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Psychiatric disorders in relation to medical illness among patients of a general medical out-patient clinic

Published online by Cambridge University Press:  09 July 2009

Albert M. Van Hemert*
Affiliation:
Department of Psychiatry, Department of Internal Medicine, Department of Clinical Epidemiology, Leiden University Hospital, The Netherlands
Michiel W. Hengeveld
Affiliation:
Department of Psychiatry, Department of Internal Medicine, Department of Clinical Epidemiology, Leiden University Hospital, The Netherlands
Jan H. Bolk
Affiliation:
Department of Psychiatry, Department of Internal Medicine, Department of Clinical Epidemiology, Leiden University Hospital, The Netherlands
Harry G. M. Rooijmans
Affiliation:
Department of Psychiatry, Department of Internal Medicine, Department of Clinical Epidemiology, Leiden University Hospital, The Netherlands
Jan P. Vandenbroucke
Affiliation:
Department of Psychiatry, Department of Internal Medicine, Department of Clinical Epidemiology, Leiden University Hospital, The Netherlands
*
1Address for correspondence: Dr Albert M. van Hemert, Department of Psychiatry, Out-patient Clinic, Leiden University Hospital. Building 1, BI-P, PO Box 9600, 2300 RC Leiden, The Netherlands.

Synopsis

In many patients clinical care in general medical settings is complicated by the presence of psychiatric disorders in addition to the presenting physical symptoms. In the present study the prevalence and type of psychiatric disorders was assessed in relation to the medical diagnostic findings in a general internal medicine out-patient clinic. The Present State Examination, a standardized psychiatric interview, was used to detect psychiatric disorders in 191 newly referred patients. Psychiatric disorders were found to be particularly prevalent among patients with medically ill-explained or unexplained symptoms. The prevalence of psychiatric disorders was 15% for patients with a medical explanation for their presenting symptom, 45% for patients with ill-explained and 38% for those with unexplained symptoms. Approximately 40% of the patients with psychiatric disorders met DSM-III-R criteria for somatization disorder or hypochondriasis, suggesting that these disorders contributed in particular to general medical out-patient referrals.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1993

