Older patients referred to a consultation-liaison psychiatry clinic

BACKGROUND: Little is known about the psychiatric disorders which are associated with somatic presentations of psychological distress in older people. METHOD: A study of patients aged 65 years and over referred to an adult consultation-liaison psychiatry clinic in a general hospital. RESULTS: Of 900 patients referred over a 7-year period, 45 (5%) were aged 65 years and over. The most frequent ICD-10 diagnostic category was somatoform disorder (N=30) followed by depressive disorder (N=6). The age of onset of the physical symptoms was significantly earlier in those with somatoform disorders (mean 49 years; SD 3.1 years) compared with patients with depressive disorders (mean 74 years; SD 3.1 years) (p<0.05). All diagnoses were equally associated with moderate functional impairment. CONCLUSION: Medically unexplained physical symptoms may occur as part of a range of psychiatric disorders in older people and diagnostic groups are distinct in a number of ways. The usefulness of the ICD-10 classification of disorders in relation to these patients is considered. Implications for the delivery of old age psychiatry services are discussed.     

Referral pattern of neurological patients to psychiatric Consultation-Liaison Services in 33 European hospitals.

The referral pattern of neurological patients to 33 European psychiatric consultation-liaison (C-L) services in the general hospital was examined. Analyses were conducted on the ECLW CS data set, which consists of 14,717 psychiatric C-L referrals made in 56 European hospitals during 1991. Psychiatric referrals of patients admitted to neurological wards were compared to referrals from other wards. Information was obtained from 33 neurological wards, consisting of 34,506 neurological admissions. Of these admissions, 839 were referred to C-L psychiatry. The median consult rate among the hospitals was 1.8%. Compared to other hospital wards, patients referred from neurology were more frequently diagnosed as suffering from somatoform (P<.01) and dissociative disorders (P<.01), and less from substance abuse (P<.01) and delirium (P<.01). Referral to C-L psychiatry from neurological wards is characterized by an underestimation of psychiatric co-morbidity and a late detection, comparable to other medical specialties. An appeal is made for a standardized referral procedure including admission screening method, detecting patients at risk for nonstandard care during their hospital admission.     

Mode of onset and two years outcome of a broad spectrum of affective disorders]

In recent years emphasis has tended to be placed on assessing and diagnosing low-grade affective disorders. If mild affective symptoms are also considered a broad spectrum of affective disorders, this spectrum can be seen, not only in the manifestation of major symptoms of such illnesses as manic-depressive illness, but also in symptoms of various mental disorders. The present study was undertaken to analyze the clinical features of a broad spectrum of affective disorders in a prospective follow-up study. Ninety mentally ill patients who visited our outpatient clinic were followed for 2 years, to investigate the mode of onset, the course and outcome of their disorders. Using a semistructured interview method specially developed for this survey, these patients were divided into a broad spectrum of affective disorder group and the other groups. Forty-nine patients were allocated to a spectrum of affective disorder group characterized by four-day (or longer) persistence of at least one of the following symptoms, depressed mood, loss of interest or elevated, expansive, or irritable mood. Of the forty-nine patients there were only two patients with manic symptoms. And the forty-seven patients with depressive symptoms were compared with the other groups as a main subject. The other groups were composed of eighteen patients with psychotic symptoms (the psychotic group) and 23 patients with neurotic symptoms (the neurotic group). The psychotic and neurotic groups did not satisfy the criteria shown above. There was no significant differences in male-to-female ratio or age between these three groups. When the mode of onset of symptoms were compared, the percentage of cases in whom symptoms could be identified early (within 10 days after onset) was 64.4% in the depressive group, 41.2% in the psychotic group and 30.4% in the neurotic group. The percentage of cases who remitted 2 years later was 70.2%, 38.9%, 45.5% in the depressive group, psychotic and neurotic groups, respectively. The GAS score (mean +/- SD), assessed 2 years later, was 76.2 +/- 12.5, 62.8 +/- 11.7, 78.2 +/- 9.9 points for these three groups, respectively. These results suggest that a broad spectrum of depressive disorders develops more acutely and patients with this spectrum are more likely to recover from symptoms and in function. Thus, the course of disorders was more favorable in the depressive group than in the psychotic group or the neurotic group.     

