Detection and treatment of psychiatric illness in a general medical ward: a modified cost-benefit analysis.

This article describes a prospective, randomized, controlled trial of screening and treatment for psychiatric disorder in medical in-patients. The study has assessed whether increased recognition of psychiatric disorder among medical in-patients improves clinical outcome and reduces the costs of care, and whether routine involvement of a psychiatrist in the assessment and care of medical in-patients with probable psychiatric disorder is superior to the efforts of the physicians alone. A total of 218 medical in-patients who scored over the screening threshold for psychiatric disorder on the General Health Questionnaire were randomly allocated to one of two intervention groups or a control group. Six months later their mental health, subjective health status, quality of life, and costs of care was reassessed. Mental health and quality of life at 6 months were similar in the two intervention groups and the control group. Patients whose physicians were told the results of the screening test had lower costs for subsequent admissions, but this was probably due to differences between the groups in terms of employment status. Treatments recommended by psychiatrists broke down when patients were discharged home, leading to inadequate treatment of psychiatric disorders. We have not been able to show that routine screening for psychiatric disorder produces any benefit, either in better outcome for patients or reduced costs for the NHS. Further research should: consider examining a more homogeneous group in terms of costs of care; screen only for disorders likely to respond to a specific treatment; and ensure that treatment recommendations are carried out.

Quality of life in liaison psychiatry. A comparison of patient and clinician assessment.

BACKGROUND: This exploratory study investigates the performance of the Health Measurement Questionnaire (HMQ), as compared with the Psychiatric Assessment Schedule (PAS) and the Nottingham Health Profile (NHP), and compares self- and observer-completed measures. METHOD: A total of 138 medical patients scoring over the screening threshold for probable psychiatric illness completed the HMQ, NHP and PAS, and were rated by a psychiatrist on Rosser disability and distress. RESULTS: HMQ disability correlated well with NHP and PAS physical health items, while HMQ distress correlated well with the NHP emotional reactions and PAS Index of Definition. There was significant correlation between self-report and psychiatrist ratings, the latter being more sensitive to distress. CONCLUSION: The HMQ is a useful measure of generic health status in liaison psychiatry settings.

The contribution of childbearing to the sex difference in first admission rates for affective psychosis.

This epidemiological study examines the contribution of childbearing to the sex difference in first admission rates for affective psychosis. The effects of sex, age, marital status and parity on first admission rates are examined in 114 patients admitted from a defined catchment area. The rate of first admission in females is almost twice that in males. Using logistic regression analysis one significant factor accounting for this sex difference emerges: female parity. The effect of parity is evident up to the age of 54, and it entirely accounts for the sex difference in relative risk. Nonparous females have a lower relative risk of admission than males. An apparent effect of marital status is only significant in females, and is accounted for by parity and age.

Pathways to psychiatric care in Ankara.

This paper describes the pathways that patients take to reach psychiatric services in Ankara. A total of 582 patients were seen in a calendar month in seven centres, two of them being child psychiatric clinics. The pathway in Ankara, unlike may other centres in Europe, is dominated by direct referrals. Only 4% of patients in our sample contacted their general practitioner (GP) first, compared with 42% who first saw hospital doctors and 53% who came direct. Religious healers appeared in the pathway of only 1% of patients, and the delay associated with them was longer. Male patients had longer delays than female patients, and delays were also longer for patients presenting with somatic symptoms. Although the availability of psychiatric services is limited, the median time taken to be seen by the psychiatric services after contacting any carer was only 1 week. The results showed that the referral system for the mental health services is still far from a GP-based system. The patients presenting with somatic symptoms consulted hospital doctors more frequently and were delayed more, pointing to the need for the training of hospital doctors, in addition to GPs, in the recognition and management of common psychiatric disorders.