Diagnostic Accuracy in the First 5 min of a Psychiatric Interview. Impact of the information given by patients.

BACKGROUND: There is little if any research on the explicit contents delivered by patients in the first minutes of a psychiatric interview. METHODS: In order to study the impact of the first minutes of a psychiatric interview on final diagnosis, we gathered information from the speech during the first 5 min in 162 new psychiatric patients with a checklist including symptoms extracted from the SCAN interview. RESULTS: The area reported most frequently was life events (51.2%). The average of psychiatric symptoms cited was 2.3. An initial suspected diagnosis was done in 126 patients, and in 73 patients (57.9% of those with a suspected diagnosis, 45.1% of the total sample) the initial diagnosis was coincident with the final diagnosis. The initial clinical impression was more accurate in adjustment and 'neurotic' disorders, and less in mood disorders. Those patients who cited more symptoms received a less accurate initial diagnosis. CONCLUSION: Psychiatric patients spontaneously report a low number of symptoms. The accuracy of psychiatric diagnosis in the first minutes of an interview is unacceptably low. However, the role of short psychiatric interviewing as a screening method deserves to be further investigated.

[Referral of patients with mental disorders from primary care to mental health units]. / Derivación de los pacientes con enfermedad mental desde Atención Primaria a Salud Mental.

INTRODUCTION: Most part of the patients suffering from mental disorders are treated by non-psychiatrist physicians, mainly by general practitioners (GPs). The aim of this study has been to analyse the factors influencing the referral of patients with mental illness to psychiatric services. METHODS: Using data of referrals from two Primary Care Centres (population: 28.039) to a Mental Health Unit in one year period, we analysed clinical records, information provided with the referral, and the opinion of GPs about mental illness. RESULTS: Out of the 486 referrals, the 153 patients without previous consultations were included in the analysis. Men, and those with higher educational status were referred more frequently. A 34% of the referrals included information about psychopathological symptoms, and 70% included clinical diagnosis. Primary care physicians specialised in family medicine included more data regarding psychopathological symptoms, and included a specific request more often than GPs without specialised training. Diagnostic accuracy (61%) were lower for adjustment and personality disorders, and in those patients with an urgent referral. Patients with an urgent referral did not present different clinical features, nor different severity than those with an ordinary referral. CONCLUSIONS: Management of patients with mental disorders in PHC should be improved with guidelines about treatment and referral. Different levels of care should be co-ordinated.

Determinants of smoking behaviour in outpatients with schizophrenia.

The present study is an assessment of the rate and severity of tobacco consumption in outpatients with schizophrenia, and the determinants of smoking behaviour. Sixty-four patients, assessed by the Item Group Checklist section of the SCAN interview and fitting DSM-IV criteria, were evaluated with CGI and the PANSS scales. In addition, they completed STAI (Spielberger), EPQ (Eysenck), and TPQ (Cloninger) questionnaires. Tobacco dependence was assessed by the Fagerström test. One hundred and thirty-seven consecutive outpatients were psychiatric controls. Forty-one out of 64 patients with schizophrenia (64.1%) were current smokers, this rate being significantly higher than in other psychiatric patients and general population. The severity of cigarette consumption in smokers was greater (mean of 22.4 cigarettes/day) than in the general population, but it was not different from that of other psychiatric patients. For patients with schizophrenia, no one variable (except male sex) was different between smokers and non-smokers, but the number of cigarettes/day correlated with state anxiety, trait anxiety, and neuroticism. In the multivariate analysis, the only variable that remained significant was neuroticism. The relationship between clinical features and severity of smoking behaviour may be linked to non-specific variables such as neuroticism and anxiety, but not to psychotic symptoms.

Folate levels in psychiatric outpatients.

This study examines folate in psychiatric outpatients. Fifty-three outpatients with schizophrenia and 24 outpatients with depressive disorder assessed with the Schedules for Clinical Assessment in Neuropsychiatry interview are included. Patients with schizophrenia had lower serum folate levels than age- and sex-matched controls, while red cell folate levels did not differ. Serum folate levels showed a negative correlation with the Clinical Global Impression, disorganized dimension, and total Positive and Negative Syndrome Scale score. Patients with depressive disorder had lower serum folate levels than healthy controls, but showed no differences in red cell folate levels. Only two patients with schizophrenia had red cell folate levels below the normal range.

