The prevalence of emotional and cognitive dysfunction in a general medical population: Using the MMSE, GHQ, and BDI

doi:10.1016/0163-8343(83)90038-5

General Hospital Psychiatry

Volume 5, Issue 1, April 1983, Pages 15-24

https://doi.org/10.1016/0163-8343(83)90038-5 Get rights and content

Abstract

The Mini Mental Status Examination, General Health Questionnaire-30, and Beck Depression Inventory were administered to 335 randomly selected hospitalized medical patients. Twenty-eight percent of the population had evidence of cognitive dysfunction on the Mini Mental Status Examination, 61% showed emotional dysfunction on the General Health Questionnaire-30, and 36% were depressed as measured by the Beck Depression Inventory. Only 29% of the patients had no evidence of emotional or cognitive dysfunction. Medical resident diagnostic concordance with these tests was poor. The effects of demographic variables on these test scores were also determined.

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While the consult psychiatry literature includes extensive work on co-occurring categorical medical and psychiatric diagnoses,9–16 less is known about the distribution of dimensional psychopathology across medical and surgical presentations. The existing literature with traditional diagnostic categories suggests that comorbid psychiatric disorders are common among those admitted to the general hospital with medical or surgical complaints.17–22 This comorbidity is not just common but also consequential, as comorbid psychopathology portends a more complicated hospital course when present.23–25
Multidimensional transdiagnostic phenotyping systems are increasingly important to neuropsychiatric phenotyping, particularly in translational research settings. The relationship the National Institute of Mental Health's Research Domain Criteria multidimensional approach to psychopathology and nonpsychiatric diagnoses has not been studied at scale but is relevant to those caring for neuropsychiatric illness in medical and surgical settings.
We applied the CQH Dimensional Phenotyper natural language processing tool to estimate National Institute of Mental Health's Research Domain Criteria domain–associated symptoms of individuals admitted to nonpsychiatric wards at each of 2 large academic general hospitals over an 8-year period. We compared patterns in individual domain symptom burden, as well as a new pooled unidimensional measure, by primary medical and surgical diagnosis.
Analysis included 227,243 patients from hospital 1 of whom 68,793 (30.3%) had a prior psychiatric history and 220,213 patients from hospital 2 of whom 50,818 (23.1%) had a prior psychiatric history. The distribution of Research Domain Criteria symptom burdens over primary diagnosis was similar across hospital sites and differed significantly across primary medical or surgical diagnosis. The effect of primary medical or surgical diagnosis was larger than that of prior psychiatric history on Research Domain Criteria symptom burden.
Research Domain Criteria–based neuropsychiatric symptom burden estimated from general hospital patients' clinical documentation is more strongly associated with the primary hospital medical or surgical diagnosis than it is with the presence of a previous psychiatric history. The bidirectional role of psychiatric and somatic illness warrants further study through the lens of transdiagnostic phenotyping.
Tuberculosis - Depression syndemic: A public health challenge
2019, Indian Journal of Tuberculosis
Citation Excerpt :
Many patients with depression possess one or more of the risk factors like homelessness, alcohol abuse, congregate housing, exposure to active case,11,12 and, consequently, TB is more common in this population. Conversely, psychiatric illness may develop subsequent to TB infection, and depression seems to be particularly common in TB patients and is associated with increased mortality, morbidity and drug resistance.13–17 A study conducted in Vellore, south India has shown that about one-fifth of the tuberculosis patient suffer from some psychiatric comorbidity, depression being the commonest.18
Depression is common in Tuberculosis (TB) and associated with adverse outcomes through pathogenic mechanisms and impaired self-care behaviours including reduced treatment adherence. Undiagnosed depression can threaten the robustness of DOTS model despite large public health investment. The Depression-Tuberculosis Syndemic requires collaborative partnership with mental health professionals.
To study the evidence base for Depression-Tuberculosis Syndemic.
A Pubmed and Google Scholar search was conducted using the key words “Depression”, “Tuberculosis” and “Syndemic” and abstracts screened for appropriateness and relevance.