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References

REFERENCES

American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn., revised. American Psychiatric Association: Washington, DC.Google Scholar
Barsky, A. J., Geringer, E. & Wool, C. A. (1988). A cognitive educational treatment for hypochondriasis. General Hospital Psychiatry 10, 322327.Google Scholar
Bebbington, P., Hurry, J., Tennant, C., Sturt, E. & Wing, J. K. (1981). Epidemiology of mental disorders in Camberwell. Psychological Medicine 11, 561579.Google Scholar
Bland, R. C., Newman, S. C. & Orn, H. (1988). Period prevalence of psychiatric disorders in Edmonton. Acta Psychiatrica Scandinavica 77 (suppl 338), 3342.Google Scholar
Brown, F. W., Golding, J. M. & Smith, R. (1990). Psychiatric comorbidity in primary care somatization disorder. Psychosomatic Medicine 52 445451.CrossRefGoogle ScholarPubMed
Burvill, P. W. & Knuiman, M. W. (1983). The influence of minor psychiatric morbidity on consulting rates to general practitioners. Psychological Medicine 13, 635643.Google Scholar
Colgan, S., Creed, F. H. & Klass, S. H. (1988). Psychiatric disorders and abnormal illness behaviour in patients with upper abdominal pain. Psychological Medicine 18, 887892.CrossRefGoogle ScholarPubMed
Computing Resource Center (1990). Stata Reference Manual. Release 2, 4th edn., pp. 393403. Computing Resource Center: Santa Monica, CA.Google Scholar
DeGruy, F., Crider, J., Hashimi, D. K., Dickinson, P., Mullins, H. C. & Troncale, J. (1987). Somatization disorder in a University Hospital. Journal of Family Practice 25, 579584.Google ScholarPubMed
Feldman, E., Mayou, R., Hawton, K., Ardern, M. & Smith, E. B. O. (1987). Psychiatric disorders in medical in-patients. Quarterly Journal of Medicine 63, 405412.Google Scholar
Feuerlein, W., Kufner, H., Ringer, Ch. & Antons, K. (1979). The diagnosis of alcoholism: the Munich Alcoholism Test (MALT). International Journal of Rehabilitation Research 2, 533534.CrossRefGoogle ScholarPubMed
Ford, M. J., Miller, P. M., Eastwood, J. & Eastwood, M. A. (1987). Life events, psychiatric illness and the irritable bowel syndrome. Gut 28, 160165.CrossRefGoogle ScholarPubMed
Goldberg, D. & Huxley, P. (1980). Mental Illness in the Community. Tavistock: London.Google Scholar
Henderson, S., Duncan-Jones, P., Byrne, D. G., Scott, R. & Adcock, S. (1979). Psychiatric disorders in Canberra. A standardized study of prevalence. Acta Psychiatrica Scandinavica 60, 355374.CrossRefGoogle ScholarPubMed
Hodiamont, P., Peer, N. & Syben, N. (1987). Epidemiological aspects of psychiatric disorders in a Dutch health area. Psychological Medicine 17, 495505.CrossRefGoogle Scholar
Hosmer, D. W. & Lemeshow, S. (1989). Applied Logistic Regression. John Wiley & Sons: New York.Google Scholar
Kellner, R., Abbott, P., Winslow, W. W. & Pathak, D. (1989). Anxiety, depression, and somatization in DSM-III Hypochondriasis. Psychosomatics 30, 5764.Google Scholar
Lobo, A., Perez-Echeverria, J., Artal, J., Rubia, L., Escolar, V., González-Torrecillas, J. L., Morera, B., Dia, J. L. & Miranda, M. (1988). Psychiatric morbidity among medical out-patients in Spain: a case for new methods of classification. Journal of Psychosomatic Research 32, 355364.CrossRefGoogle Scholar
Macdonald, A. J. & Bouchier, I. A. D. (1980). Non-organic gastrointestinal illness: a medical and psychiatric study. British Journal of Psychiatry 136, 276283.CrossRefGoogle ScholarPubMed
Mayou, R. & Hawton, K. (1986). Psychiatric disorders in the general hospital. British Journal of Psychiatry 149, 172190.Google Scholar
Murphy, M. (1989). Somatisation: embodying the problem. The commonest way for psychiatric disorder to present. British Medical Journal 298, 13311332.CrossRefGoogle Scholar
Regier, D. A., Boyd, J. H., Burke, J. D., Rae, D. S., Myers, J. K., Kramer, M., Robins, L. N., George, L. K., Karno, M. & Locke, B. Z. (1988). One-month prevalence of mental disorders in the United States. Based on five epidcmiologic catchment area sites. Archives of General Psychiatry 45, 977986.CrossRefGoogle ScholarPubMed
Sacket, D. L., Haynes, R. B. & Tugwell, P. (1985). Clinical Epidemiology. A Basic Science for Clinical Medicine, pp. 2228. Little, Brown and Company: Boston/Toronto.Google Scholar
Shepherd, M., Cooper, B., Brown, A. C. & Kalton, G. W. (1966). Psychiatric Illness in General Practice. Oxford University Press: London.Google Scholar
Slooff, C. J., Mulder-Hajonides van der Meulen, W. R. E. H. & Van den Hoofdakker, R. H. (1983). De nederlandse vertaling van de Present State Examination 9e editie. 1. Betrouwbaarheidsaspecten. (The Dutch translation of the Present State Examination 9th edition. I. Aspects of reliability.) Tijdschrift voor Psychiatrie 25, 151163.Google Scholar
Smith, G. R., Monson, R. A. & Ray, D. C. (1986). Psychiatric consultation in somatization disorder. A randomized controlled study. New England Journal of Medicine 314, 14071413.CrossRefGoogle ScholarPubMed
Toner, B. B., Garfinkel, P. E. & Jeejeebhoy, K. N. (1990). Psychological factors in irritable bowel syndrome. Canadian Journal of Psychiatry 35, 158161.Google Scholar
Walburg, J. A. & Van Limbeek, J. (1987). München Alkohol Test. Swets & Zeitlinger BV: Lisse.Google Scholar
Warwick, H. M. C. (1989). A cognitive-behavioral approach to hypochondriasis and health anxiety. Journal of Psychosomatic Research 33, 705711.CrossRefGoogle ScholarPubMed
Wing, J. K., Cooper, J. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar