- Email: [email protected]
30 - Psychiatric consultation activities at the emergency department
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EACLLP Abstracts / Journal of Psychosomatic Research 60 (2006) 655 – 664
dysfunction. The ICD-10 definition requires the persistence of at least three symptoms, whereas the DSM-IV definition also require disability in professional or social function and demonstrable signs of cognitive dysfunction. Cases were assessed according to the different sets of criteria. Results: Large differences in the prevalence of PCD was found, depending on the definition used. There was good correlation between symptoms and disability, but poor correlation was found between cognitive deficits and the reporting of symptoms and disability. Conclusion: Symptoms and disability on the one hand and cognitive dysfunction on the other are expressions of different illness dimensions and are due to different disease mechanisms. A diagnosis of PCD should be based only on the reporting of symptoms and disability.
28 – Depressive disorder and frequent attendance in primary care. A comparison between elderly and nonelderly patients Menchetti M, Cevenini N, Bortolotti B, Berardi D Institute of Psychiatry, Bologna University, Italy Background and aims: Frequent attenders (FAs) represent a substantial proportion of the workload and a major challenge for primary care physicians (PCPs). It is well known that FAs are overrepresented in the elderly. The aim of this study is to compare prevalence and clinical characteristics of FAs in the elderly and non-elderly patients. Methods: This nationwide, cross-sectional, two-phase epidemiological study on depressive disorders involved 191 PCPs and 1896 patients 14 years and older. We consider as FAs those subjects attending PCP practice more than once a month in the last six months. Screening for psychiatric disorders was conducted by using the GHQ-12. Subsequently, probable cases were assessed by the PCPs with the World Health Organization International Statistical Classification of Diseases, 10th Revision Checklist for Depression. Results: Prevalence value of frequent attendance was 22.4% [95% confidence interval (CI) 19.1–25.8] in the elderly and 10.1% (95% CI 8.4 – 11.8) in the nonelderly. The profile of risk factors for being an FA is similar in the two age groups and highlights the role of physical illness, depression, and unexplained somatic complaints. Depression was associated with frequent attendance in the elderly even after controlling for physical illness and unexplained somatic complaints. Considering subjects without medical illness, depression increased the risk of being an FA 5-fold among elderly and 3-fold among nonelderly. Conclusions: Depression seems to play a more important role in determining frequent attendance in elderly and nonelderly primary care patients. In particular, depressed elderly patients without clinically relevant physical problems seem to be a high-risk group of excess utilization of health services.
29 – Illness causes representation and disease evolution during a week in Romanian hospitalised cardiovascular patient Muntele Hendres D a, Pocnet C b a Faculty of Psychology and Educational Sciences, Al.I.Cuza University, Iasi, Romania b Lausanne University, Social and Political Sciences Faculty, Psychology Institute, Lausanne, Switzerland The main aim of our study was to explore if disease evolution was associated with causal elements of illness representation (Moss-Morris, 2002) and neuroticism (Francis et al. 1992). We also investigated the relationship between medical compliance and disease evolution. Subjects were 119 cardiovascular hospitalised patients (55 males and 64 females). Age ranged from 18 to 80 years, with a mean of 55 years. The most frequent illness perceived cause was psychological causes (64%), succeeded by risk factors (18%), accidents (10%), and immunity (8%). Within patients with a poorer disease evolution, risk factor as cause of own disease was almost equally frequent as psychological causes. The
higher scores in neuroticism, were proper for those with higher beliefs in psychological causes of illness (t= 4.14, Pb.00). Medical compliance correlated significantly with disease-positive evolution (r=0.38, Pb.00). Patient’s evaluation of own disease evolution was contrasted with doctor’s appraisal of the patient’s state evolution. The higher the concordance, the higher was the compliance (t= 4.95, Pb.00). Values of concordance between patients’ and doctors’ appreciation of illness evolutions were not influenced by neuroticism scores (t=0,20, P=,83). Details concerning our evaluations and more results will be presented.