Somatoform disorders: the role of consultation liaison psychiatry

The somatoform disorders are encountered commonly in both primary and secondary care. Despite their high incidence, few hospitals have teams with the expertise to manage this group of conditions. The lack of appropriate carers leads to inappropriate care, including increased numbers of admissions and investigations, to the detriment of the patients. The absence of appropriate care also increases the cost to the health services. Multidisciplinary Consultation Liaison (C-L) Psychiatry teams operate within non-psychiatric settings and are dedicated to the mental health care of patients presenting in these areas. Their unique skills and approaches offer support and education to these non-psychiatric teams and care to this group of patients. They are thus ideally placed to assess, diagnose and manage individuals presenting with somatoform disorders. Unfortunately, these teams are not widely available, largely because the current climate within psychiatry leads services to concentrate on what is defined as serious mental illness, a term usually used synonymously with psychotic disorders, despite the large number of people suffering from somatoform disorders and the cost of their care. The dislike that some colleagues have for this group of conditions may further hamper the creation of these services. In order to provide efficient assessment of and treatment for individuals with somatoform disorders, C-L Psychiatry teams must be created to lead clinical development, research and training in this discipline. These teams will also lead on the further research required.     

Somatoform disorders: The role of consultation liaison psychiatry

The somatoform disorders are encountered commonly in both primary and secondary care. Despite their high incidence, few hospitals have teams with the expertise to manage this group of conditions. The lack of appropriate carers leads to inappropriate care, including increased numbers of admissions and investigations, to the detriment of the patients. The absence of appropriate care also increases the cost to the health services. Multidisciplinary Consultation Liaison (C-L) Psychiatry teams operate within non-psychiatric settings and are dedicated to the mental health care of patients presenting in these areas. Their unique skills and approaches offer support and education to these non-psychiatric teams and care to this group of patients. They are thus ideally placed to assess, diagnose and manage individuals presenting with somatoform disorders. Unfortunately, these teams are not widely available, largely because the current climate within psychiatry leads services to concentrate on what is defined as serious mental illness, a term usually used synonymously with psychotic disorders, despite the large number of people suffering from somatoform disorders and the cost of their care. The dislike that some colleagues have for this group of conditions may further hamper the creation of these services. In order to provide efficient assessment of and treatment for individuals with somatoform disorders, C-L Psychiatry teams must be created to lead clinical development, research and training in this discipline. These teams will also lead on the further research required.     

A multicenter investigation of consultation-liaison psychiatry in Italy. Italian C-L Group.

In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55-75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.     

Munchhausen patients in general hospitals--Clinical features and treatment approaches in C-L psychiatry settings

Factitious disorders have been reported in 0.5 - 1 % of general hospital patients. It often takes several years until the disorder is detected. During this period, enormous health care cost can arise not least out of iatrogenic self-induced mutilations and related secondary somatic complications. Apart from surgeons and physicians, consultation-liaison (C-L) psychiatrists are particularly called on to diagnose factitious disorders at an early stage in order to avoid unnecessary diagnostic and therapeutic procedures, treatment dropout and doctor shopping. This article gives an overview of clinical features and treatment approaches in C-L psychiatry settings.     

Health-related quality of life of children and adolescents with mental disorders

OBJECTIVE: To compare the health-related quality of life (HRQL) between children aged 6-17 years with one of three mental disorders (attention-deficit/hyperactivity disorder, major depressive disorder, or conduct disorder), a physical disorder, and those with none of these disorders. METHOD: Parent reports describing the HRQL, mental disorders, and physical disorders of a national sample of 3,597 children and adolescents in Australia, aged 6-17 years (response rate = 70%), were obtained by means of a structured diagnostic interview and questionnaires. RESULTS: After controlling for age, gender, and family structure, children with mental disorders were reported to have a significantly worse HRQL in several domains than children with no disorder. In many areas they were reported to have a worse HRQL than children with physical disorders. Parents also reported that the problems of children with mental disorders interfered significantly with the daily lives of children, parents, and families. CONCLUSIONS: The findings are consistent with previous studies which have reported that adults with mental disorders have substantial impairment in their HRQL. The findings suggest that children with a mental disorder require help in many areas of their lives. Achieving this will require an integrated approach to health care delivery rather than the current distinction between physical and mental health services.     

Screening for mental disorders in cardiology outpatients

The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86 were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic and mental problems in each patient on visual analogue scales (VAS-som and VAS-men). The current treatments, including psychiatric and psychological treatments, were noted, and the survival was followed for 3 years. Of the 86 patients included, 34 (40%) had a diagnosis of mental disorder. Eleven (12.8%) had major depression, six (7.0%) minor depression, six (7.0%) anxiety disorder, two unspecified somatoform disorder, seven (8.1%) dementia, one alcohol abuse and one psychosis. Three of the patients were in long-term psychopharmacological treatment. Although the cardiologists predicted mental disorder significantly better than chance, none of the patients was in relevant treatment for their mental disorder. At 3-year follow-up, 20 (24%) of the patients had died. Age and severity of heart disease predicted mortality, while the presence of a mental disorder did not. Mental disorders, especially depression, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment.     