[The recognition of mental disease in primary health care and its determining factors]. / El reconocimiento de la enfermedad mental en Atención Primaria y sus factores determinantes.

AIMS: It is known that recognition of mental illness by the General Practitioner (GP) is low. The GP usually identify less than a half of these cases. Our aim has been to study the prevalence of mental disorders in Primary Care, and to analyse the influence of several variables over the identification of mental illness by the GP. METHODS: Transversal study in four Primary Care centres in the north of Spain. We studied 823 patients attended with a <> in primary care practices. Patients were evaluated with the GHQ-28, Belloc questionnaire, and data regarding diagnosis and treatment provided by the GP, in addition of additional information from medical records. RESULTS: The prevalence of mental illness according the GHQ-28 was 33%, being higher in women (38%) than in men (24%). Mental illness diagnosed by the GP was the 14,1% of cases. The rate of patients with mental disorders (diagnosed by the GHQ) recognised by the GP was the 29%. In a logistic regression, relevant factors affecting recognition were i) presentation with physical symptoms, ii) clinical severity (measured by GHQ), and, iii) employment (only for older patients). CONCLUSIONS: <> can explain the low rate of identification of mental illness by the GP.

Measuring health status in psychiatric community surveys: internal and external validity of the Spanish version of the SF-36.

The aims of the present study were to determine the acceptability of the Spanish version of the Short Form (SF-36) health survey questionnaire for its use in mental health research on the general population, and to evaluate its internal and external validity, using data obtained from a representative community sample of 1250 adults of working age. The internal consistency of the different dimensions of the questionnaire was high. Concurrent validity was tested by examining its correlation with the 12-item General Health Questionnaire (GHQ-12). Construct validity was determined by studying the extent to which scores on different variables reflected the expected distribution of health status for and between certain groups. Our findings provide strong evidence for the acceptability and validity of the SF-36 when used as part of a community mental health survey.

Sociodemographic and clinical variables as predictors of the diagnostic characteristics of first episodes of schizophrenia.

This paper examines the association of clinical and sociodemographic factors, including age and sex, with the diagnostic characteristics of first episodes of schizophrenia. The study included all patients with a first episode of schizophrenia who made contact with any of the public mental health services of the Autonomous Region of Cantabria in Northern Spain over a period of 2 years. Diagnostic characteristics were determined using the Spanish version of the Present State Examination (PSE-9), and the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS, respectively). The study confirms that the onset of schizophrenia tends to occur earlier in men than in women. However, neither sex nor age of onset were found to be associated with the clinical and psychopathological characteristics of the patients as established by the PSE-CATEGO-ID system. Furthermore, no other factors were found to be associated with these diagnostic characteristics. Being female, having a family history of mental illness, and a poor premorbid adjustment were found to predict negative symptoms as defined by SANS/SAPS scales.

Alcohol consumption in a rural area of Cantabria.

A two-stage cross-sectional survey was performed in a representative rural sample of the autonomous community of Cantabria, to investigate the social, medical and psychopathological factors associated with alcohol consumption. Alcohol consumption was investigated by means of a specific questionnaire. Mental and physical health was evaluated in the first-stage sample using: (1) the General Health Questionnaire, (2) the Cornell Medical Index. In the second stage all members of the sample were interviewed at home using the 140-item version of the Present State Examination (PSE-9). We found that 25.4% of males and 0.6% of females were consuming more than 63 alcohol units per week. Alcohol consumption was significantly associated with different social variables. Although it was possible to detect an increase in weekend drinking, especially in the heavy alcohol users, daily alcohol consumption, mainly around meals, was the predominant drinking pattern. We also found a significant inverse association between excessive alcohol consumption and the presence of physical or mental illness. Excessive alcohol use tended to be associated in males with depression and in females, with anxiety.

Analysis of positive and negative symptoms in schizophrenia. A study from a population of long-term outpatients.

Sixty-seven schizophrenic chronic outpatients (DSM-III-R criteria) were examined to study the relationship between symptoms through intercorrelational and factor analysis. Three factors were identified and associated with clusters of symptoms: factor 1 (affective flattening, alogia, avolition-apathy and anhedonia-asociality), factor 2 (formal thought disorder and bizarre behaviour) and factor 3 (hallucinations and delusions). Strong associations between factor 1 and high functional impairment were found. In this population, the segregation of the symptoms could fit into a three-syndrome model, these results agree with findings obtained from samples in which acute symptoms predominated.