30 – Psychiatric consultation activities at the emergency department Po S, Giubbarelli C, Disavoia A, Ferrari S, Rigatelli M Department of Neuroscience, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy Background and aims: A consistent part of the activities of a consultationliaison psychiatry service in the general hospital (GH) is dedicated to dealing with emergencies. The aim of this study was to assess the impact of psychiatric morbidity among patients consulting a GH emergency department with respect to the features of these subjects and in comparison with literature [1,2]. Methods: Sociodemographical and clinical data from 464 psychiatric consultations at the emergency department of the Modena GH, from 1998 to 2005, were collected and retrospectively analysed. Results: Mean age was 39.5 and male/female ratio was 50/50%. In 61.8% of cases, patients were discharged after consultation, with 38.3% admitted to the psychiatric ward. Most common disorders were psychosis (25.4%) and affective disorders (25%), with a high rate of parasuicide (65%). Lower frequency of psychiatric referral for anxiety than in other studies was found (17.8%). Conclusions: Psychiatric referral at the Modena Emergency Department is mainly motivated by the presence or the clinical suspicion of psychotic and affective disorders, whereas bminor Q psychiatric problems more rarely are referred for psychiatric consultation. Possible explanations of such a filter functioning are discussed.
References [1] Seguel M, Munoz P, Nalegach E, Santander J. Prevalence of mental disorders at emergency service. Rev Med Chil 1993;121(6):705 – 10. [2] Marchesi C, Brusamonti E, Borghi C, Giannini A, et al. Anxiety and depressive disorders in an emergency department ward of a general hospital: a control study. Emerg Med 2004;21:175 – 9.
31 – Psychotherapeutic interventions for somatizing patients in the general hospital Schweickhardt A, Larisch A, Fritzsche K Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany Background and aims: The objective of this study was to examine if short-term psychotherapeutic interventions for hospitalized somatizing patients increases the motivation for psychotherapy and utilization of psychotherapy after discharge in comparison to written psychoeducational information. Methods: Ninety-one patients were randomized into the intervention group (n=49) and into the control group (n=42). Intervention comprised five sessions at 50 minutes, based on the modified reattribution model. Primary outcomes were motivation for psychotherapy and utilization of psychotherapy. Secondary outcomes were somatoform symptoms, emotional distress, and quality of life.
EACLLP Abstracts / Journal of Psychosomatic Research 60 (2006) 655 – 664
dysfunction. The ICD-10 definition requires the persistence of at least three symptoms, whereas the DSM-IV definition also require disability in professional or social function and demonstrable signs of cognitive dysfunction. Cases were assessed according to the different sets of criteria. Results: Large differences in the prevalence of PCD was found, depending on the definition used. There was good correlation between symptoms and disability, but poor correlation was found between cognitive deficits and the reporting of symptoms and disability. Conclusion: Symptoms and disability on the one hand and cognitive dysfunction on the other are expressions of different illness dimensions and are due to different disease mechanisms. A diagnosis of PCD should be based only on the reporting of symptoms and disability.
28 – Depressive disorder and frequent attendance in primary care. A comparison between elderly and nonelderly patients Menchetti M, Cevenini N, Bortolotti B, Berardi D Institute of Psychiatry, Bologna University, Italy Background and aims: Frequent attenders (FAs) represent a substantial proportion of the workload and a major challenge for primary care physicians (PCPs). It is well known that FAs are overrepresented in the elderly. The aim of this study is to compare prevalence and clinical characteristics of FAs in the elderly and non-elderly patients. Methods: This nationwide, cross-sectional, two-phase epidemiological study on depressive disorders involved 191 PCPs and 1896 patients 14 years and older. We consider as FAs those subjects attending PCP practice more than once a month in the last six months. Screening for psychiatric disorders was conducted by using the GHQ-12. Subsequently, probable cases were assessed by the PCPs with the World Health Organization International Statistical Classification of Diseases, 10th Revision Checklist for Depression. Results: Prevalence value of frequent attendance was 22.4% [95% confidence interval (CI) 19.1–25.8] in the elderly and 10.1% (95% CI 8.4 – 11.8) in the nonelderly. The profile of risk factors for being an FA is similar in the two age groups and highlights the role of physical illness, depression, and unexplained somatic complaints. Depression was associated with frequent attendance in the elderly even after controlling for physical illness and unexplained somatic complaints. Considering subjects without medical illness, depression increased the risk of being an FA 5-fold among elderly and 3-fold among nonelderly. Conclusions: Depression seems to play a more important role in determining frequent attendance in elderly and nonelderly primary care patients. In particular, depressed elderly patients without clinically relevant physical problems seem to be a high-risk group of excess utilization of health services.
