[Somatic disorders in outpatient psychiatry: the added value of a standard physical examination during the intake of outpatients]. / Somatiek in de ambulante psychiatrie: de toegevoegde waarde van een standaard lichamelijk onderzoek tijdens de ambulante intake.

BACKGROUND: It is well-known that psychiatric patients often suffer from severe somatic problems, such as diabetes mellitus and cardiovascular disease. Up till now, research has concentrated almost exclusively on the inpatient setting, but there is strong evidence that the correlation also exists in psychiatric patients who are outpatients. In the Netherlands there are, as yet, no clear recommendations regarding a standard form of somatic screening for the outpatient population. A pilot study performed by GGz Breburg has shown that somatic screening (without a physical examination) gave substantial additional value to treatment planning. AIM: To investigate the added value that a physical examination can provide when new psychiatric patients are screened for aspects of somatic concern (ASC). METHOD: Newly referred outpatients (n = 70) were screened somatically by means of a questionnaire and supplementary medical interview, and by laboratory tests and physical examination. If a somatic problem was found which had not been detected previously, the patient was referred back to to the general practitioner. RESULTS: At least one ASC was found in 81,4% of all patients. In 45,7% of all patients the asc had not been detected. 12% of all the newly discovered somatic problems were found exclusively via the physical examination. CONCLUSION: A physical examination provides substantial information and adds value to the somatic screening of psychiatric outpatients.

[The added value of somatic screening for psychiatric outpatients]. / De meerwaarde van een somatische screening op een polikliniek psychiatrie.

BACKGROUND: Somatic disorders occur more often in psychiatric patients than in the general population; some disorders are undiagnosed at the moment of referral. According to current guidelines, patients admitted to a psychiatric clinic should receive somatic screening. This recommendation, however, does not apply to outpatients. AIM: To assess the added value of screening for somatic disorders in patients newly referred to the outpatient department of a psychiatric clinic in the Netherlands. METHOD: In a pilot study, newly referred outpatients aged between 18-65 were screened on the basis of a letter of referral, a questionnaire, an interview, standard blood tests and, if deemed necessary, additional blood tests. The screening was considered to have particular benefits when the outcome influenced the patient's subsequent somatic and/or psychiatric treatment. RESULTS: One or more 'new aspects of somatic concern' were found in 62% of the study sample. Of the total of 162 found aspects, 64% were unknown at referral. In 34% of the patients the family doctor was contacted about subsequent treatment; in 2% of the patients a medical specialist was consulted and 10% was referred to a medical specialist. CONCLUSION: A standard form of somatic screening in a psychiatric outpatient unit definitely provides added value. Further research is needed in order to optimise the screening instruments and the practicality of using such instruments.

Validity of a short clinical interview for psychiatric diagnosis: the mini-SCAN.

BACKGROUND: To promote clinical application of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) system a shorter version (the mini-SCAN) was devised. Its psychometric properties were unknown. AIMS: To establish the validity and practical properties of the mini-SCAN. METHOD: One hundred and six participants were interviewed twice, once with the SCAN and once with the mini-SCAN. The level of agreement was established for the categories: no disorder, affective disorders, anxiety disorders, non-affective psychotic disorders, affective psychotic disorders. RESULTS: The mini-SCAN is a valid instrument. Most kappa values were around 0.90. Only for the class of affective psychotic disorders was the agreement moderate. Mean duration of the mini-SCAN interviews was 25 min shorter than the SCAN interviews. Participants and interviewers were generally satisfied with the interview format and questions. CONCLUSIONS: The mini-SCAN can be used as a diagnostic instrument for clinical purposes and for clinical studies when the present episode is the focus of attention.

Psychiatric disorders in a Dutch Health Area: a repeated cross-sectional survey.

BACKGROUND: Decades of psychiatric epidemiology have shown a wide variation in prevalence rates, but a consistent relationship between psychiatric disorder and sociodemographic variables. In this repeated cross-sectional survey, the prevalence of psychiatric disorders and their distribution in the general population of the same area was assessed in 1983 and 1997. METHODS: With an interval of 14 years, 2 two-phase studies of psychiatric prevalence were carried out among the inhabitants of a Dutch Health Area (Nijmegen). In phase 1, a random sample of persons answered the General Health Questionnaire (GHQ-30). In phase 2, the respondents were interviewed using a clinical semi-structured interview. Only phase 1 data will be reported here. RESULTS: The mean overall GHQ-score changed significantly from 3.1 (+/-1.0) in 1983 to 4.6 (+/-1.8) in 1997. On a bivariate level, higher score rates were found consistently in the age categories > or = 50 years, among divorced persons, the lower educational levels, the unemployed/chronically ill and in the urban areas. On a multivariate level (second order effect), however, the variance explained by these sociodemographic variables doubled, revealing the importance of complex interactions. LIMITATIONS: Our aim to ensure identical designs in 1983 and 1997 could not completely be achieved. CONCLUSIONS: In the course of time, psychiatric prevalence increased in all sociodemographic categories, despite the improved socioeconomic conditions in the survey population as a whole. The increasing complexity of life apparently takes its toll, even of the socially best equipped.

Long-term benzodiazepine users in family practice: differences from short-term users in mental health, coping behaviour and psychological characteristics.

BACKGROUND: Contrary to short-term use, long-term benzodiazepine use is undesirable. Nevertheless, its prevalence is high. To prevent long-term use, it is important to know which short-term users are at risk of becoming long-term users. OBJECTIVES: The purpose of the present study was to identify patient-related factors of long-term versus short-term use of benzodiazepines. METHODS: A cross-sectional study was carried out in family practices among users of benzodiazepines with regard to DSM-IV diagnosis, coping and psychosocial characteristics,. In a multivariate logistic regression analysis, long-term use of benzodiazepines was the dependent variable. RESULTS: A total of 164 short-term and 158 long-term benzodiazepine users participated in the study. Having a DSM-IV disorder and psychiatric co-morbidity, being older, less educated, lonely and using more avoidance coping behaviour was associated with long-term use of benzodiazepines compared with short-term use. CONCLUSION: The associations found point to possibilities to reduce long-term benzodiazepine use, for example if patients with these characteristics are treated with the alternatives to benzodiazepines or are monitored closely for a short period after being prescribing benzodiazepines.