Mental disorders among internal medical inpatients: prevalence, detection, and treatment status

OBJECTIVE: To determine the prevalence of ICD-10 mental disorders among internal medical inpatients, the relation between mental disorder, age, and gender, and the recognition and referral of the disordered patients. METHOD: 294 consecutive medical inpatients were examined with a two-phase design using the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) for ICD-10 psychiatric diagnoses. Information from questionnaires and interviews with patients, doctors, nurses, and from medical records. RESULTS: The prevalence of current mental disorders was 38.7%, being heavily increased in young patients. Main diagnoses were somatoform disorders (17.6%), phobias (12.9%), substance use disorders (10.9%), and depression (8.3%). Psychiatric consultations were very few. About 38-56% of the cases were recognized by medical doctors and nurses, and only about 20% were in mental health treatment. CONCLUSION: The prevalence of mental disorders among internal medical inpatients is high and increased in young patients and women. Detection and referral are low, and few are treated.     

The 4-week prevalence of somatoform disorders and associated psychosocial impairment

In the course of a WHO study,we report on the prevalence of somatoform disorders (SFD) and the associated psychosocial impairment in five western German primary care settings. In accordance with ICD-10 classification, a 4-week prevalence of 28.5% was found for SFD (number of patients in the age between 18 and 60 with an SFD in the last 28 days). The accumulation of SFD was higher in female patients than in males (RR 1.7), in particular when the number of children was >1 (RR 1.8). The female-male difference was more marked in persistent somatoform pain disorder (RR 2.1) and unspecific somatization disorder (RR 5.0). Concerning other psychiatric disorders, neurasthenia occurred most frequently,with a 4-week prevalence of 8.2%.The 4-week prevalence of concomitant occurrence of SFD and other psychiatric disorders was 7.7%. Working capability was most severely impaired, with 22.5 days of absence from work during the last month, in male patients with hypochondriacal disorder. In comparison, somatization disorder resulted in a severe level of psychosocial impairment, with 10.3 days of absence in work during the last month in female patients. The coexistence of SFS with other psychiatric disorders resulted in a greater extent of psychosocial impairment.     

Use of complementary therapy among internal medical inpatients. Prevalence, costs and association with mental disorders and physical diseases

OBJECTIVES: The aims of this study were to determine the prevalence of complementary therapy/medicine (CT) use among internal medical inpatients. Furthermore, to examine the association between the use of CT and (a) mental disorders, (b) physical diseases, and (c) use of health care. METHODS: A total of 294 consecutive medical inpatients were interviewed about their use of CT. A stratified subsample of 157 people was assessed for current mental disorders, using an extensive, standardized, semistructured interview (Schedules for Clinical Assessment in Neuropsychiatry version 2.1 [SCAN]). Health care use was assessed by use of national patient registers. RESULTS: There were 22.5% CT utilizers. More females than males used CT (P=.033). CT utilization was not associated with age, mental disorders, life-threatening or chronic physical diseases or with use of health care services. CONCLUSIONS: The use of CT is common among medical inpatients. More research is needed to understand why a significant proportion of patients seeks CT.     

Dissociative disorders among alcohol-dependent inpatients

The aim of this study was to determine the prevalence of dissociative disorders among inpatients with alcohol dependency. The Dissociative Experiences Scale was used to screen 111 alcohol-dependent patients consecutively admitted to the inpatient unit of a dependency treatment center. Subgroups of 29 patients who scored 30.0 or above and 25 patients who scored below 10.0 were then evaluated with the Dissociative Disorders Interview Schedule and the Structured Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores. Of the 54 patients evaluated, 10 (9.0% of the original 111) patients had a dissociative disorder. A considerable number of the remaining patients reported a high level of dissociative experiences. Among the dissociative disorder group, nine patients had dissociative disorder not otherwise specified and one patient had depersonalization disorder. Female gender, younger age, history of suicide attempt, childhood emotional and sexual abuse, and neglect were more frequent in the dissociative disorder group than among non-dissociative patients. The dissociative disorder group also had somatization disorder, borderline personality disorder, and lifetime major depression more frequently. For 9 of the 10 dissociative patients, dissociative symptoms started before the onset of alcohol use. Although the probability of having a comorbid dissociative disorder was not higher among alcohol-dependent inpatients than among the general psychiatric inpatients, the dissociative subgroup had distinct features. Many patients without a dissociative disorder diagnosis (predominantly men) provided hints of subtle dissociative psychopathology. Implications of comorbid dissociative disorders and dissociative experiences on prevention and treatment of alcohol dependency and the importance of gender-specific characteristics in this relationship require further study.     

The prevalence of personality disorders among those with eating disorders

The genuine prevalence of personality disorders among those with eating disorders is unknown. However, in this paper, we summarize the existing data, with careful acknowledgment of our approach to interpretation as well as the limitations of previous studies. Our findings indicate that obsessive-compulsive personality is the most common personality disorder in restricting-type anorexia nervosa, while borderline personality is the most common personality disorder in binge-eating/purging type anorexia nervosa. Borderline personality is the most common personality disorder in bulimia nervosa, as well. In those with binge eating disorder, obsessive-compulsive personality is the most common personality disorder although, compared with the preceding eating disorder diagnoses, there are broader clusters of personality disorders represented in this group. We discuss the implications of these findings.     

Rethinking somatoform disorders

PURPOSE OF REVIEW: From the very moment of their inclusion in contemporary classification systems in psychiatry, the concept of somatization and diagnostic categories of somatoform disorders became a matter of controversy that created an ongoing debate about their validity, reliability and applicability in clinical and research settings. The aim of this review is to provide an insight into the current theoretical, research and clinical dilemmas in the area of somatoform disorders and to illustrate them with brief summaries of scientific papers recently published in this field. RECENT FINDINGS: In the period covered by this review, the most valuable scientific contributions to the current state of knowledge on somatoform disorders were (surprisingly numerous) review papers produced by the leading experts in this field. These comprehensive and critical meta-analyses covered historical, conceptual, epidemiological and cross-cultural aspects of somatoform disorders. Another and a relatively smaller group of recently published papers reported on some novel treatment strategies for patients with specific somatoform disorders, their service utilization and health care-related costs. SUMMARY: If one were to find a common denominator of the papers covered by this review, it is a general agreement amongst their authors that the current concepts of somatization and somatoform disorders have serious theoretical and practical limitations in both research and clinical settings. They suggest that the time has come to seriously rethink these concepts so as to find better nosological solutions for the forthcoming revisions of classification systems in psychiatry and medicine.     

Genetics of somatoform disorders

I investigated the contribution of hereditary factors in somatoform disorders. Fourteen monozygotic and 21 dizygotic index twins and their co-twins were personally interviewed. The results showed a concordance of 29% in monozygotic and 10% in dizygotic pairs. However, similarity in childhood experience seemed to influence the concordance rates. Thus, even if somatoform disorders appear familial, the transmission may be environmental. Furthermore, the study showed a high frequency of anxiety disorders, especially generalized anxiety disorders, in the co-twins of somatoform-disordered twins.     

Pharmacotherapy of somatoform disorders

OBJECTIVE: This paper reviews the published literature on the pharmacologic management of somatoform disorders. METHODS: Using Medline, the author identified all articles published between 1970 and 2003 on this topic, selecting the best-designed studies for inclusion. RESULTS: The review reveals that patients with the obsessional cluster of somatoform disorders (hypochondriasis and body dysmorphic disorder [BDD]) respond well to serotonin reuptake inhibitors (SRIs). Less is known about the pharmacologic responsiveness of patients with the primarily somatic cluster of somatoform disorders (somatization, pain), a patient group that is common in the health provider's office. CONCLUSIONS: Improvements in the design of future clinical trials are needed. A particular focus needs to be applied to study the neglected area of the pharmacologic treatment of syndromal and subsyndromal somatization and pain disorders.     

The general practitioner faced with somatoform disorders

Functional pain pathology is a public health issue, due to its prevalence, the costs it generates and the disability it causes the patient. The role of general practitioners is crucial. They must avoid the pitfall of pointless, sometimes dangerous, examinations and treatments, and seek to create with the patient a long-lasting and good quality relationship, key to the treatment of these disorders.     

The prevalence of suicidal behavior among preadolescent children who are psychiatric inpatients

The prevalence of suicidal behavior displayed by preadolescent children hospitalized on inpatient psychiatric units is estimated to range between 18% and 80% of the population. The current study provides an independent estimate of the prevalence of this problem. A semistructured interview was used to assess suicidal behavior displayed by 61 admissions to a child psychiatric inpatient unit between April 1988 and September 1989. According to the Pfeffer Spectrum of Suicidal Behavior Scale, 63% of the sample engaged in some form of suicidal behavior. Preadolescents and their parents reported similar rates of suicidal thoughts, threats and attempts. The dangerousness of recent suicidal behavior was not found to differ by age, sex, legal custody status or socioeconomic status.     

躯体形式障碍患者就医行为研究

目的 探讨躯体形式障碍(SFD)患者就医行为及其影响因素.方法 采用自编的就医行为与躯体症状报告单对115例SFD患者进行评定.结果 完成研究的109例SFD中,首诊于综合性医院者73例(67％),私人诊所者10例(9％),药店购药者4例(4％),求助于巫医者2例(2％),精神病专科医院者19例(17％);曾经到非精神专科诊疗的98例患者中,仅有24例患者得到明确诊断.相关分析显示,非专科诊疗次数与患者年龄、对精神疾病相关信息了解程度、前后非专科诊疗的经济花费、运动系统、心血管系统、呼吸系统、感觉系统功能障碍及症状清单总分呈正相关(r =0.21 ～0.35,P＜0.05或0.01).患者对精神疾病相关信息了解程度、症状清单总分、经济花费、年龄依次进入非专科治疗次数的回归方程(P＜0.05).结论 SFD患者首诊于精神专科的比率较低,非精神专科对疾病的检出率较低.对精神疾病相关信息了解少、躯体化症状严重等可能为SFD患者就诊于非专科的重要影响因素.     

Personality disorders and unmet needs among psychiatric inpatients

OBJECTIVE: This study sought to examine the association between unmet need and personality disorders in a sample of psychiatric inpatients. The authors tested the hypothesis that the presence of a personality disorder would be independently associated with a significantly greater number of unmet needs. METHODS: A total of 153 psychiatric inpatients from four acute hospital wards serving an inner-city borough in London, United Kingdom, received standardized assessments of need and personality disorder by use of the Camberwell Assessment of Need Short Assessment Schedule and Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: Fifty-four percent of the sample had a personality disorder. The presence of a personality disorder was associated with greater unmet need. In multiple regression analyses, after adjustment was made for the effects of all covariates, severity of personality disorder was significantly associated with unmet need. Personality disorder was significantly associated with greater need in eight of 22 domains of need: self-care, psychotic symptoms, psychological distress, risk to self, risk to others, alcohol use, sexual expression, and budgeting. CONCLUSIONS: Personality disorder was found to be independently associated with a greater level of unmet need among psychiatric inpatients. The study highlights for the first time the importance of a comprehensive assessment of need for patients with personality disorders.