Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic

1993 ◽  
Vol 23 (1) ◽  
pp. 167-173 ◽  
Author(s):  
Albert M. Van Hemert ◽  
Michiel W. Hengeveld ◽  
Jan H. Bolk ◽  
Harry G. M. Rooijmans ◽  
Jan P. Vandenbroucke

SynopsisIn many patients clinical care in general medical settings is complicated by the presence of psychiatric disorders in addition to the presenting physical symptoms. In the present study the prevalence and type of psychiatric disorders was assessed in relation to the medical diagnostic findings in a general internal medicine out-patient clinic. The Present State Examination, a standardized psychiatric interview, was used to detect psychiatric disorders in 191 newly referred patients. Psychiatric disorders were found to be particularly prevalent among patients with medically ill-explained or unexplained symptoms. The prevalence of psychiatric disorders was 15% for patients with a medical explanation for their presenting symptom, 45% for patients with ill-explained and 38% for those with unexplained symptoms. Approximately 40% of the patients with psychiatric disorders met DSM-III-R criteria for somatization disorder or hypochondriasis, suggesting that these disorders contributed in particular to general medical out-patient referrals.

2001 ◽  
Vol 35 (4) ◽  
pp. 474-480 ◽  
Author(s):  
Gordon Parker ◽  
Gordon Parker ◽  
Therese Hilton ◽  
Dusan Hadzi-Pavlovic ◽  
Jatinder Bains

Objective: There is a need for a valid measure of depression in the medically ill, and one that is independent of medical illness characteristics. As yet, there is no such widely accepted measure. We thus report on the early development of such a measure using cognitive constructs that define depressive mood state nuances. Method: We studied 67 patients with a significant medical illness, verbally administering a set of 81 provisional items. Sample members also alternatively completed one of two comparison measures: the Hospital Anxiety and Depression Scale (HADS) or the Beck Depression Inventory for Primary Care (BDI-PC). A psychiatrist interviewed a subset to determine severity of any depression and whether subjects met formalized caseness criteria for depression. The Composite International Diagnostic Interview (CIDI) was also administered during interviews to assess agreement with psychiatrist judgements about caseness. Results: A 16-item measure with high internal consistency was derived, with validation analyses suggesting it was distinctly superior to the HADS and somewhat superior to the BDI-PC measure. Conclusions: A cognitive-based approach (as used by both our measure and the BDI-PC) to screen for depression in medically ill groups appears to have distinct utility in identifying depressed patients, and in avoiding confounding influences of physical symptoms.


2019 ◽  
Vol 54 (4) ◽  
pp. 346-366 ◽  
Author(s):  
Joshua D Rosenblat ◽  
Paul Kurdyak ◽  
Fiammetta Cosci ◽  
Michael Berk ◽  
Michael Maes ◽  
...  

Background: Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. Methods: Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. Results: Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug–drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. Limitations: Non-systematic review of the literature. Conclusion: Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.


2019 ◽  
Vol 10 (3) ◽  
pp. 812-816 ◽  
Author(s):  
Marije L van der Lee ◽  
Melanie P J Schellekens

Abstract Since Descartes introduced dualism, body and mind have been seen as separate entities. The latent disease model, the view that symptoms are caused by an underlying disease, was possible within the dualistic paradigm. This paradigm, although successful in some aspects of medicine, is also assumed to underlie psychiatric disorders. As an alternative to the latent disease model, the network approach conceptualizes disorders as complex networks of causally connected symptoms. It offers a new way of understanding psychiatric disorders by directing attention away from the underlying cause and towards the symptoms and their functional interconnectedness, making the distinction between mental and physical symptoms obsolete. This article discusses how the network perspective helps us to overcome some of the problems we have faced when diagnosing and treating psychopathology in the medically ill. Furthermore, we describe how the network perspective can stimulate new research to better understand psychopathology in medically ill patients and how it can help deliver the most suitable treatment to the individual patient.


