session was shown to have a positive impact on the current state of patients, considerably improving their well-being and reducing the manifestations of anxiety. Improving both the somatic and mental state of patients immediately before their discharge from a hospital seems to be an important therapeutic and social factor also for successful outpatient treatment. Conclusion . It is necessary to conduct a follow-up study to clarify how long the impact of short-term intervention using HSPT can persist. The latter can be effective in multidisciplinary hospital patients.

Mental health resources and awareness of anxiety and depressive disorders in general hospitals in China

Abstract Background Mental health disorders are common in China. There is a lack of knowledge and resources of mental health in China. Objectives To assess the levels of psychiatric resources and services in general hospitals in China. Methods Data regarding psychiatric departments, wards and staff were collected from 57 general hospitals in four provinces of China (Hubei, Zhejiang, Heilongjiang and Yunnan) between April 2014 and June 2014. Questionnaires were distributed to 1,200 non-psychiatric clinicians. Results Among the 57 hospitals, 50 provided mental health services, 36 had mental health wards, and seven had neither mental health clinics nor wards. The median number of mental health clinicians was six per hospital. The median number of specialized nurses was 42 per hospital. A total of 1,152 non-psychiatric clinicians with a career duration of 9.4 ± 8.9 years returned completed questionnaires. Only 6.9% reported a good understanding of the manifestation of anxiety and depressive disorders, 4.5% reported a good understanding of the diagnostic criteria, and 3.8% reported a good understanding of the treatment protocols. Discussion There is inadequate awareness of anxiety and depressive disorders among non-psychiatric clinicians in general hospitals in China. This awareness/understanding increased with increasing hospital level.

Detaining patients in the general hospital - current practice and pitfalls.

Much has been written about the use of the Mental Health Act in psychiatric settings. There is, however, little written on its use to detain patients with mental disorder in general hospitals. We therefore carried out a survey of the use of the Mental Health Act in general hospital settings in Aberdeen, and also posted a questionnaire to Scottish Liaison Psychiatrists, asking about their experience of the use of the Mental Health Act in general hospitals. Over a six-month period in Aberdeen Royal Infirmary, we identified 39 detentions. Out of hours, the use of Emergency Detention Certificates was more common than use of Short Term Detention Certificates - the latter is recommended by the Mental Welfare Commission, as patients are afforded more rights. When psychiatric staff were not directly involved, procedural and administrative errors were more likely to occur. Liaison psychiatrists elsewhere in Scotland reported similar observations. General hospital clinicians are unfamiliar with the Mental Health Act and its use. Errors in its application therefore arise, and are more common when psychiatric staff is not involved. Better education, including the provision of written information and consideration of an electronic system, may improve current practice.

Diagnosis, differential diagnosis and therapy of substance use disorders in general hospital (general section)

Substance use disorders are becoming an increasingly significant problem in general hospitals and hence play a key role in consultation- and liaison psychiatry. Diverse psychotropic effects of various substances mimic psychiatric disorders. An alcohol intoxication can present depressive or manic symptoms, a cannabis delirium can present as a psychosis while stimulants use can suggest the diagnosis of an anxiety disorder. Obtaining dual diagnoses by identifying substance-induced and non-substance-induced psychopathologies is clinically challenging.The aim of this article is to systematically describe the psychopathology, pathophysiology and therapeutic options of substance-use disorders particularly relevant for consultation and liaison psychiatry.

Risk factors for the incidence of delirium in cerebrovascular patients in a Neurosurgery Intensive Care Unit: A prospective study.