Depression-TB Syndemic is common with a bidirectional relationship. Depression is associated with higher hazard ratio and increased prevalence of TB. Depression is independently associated with higher morbidity, mortality, drug resistance, risk of TB reactivation and community TB transmission. The underlying biopsychosocial mechanism of Depression- Tuberculosis Syndemic includes biological factors like inflammatory cascade, HPA axis dysregulation and psychosocial factors like perceived stigma and treatment non-adherence.
Depression is a poor prognostic factor in TB. The National Mental Health Programme (NMHP) and National Strategic Plan (NSP) for Tuberculosis Elimination (2017–2025) work in independent verticals with no integration at policy or at ground level. This results in lack of identification and appropriate management of depression in patients with Tuberculosis despite repeated contact with health care personnel in DOTS centres. A collaborative approach for early diagnosis and management of depression in patients with Tuberculosis (Secondary Prevention) can help decrease the burden of disease and improve outcomes.
Depression-TB Syndemic requires collaborative approaches at the program level and at the point of service delivery.
A review of the interplay between tuberculosis and mental health
2013, General Hospital Psychiatry
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In addition to this, patients with mental illness often have risk factors for the progression of latent tuberculosis infection (LTBI) to active disease, including smoking, poor nutrition and co-morbidities including diabetes and HIV infection. Rates of major depression are higher in those individuals with medical illness than in the general population [5,6]. However they may be higher still in those individuals with a diagnosis of tuberculosis, as demonstrated in one study of hospitalised TB inpatients, where 68% met the criteria for a depressive illness [7].
Tuberculosis and mental illness share common risk factors including homelessness, HIV positive serology, alcohol/substance abuse and migrant status leading to frequent comorbidity. We sought to generate a comprehensive literature review that examines the complex relationship between tuberculosis and mental illness.
A literature search was conducted in MedLine, Ovid and Psychinfo, with further examination of the references of these articles. In total 316 articles were identified. It was not possible to conduct a formal meta-analysis due to the absence of randomised controlled data.
Rates of mental illness of up to 70% have been identified in tuberculosis patients. Medications used in the treatment of common mental illnesses, such as depression, may have significant interactions with anti-tuberculosis agents, especially isoniazid and increasingly linezolid. Many medications used in the treatment of tuberculosis can have significant adverse psychiatric effects and some medications such as rifampicin may reduce the effective doses of anti-psychotics y their enzyme induction actions. Treatment with agents such as cycloserine has been associated with depression, and there have been reported cases of psychosis with most anti-tuberculous agents. Mental illness and substance abuse may also affect compliance with treatment, with attendant public health concerns.
As a result of the common co-morbidity of mental illness and tuberculosis, it is probable that physicians will encounter previously undiagnosed mental illness among patients with tuberculosis. Similarly, psychiatrists are likely to meet tuberculosis among their patients. It is important that both psychiatrists and physicians are aware of the potential for interactions between the drugs used to treat tuberculosis and psychiatric conditions.
Does depression in older medical inpatients predict mortality? A systematic review
2007, General Hospital Psychiatry
Citation Excerpt :
Depressive disorders in older medical inpatients are frequent and disabling. The prevalence of major depression in this population ranges from 10% to 30% [1–4]; the prevalence of minor depression ranges from 9% to 50% [4–6]. The prognosis of these disorders is poor: up to 75% of patients have a protracted course over 12 months [7,8].
To determine whether depression in older medical inpatients predicts mortality.
Medline, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles; the bibliographies of relevant articles were searched for additional references. Retrieved studies were screened to meet five inclusion criteria. Validity of studies was assessed according to four criteria adapted from the Evidence-Based Medicine Working Group. Data were abstracted from each study and tabulated. Data synthesis involved a qualitative meta-analysis.