[Alcohol-related problems in Cantabria]. / Problemas relacionados con el alcohol en Cantabria.

It is a cross sectorial epidemiological community survey into a random sample of 1,816 adult people. The objetivo of our work is to test the existence of some social-demographic variables that can be accumulated to the existence of alcohol related problems. We found that the men, the young people, with low socioeconomic level, and semiurban style of life have the highest risk of alcohol related problems. 48% of the sample men have recognized any alcohol related problems during the previous year to our study. The highest problem prevalence is associated to increased alcohol consumption. After all, there are many people with low alcohol consumption who have alcohol related problems.

[The female role as assessment of mental health of women within the general population of Cantabria]. / El rol femenino como determinante de la salud mental de las mujeres de la población general de Cantabria.

This paper tries to analyse the relationship between traditional feminine role (marriage, motherhood and housing) and mental health in spanish women. The General Health Questionnaire 60-items (GHQ-60) was used to define "cases" in a random sample of the general population of Cantabria consisting of 630 women aged 17 and over. The rate of probable prevalence of psychiatric disorders was 26.4%. In contrast to previous studies, motherhood and traditional feminine role correlated with the lowest GHQ-60 mean scores. Occupational status was not related to mental health. Women living with husband, children, parents and/or parents-in-law scored lower on GHQ-60 than those living with husband and children. These results are discussed in the light of previous findings in the literature. At least, they reconfirm the importance of socio-cultural factors in community psychiatric disorder.

[Development and verification of the Spanish version of the "scanning system" psychiatric interview ("Questionnaires for clinical evaluation in neuropsychiatry"]. / Desarrollo y verificación de la versión española de la entrevista psiquiátrica "sistema scan" ("cuestionarios para la evaluación clínica en neuropsiquiatria").

The SCAN System (Schedules for Clinical Assessment in Neuropsychiatry) represents the latest stage in a 30 year line of development. It is a set of instruments aimed at assessing, measuring and classifying the psychopathology and behaviour associated with the mayor psychiatric disorders of adult life. The SCAN System has several components: the SCAN interview, the Glossary of differential definitions, the CATEGO5 program and the CAPSE (Computer Assisted PSE versión). This latest element is a computerised versión of the System, combining the SCAN's interview, Glossary and CATEGO5. The SCAN interview has 3 components, the tenth edition of the Present State Examination (PSE10), the Item Group Checklist (IGC) and the Clinical History Schedule (CHS), whose main features are described in the paper. The CATEGO5 suite of computer programs consists in a set of utilities concerned with data entry and diagnosis. The Entry program is used to enter data recorded manually during a SCAN interview and the diagnosis programs derive diagnosis according to ICD-10 and DSM-III-R/DSM-IV criteria. This report analyses the main methods and results of the "Field Trials" that took place in 20 Centres of different countries. These studies showed that the diagnosis and symptoms scores have a high degree of reliability and that this is also applicable to the spanish version. In conclusion, we consider that the SCAN System is once of the more suitable psychiatric diagnostic instruments currently available.

[Bibliographic analysis of the concept "alcohol-related problems"]. / Análisis bibliográfico del concepto "problemas relacionados con el alcohol".

This survey, which is related to one of the research lines of our Unit, has a main objective to conduct a bibliographic analysis, in the medical literature of the "Alcohol Related Problems", (A.R.P.) concept. For this reviewed, by means of the MEDLINE data base, the last five years of the international scientific literature, selecting as key words: "Alcohol Related Problems", "Epidemiology", "Alcohol Drinking", "Social Problems". We detected 215 publications with abstracts, 174 presented data from epidemiological surveys and the remaining 31 were related to theoretical aspect. In 90 per cent of the revised articles alcohol was considered a risk factor and cause of illness; however, only 13 percent of them used the A.R.P. terminology. The majority of these studies were related to epidemiological surveys, mainly of a descriptive nature and with a cross-sectional or a retrospective design. We also identified, among other things, an increasing interest for the medical and social aspects of the A.R.P., this appears to be related to a more innovative view of this health problems.

