Child psychiatric disorders in a primary care Arab population

OBJECTIVES: Physical and psychiatric comorbidity is relatively common in general practice but there have been few systematic studies using clinical interviews of children attending the primary care services in the Arab population, and none from the Gulf countries. This study was undertaken to determine the prevalence and nature of child psychiatric morbidity in primary care in the United Arab Emirates (UAE). METHOD: Systematic psychiatric evaluations were carried out on consecutive children aged 6 to 18 years visiting their primary care doctors in Al Ain. The sample consisted of 141 (50.7%) boys and 137 (49.3%) girls. RESULTS: Forty-three percent of the 278 children received a DSM-IV diagnosis. Of these, 46 (38%) were males and 74 (62%) were females. However, only 1.1% (3/120) of the patients consulted general practitioners for a primary psychiatric symptom. The most common diagnosis was anxiety disorder followed by depression. Obsessive compulsive disorder was present in 11%, conduct disorder in 7%, and attention deficit hyperactivity disorder in 3% of those with a diagnosis. A statistically significant association was found between DSM-IV caseness and female gender, higher number of children in the household, relationship problems in the family, physical illness and family history of psychiatric disorder. Other factors that did not show any significant association were age, nationality, socioeconomic status, parental education or occupation, scholastic performance or developmental delay in the child, or parental consanguinity. CONCLUSION: Our findings suggest that psychiatric disorders are common among young people of Arab origin attending primary care facilities, and that doctors need to be vigilant about this possibility.     

Al Ain Community Psychiatric Survey. I. Prevalence and socio-demographic correlates

  Background: Psychiatric community stud- ies are essential for the planning and development of psychiatric services, as well as being helpful in examining the socio-demographic correlates of mental disorders in a given community. Few such studies have been carried out to date in the Arabian peninsula. This paper forms part of a multipurpose community psychiatric survey conducted in A1 Ain in the United Arab Emirates. The findings regarding lifetime prevalence and psychiatric morbidity are reported. Methods: A total of 1394 (n= 1394) adults systematically sampled from Al Ain community were assessed with a modified version of the Composite International Diagnostic Interview (CIDI) as well with other instruments: the new screening psychiatric instrument, Self-Reporting Questionnaire (SRQ-20), and the Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID) screening module. Lifetime prevalence and 1-week prevalence rates of mental distress as measured by screening instruments were estimated as well as the lifetime prevalence rate of CIDI ICD-10 psychiatric disorders. The sensitivity of the CIDI interview to correctly pick up distressed subjects, as well as those who had undergone previous treatment for a psychiatric disorder, was also calculated. Associations between socio-demographic risk factors and ICD-10 psychiatric disorder as well as with mental distress were also examined by bivariate and multivariate analyses. Results: Overall lifetime prevalence of ICD-10 psychiatric disorder was found to be 8.2% (95% CI: 6.7–9.7), while the 1-week prevalence rate of mental distress as measured by the SRQ-20 was 15.6% (95% CI: 11.8–19.5) and the lifetime prevalence rate of mental distress as measured by the new screening instrument was 18.9% (95% CI: 11.5–25.9). The CIDI interview correctly picked up 42% of subjects who had received previous psychiatric treatment and 51% of the distressed. Mood disorders and anxiety (neurotic) disorders were more common in women and alcohol and substance use disorders were exclusively confined to men. Female sex, young age, quality of marital relationship, life events over past year, chronic life difficulties, physical illness, family history of psychiatric disorders and past history of psychiatric treatment were found to be significantly associated with ICD-10 psychiatric disorder. Multivariate analysis revealed that age, sex, exposure to chronic difficulties and past history of psychiatric treatment were the most significant predictors of ICD-10 psychiatric disorders, and exposure to chronic difficulties, past history of psychiatric treatment and educational attainment were the significant predictors of lifetime ever and current mental distress. Conclusion: The pattern and trend of psychiatric morbidity found in this survey is in line with those reported by other surveys that utilized similar assessment instruments. Differences in rates are explained by different methodologies used. Accepted: 3 October 2000     

Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care

OBJECTIVE: Prevalence rates of mental health problems in primary care vary according to population and the type of measure used. This study examined the prevalence of a full range of mental health problems, including sub-threshold diagnoses, and the socio-demographic risk factors for psychiatric disorders among a population with low out-of-pocket expenditures for medical care. METHOD: Four validated mental health assessment instruments, including the CIDI-SF, were administered to a sample of 976 users of primary care in Israel between the ages of 25-75 in eight clinics throughout the country. Prevalence estimates were obtained for seven psychiatric diagnoses, two "other mental health disorders" (somatization and disordered eating) and five sub-threshold conditions. RESULTS: The most common types of morbidity were depression and disordered eating (20.6% and 15.0%, respectively), followed by somatization (11.8%) and general anxiety (11.2%). Among respondents, 31.1% had at least one psychiatric diagnosis, 24.3% had 'other mental disorders' and 15.5% had sub-threshold conditions. Panic attack, disordered eating and somatization, as well as a global measure of any psychiatric diagnosis were significantly more prevalent among women than men. Psychiatric diagnoses were also more common among those in the age group 45-64, with less education and insufficient income, the never married and separated/divorced and those not working. No significant differences were found between recent immigrants, veteran immigrants and Israeli-born, between Arab and Jewish Israelis or between secular or religious sectors of the population. CONCLUSIONS: This study establishes the prevalence of the most common disorders in primary care including PTSD, somatization and disordered eating behaviors. The additional of other mental disorders suggests that a more accurate picture of mental disorders in primary care requires an expanded assessment procedure.     

Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain

OBJECTIVE: The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. METHOD: The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. RESULTS: A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but most of this disability was explained by the association between fatigue and psychiatric morbidity. CONCLUSIONS: Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their etiologies.     

The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective

There have been numerous studies of the prevalence of postpartum psychiatric illness and its putative risk factors in Western Europe and North America, but very few studies have been undertaken in developing countries, including the Arab world. A total of 95 women admitted to the New Dubai Hospital in Dubai, United Arab Emirates, for childbirth were studied. All subjects were assessed in the postpartum period using clinical and socio-cultural instruments, namely the Self-Reporting Questionnaire (SRQ) on day 2 and the Edinburgh Postnatal Depression Scale (EPDS) on day 7 after delivery. The prevalence of psychiatric morbidity was 24% according to the SRQ and 18% according to the EPDS. A number of psychosocial factors emerged as putative risk factors for postpartum psychiatric disturbance, including depressive illness. It is concluded that the prevalence of postpartum psychiatric morbidity and its risk factors in this Arab culture are similar to the results obtained in numerous previous studies conducted in industrialized countries. These findings have implications for the early detection and care of women at risk for postpartum psychiatric illness.     

Prevalence of emotional and behavioural problems among 6–12 year old children in Egypt

Epidemiological information about prevalence of child mental health problems is essential to inform policy and public health practice. This information is weak in many developing countries and those in developmental transition. There have been few such studies in Arab countries and none in Egypt. We conducted a population prevalence study of emotional and behavioural disorders among 1186 6–12 year old children in Minia, Egypt. Data was collected from teachers and parents using the Strengths and Difficulties Questionnaire with a 98 and 91% response respectively. Prevalence of abnormal symptom scores is reported for both parents and teachers. Prevalence of probable psychiatric diagnoses was measured using the SDQ multi-informant algorithm. These prevalences have then been compared to published UK data. The prevalence of emotional and behavioural symptoms was high as reported by both parents and teachers (Abnormal total difficulties: teachers 34.7% (95% CI 32.0–37.5), parents 20.6% (18.2–23.2). Abnormal prosocial scores: teachers 24.9% (22.5–27.5), parents 11.8% (9.9–13.9)) but prevalence of probable psychiatric diagnoses was much lower (Any psychiatric diagnosis 8.5% (6.9–10.5); Emotional disorder 2.0% (1.2–3.0); Conduct disorder 6.6% (5.1–8.3); Hyperactivity disorder 0.7% (0.3–1.4)). Comparison with UK data showed higher rates of symptoms but similar rates of probable disorders. Despite public, professional and political underestimation of child mental health problems in Egypt, rates of symptoms are higher than in developed countries, and rates of disorders are comparable. These findings support greater investment in community and primary care prevention and treatment initiatives.     