Dissociative disorders among inpatients with drug or alcohol dependency

OBJECTIVE: To determine the prevalence of dissociative disorders among inpatients with alcohol or drug dependency. METHOD: The Dissociative Experiences Scale was used to screen 215 consecutive inpatients admitted to the dependency treatment center of a large mental hospital over a 1-year period (March 1, 2003, to March 31, 2004). Patients who had scores of 30.0 or above were compared with patients who scored below 10.0 on the scale. The patients in both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores. RESULTS: Of the patients, 36.7% had a Dissociative Experiences Scale score of 30.0 or above. The prevalence of DSM-IV dissociative disorders was 17.2% (N = 37). On average, 64.9% of these patients' dissociative experiences had started 3.6 years (SD = 2.9; range, 1.0-11.0 years) before onset of the substance use. Patients with dissociative disorders were younger, and the mean duration of their remission periods was shorter. Dissociative disorder patients tended to use more than 1 substance, and drugs were used more frequently than alcohol in this group. The frequency of borderline personality disorder, somatization disorder, history of suicide attempt, and childhood abuse and neglect occurred more frequently in the dissociative disorder group than in the nondissociative disorder group. History of suicide attempt (p = .005), female sex (p = .050), and childhood emotional abuse (p = .010) were significant predictors of a dissociative disorder diagnosis. Significantly more patients with dissociative disorders stopped their treatment prematurely (p < .001). CONCLUSION: Impact of dissociative disorders on development and treatment of substance dependency requires further study.     

精神疾病共病高血压病的调查

目的 调查精神疾病患者共病高血压病的现状,探讨相关的危险因素.方法 回顾性分析河北医科大学第一医院精神卫生科住院的精神疾病患者,采用自制量表调查所有患者共病高血压病的情况,分析精神疾病共病高血压病的危险因素.结果 (1)2770例患者中,男性1234例(44.5%),女性1536例(55.5%);其中共病高血压病者528例(19.1%).(2)不同精神疾病患者共病高血压病的比例:精神分裂症10.6%,双相障碍10.7%,抑郁症24.7%,焦虑障碍29.0%,应激障碍20.0%,器质性精神疾病41.8%,其他19.8%;各组间的差异有统计学意义(χ2=124.90,P<0.01).(3)年龄大、精神疾病的病程长、患器质性精神疾病是精神疾病共病高血压病的危险因素.结论 综合医院精神科住院患者共病高血压病的比例为19.1%,其中器质性疾病共病高血压病的比例最高,精神分裂症和双相障碍患者共病高血压病的比例最低.     

气功相关精神障碍患者82例随访对照分析

目的：对气功所致精神障碍与气功相关的精神分裂症的临床特点差异进行探讨。方法：收集在1990年至2000年间连续入院患者中与气功相关的精神病性障碍患者82例，其中住院时诊断为气功所致精神障碍46例，精神分裂症36例。收集两组病例的人口统计学、临床表现等资料并作5年以上随访。结果：气功所致精神障碍（气功组）与精神分裂症（分裂症组）比较，在性别、婚姻、年龄、接受教育年限、起病年龄及病程方面差异均有显著性（P均〈0．001）。获得68例5年以上的随访资料，其中气功组38例，分裂症组30例。至随访结束，气功组中84％（32例）、分裂症组中57％（17例）维持原诊断，二者差异有显著性（P〈0．001）。气功组的精神障碍缓解程度达89％（34例），而分裂症组的缓解程度仅33％（10例），差异有显著性（P〈0．001）。气功组的社会功能也明显优于分裂症组（P〈0．01）。结论：气功所致精神障碍与气功相关的精神分裂症是两种不同类型的疾病，根据临床特点，二者可以鉴别。     

Impact of adverse childhood experiences on the symptom severity of different mental disorders: a cross-diagnostic study

