Mental illness in new neurological patients
Fink P, Hansen MS, Søndergaard L and Frydenberg M;
Commented by , 24 Jun 2003
Aim of the study
To determine the prevalence of mental disorders in patients admitted for the first time in a Neurology Department and to examine whether mental disorders are recognised, treated, and referred to psychiatric consultation by neurologists.
Method
A consecutive series of 198 patients, aged 18 or older, admitted for the first time to the Neurology Department of a Hospital in Denmark, either as inpatients or outpatients, were included in the study.
All patients were screened for anxiety and depression using an eight item version of the Symptom Checklist (SCL-8) and for illness, worrying and somatization using the seven item Whiteley (Whiteley-7) index. Patients with a score of two or more on the SCL-8 and/or three or more on the Whiteley-7 were considered high scorers.
50 % of all patients were randomly selected for psychiatric interviews. The random sample was augmented by the addition of all high-scorers from the remaining 50%.
130 patients were interviewed by a psychiatrist, using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN, version 2.1). The SCAN is a semi-structured diagnostic interview for making a comprehensive assessment of psychopathology.
In particular, the SCAN contains items for the assessment of all signs and symptoms required for making a diagnosis of most disorders included in either ICD-10 and DSM-IV (with the exception of personality disorders). Diagnoses are made using a diagnostic computer program which follows the diagnostic criteria and algorithms included in either diagnostic system.
Results
The SCAN data were analysed according to ICD-10 criteria and algorithms. According to the SCAN data and SCAN computer program, the overall prevalence of current mental disorders in this sample of new neurological patients was 55%. The most prevalent were somatoform disorders (33.8%), phobias (21.8%), mood disorders (14.4%) and substance use disorders (13.3%).
65% of the patients had a lifetime prevalence for at least one mental disorder. Less than half (41.5%) of the SCAN positive patients were rated as presenting a mild to severe mental disturbance by the neurologists. Only 4.6% of the SCAN positive patients were referred to a psychiatrist or a psychologist.
Discussion
This is a very interesting study on the prevalence of mental disorders in neurological patients. The results show a high prevalence of mental disorders in new neurological patients. More than half of the mental disorders in new neurological patients are not recognized as such by neurologists. Very few are referred to a psychiatrist or a psychologist.
At least three important questions need to be discussed. First, it would be interesting to know the prevalence of mental disorders that would have been detected by psychiatrists during a routine psychiatric assessment, i.e. by clinicians not using the SCAN.
Second, it would have important to assess the proportion of positive SCAN diagnoses judged to be clinically significant by psychiatrists not involved in the SCAN interviews. Finally, one may regret that the authors do not present the results according to DSM-IV criteria and algorithms although the SCAN computer program provides DSM-IV as well as ICD-10 diagnoses.
On the whole, the study highlights the importance of assessing neurological patients for the presence of mental disorders. It also emphasizes the need for neurologists and psychiatrists to work more closely together.