Physical and Psychiatric Comorbidity in General Practice

1996 ◽  
Vol 169 (2) ◽  
pp. 236-242 ◽  
Author(s):  
S. R. Kisely ◽  
D. P. Goldberg
Keyword(s):  
General Practice ◽  
Psychiatric Comorbidity ◽  
Psychiatric Symptoms ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Female Gender ◽  
Medical Illness ◽  
Social Disability ◽  
Increased Risk ◽  
Research Interview

BackgroundThe aim of this study was to determine the association between physical and psychiatric morbidity among general practice patients and to explore the influence of possible intervening variables.MethodPhysical and psychiatric morbidity in 1620 consecutive patients attending their general practitioner (GP) was assessed using a two-stage design. Ninety-four per cent of the patients (n=1523) were successfully screened using the General Health Questionnaire (GHQ–12); 428 of the 602 patients (71%) eligible for the second stage were interviewed using the Composite International Diagnostic Instrument adapted for use in primary health care (CIDI–PHC), the Brief Disability Questionnaire (BDQ) and the Groningen Social Disability Schedule (GSDS) to assess psychiatric, physical and social status. Assessments of physical and psychiatric morbidity were also obtained from the patients' GPs.ResultsThere was a significant association between physical and psychiatric morbidity, although patients with four symptoms or less of physical illness were no more likely to be psychiatric cases than those with none. The association was accounted for by patients at the severe end of the physical continuum with five or more medically explained somatic symptoms: these were twice as likely to be psychiatric cases as those with no such symptoms. Female gender, social disability and physical disability were all significantly more likely to be associated with psychiatric disorder, whether measured by GP or research interview; and these relationships remained after the data were corrected for age differences.ConclusionsPatients in general practice with moderate to severe physical morbidity are at increased risk of developing psychiatric illness, and when medical illness is present, psychiatric symptoms are more severe. As physical and psychiatric comorbidity is relatively common in general practice, the specific needs of these patients should receive greater attention.

General medical disorders with psychiatric implications

2015 ◽  
Author(s):  
Erik J. Garcia ◽  
Warren J. Ferguson
Keyword(s):  
Mental Illness ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Prior History ◽  
Medical Illness ◽  
Medical Conditions ◽  
Presenting Symptoms ◽  
Medical Disorders ◽  
Increased Risk ◽  
History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

5. Psychiatric morbidity in general practice

1991 ◽  
Vol 19 ◽  
pp. 41-45 ◽  
Author(s):  
C. Bellantuono ◽  
P. Williams ◽  
M. Tansella
Keyword(s):  
General Practice ◽  
Emotional Disorders ◽  
Psychiatric Symptoms ◽  
Psychiatric Morbidity ◽  
Great Majority ◽  
Psychiatric Services ◽  
Level 3 ◽  
Level 1 ◽  
Pass Through ◽  
Level 2

It is well known that the great majority of patients presenting psychiatric symptoms are treated by GPs rather than by specialist psychiatric personnel (Shepherd et al. 1966). Goldberg & Huxley (1980) have proposed a model to describe psychiatric disorders and their care, consisting of five levels and four filters. Level 1 refers to psychiatric and emotional disorders in the community as a whole, and filter 1 represents the decision to, and act of, consulting a GP. Level 2 consists of all psychiatric morbidity that presents to GPs, although a proportion is not recognized as such (the hidden psychiatric morbidity – HPM). Filter 2 is thus the process of identification, and level 3 refers to the morbidity so identified (the conspicuous psychiatric morbidity – CPM). Filter 3 is the process of referral to the specialist psychiatric services, the patients of which are designated as level 4. A proportion of patients at this level will be admitted to hospital (i.e. will pass through filter 4) and reach level 5 (psychiatric in-patients).

Factors Associated with Psychiatric Symptoms in Patients Undergoing Chronic Hemodialysis

1981 ◽  
Vol 26 (8) ◽  
pp. 562-566 ◽  
Author(s):  
W. John Livesley
Keyword(s):  
Rural Areas ◽  
Nuclear Family ◽  
Psychiatric Symptoms ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Well Being ◽  
Chronic Hemodialysis ◽  
Home Dialysis ◽  
Family Factor ◽  
High Incidence

Psychiatric morbidity in a sample of 85 patients undergoing chronic hemodialysis was assessed using standard questionnaires (General Health Questionnaire and Middlesex Hospital Questionnaire). Examination of the effects of demographic, illness, treatment, and history variables on questionnaire scores revealed that psychiatric symptoms were more frequent in women than in men, in those on home dialysis, in those living in rural areas, in unemployed men and in those with a disturbed nuclear family. Factor analysis of symptoms assessed by one of the questionnaires (GHQ) revealed six factors: general dissatisfaction, suicidal ideation, confidence and well-being, usefulness and enjoyment, concentration and alertness, sleep disturbance. Interview responses revealed a high incidence of general distress and anxiety and also a high incidence of sexual problems.