BackgroundAdverse childhood experiences have a significant impact on different mental disorders.ObjectiveTo compare differences in adverse childhood experiences among those with different mental disorders and their relationships in a cross-disorder manner.MethodsThe study included 1513 individuals aged ≥18 years : 339 patients with substance use disorders, 125 patients with schizophrenia, 342 patients with depression, 136 patients with bipolar disorder, 431 patients with obsessive-compulsive disorder (OCD), and 140 healthy controls. The Early Trauma Inventory Self Report-Short Form was used to investigate childhood traumatic experiences, and the Addiction Severity Index, Positive and Negative Syndrome Scale, Hamilton Depression Scale, Young Mania Rating Scale, and Yale-Brown Obsessive-Compulsive Scale were used to assess mental disorder severity. Correlation and multivariate logistic regression were analysed between adverse childhood experiences and clinical features.ResultsLevels of adverse childhood experiences were significantly different among different mental disorders. Moreover, 25.8% of patients with substance use disorders reported childhood trauma, which was significantly higher than found in the other four psychiatric disorder groups. Emotional abuse scores were positively correlated with disease severity: the higher the total trauma score, the more severe the mental disorder.ConclusionsAdverse childhood experiences are a common phenomenon in those with mental disorders, and the level of trauma affects mental disorder severity. Emotional abuse is closely related to many mental disorders. The incidence or severity of mental disorders can be reduced in the future by reducing the incidence of adverse childhood experiences or by timely intervention in childhood trauma.     

Mental disorders in general hospital patients

Two major epidemiological studies using standardized instruments for diagnosis have revealed that the prevalence of mental disorders in general hospital inpatients range from 41.3% to 46.5%. The most prevalent groups of psychiatric disorders among general hospital inpatients are organic mental illness, depressive disorders, and alcohol dependence or abuse. The prevalence rates of organic brain syndromes, adjustment disorders with depressed mood, and alcohol dependence in general hospital inpatients are above those of the general population. In nearly half of the studied general hospital inpatients receiving a psychiatric diagnosis Consultation-Liaison (C-L) psychiatry interventions were found to be necessary. However, psychiatric consultation rates found in most recently presented studies in Germany and Austria range from 2.66% to 3.30%, and remain low when compared to the reported prevalence figures of psychiatric disorders and the demonstrated necessity for specific therapeutic interventions among general hospital inpatients. There is also evidence stemming from newly presented C-L follow-up studies that the remarkable advances in intensive care treatment, organ transplantation medicine and cardiac surgery with cardiopulmonary bypass within the past decade have an important impact on the general hospital inpatients; psychosocial outcome. One follow-up study of long-term acute respiratory distress syndrome (ARDS) survivors using the Structural Clinical Interview for the DSM-IV (SCID) has shown that 43.5% of these patients met the criteria for a full posttraumatic stress disorder (PTSD), 8.9% of these patients for a subthreshold or partial PTSD (sub-PTSD) at hospital discharge, and 23.9% of them still suffered from full PTSD, 17.8% of them from sub-PTSD. ARDS-Patients with PTSD symptomatology exhibited major impairments in a variety of dimensions of health-related quality of life. Another outcome study examining concurrently psychiatric morbidity and quality of life in intermediate-term survivors of orthotopic liver transplantation (OLT) survivors has documented that 5.4% of these patients had a full PTSD, and 17.3% of them a sub-PTSD at 4 year-follow-up. OLT- related PTSD symptomatology was associated with maximal decrements in health-related quality of life. The duration of intensive care treatment, the number of medical complications, and the occurrence of acute rejection were positively correlated with the risk of PTSD symptoms subsequent to OLT. Finally, one prospective 1-year outcome study has focused on psychiatric morbidity including postoperative delirium in patients who had undergone cardiac surgery employing cardiopulmonary bypass. Postoperative delirium developed in 32.4% of these patients, however, only in 5.9% of them severe delirium was noted. Short-term consequences of cardiac surgery included adjustment disorders with depressed features (32.4%), acute full in-hospital PTSD (17.6%), and in-hospital major depression (17.6%). The diagnostic status of in-hospital PTSD was linked to postoperative delirium. At 12 months, the severity of depression and anxiety disorders including PTSD improved and returned to the preoperative level. However, patients who were found to have major depression or PTSD before discharge, C-L psychiatric consultations were conducted. In conclusion, PTSD symptoms following medical illness and treatment are not rare. If they are untreated, PTSD symptoms such as intrusive recollections, avoidance and hyper-arousal may impair the patients; quality of life more than the primary disease. This seems to be also true for a subthreshold PTSD. To adequately diagnose and treat patients at risk of developing PTSD, close collaboration between physicians of all subspecialties and C-L psychiatrists will be necessary.     