Many of the studies had methodological limitations. Six reported that depression predicted increased mortality, five reported that depression did not predict mortality, and one reported that depression predicted decreased mortality when there was a history of prior depression. Unadjusted risk ratios for death ranged from 0.60 to 12.6; adjusted risk ratios ranged from 0.42 to 7.4. The disparate findings may be explained in part by differences in the proportions of young older patients and men enrolled in the different studies.
The evidence that depression in older medical inpatients predicts mortality is inconclusive. There is a need for further studies that pay attention to design, populations enrolled, and analysis.
The prognosis of major and minor depression in older medical inpatients
2006, American Journal of Geriatric Psychiatry
Major and minor depression is frequent in older medical inpatients, but the prognosis of these two disorders is not clear. The current study proposed to determine the prognosis of major and minor depression in this population.
This prospective, observational cohort study, conducted in Montreal, Quebec, Canada, involved assessment of 380 elderly medical inpatients with major, minor, or no depression at three, six, and 12 months after enrollment using the Diagnostic Interview Schedule and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Information on suicide attempts, completed suicides, and potential prognostic factors was also collected. Analysis of outcomes and potential prognostic factors involved descriptive statistics and multiple logistic regression.
Among patients with major depression at enrollment, 13% were recovered, 14% were partially recovered, and 73% remained depressed with a protracted stable or protracted fluctuating course. Among patients with minor depression, 28% were recovered and 72% had a protracted course. Patients diagnosed with major depression at enrollment often had minor depression at follow up and vice versa.
The prognosis of both major and minor depression in older medical inpatients is poor and worse than previously thought.
The impact of psychiatric comorbidity on length of stay of medical inpatients
2003, General Hospital Psychiatry
The aim of the study was to determine the impact of psychiatric comorbidity (PC) on length of hospital stay (LOS) of medical inpatients. A prospective cohort study was conducted. A series of 317 medical inpatients consecutively admitted to the general medical wards of a University Hospital composed the sample, after excluding those who refused or who could not be evaluated due to their physical illnesses or treatments (n=78). Data on demographic and medical variables were collected. A psychiatrist categorized subjects into two cohorts (with and without PC), according to DSM-IV, using the Schedule for Affective Disorders and Schizophrenia, except in patients cognitively impaired who were diagnosed by clinical interview. Mortality and length of stay during the index hospitalization were recorded. At admission, 156 (49%) inpatients had a current psychiatric comorbidity. After controlling for confounders (age and physical severity), in the multivariate analysis of covariance, the patients with cognitive impairment had a significantly prolonged LOS (F=17.8; P<.01) compared with those without cognitive impairment. No difference existed in LOS for the patients with depressive disorders (F=0.36; P=.55), Anxiety disorders (F=1.48; P=.22) or Substance related disorders (F=1.05; P=.30). These results suggest an independent effect of cognitive impairment increasing LOS of medical inpatients.

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The prevalence of emotional and cognitive dysfunction in a general medical population: Using the MMSE, GHQ, and BDI

Abstract

J Psychiatr Res

Lancet

Gen Hosp Psychiatry

Lancet

Psychiatry of somatic diseases: Epidemiology, pathogenesis, classification

Compr Psychiatry

The uses and abuses of screening devices

The detection of psychiatric illness by questionnaire

The sensitivity of the Beck depression inventory to changes of symptomatology

Br J Psychiatry

An inventory for measuring depression

Arch Gen Psychiatry

Limits of the mini-mental state in screening for dementia among hospitalized patients

Psychol Med

Psychiatric disturbances in neurological patients: Detection, recognition, and hospital course

Ann Neurol

Psychiatric morbidity in general practice and the community

Psychol Med

A prospective study of the incidence of mental disorder

Depression: Clinical, experimental and theoretical aspects

A rating scale for depression

J Neurol Neurosurg Psychiatry

A comparison of two rating scales for depression

J Clin Psychol

Comparative studies of psychological function in patients with advanced cancer—I. Self-reported depressive symptoms

Psychosom Med