General medical disorders with psychiatric implications

2017 ◽  
Author(s):  
Erik J. Garcia ◽  
Warren J. Ferguson
Keyword(s):  
Mental Illness ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Prior History ◽  
Medical Illness ◽  
Medical Conditions ◽  
Presenting Symptoms ◽  
Medical Disorders ◽  
Increased Risk ◽  
History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

scholarly journals Psychiatric comorbidity in individuals with bullous pemphigoid and all bullous disorders in the Danish national registers

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Marianna Rania ◽  
Liselotte Vogdrup Petersen ◽  
Michael Eriksen Benros ◽  
Zhi Liu ◽  
Luis Diaz ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Bullous Pemphigoid ◽  
Psychiatric Comorbidity ◽  
Psychiatric Symptoms ◽  
Integrated Approach ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Bidirectional Association ◽  
Broad Array ◽  
Subsequent Onset

Abstract Background Bullous pemphigoid (BP) is an autoimmune blistering skin disease that takes a profound physical and mental toll on those affected. The aim of the study was to investigate the bidirectional association between BP and all bullous disorders (ABD) with a broad array of psychiatric disorders, exploring the influence of prescribed medications. Methods This nationwide, register-based cohort study encompassed 6,470,450 individuals born in Denmark and alive from 1994 to 2016. The hazard ratios (HRs) of a subsequent psychiatric disorder in patients with BP/ABD and the reverse exposure and outcome were evaluated. Results Several psychiatric disorders were associated with increased risk of subsequent BP (4.18-fold for intellectual disorders, 2.32-fold for substance use disorders, 2.01-fold for schizophrenia and personality disorders, 1.92–1.85-1.49-fold increased risk for organic disorders, neurotic and mood disorders), independent of psychiatric medications. The association between BP and subsequent psychiatric disorders was not significant after adjusting for BP medications, except for organic disorders (HR 1.27, CI 1.04–1.54). Similar results emerged with ABD. Conclusion Psychiatric disorders increase the risk of a subsequent diagnosis of BP/ABD independent of medications, whereas medications used for the treatment of BP/ABD appear to account for the subsequent onset of psychiatric disorders. Clinically, an integrated approach attending to both dermatological and psychiatric symptoms is recommended, and dermatologists should remain vigilant for early symptoms of psychiatric disorders to decrease mental health comorbidity.

scholarly journals Childhood cognitive function and adult psychopathology: associations with psychotic and non-psychotic symptoms in the general population

2012 ◽  
Vol 201 (2) ◽  
pp. 124-130 ◽  
Author(s):  
Jennifer H. Barnett ◽  
Fiona McDougall ◽  
Man K. Xu ◽  
Tim J. Croudace ◽  
Marcus Richards ◽  
...  
Keyword(s):  
Risk Factor ◽  
General Population ◽  
Cognitive Ability ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Phenotypic Expression ◽  
Population Based ◽  
Cognitive Test ◽  
Psychotic Symptoms ◽  
Increased Risk

BackgroundLower cognitive ability in childhood is associated with increased risk of future schizophrenia, but its relationship with adult psychotic-like experiences and other psychopathology is less understood.AimsTo investigate whether this childhood risk factor is shared with adult subclinical psychiatric phenotypes including psychotic-like experiences and general psychiatric morbidity.MethodA population-based sample of participants born in Great Britain during 1 week in March 1946 was contacted up to 20 times between ages 6 weeks and 53 years. Cognition was assessed at ages 8, 11 and 15 years using a composite of age-appropriate verbal and non-verbal cognitive tests. At age 53 years, psychotic-like experiences were self-reported by 2918 participants using four items from the Psychosis Screening Questionnaire and general psychiatric morbidity was assessed using the scaled version of the General Health Questionnaire (GHQ-28).ResultsPsychotic-like experiences were reported by 22% of participants, and were highly comorbid with other psychopathology. Their presence in adults was significantly associated with poorer childhood cognitive test scores at ages 8 and 15 years, and marginally so at age 11 years. In contrast, high GHQ scores were not associated with poorer childhood cognition after adjustment for the presence of psychotic-like experiences.ConclusionsPsychotic and non-psychotic psychopathologic symptoms are highly comorbid in the general population. Lower childhood cognitive ability is a risk factor for psychotic-like experiences in mid-life; these phenomena may be one end of a continuum of phenotypic expression driven by variation in early neurodevelopment.

