Utility of the dexamethasone suppression test in the diagnosis of poststroke depression.

The utility of the dexamethasone suppression test (DST) in the diagnosis of depression was examined in an outpatient sample of 29 stroke patients. Results indicated that the DST's sensitivity was 15%, its specificity was 67%, and its positive predictive value was 48%. These findings suggest that the DST yields no more information than would be gained from random assignment of the diagnosis of depression. Therefore, it is not a useful measure of mood in these patients.

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients.

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.

Issues in the identification of premenstrual syndromes.

Lack of information about the natural history of the premenstrual syndromes may make efforts regarding classification and treatment misguided. Thus, we report a naturalistic and noninstrusive approach to the problem of identification of the premenstrual syndromes, with particular focus on the issue of compliance with 2 months of daily prospective recordkeeping. Seventy-nine patients presenting for treatment of severe premenstrual symptoms were evaluated with a structured interview, psychological tests, and 2 months of daily prospective ratings of their symptoms. Weekly group follow-up meetings were held to foster compliance with recordkeeping. The typical woman seeking treatment for premenstrual symptoms in this study was middle-aged, highly educated, highly functioning, living in an urban setting, either married with children and family responsibilities or single and living alone, and supporting herself by a high-level job. She was anxious and depressed with multiple medical and gynecological problems. Despite a highly stressful life, she functioned at a very high level, but had consulted mental health professionals in the past. In general, she did not want medication. Consistent with other reports, only 20% of women seeking treatment for premenstrual symptoms had a premenstrual syndrome prospectively confirmed on the basis of 2 months of daily ratings. However, 81% of those with a prospectively confirmed premenstrual syndrome stated that after the 2-month evaluation period their symptoms no longer interfered with their functioning.

Sexual abuse and premenstrual syndrome: comparison between a lower and higher socioeconomic group.

Of 174 women presenting symptoms of premenstrual syndrome (PMS), 40% had a history as victims of sexual abuse. Thirty-three percent were of a high-SES (socioeconomic status) group and 52% of a low-SES group. The authors found a connection between sexual abuse and psychiatric hospitalization for women seeking treatment for PMS. Beck Depression Inventory scores were high, supporting current research indicating a prevalence of affective disorders in women seeking treatment for PMS. However, the authors found few differences between the high- and low-SES groups. Specific questioning regarding a history of adverse sexual experiences is critical in evaluating all patients.

Psychiatric consults on medical and surgical wards: a six year study.

Using a psychiatric consultation database 1,463 consults were completed over a six-year period (1980 to 1986). Many variables were studied, including demographics, who requested the consults, the reasons for consultation, DSM-III diagnoses, and treatment recommendations. Most variables were unstable from year to year despite thorough and consistent supervision. This study demonstrates the vulnerability of traditionally reported consultation data in establishing norms for defining psychiatric morbidity in the hospital. Future recommendations are discussed.