Psychiatric Disorders in Medically Ill Patients: Prevalence, Impact, and Management, Slides of Psychiatry

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Psychiatric problems in the

medically illmedically ill

Psychiatric problems

• Depressive disorders• Anxiety states •^

Sexual problems

-^

Sexual problems

• Alcohol problems

Depressive symptoms

•^

Mood and motivation^ – Persistent low mood^ –

Diminished interest or pleasure

Diminished interest or pleasure

• Social withdrawal– Loss of energy

Depressive symptoms

Cognitive changes Depressive thoughts, Worthlessness,Self blameSuicidal wishes,Hopelessness

Depressive Symptoms

Biological symptoms Poor appetite, W

eight loss, W

eight loss, Sleep disturbance,Poor concentration,Decreased sex drive,Retardation or agitation

Prevalence of psychiatric disorder in different organic

conditions (bars show the highest and lowest recorded rates)

Stroke HIV/AIDS

Inflammatory bowel disease

0

10

20

30

40

50

60

out-patients

cancer

rheumatoid arthritismyocardial infarction

Parkinson's

high low Per cent

Prospective Longitudinal Cohort Study of Anxiety

and Depression in Medical In-Patients

Psychiatric diagnosis

Acute medicalin-patients

Follow-up 5months later

(n=263)

(n=

)

Health Status-SF-36Duke Severity of IllnessScaleKarnofsky PerformanceStatus ScaleHealth care costs

Creed et al, Psychosomatics;43:302-

Prevalence of psychiatric

disorder

• 27% of acute medical in-patients had

diagnosable depressive or anxiety disorders

-^

A further 41% had sub

• threshold disorders

•^

A further 41% had sub

• threshold disorders

Mean SF36 scores for physical dimensions at 5 months

follow-up, adjusted for severity of illness

80 70 60 5050 40 30 20 10 0

physicalfunction

physical rolelimitation

healthperception

pain

case subthreshold control general population

Main findings

• Patients with depression and anxiety had

significantly lower quality of life thancontrols

-^

Recovery from depression following

-^

Recovery from depression following discharge was very unlikely

• Costs incurred by patients who were

depressed were higher than controls, butthere was no effect on length of stay

(^7654) Mean HRQOL Scores

Depressed Not depressed

*^

*^

*^

*^

*^

Mean HRQOL in CD by Depression

4 3 2 1 0 Inactive

Active

<40 yrs

40 yrs

Male

Female

<$25,

$25,

Mean HRQOL Scores

Irvine et al 2002

Anxiety states

• Panic disorder• Agoraphobia •^

Generalised anxiety disorder

-^

Generalised anxiety disorder

• Specific phobia• Social phobia• Obsessional compulsive disorder• Post-traumatic stress disorder

Sexual problems

• Common• 35-40% diabetic males report sexual

problemsproblems

• Caused by:
  • the condition itself– Effects of drugs and other physical treatments– Psychological sequelae of the condition– Co-existing psychiatric disorder

Sexual problems

• Enquiry• Know something about the patient and their

circumstances before askingcircumstances before asking

• Detailed enquiry not necessary• One or two relevant screening questions• Enquire in a matter of fact but sensitive way

Summary

• Major health problems cause worry and

distress.

-^

The stressfulness of an illness depends upon

-^

The stressfulness of an illness depends upon the patient’s perception of the illness

• People react and cope in different ways.• Most people, given time, develop adaptive

ways to manage illness

Summary

-^

Psychiatric disorders are twice as common inmedical patients than in the general population

-^

Approximately one quarter of patients admitted tohospital develop depressive disorders which aresevere enough to require medical treatment

-^

Psychiatric disorder in the physically ill is often

-^

Psychiatric disorder in the physically ill is often missed

-^

If untreated, depression results in increasedmorbidity, poor physical function and increasedhealth care costs.

-^

Improved psychological medicine services forpatients whilst in hospital would ensure betterdetection and treatment of such problems.