Psychiatric morbidity among Dunedin Chinese women.

A community postal survey of minor psychiatric morbidity among Chinese women living in Dunedin was conducted. The 28-item version of the General Health Questionnaire (GHQ-28) was used as the case identification instrument. The overall rate of psychiatric morbidity of Dunedin Chinese women did not differ from their European counterparts. The sociodemographic factors found to be associated with minor psychiatric morbidity included having no children, and being either very well or very poorly educated. Among (foreign born) migrants, those who were born in China, whose reason for migration was "follow the lead of their family" or "family reunion", had resided in New Zealand for ten years or more and spoke English infrequently tended to have higher psychiatric morbidity.     

Prevalence and development of psychiatric disorders in childhood and adolescence

BACKGROUND: This longitudinal community study assessed the prevalence and development of psychiatric disorders from age 9 through 16 years and examined homotypic and heterotypic continuity. METHODS: A representative population sample of 1420 children aged 9 to 13 years at intake were assessed annually for DSM-IV disorders until age 16 years. RESULTS: Although 3-month prevalence of any disorder averaged 13.3% (95% confidence interval [CI], 11.7%-15.0%), during the study period 36.7% of participants (31% of girls and 42% of boys) had at least 1 psychiatric disorder. Some disorders (social anxiety, panic, depression, and substance abuse) increased in prevalence, whereas others, including separation anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), decreased. Lagged analyses showed that children with a history of psychiatric disorder were 3 times more likely than those with no previous disorder to have a diagnosis at any subsequent wave (odds ratio, 3.7; 95% CI, 2.9-4.9; P<.001). Risk from a previous diagnosis was high among both girls and boys, but it was significantly higher among girls. Continuity of the same disorder (homotypic) was significant for all disorders except specific phobias. Continuity from one diagnosis to another (heterotypic) was significant from depression to anxiety and anxiety to depression, from ADHD to oppositional defiant disorder, and from anxiety and conduct disorder to substance abuse. Almost all the heterotypic continuity was seen in girls. CONCLUSIONS: The risk of having at least 1 psychiatric disorder by age 16 years is much higher than point estimates would suggest. Concurrent comorbidity and homotypic and heterotypic continuity are more marked in girls than in boys.     

Psychiatric morbidity in mothers of children attending primary care facility in Ilorin, Nigeria: drawing attention to those affected concurrently with their children

Objective

To determine the prevalence of psychiatric morbidity among mothers of children attending a primary care clinic in University of Ilorin Teaching Hospital as precursor to developing an intervention programme.

Method

WThree hundred fifty mothers of children aged 7–14 years were screened with the 12-item General Health Questionnaire for psychiatric morbidity. As part of the larger study, their children were screened for psychiatric disorders with the parents’ version of the Child Behaviour Questionnaire, and a subsample of 157 mother/child dyad had second-stage interview with the children’s version of the Schedule for Affective Disorders and Schizophrenia to determine psychiatric morbidity in these children.

Results

Twenty-eight out of 350 mothers (8%) had probable psychiatric morbidity. Mothers with psychiatric morbidity were significantly more likely to have children with Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition psychiatric diagnosis (8 of 28, P=0.011), experience parenting difficulties with some of their children (13 of 28, P=0.000) and have poor husband support for the care of their children.

Conclusion

The presence of psychiatric morbidity in mothers may require that other members of the family especially the children be screened for psychiatric disorders particularly when there are parenting difficulties and poor spousal support; in this way primary prevention or control can effectively be carried out.     

Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain

The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but the association between fatigue and psychiatric morbidity explained most of this disability. Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their aetiologies.     

Mental health problems and social supports among homeless mothers and children victims of domestic and community violence.

