What happens to medical patients with psychiatric disorder?

doi:10.1016/0022-3999(88)90038-4

Journal of Psychosomatic Research

Volume 32, Issues 4–5, 1988, Pages 541-549

https://doi.org/10.1016/0022-3999(88)90038-4 Get rights and content

Abstract

Medical, psychiatric and social outcome were examined in medical in-patients previously identified as suffering from psychiatric disorder. One third of patients with an affective (emotional) disorder on admission were still psychiatrically ill four months after discharge. Persistent disorder was associated with continuing physical illness. During the year following admission those with affective disorder on admission continued to make greater demands on medical, social and psychiatric services than matched controls and had double the mortality rate (not significant). Patients with organic mental states on admission had a high mortality and morbidity, and made considerable continuing use of general hospital social and psychiatric services. Improved recognition of psychiatric disorder during hospital admission could result in better overall care of medical patients' psychiatric and social difficulties and more effective use of medical resources.

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Cited by (81)

Which factors predict the persistence of DSM-IV depression, anxiety, and somatoform disorders in the medically ill three months post hospital discharge?
2010, Journal of Psychosomatic Research
Citation Excerpt :
This large follow-up study of psychiatric disorder in the medically ill has uniquely examined the contribution of coping style, illness behavior, hypochondriasis, and social support to the persistence of depression, anxiety, and somatoform disorders. The rates of persistence of depression and anxiety disorders found here are similar to those reported by other studies of the medically ill [57–59], which range from 36% to 52% for depression and 49% for anxiety disorders [60]. Higher rates of persistence of somatoform disorders have been reported elsewhere [22] and for major and minor depression in medically ill [27,61–63] and psychiatrically ill [9] samples.
This study sought to assess the persistence of DSM-IV depression, anxiety, and somatoform disorders in a sample of 206 medical patients 3 months after hospital discharge and to examine which baseline factors predicted the persistence of disorder.
Patients were interviewed using the Monash Interview for Liaison Psychiatry (a structured psychiatric interview for the medically ill) during admission and again at 3 months post discharge. Scales completed during admission elicited sociodemographic data, psychiatric history, mental and physical functioning, illness behavior, coping modes, and number of close relationships. Best-subset logistic regression was employed to find the best combination of these potential predictors of the persistence of psychiatric disorder.
Persistence of anxiety disorders [n=43; 50.6%; 95% CI=39.5–61.6], depression (n=55; 44.4%; 95% CI=35.4–53.5), and somatoform disorders (n=35; 42.2%; 95% CI=31.3–53.0) was moderately high, with no statistically significant difference in the rate of persistence of the three groups of disorder. Family psychiatric history, education, and poorer physical and mental functioning during hospitalization predicted persistence of depression. Poorer mental functioning, less denial, and greater number of close relationships predicted persistence of anxiety disorders. Higher levels of education, use of acceptance–resignation as a coping mechanism, and greater hypochondriasis predicted persistence of somatoform disorders.
The belief that psychiatric disorders in hospitalized medically ill patients spontaneously remit after discharge is false. A substantial proportion persist for at least 3 months. Early detection and treatment is possible and warranted. Features of the illness (poorer physical and mental health) and personal and social factors identifiable at hospital admission identify patients at risk for persistence.
Early prediction of psychosocial intervention needs in pneumology patients after nurses' evaluation
2008, Medicina Clinica
El objetivo del estudio ha sido verificar la hipótesis de que con el método INTERMED se identificará, en el momento del ingreso, a los pacientes neumológicos con riesgo de «complejidad» y necesidades de intervención psicosocial especializada.
Una enfermera entrenada en la versión española del método INTERMED (para detectar el riesgo de complejidad de cuidados médicos) entrevistó a una muestra aleatoria de 144 pacientes en el momento de su ingreso. Al alta se revaluó a los pacientes de modo ciego con versions españolas estandarizadas de instrumentos como la Hospital Anxiety and Depression Scale (HADS), y se documentaron independientemente las variables de enfermedad somática (incluido el Índice Acumulativo de Enfermedad). Todas las variables se definieron de modo operativo y entre ellas figuraban: pacientes complejos (IM+; INTERMED > 20), pacientes no complejos (IM−) y probable necesidad de intervención psicosocial. Se realizó un análisis multivariante de regresión logística.