To explore the incidence of delirium in cerebrovascular patients admitted in our Neurosurgery Intensive Care Unit and analyse the risk factors leading to delirium. Delirium is one of the most common mental disorders in general hospitals, but the incidence of different kinds of diseases and studies varies. Cerebrovascular patients in our Neurosurgery Intensive Care Unit are high-risk groups for delirium; identifying risk factors for delirium and taking early interventions are crucial for patient prognosis. A prospective study. A convenience sampling method was used to collect data from 128 patients in the Neurosurgery Intensive Care Unit of Xuanwu Hospital, Capital Medical University, Beijing, China, between May 2016-January 2017. Researchers used Confusion Assessment Method for the Intensive Care Unit (Chinese version) to assess each patient's delirium statement twice a day at regular times. We also collected other independent data variables and followed up the short-term clinical outcomes daily. On the basis of Confusion Assessment Method for the Intensive Care Unit evaluation, patients were divided into a delirium group and a nondelirium group. The prevalence of delirium among the 128 patients was 42.2%. Multivariate analysis showed that severity of illness, fever, the use of physical restraints and sleep deprivation were independent predictors of delirium in cerebrovascular patients in the Neurosurgery Intensive Care Unit. Cerebrovascular patients in the Neurosurgery Intensive Care Unit with a critical condition, fever or use of physical restraints or experiencing sleep deprivation were more prone to delirium. Cerebrovascular patients in the Neurosurgery Intensive Care Unit showed a high incidence of delirium. There are many risk factors leading to delirium, some of which are independent predictors of intensive care delirium. Patients with delirium will suffer various adverse effects upon their short-term clinical outcomes. Therefore, nurses should pay close attention to changes in a patient's mental state and learn about the risk factors associated with delirium, in order to be able to take early measures to prevent delirium.

Survey on the non-psychiatric physician's ability of diagnosis and treatment of depression/anxiety disorders in general hospital

Objective To investigate the status of the non-psychiatrist's diagnostic and therapeutic ability of depression/anxiety disorders in 57 General Hospitals. Methods 1 152 non psychiatric clinicians in 57 general hospitals were surveyed. A custom-made questionnaire included the training of mental health-related knowledge which the general hospital physicians received and typical anxiety/depression case analysis. Results Among 1 521 non-psychiatric clinicians, 596(51.74%) clinicians participated the training of psychiatry, 562(48.78%) participated the training of medical psychology and 230(20.97%) clinicians participated the training of Healthy Psychology. In professional setting, 59(5.12%) clinicians participated the training of psychotherapy, 255(22.14%) clinicians had attended related academic symposiums. 80(6.94%) clinicians believed that they understand the clinical display of anxiety/depression disorders, 52 (4.51%) clinicians expressed the understanding of diagnostic criteria of anxiety/depression disorders and its treatments, while 44(3.82%) clinicians only possessed the knowledge of anxiety/depression disorder treatment. In the typical case analysis, it revealed that 794 (68.89%) clinicians made accurate diagnosis, 458(57.68%)clinicians made a choice of medical treatment, 764(96.22%) clinicians chose psychotherapy, 29(3.65%) clinicians applied physical therapy , while 438(55.16%) clinicians combined drug therapy with one or more other therapeutic methods. Binary logistic regression analysis showed that the age(P=–0.093, Exp(B)=0.911)and work experience(P=–0.002, Exp(B)=1.080)significantly contribute to the diagnostic accuracy of non-psychiatrists. Conclusion The non-therapeutic psychiatric clinicians in general hospitals have certain basic knowledge of depression/anxiety disorders with lower level of diagnosis and treatment diagnosis and treatment.And there is bigger difference among different hospitals. Key words: Depression/anxiety disorders; General hospital; Diagnosis and treatment ability

Development of psychiatric risk evaluation checklist and routine for nurses in a general hospital: ethnographic qualitative study.

There is high prevalence of mental and behavioral disorders in general hospitals, thus triggering psychiatric risk situations. This study aimed to develop a psychiatric risk assessment checklist and routine for nurses, the Psychiatric Risk Evaluation Check-List (PRE-CL), as an alternative model for early identification and management of these situations in general hospitals. Ethnographic qualitative study in a tertiary-level private hospital. Three hundred general-unit nurses participated in the study. Reports were gathered through open groups conducted by a trained nurse, at shift changes for two months. The questions used were: "Would you consider it helpful to discuss daily practice situations with a psychiatrist? Which situations?" The data were qualitatively analyzed through an ethnographic approach. The nurses considered it useful to discuss daily practice situations relating to mental and behavioral disorders with a psychiatrist. Their reports were used to develop PRE-CL, within the patient overall risk assessment routine for all inpatients within 24 hours after admission and every 48 hours thereafter. Whenever one item was present, the psychosomatic medicine team was notified. They went to the unit, gathered data from the nurses, patient files and, if necessary, attending doctors, and decided on the risk management: guidance, safety measures or mental health consultation. It is possible to develop a model for detecting and intervening in psychiatric and behavioral disorders at general hospitals based on nursing team observations, through a checklist that takes these observations into account and a routine inserted into daily practice.

Unrecognized psychiatric disorders among adult patients admitted into a general hospital in Maiduguri, Northeastern Nigeria.