1992 ◽  
Vol 22 (2) ◽  
pp. 183-195 ◽  
Author(s):  
HArold G. Koenig ◽  
Harvey J. Cohen ◽  
Dan G. Blazer ◽  
Keith G. Meador ◽  
Ron Westlund

Objective: Using items from two existing depression scales, we have sought to develop a brief self-rated instrument for detecting major depressive disorder (M.D.D.) in medically ill, hospitalized patients. Method: Forty-two items from the Geriatric Depression Scale (G.D.S.) and Carroll Depression Scale were administered to 559 men under age 40 or over age 70 consecutively admitted to the hospital. Eighty-two M.D.D.'s were diagnosed in this group by structured psychiatric interview. After eliminating 12 items confounded by medical illness, 11 items were selected using regression analysis, correlation with the total score, and factor analysis. The 11-item scale includes an assessment of the five DSM-III-R criteria for M.D.D. which are least confounded by medical illness (mood, suicidal intent, guilt or worthlessness, concentration, and psychomotor agitation). The scale was then tested in 78 medical inpatients who were later assessed for M.D.D. using a structured psychiatric interview. Results: Ten out of twelve M.D.D.'s were identified (83% sensitivity) and depression excluded in 51 of 66 non-depressed subjects (77% specificity) (compared with 82% sensitivity and 76% specificity for the 30-item G.D.S.). Scores on the 11-item scale were also correlated with the G.D.S. (.92), the Zung Depression Scale (.58), and the C.E.S.-D (.67). Conclusion: The 11-item scale is a practical tool for clinicians who screen patients for depression and for investigators who need a brief measure of depression in studies involving medical inpatients.


2020 ◽  
Vol 15 ◽  
Author(s):  
Shiva Shanker Reddy Mukku ◽  
Preeti Sinha ◽  
Palanimuthu Thangaraju Sivakumar ◽  
Mathew Varghese

Background: Drugs with anticholinergic properties are known to be associated with deleterious effects on cognition in older adults. There is a paucity of literature in this aspect in older adults with psychiatric disorders. Objective: To examine the anticholinergic cognitive burden and its predictors in hospitalised older adults having psychiatric disorders. Methods: Case records of older adults who sought inpatient care under the Geriatric Psychiatry Unit from January, 2019 to June, 2019 were reviewed. The anticholinergic burden was assessed with Anticholinergic Cognitive Burden (ACB) scale updated version, 2012. Results: Sample included 129 older adults with an almost equal number of males (53.48%) and females (46.52%) having a mean age of 67.84 (SD = 6.96) years. The diagnostic spectrum included depression (34.89%), dementia (31.01%), mania (10.85%), psychosis (13.95%), delirium (6.20%) and others (3.1%). 60.47% of the patients had more than one medical illness. 48.84% of the older adults had clinically relevant anticholinergic cognitive burden ( ACB score ≥ 3). Use of 3 or more psychotropic drugs (OR = 4.88), diagnosis of psychosis/ mania (OR = 7.62) and dementia/ delirium (neurocognitive disorders group) (OR = 5.17) increased the risk of ACB score ≥ 3. Conclusion: Nearly half of the older adults in psychiatry in-patient setting had clinically relevant anticholinergic burden, which was associated with higher use of psychotropics. Our study highlights the importance of monitoring for anticholinergic effects of psychotropics in older adults.


2019 ◽  
Author(s):  
Valentina Escotet Espinoza

UNSTRUCTURED Over half of Americans report looking up health-related questions on the internet, including questions regarding their own ailments. The internet, in its vastness of information, provides a platform for patients to understand how to seek help and understand their condition. In most cases, this search for knowledge serves as a starting point to gather evidence that leads to a doctor’s appointment. However, in some cases, the person looking for information ends up tangled in an information web that perpetuates anxiety and further searches, without leading to a doctor’s appointment. The Internet can provide helpful and useful information; however, it can also be a tool for self-misdiagnosis. Said person craves the instant gratification the Internet provides when ‘googling’ – something one does not receive when having to wait for a doctor’s appointment or test results. Nevertheless, the Internet gives that instant response we demand in those moments of desperation. Cyberchondria, a term that has entered the medical lexicon in the 21st century after the advent of the internet, refers to the unfounded escalation of people’s concerns about their symptomatology based on search results and literature online. ‘Cyberchondriacs’ experience mistrust of medical experts, compulsion, reassurance seeking, and excessiveness. Their excessive online research about health can also be associated with unnecessary medical expenses, which primarily arise from anxiety, increased psychological distress, and worry. This vicious cycle of searching information and trying to explain current ailments derives into a quest for associating symptoms to diseases and further experiencing the other symptoms of said disease. This psychiatric disorder, known as somatization, was first introduced to the DSM-III in the 1980s. Somatization is a psycho-biological disorder where physical symptoms occur without any palpable organic cause. It is a disorder that has been renamed, discounted, and misdiagnosed from the beginning of the DSMs. Somatization triggers span many mental, emotional, and cultural aspects of human life. Our environment and social experiences can lay the blueprint for disorders to develop over time; an idea that is widely accepted for underlying psychiatric disorders such as depression and anxiety. The research is going in the right direction by exploring brain regions but needs to be expanded on from a sociocultural perspective. In this work, we explore the relationship between somatization disorder and the condition known as cyberchondria. First, we provide a background on each of the disorders, including their history and psychological perspective. Second, we proceed to explain the relationship between the two disorders, followed by a discussion on how this relationship has been studied in the scientific literature. Thirdly, we explain the problem that the relationship between these two disorders creates in society. Lastly, we propose a set of intervention aids and helpful resource prototypes that aim at resolving the problem. The proposed solutions ranged from a site-specific clinic teaching about cyberchondria to a digital design-coded chrome extension available to the public.