El 9,6% de los pacientes tuvo un curso complejo y el 28,8% un alta compleja. Se documentaron proporciones significativamente mayores de ansiedad o depresión grave en los IM+ (12,1%) que en los IM− (0,9%), y también de necesidad de intervención psicosocial (el 24,2 frente al 6,3%, respectivamente). En el análisis de regresión multivariante, tras controlar las variables médicas y sociodemográficas de confusión, INTERMED se asoció significativamente con la variable necesidad de intervención psicosocial.
En apoyo de la utilidad clínica de INTERMED en su versión española, se documenta por vez primera en la bibliografía internacional que con dicho método una enfermera preparada puede identificar en el momento del ingreso qué pacientes de planta médica necesitarán intervención psicosocial especializada.
This study was aimed to verify whether it is possible to detect at hospital admission, by means of INTERMED, pneumonology patients at risk of «complexity» and of specialized psychosocial intervention.
With the Spanish version of INTERMED (for detection of risk for complexity of care) 144 patients were interviewed at admission by a standardized nurse. At discharge, patients were reassessed blindly with standardized Spanish versions of instruments including the Hospital Anxiety and Depression Scale (HADS). Somatic illness variables were independently documented, and severity was assessed by means of the Cummulative Illness Rating Scale. All variables were operationalized including complex (IM+; INTERMED > 20) and non-complex patients (IM−), and probable need of psychosocial treatment/intervention. Statistical analysis included multivariate logistic regression.
A complex course was documented in 9.6% of patients, and 28.8% had complex discharge. Significantly higher proportions of severe anxiety and/or depression were documented in IM+ cases (12.1%) when compared to IM− cases (0.9%), and the need of psychosocial treatment/intervention was also significantly more frequent among the former (24.2% versus 6.3% respectively). Furthermore, in the multivariate analysis and controlling for medical and sociodemographic confounders INTERMED was significantly associated with the variable need of psychosocial intervention.
In support of the clinical utility of the INTERMED method (Spanish version), this is the first report in the international literature documenting that standardized nurses are able to detect at admission those medical patients who will eventually need specialized psychosocial intervention.
Gyneco-psychosomatic counseling in Germany and Switzerland-aims and state of the art
2006, Journal of Psychosomatic Research
To investigate actual counseling models for gynecological patients in Switzerland and in Germany.
A questionnaire investigating psychosomatic care was sent to all Swiss (N=183) and German (N=1078) departments of gynecology, obstetrics, and/or endocrinology.
One hundred twenty-eight (27%) completed questionnaires from Germany and 57 (31%) from Switzerland were available for statistical evaluation. Eighty-seven percent of the answering clinics from Switzerland and 93% of those from Germany (ns) considered psychosomatic counseling for gynecological and obstetrical patients as very important or important. Seventy-two percent of the Swiss and 70% of the German departments (ns) offered psychosomatic support. Models of counseling varied greatly between types of hospitals and both countries. Less than 15% of the medical doctors had a formation for psychosomatic counseling.
Actual possibilities seem to be below the need for psychosomatic care. An adequate formation of medical doctors and considering the effects of psychosomatic care in the discussion on cost reduction for medical treatment would help to improve counseling structures.
Who is at risk of post-MI depressive symptoms?
2005, Journal of Psychosomatic Research
The aim of this study was to identify cardiologic, psychologic, and demographic risk factors in two groups of patients with post-myocardial infarction (MI) depressive symptoms (in-hospital and during the postdischarge year).
Patients admitted for MI were assessed for depressive symptoms with the Beck Depression Inventory (BDI) during hospitalization and 3, 6, and 12 months post-MI. We contrasted both groups with nondepressed patients.