BACKGROUND: Children and mothers who have suffered domestic or neighbourhood violence constitute a high risk group, although it has not been clear whether their mental health needs are specifically related to the type of violence. This paper reports on the prevalence of mental health problems in homeless parents and children who have experienced domestic and neighbourhood violence and their access to social support networks. METHODS: Three groups of families who had become homeless were compared: those experiencing domestic violence (48 with 75 children), victims of neighbourhood violence (14 with 29 children), and those who became homeless for other reasons (31 with 54 children). Mothers completed a service use semi-structured interview, the Strengths and Difficulties Questionnaire, the General Health Questionnaire, the Family Support Scales, and the SF-36 Health Status Questionnaire. RESULTS: Levels of psychiatric morbidity were high in the group experiencing domestic violence (35.7% in children and 21.9% in mothers) and higher still in those who were victims of neighbourhood violence (52.2% in children and 50% in mothers). Levels of social support were found to be an important factor, particularly in relation to professional support and support from other family members, as they predicted both child and maternal psychopathology. CONCLUSIONS: Mental health interventions for victims of domestic and neighbourhood violence should be integrated with community programmes of social reintegration. Mental health professionals should work in close collaboration with Housing Departments, Social Services, Education and the Police.     

Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain

The study examined the associations between several sociodemographic and psychosocial variables and unexplained chronic fatigue in the community before and after adjustment for psychiatric morbidity and determined the prevalence of fatigue and rate of disability resulting from fatigue in the general population. The study is a secondary analysis of 1993 data from a household survey of psychiatric morbidity conducted by the Office for Population Censuses and Surveys in Great Britain. The survey included 12,730 subjects age 16-64 years. Unexplained chronic fatigue was used as the dependent variable in a logistic regression analysis, with various sociodemographic and psychosocial variables and psychiatric morbidity as the independent variables. Psychiatric morbidity was assessed by using the Revised Clinical Interview Schedule. Fatigue was measured by using the fatigue section of the Revised Clinical Interview Schedule. A total of 10,108 subjects agreed to cooperate (79.4% participation rate). The prevalence of unexplained chronic fatigue was 9%. Subjects with psychiatric morbidity had higher rates of fatigue. Adjustment for psychiatric morbidity had a minor effect on the associations between sociodemographic factors and chronic fatigue. After adjustment, older subjects, women, and couples with children had higher rates of fatigue. Single subjects, widowed subjects, adults living with parents, and economically inactive subjects had lower rates of fatigue. Fatigue was associated with considerable disability, but the association between fatigue and psychiatric morbidity explained most of this disability. Unexplained chronic fatigue is a common condition, strongly associated with psychiatric morbidity. The close relationship between fatigue and psychiatric morbidity should not obscure the possibility of differences as well as similarities in their aetiologies.     

Indicators of elder abuse: a crossnational comparison of psychiatric morbidity and other determinants in the Ad-HOC study.

OBJECTIVE: The objective of this study was to determine crossnationally the prevalence of indicators of elder abuse and their relationship to putative risk factors, particularly depression, dementia, and lack of service provision. METHOD: Nearly 4,000 people aged 65+ receiving health or social community services in 11 European countries were interviewed using the minimum dataset homecare (MDS-HC) interview, which includes an abuse screen used previously in elder abuse studies and questions about demographic, physical, psychiatric, cognitive, and service factors. RESULTS: One hundred seventy-nine (4.6%) people assessed had at least one indicator of abuse. The proportion screening positive increased with severity of cognitive impairment, presence of depression, delusions, pressure ulcers, actively resisting care, less informal care, expressed conflict with family or friends, or living in Italy or Germany, but not with having a known psychiatric diagnosis. CONCLUSION: Severity of cognitive impairment, depression, and delusions predicted screening positive for abuse in older adults, but having a known psychiatric diagnosis did not, indicating that screening for psychiatric morbidity might be rational strategies to combat elder abuse. People in Italy and Germany were most likely to screen positive for indicators of abuse, and the authors suggest that this might relate to higher levels of dependency in the participants looked after at home in these countries as a result of cultural and service provision differences.     