1998 ◽  
Vol 28 (3) ◽  
pp. 265-272 ◽  
Author(s):  
James E. Aikens

Objective: Because psychiatric screening methods are usually developed using psychiatric samples but not medical samples, they often include distress indicators that overlap with medical illness. This potentially inflates psychopathology estimates for medically ill patient groups. The objective of this study was to determine whether somatic distress indicator base rates are elevated in diabetes patients. Method: The occurrence of Symptom Checklist 90-R (SLC-90-R) somatic symptoms was studied in fifty-six diabetes mellitus patients (27 insulin dependent, 29 non-insulin dependent) with non-elevated SLC-90-R profiles, as compared to both community nonpatient and psychiatric patient norms. Results: Of the fifteen SCL-90-R items rated by endocrinologists as most likely to be diabetes-related, nine were endorsed more frequently by diabetes patients than by nonpatients: faintness/dizziness (endorsed by 36% of diabetics), reduced libido (endorsed by 41%), anenergia (68%), memory problems (66%), trembling (18%), numbness (55%), weakness (39%), overeating (59%), and somatic concerns (41%). Anergia and faintness/dizziness were endorsed more frequently by psychiatric patients than diabetes patients, whereas numbness was endorsed more often by diabetes patients. Conclusions: Conservatism is warranted when applying these somatic indicators of distress to diabetes patients. Further studies are needed to determine whether such illness overlap biases case classification.


2015 ◽  
Vol 4 (3) ◽  
pp. 173-179
Author(s):  
Louise Stone ◽  
Jill Gordon

Background Culture shapes the way illness is experienced and disease is understood. Patients with medically unexplained symptoms describe feeling their suffering is not valued because they lack a “legitimate” diagnosis. Doctors also describe feeling frustrated with these patients. This is particularly problematic for young general practitioners (GPs) who lack experience in managing patients with medically unexplained symptoms in primary care settings.Objectives To explore how general practice supervisors help registrars to provide patient-centered care for patients with medically unexplained. Methods A constructivist grounded theory study was undertaken with 24 general practice registrars and supervisors from Australian GP training practices in urban, rural and remote environments. Participants were asked to describe patients with mixed emotional and physical symptoms without an obvious medical diagnosis. Results Registrars came from hospital posts into general practice equipped with skills to diagnose and manage organic disease but lacked a framework for assessing and managing patients with medically unexplained symptoms. They described feelings of helplessness, frustration and sometimes hostility. Because these feelings were inconsistent with their expressed value systems, they were uncomfortable and confronting. The registrars valued interactions that helped them explore this area. Conclusions In hospital practice, biomedical language and explanations predominate, but in general practice patients bring different explanatory illness models to the consultation, using their own language, beliefs and cultural frameworks. Medically unexplained symptoms occupy a contested space in both the social and medical worlds of the doctor and patient. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from providing patient-centered care.


2011 ◽  
Vol 106 (10) ◽  
pp. 600-608 ◽  
Author(s):  
Sharon Welner ◽  
Maria Kubin ◽  
Kerstin Folkerts ◽  
Sylvia Haas ◽  
Hanane Khoury

SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.


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