29 – Illness causes representation and disease evolution during a week in Romanian hospitalised cardiovascular patient Muntele Hendres D a, Pocnet C b a Faculty of Psychology and Educational Sciences, Al.I.Cuza University, Iasi, Romania b Lausanne University, Social and Political Sciences Faculty, Psychology Institute, Lausanne, Switzerland The main aim of our study was to explore if disease evolution was associated with causal elements of illness representation (Moss-Morris, 2002) and neuroticism (Francis et al. 1992). We also investigated the relationship between medical compliance and disease evolution. Subjects were 119 cardiovascular hospitalised patients (55 males and 64 females). Age ranged from 18 to 80 years, with a mean of 55 years. The most frequent illness perceived cause was psychological causes (64%), succeeded by risk factors (18%), accidents (10%), and immunity (8%). Within patients with a poorer disease evolution, risk factor as cause of own disease was almost equally frequent as psychological causes. The
higher scores in neuroticism, were proper for those with higher beliefs in psychological causes of illness (t= 4.14, Pb.00). Medical compliance correlated significantly with disease-positive evolution (r=0.38, Pb.00). Patient’s evaluation of own disease evolution was contrasted with doctor’s appraisal of the patient’s state evolution. The higher the concordance, the higher was the compliance (t= 4.95, Pb.00). Values of concordance between patients’ and doctors’ appreciation of illness evolutions were not influenced by neuroticism scores (t=0,20, P=,83). Details concerning our evaluations and more results will be presented.
30 – Psychiatric consultation activities at the emergency department Po S, Giubbarelli C, Disavoia A, Ferrari S, Rigatelli M Department of Neuroscience, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy Background and aims: A consistent part of the activities of a consultationliaison psychiatry service in the general hospital (GH) is dedicated to dealing with emergencies. The aim of this study was to assess the impact of psychiatric morbidity among patients consulting a GH emergency department with respect to the features of these subjects and in comparison with literature [1,2]. Methods: Sociodemographical and clinical data from 464 psychiatric consultations at the emergency department of the Modena GH, from 1998 to 2005, were collected and retrospectively analysed. Results: Mean age was 39.5 and male/female ratio was 50/50%. In 61.8% of cases, patients were discharged after consultation, with 38.3% admitted to the psychiatric ward. Most common disorders were psychosis (25.4%) and affective disorders (25%), with a high rate of parasuicide (65%). Lower frequency of psychiatric referral for anxiety than in other studies was found (17.8%). Conclusions: Psychiatric referral at the Modena Emergency Department is mainly motivated by the presence or the clinical suspicion of psychotic and affective disorders, whereas bminor Q psychiatric problems more rarely are referred for psychiatric consultation. Possible explanations of such a filter functioning are discussed.
References [1] Seguel M, Munoz P, Nalegach E, Santander J. Prevalence of mental disorders at emergency service. Rev Med Chil 1993;121(6):705 – 10. [2] Marchesi C, Brusamonti E, Borghi C, Giannini A, et al. Anxiety and depressive disorders in an emergency department ward of a general hospital: a control study. Emerg Med 2004;21:175 – 9.
31 – Psychotherapeutic interventions for somatizing patients in the general hospital Schweickhardt A, Larisch A, Fritzsche K Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany Background and aims: The objective of this study was to examine if short-term psychotherapeutic interventions for hospitalized somatizing patients increases the motivation for psychotherapy and utilization of psychotherapy after discharge in comparison to written psychoeducational information. Methods: Ninety-one patients were randomized into the intervention group (n=49) and into the control group (n=42). Intervention comprised five sessions at 50 minutes, based on the modified reattribution model. Primary outcomes were motivation for psychotherapy and utilization of psychotherapy. Secondary outcomes were somatoform symptoms, emotional distress, and quality of life.