Mental disorders in Australian prisoners: a comparison with a community sample

BACKGROUND: The plight of those with mental health problems and the possible role of prisons in "warehousing" these individuals has received considerable media and political attention. Prisoners are generally excluded from community-based surveys and to date no studies have compared prisoners to the community. OBJECTIVE: The objective was to examine whether excess psychiatric morbidity exists in prisoners compared to the general community after adjusting for demographics. METHOD: Prison data were obtained from a consecutive sample of reception prisoners admitted into the state's correctional system in 2001 (n = 916). Community data were obtained from the 1997 Australian National Survey of Mental Health and Wellbeing (n = 8168). Mental health diagnoses were obtained using the Composite International Diagnostic Interview and a number of other screening measures. Weighting was used in calculating the 12-month prevalence estimates to control for demographic differences between the two samples. Logistic regression adjusting for age, sex and education was used to compare the prison and community samples. RESULTS: The 12-month prevalence of any psychiatric illness in the last year was 80% in prisoners and 31% in the community. Substantially more psychiatric morbidity was detected among prisoners than in the community group after accounting for demographic differences, particularly symptoms of psychosis (OR = 11.8, 95% CI 7.5-18.7), substance use disorders (OR = 11.4, 95% CI 9.7-13.6) and personality disorders (OR = 8.6, 95% CI 7.2-10.3). Mental functioning and disability score were worse for prisoners than the community except for physical health. CONCLUSIONS: This study found an overrepresentation of psychiatric morbidity in the prisoner population. Identifying the causes of this excess requires further investigation.     

Comorbid psychiatric disorders in Arab children with Autism spectrum disorders

The objective of our study is to estimate the prevalence of comorbid psychiatric disorders in a sample of children with autism spectrum disorders (ASD) recruited from three Arab countries. We also examine the relationship between comorbidity and children's cognitive functioning and gender. Children who received a diagnosis of ASD (n = 60) from a child psychiatric outpatient clinic in Mansoura (Egypt), Al-Ahsa (Saudi Arabia) and Amman (Jordan) were included in this study. Comorbid diagnoses were established with a clinical interview and a semi-structured clinical interview for children and adolescents (SCICA). In addition, for all patients the cognitive evaluation was measured given the range in age and level of ability. Sixty-three percent of the children were diagnosed with at least one comorbid disorder. The most commonly reported comorbid disorders were anxiety disorders (58.3%), ADHD (31.6%), conduct disorders (23.3%), and major depressive disorder (13.3%). Out of the total sample, Obsessive compulsive disorder was the most prevalent anxiety disorder (55%). Elimination disorders were also diagnosed in 40% of patients. These findings emphasize a wide variety of psychiatric comorbidity afflicting youth with ASD and may be important targets for intervention.     

Screening for emotional and behavioural problems amongst 5–11-year-old school children in Karachi,Pakistan

Background While a number of studies in the western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like Pakistan. Method A cross sectional survey of 5–11-year-old children attending main stream private and community schools in Karachi was conducted. Seven private and eight community schools agreed to participate. About 1488 consent forms were sent to 700 parents of private school and 788 parents of community school children. A total of 675 parents agreed to participate in the study. The response rate was 45.4%. Assessment of children’s mental health was conducted using Strength and difficulties questionnaire (SDQ) by parents based on cut-off provided by Goodman. Results About 47% children were rated as normal, 19% as borderline and 34% as abnormal by the parents. Ordinal regression was used to identify factors associated with parent’s rating. The odds of female children of being normal was 1.5 times relative to male children, adjusting for school type and mother’s education (ORadj = 1.5, 95% CI: 1.1–2.0). Children attending private schools were more likely to be normal as compared to community school children, adjusting for child’s gender and mother’s education (ORadj = 2.3, 95% CI: 1.3–4.0). Conclusion In the present study, prevalence of child mental health problems was higher than reported in studies from other countries. Prevalence was higher amongst children attending community schools. Consistent with most studies, male children were at a higher risk than females. There is a need for developing programs to train, sensitise and mobilize teachers and parents regarding child’s psychological, emotional and behavioural problems with special attention to community schools. Since the male child is at a greater risk we should be cognizant of this while evaluating children for psychopathology.     

Profile of psychiatric disorders and life events in medically ill elderly: experiences from geriatric clinic in Northern India