IntroductionPatients with unrecognized psychiatric disorders in general hospitals, suffer economic and psycho-social difficulties. This study aimed to determine (i) prevalence and pattern of psychiatric disorders, and (ii) prevalence of unrecognized psychiatric disorders among adult in-patients of a general hospital.MethodsIn this two-stage, cross-sectional study, we used (i) General Health Questionnaire (GHQ) and Composite International Diagnostic Interview (CIDI) to assess the prevalence of psychiatric disorders, and (ii) Patient Encounter Form to determine unrecognized psychiatric disorders, among patients admitted into a general hospital.ResultsOf the 283 respondents, 174 (61.5%) had GHQ scores of ≤ 4. Eighty seven respondents (31%) had psychiatric disorders of which 85 (98%) were not recognized. The frequency of Depression and Anxiety disorders were 61.5% and 26.2% respectively. Unmarried (2.3, 1.2-4.3; p < 0.00), females (2.1, 1.1-4.05; p = 0.01) and patients with “unexplained symptoms” (≤ = 8.4, p< 0.00, df = 1) were more likely to have diagnosis of depression and anxiety disorder.ConclusionWe conclude that one-third of the patients in the general hospital, had co-morbid psychiatric diagnoses, mostly unrecognized by their physicians. Unmarried, females and respondents with unexplained symptoms were associated with depression and anxiety disorders. We recommend the posting of psychiatric trainees to general hospitals, and training of general practitioners on the use of simple depression and anxiety screening instruments.

The characteristics of complaints among gastrointestinal outpatients with depressive or anxiety disorders in general hospitals

Objective To help physicians improve detection rate of depressive and anxiety disorders by exploring the complaints of gastrointestinal(GI) outpatients with these disorders in the general hospitals. Methods A multicenter cross-sectional study was conducted from May to June in 2007.A total of 1995 subjects from 13 general hospitals in China were screened with the hospital anxiety and depression scale(HADS) and patient health questionnaire 15-item (PHQ-15). Meanwhile patients' complaints were recorded. Psychiatrists interviewed subjects scored ≥8 on HADS and made diagnoses by using the mini international neuropsychiatric interview(MINI). There were 323 outpatients diagnosed as depressive or anxiety disorders and 1287 outpatients without diagnosis of depressive or anxiety disorders. The complaints and PHQ-15 sores were compared between these two groups.The logistic regression analysis was used to determine the risk of having depressive or anxiety disorders with the number of complaints as an independent variable. Results Some symptoms between two groups were statistically significant, including weakness(34.1% vs 18.8%; χ2 =18.04; P=0.000), fatigue(9.6% vs 5.7%; χ2 =6.58, P=0.010)and insomnia(7.1% vs 3.4%; χ2=8.87; P=0.003). Logistic regression analysis showed that with each additional complaint, the odds for an interview-based diagnosis of depressive or anxiety disorders increased, the odds ratio(OR) was 1.12(95%CI, 1.08~1.17, P=0.000). In comparison to the outpatients without depressive or anxiety disorders, outpatients with these disorders signifycantly had higher PHQ-15 scores ((11.12±4.92) vs (6.68±4.05); t=16.84, P=0.000). Conclusion The GI outpatients with depressive and/or anxiety disorders have worse mental heath and more complaints, compared to patients without these disorders.These results may help physicians to better identify depressive disorders and anxiety disorders. Key words: Gastrointestinal; Outpatients; Depression; Anxiety

Clinical characteristics of patients with depressive disorders at Department of Neurology in general hospitals

To evaluate the clinical characteristics of patients with depressive disorders at Department of Neurology in general hospitals. A total of 596 consecutive patients with depressive symptoms, such as insomnia, or somatic symptoms were collected prospectively and those who were unable to answer the questionnaire were excluded. Data of demography and clinical characteristics were obtained from a questionnaire. The 17-item Hamilton depression rating scale (HDRS17) was used to identify the presence of depressive disorders. Case control method was employed to evaluate the clinical characteristics of patients with depressive disorders. Among all patients, 347 were diagnosed as depressive disorders (58.1%). The mean score of HDRS17 was 21.9 ± 3.4. Fewer psychological symptoms were complained by patients with depressive disorder. The depressive mood was found in 146 (41.2%), a loss of interest or pleasure 161 (46.4%)and depressive mood plus a loss of interest or pleasure 108 (31.3%). The factors of manual worker, lower education level, worse marital status, lower economic status, irregular lifestyle and coexisting medical conditions were associated with depressive disorders. The most frequent complaints of somatic symptoms were as follows: hard to fall asleep 254 (73.2%), early awakening 218 (76.0%), poor memory 219 (63.1%), fatigue 181 (52.2%), palpitation 179 (51.6%), dizziness 170 (49.0%), headache 160 (46.1%) and dyspnea 140 (40.3%). The mean number of somatic symptoms was 6.87 ± 2.78. The patients complaining of multiple somatic symptoms (≥ 4) was 322 (92.8%). The number of somatic symptoms was correlated with depressive disorders. More minor depression and somatic symptoms are the main characteristics of patients with depressive disorder in general hospitals.

