J Neurol Neurosurg Psychiatry 2000;68:202-206 ( February )

Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department

Alan J Carson^a, Brigitte Ringbauer^a, Lesley MacKenzie^d, Charles Warlow^b, Michael Sharpe^{a c}

^a Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh, Scotland, UK, ^b Department of Medical Neurology, University of Edinburgh, Scotland, UK, ^c Department of Psychological Medicine, ^d Department of Clinical Neurology, Western General Hospital, Edinburgh, Scotland, UK

Correspondence to: Dr A J Carson, Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Morningside Park, Edinburgh, EH10 5HF, Scotland, UK email A.Carson{at}ed.ac.uk

Received 4 March 1999 and in revised form 19 July 1999; Accepted 5 August 1999

OBJECTIVESTo determine the prevalence of anxiety and depressive disorders in patients referred to general neurology outpatient clinics, to compare disability and number of somatic symptoms in patients with and without emotional disorder, the relation to neurological disease, and assess the need for psychiatric treatment as perceived by patients and doctors.
METHODSA prospective cohort study set in a regional neurology service in Edinburgh, Scotland. The subjects were 300 newly referred consecutive outpatients who were assessed for DSM IV anxiety and depressive disorders (PRIME-MD, and HAD), health status, and disability (SF-36), and patients', GPs' and neurologists' ratings of the need for patient to receive psychiatric or psychological treatment.
RESULTSOf 300 new patients, 140 (47%) met criteria for one or more DSM IV anxiety or depressive diagnosis. Major depression was the most common (27%). A comparison of patients with and without emotional disorder showed that physical function, physical role functioning, bodily pain, and social functioning were worse in patients with emotional disorders (p<0.0005). The median number of somatic symptoms was greater in patients with emotional disorders (p<0.0005). These differences were independent of the presence of neurological disease. Few patients wished to receive psychiatric or psychological treatments. Both general practitioners and neurologists were more likely to recommend psychiatric treatment when the patients' symptoms were medically unexplained.
CONCLUSIONSAlmost half of new referrals to general neurology clinics met criteria for a DSM IV psychiatric diagnosis. These patients were more disabled, and had more somatic symptoms. They expressed little enthusiasm for receiving psychiatric treatment.


Keywords: neurological disease; emotional disorder

---

© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Who should treat psychiatric disorders in neurology patients?

G G LLOYD
J. Neurol. Neurosurg. Psychiatry 2000 68: 134-135. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Low, N. C, Lee, S. S, Johnson, J. G, Williams, J. B, Harris, E. S (2008). The association between anxiety and alcohol versus cannabis abuse disorders among adolescents in primary care settings. Fam Pract 25: 321-327 [Abstract] [Full Text]  
• Jefferies, K., Owino, A., Rickards, H., Agrawal, N. (2007). Psychiatric disorders in inpatients on a neurology ward: estimate of prevalence and usefulness of screening questionnaires. J. Neurol. Neurosurg. Psychiatry 78: 414-416 [Abstract] [Full Text]  
• Gahir, K K, Larner, A J (2006). Primary headache disorder in the emergency department: perspective from a general neurology outpatient clinic. Emerg. Med. J. 23: 135-136 [Abstract] [Full Text]  
• Goadsby, P. J. (2005). Advances in the understanding of headache. Br Med Bull 73-74: 83-92 [Abstract] [Full Text]  
• Mitchell, A. J., Agrawal, N. (2005). Training in neuropsychiatry: is it time to reintegrate into mainstream psychiatry?. Psychiatr. Bull. 29: 361-364 [Full Text]  
• Reuber, M, Mitchell, A J, Howlett, S J, Crimlisk, H L, Grunewald, R A (2005). Functional symptoms in neurology: questions and answers. J. Neurol. Neurosurg. Psychiatry 76: 307-314 [Abstract] [Full Text]  
• Jackson, M J, Turkington, D (2005). Depression and anxiety in epilepsy. J. Neurol. Neurosurg. Psychiatry 76: i45-i47 [Full Text]  
• Stone, J, Townend, E, Kwan, J, Haga, K, Dennis, M S, Sharpe, M (2004). Personality change after stroke: some preliminary observations. J. Neurol. Neurosurg. Psychiatry 75: 1708-1713 [Abstract] [Full Text]  
• Carson, A J, Stone, J, Warlow, C, Sharpe, M (2004). Patients whom neurologists find difficult to help. J. Neurol. Neurosurg. Psychiatry 75: 1776-1778 [Abstract] [Full Text]  
• Williams, L.S., Jones, W.J., Shen, J., Robinson, R.L., Kroenke, K. (2004). Outcomes of newly referred neurology outpatients with depression and pain. Neurology 63: 674-677 [Abstract] [Full Text]  
• Larner, A J (2003). NHS Direct for headache. J. Neurol. Neurosurg. Psychiatry 74: 1698-1698 [Full Text]  
• Williams, L S, Jones, W J, Shen, J, Robinson, R L, Weinberger, M, Kroenke, K (2003). Prevalence and impact of depression and pain in neurology outpatients. J. Neurol. Neurosurg. Psychiatry 74: 1587-1589 [Abstract] [Full Text]  
• Lipton, R.B., Dodick, D., Sadovsky, R., Kolodner, K., Endicott, J., Hettiarachchi, J., Harrison, W. (2003). A self-administered screener for migraine in primary care: The ID MigraineTM validation study. Neurology 61: 375-382 [Abstract] [Full Text]  
• Carson, A J, Postma, K, Stone, J, Warlow, C, Sharpe, M (2003). The outcome of depressive disorders in neurology patients: a prospective cohort study. J. Neurol. Neurosurg. Psychiatry 74: 893-896 [Abstract] [Full Text]  
• Fink, P, Hansen, M S, Sondergaard, L, Frydenberg, M (2003). Mental illness in new neurological patients. J. Neurol. Neurosurg. Psychiatry 74: 817-819 [Abstract] [Full Text]  
• Maiden, N. L., Hurst, N. P., Lochhead, A., Carson, A. J., Sharpe, M. (2003). Quantifying the burden of emotional ill-health amongst patients referred to a specialist rheumatology service. Rheumatology (Oxford) 42: 750-757 [Abstract] [Full Text]  
• Kroenke, K. (2001). Studying Symptoms: Sampling and Measurement Issues. ANN INTERN MED 134: 844-853 [Abstract] [Full Text]  
• Wade, D. T (2001). Medically unexplained disability - a misnomer, and an opportunity for rehabilitation. Clin Rehabil 15: 343-347 [Abstract]  
• Sullivan, M. D., LaCroix, A. Z., Russo, J. E., Walker, E. A. (2001). Depression and Self-Reported Physical Health in Patients With Coronary Disease: Mediating and Moderating Factors. Psychosom. Med. 63: 248-256 [Abstract] [Full Text]  
• Carson, A. J, Best, S., Warlow, C., Sharpe, M. (2000). Suicidal ideation among outpatients at general neurology clinics: prospective study. BMJ 320: 1311-1312 [Full Text]  
• LLOYD, G G (2000). Who should treat psychiatric disorders in neurology patients?. J. Neurol. Neurosurg. Psychiatry 68: 134-135 [Full Text]