BACKGROUND: Morbidity among elderly people has an important influence on their psychological well-being. Evaluation of the morbidity profile and its determinants, which have implications for management of medical problems of elderly people, are scarce in developing countries. Even the physicians' detection rate of mental distress in elderly populations is low in medical outpatient clinics. This could be due to the large caseloads and also, importantly, underestimation of psychological concerns of the elderly. The objective of this study was to study the psychiatric co-morbidity and life events among elderly medical outpatients. METHODS: One hundred medically ill elderly (>60 years) patients attending the Geriatric Clinic at Bikaner (North India) constituted the study population. The physical diagnosis was made by a physician based on reported illness, clinical examination and medical records. Psychiatric diagnosis was made by detailed clinical psychiatric interview using ICD-10 guidelines. Life events were assessed by the Indian adaptation of Presumptive Stressful Life Events Scale. RESULTS: Hypertension was the most commonly reported physical diagnosis (50%), other specific medical illnesses were osteoarthritis (15%), diabetes (13%) and constipation (8%). The study found 18% subjects had depression and 11% had other mental disorders. Patients with mental disorders had suffered more recent stressful life events. Among life events, conflicts in family (16%); unemployment of self or children (9%) was reported by elderly psychiatric patients. Other reported life events in psychiatric diagnosed elderly were conflict in family (7%), illness of self (6%) or family members (5%) and death of family members (5%) or close relatives (4%). CONCLUSION: Mental disorders are common among medically ill elderly patients, but they are poorly recognized and treated. Assessment of the psychiatric morbidity will help in strengthening psycho-geriatric services and thus, improve the quality of life of the elderly.     

Physical morbidity in a group of patients referred to a psychogeriatric unit; A 6-month prospective study

In a 6-month prospective study of all admissions (N = 72) to an old age psychiatric unit, 34% (N = 24) were found to have significant physical illnesses at the time of admission. Sixty-two per cent of the conditions were detected by a combination of clinical methods and simple tests alone. There was no significant difference in terms of age, sex, marital status or a past history of psychiatric treatment between those who were initially diagnosed as physically ill and those who were physically well at the time of admission. Higher levels of morbidity were found in those with an organic psychiatric diagnosis compared to those with a functional psychiatric diagnosis, although this did not reach a statistically significant level. It is suggested that simple tests can be carried out in the community by family doctors.     

Psychiatric disturbances among prepubertal children in Southern Finland

The prevalence of psychiatric disorders among prepubertal children in Southern Finland was studied in a two-stage epidemiological survey. In the first stage of the study 3397 children aged 8 or 9 were screened with the Rutter A2 scale for parents, Rutter B2 scale for teachers and Children's Depression Inventory (CDI). In the second stage a random sample of the children screened was drawn for more detailed assessment. Altogether 279 children were interviewed with the Finnish version of the Diagnostic Interview Schedule for Children (DISC), and their parents with the Isle of Wight Interview Schedule. In the parental interview the prevalence of psychiatric disturbance among children was 15.1%. The rate was higher for boys (23.7%) than for girls (5.3%). The prevalence of psychiatric disturbance verified with the child interview was 14.9%. The prevalence of psychiatric disturbance in boys based on the child interview was 20.5%. For girls the prevalence of psychiatric disturbance based on the child interview was 8.7%. The spectrum of psychiatric disturbance differed in the two interviews. Attention deficit disorder, depression and conduct disorder were the most common diagnoses in the parent interview, while anxiety disorder and depression were most common according to the child interview. In only 24% of the cases both the parent and child interview gave the same diagnosis. Accepted: 3 December 1997     

Patients with a psychiatric disorder in general practice: determinants of general practitioners' psychological diagnosis

BACKGROUND: Although psychiatric disorders are highly prevalent in the community, many patients with a psychiatric morbidity remain unidentified as such in primary care. OBJECTIVE: The aim of this study was to analyze which clinical and sociodemographic characteristics of patients with psychiatric morbidity are related to general practitioners' (GPs) diagnosis of mental illness. METHODS: A 1-year naturalistic survey of primary care contacts of patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of affective disorder, anxiety disorder or alcohol abuse was carried out. RESULTS: Of the patients with a DSM-IV diagnosis, 10% did not visit their GP at all during 1 year, 40% visited their GP but were only diagnosed as having somatic diagnoses and 50% were given a psychological or social diagnosis at least once during 1 year. Affective disorders are more frequently diagnosed than anxiety disorders or alcohol abuse. The chances of psychological GP diagnosis increase with the number of GP contacts. CONCLUSIONS: GPs appear to have few indications to help them distinguish patients with a psychiatric morbidity from others, as long as the patients themselves do not express more explicit clues to their condition. Public mental health education and a better public relations policy are badly needed.