Recognising delirium.

Delirium is one of the most common acute disorders in general hospitals. It predicts several adverse outcomes including higher length of stay, higher mortality and increased risk of institutionalisation. An episode of delirium is also highly distressing for patients and carers. Recognition can improve the outcome of delirium but it is under-diagnosed in acute hospitals, with 65 to 75 per cent of cases going undetected.

Cost-effectiveness of collaborative care for chronically ill patients with comorbid depressive disorder in the general hospital setting, a randomised controlled trial

BackgroundDepressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated.Methods/DesignCC: DIM (Collaborative Care: Depression Initiative in the Medical setting) is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months) will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36.DiscussionEarlier research has indicated that depressive disorder is a chronic, mostly recurrent illness, which tends to cluster with physical comorbidity. Even though the treatment of depressive disorder based on the guidelines for depression is proven effective, these guidelines are often insufficiently adhered to. Collaborative care and 'Problem Solving Treatment' will be specifically tailored to patients with depressive disorders and evaluated in a general hospital setting in the Netherlands.

Is insomnia a marker for psychiatric disorders in general hospitals?

Background and purpose The aim was to evaluate the relationship between insomnia and psychiatric disorders in general hospital inpatients. Patients and methods Information about insomnia was collected using a structured and codified questionnaire adapted from a previously validated one in Brazil. For Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) psychiatric diagnosis, the Portuguese version of the International Neuropsychiatric Interview (MINI) was used. Results Out of the 200 patients interviewed, 56.5% complained of insomnia, and 50.0% suffered from at least one psychiatric disorder. Major depressive episode (MDE) ( P<0.001), generalized anxiety disorder ( P=0.025) and suicide risk ( P=0.034) were associated with insomnia (univariate analysis). The results of the multivariate analysis showed that only MDE had a statistically significant association with insomnia (OR=3.6; 95% CI=1.9–6.9). Conclusions This study found a high prevalence of psychiatric disorders and insomnia in a general hospital population and found that insomnia can be a marker for MDE.

Detecting mental disorders in general hospitals by the SCL-8 scale

Objective The objective of this study is to validate the eight-item dichotomised version of the Symptoms Check List (SCL-8d) as a screening tool for psychiatric disorders. Methods The study population included 198 consecutive new neurological inpatients and outpatients and 294 consecutive internal medical inpatients, aged 18 or older. All patients received the SCL-8d questionnaire, and a stratified subsample was interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) interview. We tested the external SCL-8d validity using the SCAN interview as gold standard. The test was performed based on weighted data to correct for the skewness introduced by stratification. Results The diagnostic performance of the SCL-8d was excellent in the internal medical setting but not quite as good in the neurological sample. It performed better among the older compared with the younger patients, whereas the scale was not affected by gender. In the combined sample at the cut point 0/1, the sensitivity (SE) of the SCL-8d was 0.73 (confidence interval [CI] 95%: 0.60–0.82), the specificity (SP) 0.61 (CI 95%: 0.53–0.68) and the positive predictive value (PPV) 0.42 (CI 95%: 0.34–0.50), using any International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychiatric disorder, excluding somatoform and substance abuse disorders, as gold standard. The risk of a patient having a mental disorder (except phobia, substance abuse or somatoform disorder) was less than 6% in case of a negative screening test. In patients with a current depressive disorder, 87.1% (27/31) were screening positive, and all except 1 (93.0%) of the 14 patients with a modest to severe depression scored 1 or higher on the SCL-8d. All 17 patients with an anxiety disorder, excluding phobias, were screening positive. Conclusion The study suggests that the SCL-8d is a valid, brief screening tool for use in nonpsychiatric medical settings, especially to detect emotional psychiatric disorders (EPDs).