Prevalence, Detection and Management of Anxiety and Depressive Symptoms in Unemployed Patients Attending General Practitioners

2000 ◽  
Vol 34 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Elizabeth J. Comino ◽  
Elizabeth Harris ◽  
Derrick Silove ◽  
Vijaya Manicavasagar ◽  
Mark F. Harris
Keyword(s):  
General Practice ◽  
Depressive Symptoms ◽  
General Practitioners ◽  
General Health Questionnaire ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
Cross Sectional ◽  
Unemployed People ◽  
Increased Risk ◽  
Use Of Services

Introduction: This study examined the detection and management of anxiety and depressive symptoms among unemployed patients attending general practitioners (GPs). Method: A cross-sectional study was undertaken of anxiety and depressive symptoms in general practice using measures completed by patients and GPs. Eligible patients were adults aged 18 to 64 years either working (n = 2273) or unemployed (n = 392). Results: Eighty per cent of patients were attending their regular GP at the time of the study. Unemployed patients were found to have a higher mean general health questionnaire (GHQ-12) score than employed patients (3.8 compared with 2.4, p < 0.001); were more likely to report symptoms of anxiety and depression which required medical treatment during the previous 4 weeks (30.9% compared with 14.6%, p < 0.001); and were more likely to have been treated for anxiety and depression by the GP (27.8% compared with 15.7%, p < 0.001). Among patients who the GPs reported treating for anxiety and depression, unemployed patients were 3.3 times (95% CI: 2.0–5.4) more likely to be prescribed medication than employed patients when severity was controlled but were no more likely to be referred to other health services. Unemployed patients identified increased use of services and were less satisfied with the care that they had received. Conclusions: Unemployed patients attending GPs have an increased risk of anxiety and depressive symptoms. Increased prescription of medication as opposed to referral suggests that GPs may treat their unemployed patients differently to employed patients. GPs need to be aware of the higher risk and severity of anxiety and depressive symptoms among unemployed patients and their desire to be more actively involved in their treatment. General practice is an important setting for addressing the health needs of unemployed people.

Contrasting demographic patterns of minor psychiatric morbidity in general practice and the community

1978 ◽  
Vol 8 (3) ◽  
pp. 455-466 ◽  
Author(s):  
Robert A. Finlay-Jones ◽  
Peter W. Burvill
Keyword(s):  
At Risk ◽  
General Practice ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Screening Instrument ◽  
Completion Rates ◽  
Population At Risk ◽  
Demographic Groups ◽  
Lower Social Class ◽  
Demographic Patterns

SynopsisThe 60-item General Health Questionnaire was completed by 90% of 4798 patients aged 15–69 years who consulted, on one day, the general practitioners of 97% of practices in the Perth Statistical Division. A point prevalence rate of minor psychiatric morbidity in various demographic groups was calculated in terms of the population at risk. The demographic pattern of morbidity was compared with that found in a probability sample of 2324 community residents drawn from the same population at risk, and surveyed at the same time using the same screening instrument.Widowed persons, British-born men who had recently migrated to Australia, and lower-social-class men with minor psychiatric morbidity were under-represented in general practice. Elderly men and women in upper-class occupations with minor psychiatric morbidity were over-represented in general practice. These differences, unlike others that were found, could not be explained by differing consulting habits or by differing completion rates of the screening instrument.

Severity of symptoms of psychiatric outpatients: use of the General Health Questionnaire in hospital and general practice patients

1975 ◽  
Vol 5 (1) ◽  
pp. 62-66 ◽  
Author(s):  
A. C. P. Sims ◽  
P. H. Salmons
Keyword(s):  
General Practice ◽  
General Health ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Control Sample ◽  
Outpatient Service ◽  
Health Questionnaire ◽  
Psychiatric Outpatient ◽  
Screening Device ◽  
Matched Samples

SynopsisA sample of 91 new referrals to a community based psychiatric outpatient service was compared with a cross-matched control sample of 107 patients attending the general practitioner's surgery. The subjects in both groups completed the General Health Questionnaire and there was a very marked difference between the scores of the two groups. Seventy-five of the psychiatric group had a high score on the questionnaire, and a large number of these were extremely high, while 74 of the general practice group had a low score. The ‘false’ positives and negatives are discussed. It is considered that the validity of this questionnaire as a screening device for demonstrating psychiatric morbidity and severity in general practice is further established in this study by showing that in matched samples the expected psychiatric morbidity in general practice can be compared with the much greater morbidity in psychiatric outpatient referrals. For the psychiatric sample more patients showed high scores and these tended to be much higher.

Emotional Disturbance in Newly Registered General Practice Patients

1978 ◽  
Vol 132 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Charles M. Corser ◽  
Alistair E. Philip
Keyword(s):  
General Practice ◽  
Emotional Disturbance ◽  
Emotional State ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Health Questionnaire ◽  
New Town ◽  
Emotional Upset ◽  
One Year ◽  
To Receive

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ, inherent in a ‘present state’ inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.

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