Challenging times: a study to detect Irish adolescents at risk of psychiatric disorders and suicidal ideation

Suicide rates in young Irish males have risen markedly in the past 10 years, and suicide is now the leading cause of death in young men in the 15-24-year-old age range. This is the first large-scale study in Ireland that set out to identify young people at risk of psychiatric disorders, including depressive disorders, and suicidal ideation. Seven hundred and twenty three school-going adolescents aged 12-15 years were screened using the Children's Depression Inventory and the Strengths and Difficulties Questionnaire. 19.4% were identified as being 'at risk' of having a mental health disorder. Of this 'at risk' group, 12.1% expressed possible suicidal intent and 45.7% expressed suicidal ideation. Of the 583 adolescents identified as being 'not at risk', 13% expressed suicidal ideation while none expressed suicidal intent. Being 'at risk' was not related to gender or to socio-economic status. Those living with two parents were significantly more likely to be in the 'not at risk' group. Girls attending co-educational schools were twice as likely to be in 'at risk' group compared with those attending all girls schools, while school type was not a risk factor for boys. This study shows that, as in other western countries, there are large numbers of young Irish people at risk of mental health disorders and suicidal ideation in the community, and raises the question of the importance of mental health promotion in our education system.     

Mental disorders among elderly people in primary care: the Linköping study

OBJECTIVE: The aims of this study were to describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with diagnoses in medical records. METHOD: Patients aged 70 years and above attending a primary care centre (N = 350) were studied using a psychiatric and medical record examination. RESULTS: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnosis in case records and 17-38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1% and 66%. Patients with mental disorders were more often females, had more visits to a doctor, more diagnoses in medical records, and were prescribed more drugs. CONCLUSION: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.     

Prospective assessment of treatment use by patients with personality disorders

OBJECTIVE: This study examined the utilization of mental health treatments over a three-year period among patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorders compared with patients with major depressive disorder and no personality disorder. METHODS: A prospective, longitudinal study design was used to measure treatment use for 633 individuals aged 18 to 45 years during a three-year period. RESULTS: Patients with borderline personality disorder were significantly more likely than those with major depressive disorder to use most types of treatment. Furthermore, all patients continued using high-intensity, low-duration treatments throughout the study period, whereas individual psychotherapy attendance declined significantly after one year. CONCLUSIONS: Although our data showed that patients with borderline personality disorder used more mental health services than those with major depressive disorder, many questions remain about the adequacy of the treatment received by all patients with personality disorders.     

The Epworth sleepiness scale: relationship to sleep and mental disorders in a sleep clinic

BACKGROUND AND PURPOSE: Both sleep disorders and mental disorders are associated with excessive daytime sleepiness as measured by the Epworth sleepiness scale (ESS). We sought to assess the relationship between the ESS scores and mental disorders in a sleep clinic. METHODS: One hundred sixty-five consecutive new referrals to a sleep clinic completed the ESS prior to their initial visit. Mental disorders (major depression, minor depression, anxiety not otherwise specified, and panic disorder) were diagnosed with the primary care evaluation of mental disorders (PRIME-MD) questionnaire, a reliable and valid instrument. Nearly all sleep diagnoses (95%) were made by polysomnography. RESULTS: The mean ESS for the cohort was 12.3 (standard deviation (SD) 5.1). There was no difference in the mean ESS for those with and without mental disorders (12.8 vs. 12.2, P=0.48) or sleep-disordered breathing (SDB) (12.3 vs. 12.3, P=0.99). ESS scores were not different between patients with a comorbid mental disorder and SDB compared with the presence of a mental disorder or SDB alone (combination: 13.0 vs. mental disorder: 11.5 vs. SDB: 12.2, P=0.70). There was also no relationship between ESS scores and the respiratory disturbance index (RDI) (P=0.63). CONCLUSIONS: We found no relationship between ESS scores and mental disorders among referrals to a sleep clinic. ESS cannot be used to screen for mental disorders among sleep clinic patients.     

Prevalence of psychiatric disorders in New Zealand prisons: a national study

OBJECTIVE: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. METHOD: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview - Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. RESULTS: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive- compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. CONCLUSIONS: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.     

山东省18岁及以上人群精神障碍流行病学调查

目的:调查山东省18岁及以上人群精神障碍的患病率及其分布特点。方法:于2015年在山东省49个县（市、区）开展精神障碍流行病学调查,采用多阶段分层整群抽样方法,抽取山东省≥18岁人群28 000人,利用修订的一般健康问卷进行筛查,将调查对象分为精神障碍高危和低危人群,采用DSM-Ⅳ、SCID-Ⅰ/P或MMSE对高危人群...