[Social and family variables related to alcohol consumption]. / Variables sociofamiliares relacionadas con el consumo de alcohol.

The present study analyzed some family factors which are considered to be relevant for excessive alcohol consumption. Such analysis is conducted on the data derived from a cross-sectional epidemiological community survey directed to investigate, in a random sample of 1.800 persons of 18 to 65 years of age--and representative of the population of Cantabria--community responses to alcohol consumption. For this we applied among other instruments, a questionnaire designed by the WHO for exploring Alcohol consumption, and which has being extensively used in other countries. We found, among other things, that: i) Among the males excessive alcohol consumption tends to be higher in the single marital status, and also in those with a higher number of brothers; ii) On the females on the contrary, single marital status is associates to higher percentages of non excessive alcohol consumption, while the fact of having a higher number of brothers is related to higher rates of non consumption of alcohol.

[Family response and alcohol consumption]. / Respuesta familiar y consumo de alcohol.

The present study has its main objective the analysis of family responses to excessive alcohol consumption. For this we used data derived from a cross-sectional epidemiological community survey directed to investigate, in a random sample of 1.800 persons of 18 to 65 years of age and representative of the population of Cantabria community responses to alcohol consumption. We applied, among other instruments, a questionnaire designed by the WHO for exploring alcohol consumption, and which has being extensively used in other settings. We found, among other things, that: i) The concern about parents excessive alcohol consumption has different repercussions depending of the sex of their children, thus producing more alcohol related problems in males; ii) The concern for the alcohol consumption of ones partner is more often seeing in females, thus females tend to be more sensitive to these problems, and also they tend to detect them earlier and be more tolerant to them; iii) Persons who worry for the alcohol consumption of their partners usually have also had parents with such sort of problems; iv) And lastly about 11% of males and 13% of females with adolescent children tend to worry about the children' excessive alcohol consumption.

Why people with probable minor psychiatric morbidity consult a doctor.

This epidemiological investigation examines factors determining medical consultation in people with probable minor psychiatric morbidity. About 54% of people with probable minor psychiatric morbidity and about 23% of the (numerically much greater) remainder with lower probability of psychiatric morbidity consulted a doctor, usually a primary care physician, in the two weeks prior to a research interview. Medical consultation rates were higher in females than in males. The dominant finding was that in people with probable minor psychiatric morbidity physical illness was strongly associated with medical consultation. Almost 89% of males and 97% of females with probable minor psychiatric morbidity and physical illness consulted a doctor in the two weeks prior to interview. Logistic regression modelling was used to investigate the joint effects on medical consultation of physical illness and six socio-demographic variables, and physical illness emerged as the major single determinant of medical consultation in women and, in men, it exerted its effect through an interaction with lower educational level.

Sex differences in mental illness: a community study of the influence of physical health and sociodemographic factors.

This paper examines sex differences in psychiatric morbidity, using data from a community sample. The PSE-CATEGO-ID system was used to evaluate psychopathology. Six sociodemographic factors and physical illness were taken as independent variables. Females exhibit both a significantly higher psychiatric morbidity than males and a predominance of syndromes closely related to depression (SD; OD syndromes) and anxiety (GA; SA; TE; IT syndromes). Logistic modelling analysis, carried out separately for each sex, yielded different models. Psychiatric illness in men was best predicted by physical illness, unemployment and the interaction between the two. In contrast, physical illness emerged, in women, as the only factor exerting significant effects on psychiatric morbidity.

[Prevalence and psychosocial patterns of alcohol consumption in Cantabria]. / Prevalencia y patrones psicosociales de consumo de alcohol en Cantabria.

This is a cross-sectional community survey directed to investigate aspects related ot the alcohol consumption of 1,816 persons, of 16-65 years of age, representative of the population of Cantabria. It was found, among other things, that 7% of the male and 23% of the female were abstinent, being the prevalence for excessive alcohol consumption of 14.36% for males and of 0.22% for females. We also found, especially among the younger age groups, a growing female incorporation into the masculine patterns of alcohol consumption. It was also analyzed in the study the characteristics of the patterns of alcohol consumption. We found, in this respect, for the different socio-demographic groups of this community, specific profiles of alcohol consumption.