Pre-MI vital exhaustion, living alone, history of depressive disorder, history of MI, poor performance on exercise tolerance testing, and female gender were significantly and independently associated with in-hospital depressive symptoms. Pre-MI vital exhaustion, history of depressive disorder, female gender, poor ejection fraction, and longer hospital stay were independent predictors of the development of postdischarge depressive symptoms.
Post-MI depressive symptoms seem largely driven by the psychological and social consequences of the MI in patients vulnerable to depression, as indexed by a history of depression and vital exhaustion.
Communication between psychosomatic C-L consultants and general practitioners in a German health care system
2005, General Hospital Psychiatry
A randomized and prospective study examined the effects of intensive communication between treatment providers on physician behavior and patient care using a representative sample of patients referred to a German psychosomatic consultation–liaison (C–L) service (1998–1999). Sixty-seven patients were grouped (ICD-10) and randomized into intervention (n=33) and control groups (n=34). In the control group (CG), only the inpatient referring physicians were informed of consultation findings, as is standard practice in Germany. In the IG, the consultant directly reported the consultation findings to the general practitioner (GP). Patients were examined at 6-month (T2) and 3.5-year (T3) follow-up. Physician feedback and requests regarding the nature of communication were also assessed at T2. A significant reduction in symptoms was revealed at both follow-ups for the IG and CG. No significant group differences were found for acceptance of psychotherapy (59.1% IG and 42.3% CG at T3). The utilization of medical services remained stable across time. Patients who began psychotherapy were shown to have greater baseline symptom levels and “openness for new experiences” (NEO Five-Factor Inventory, NEO-FFi). Regular GP integration of psychosocial aspects into primary care differed between IG (44.0%) and CG (25.0%). Ninety-one percent of the GPs requested the option for a telephone conversation with the consultant or a case conference involving the patient at either their practice (37.7%) or the clinic (24.5%). We conclude that GPs are interested in a differentiated and more intensive cooperation concerning the integration of psychosocial aspects in their outpatient treatment. The patient's acceptance to follow a recommendation for psychotherapy, however, is related to the level of symptom severity and openness for new experiences.
Follow-up on mental illness in medical inpatients: Health care use and self-rated health and physical fitness
2004, Psychosomatics
Citation Excerpt :
Hence, the overall finding of the present study (Table 3) is that mental illness has an impact on health service use in hospitals and in family practice, even after we controlled for central aspects of medical disease severity. This was also in accordance with the few existing prospective studies.13,15,16,25 Although few of the associations tested and presented in Table 4 were statistically significant, the overall tendency was that mental illness, as defined by ICD-10 or dimensional measures, has a negative future impact on the patient's health and physical ability.
Consecutively admitted internal medical inpatients (N = 294) who were psychiatrically assessed with the Schedules for Clinical Assessment in Neuropsychiatry in a two-phase design were followed up in a review of public files on their use of medical care over 18 months. Self-rated outcome was assessed from health and fitness ratings at admission and after 1 year. ICD-10 mental disorders had a statistically significant impact on the risk (odds ratio) of high use (above the 80th percentile) of primary care, as did ICD-10 anxiety/depression, and worry about illness (as assessed by the Whiteley-7 Scale). The authors found a less-than-significant tendency for mental illness to influence the use of inpatient admissions and self-rated outcome.

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What happens to medical patients with psychiatric disorder?

Abstract

J psychosom Res

Gen Hosp Psychiat

Psychiatric disorder in the General Hospital

Br J Psychiat

Forecast and follow-up. An investigation into the clinical, social, and mental factors determining the results of hospital treatment

Br J prev soc Med

Psychiatric disorder in medical in-patients

Quart Jl Med

The construction, development and testing of a self-report questionnaire to identify social problems

Psychol Med

Detection of Psychiatric Illness by Questionnaire

The Measurement and Classification of Psychiatric Symptoms

Manual of the Clifton Assessment Procedures for the Elderly (CAPE)

The Oxford Record Linkage Study: Current position and future prospects