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Objective: Psychiatric comorbidity has been found to be associated with increased length of hospital stay, increased morbidity and mortality. For example cognitive disorders were found to be associated with increased length of hospital stay, increased morbidity, and mortality for adult patients of all ages. Although psychiatric comorbidity is high in medical illnesses, it is not recognized and treated sufficiently. In this study we aimed to investigate the accuracy of all psychiatric referrals and agreement between primary medical providers and consulting psychiatrists in terms of initial and final psychiatric diagnosis. Method: A retrospective review of all consultation requests from January 1, to June 30, 2003 was evaluated. The accuracy rate between the initial psychiatric diagnoses determined by primary medical providers and the final psychiatric diagnoses determined by consultant psychiatrists was calculated and measure of agreement in terms of psychiatric diagnoses between two doctors was evaluated. Results: A total of 580 psychiatric referrals (277 men, 47.8%; 303 women, 52.2%) were retrospectively reviewed. Mean age of the sample was 46.36 (SD=19.83) years. Psychiatric referrals were requested 40% from surgery departments (general surgery, plastic and reconstructive surgery, obstetrics and gynecology, chest heart blood vessel surgery, neurosurgery, orthopedics, and urology), 25.3% from emergency service, 10.5% from internal medicine departments, and 24.7 % from other inpatient clinics of the center. Final psychiatric diagnoses of 580 patients were classified as depressive disorders (33.8%), anxiety disorders (4%), adjustment disorders (13.3%), psychotic disorders (6.6%), cognitive disorders (14.3%), bipolar disorder (1.4%), alcohol and substance use disorders (4.8%), personality disorders (1.7%), no active psychopathology (14%) and other (6.1%). In this study primary medical providers requested psychiatric referrals for five different psychiatric disorder categories. They were; depressive disorders, cognitive disorders, substance use disorders, anxiety disorders, and somatoform disorders. There were no psychiatric referrals for psychosis, adjustment disorder or bipolar disorder. Therefore in this study accuracy rates of five psychiatric disorder categories and agreement between two doctors were assessed. The accuracy rates of depressive and cognitive disorders were similar (57% and 52.3% respectively) hence substance use disorders were assigned 79.2% accurately. The accuracy rates for anxiety disorders and somatoform disorders were 26.5% and 41.2% respectively. The degree of agreement between two doctors for substance use disorders was high (kappa value=0.718), but for the rest four diagnostic categories (depressive disorders, cognitive disorders, anxiety disorders, somatoform disorders) it was moderate or low. Conclusions: This study showed that substance use disorders were recognized well, whereas, depression and anxiety disorders which are seen more frequently than other psychiatric disorders among inpatients were recognised poorly by primary medical care providers.
Bir üniversite hastanesi konsültasyon liyezon servisinde psikiyatrik hastalıkların psikiyatri dışı hekimlerce doğru tanınma oranları
Amaç: Psikiyatrik komorbidite hastanede yat›fl süresinin uzamas›, artm›fl morbidite ve mortalite riski ile iliflkili bulunmufltur. Örne¤in, eriflkinlerde tüm yafl gruplar›nda kognitif bozukluklar›n hastanede yat›fl süresini uzatt›¤› ve artm›fl morbidite ve mortalite ile iliflkili oldu¤u bulunmufltur. Bedensel hastal›klarda psikiyatrik komorbidite yeterince tan›nmamakta ve tedavi edilmemektedir. Bu çal›flmada yatan hastalarda psikiyatrik hastal›klar›n do¤ru tan›nma oranlar› ve psikiyatri hekimi ile hastan›n birincil bak›m›ndan sorumlu hekimi aras›ndaki psikiyatrik tan› uyumunun araflt›r›lmas› amaçlanm›flt›r. Yöntem: 1 Ocak 2003 - 30 Haziran 2003 tarihleri aras›nda istenen tüm psikiyatri konsültasyonlar› geriye dönük olarak de¤erlendirilmifl ve konsültan psikiyatristin belirledi¤i son psikiyatrik tan›ya karfl›n hastan›n birincil bak›m›ndan sorumlu hekimin belirledi¤i ilk psikiyatrik tan› aras›ndaki do¤ruluk oran› ve iki hekim aras›ndaki tan› uyumu hesaplanm›flt›r. Bulgular: Toplam 580 (erkek hastalar n= 277, %47.8; kad›n hastalar n=303, %52.2) psikiyatri konsültasyonundan oluflan örneklemin yafl ortalamas›, 46.36 ± 19.83 y›l bulunmufltur. Psikiyatri konsültasyonu isteyen kliniklerin da¤›l›m›na bak›ld›¤›nda, yerinde konsültasyon isteminin %40’› cerrahi kliniklerinden (genel cerrahi, plastik cerrahi, kad›n do¤um, gö¤üs kalp damar cerrahisi, beyin cerrahisi, ortopedi ve üroloji), %25.3’ü acil servisden, %10.5’i dahiliye ve %24.7’si di¤er kliniklerden yap›lm›flt›r. Alt› ayl›k sürede yerinde konsültasyon istenen 580 hastan›n psikiyatrik tan› da¤›l›m› depresif bozukluklar (%33.8), anksiyete bozukluklar› (%4), uyum bozukluklar› (%13.3), psikotik bozukluklar (%6.6), kognitif bozukluklar (%14.3), bipolar bozukluk (%1.4), alkol ve madde kullan›m bozukluklar› (%4.8), kiflilik bozukluklar› (%1.7), aktif psikopatoloji yok (%14) ve di¤er (%6.1) fleklinde s›n›fland›r›lm›flt›r. Psikiyatri d›fl› hekimlerce befl farkl› psikiyatrik hastal›k tan› kategorisi için konsültasyon istenmifltir. Bu tan› kategorileri içinde depresif bozukluklar, kognitif bozukluklar, madde kullan›m bozukluklar›, anksiyete bozukluklar› ve somatoform bozukluklar yer alm›flt›r. Psikoz, bipolar bozukluk, uyum bozuklu¤u ön tan›s› ile psikiyatri konsültasyonu istenmemifltir. Bu nedenle yukar›da belirtilen befl tan› kategorisi için tan› do¤rulu¤u ve iki hekim aras›ndaki tan› uyumu incelenmifltir. Depresif ve kognitif bozukluklar›n do¤ru tan›nma oranlar› birbirine benzer (s›ras›yla, %57 ve %52.3) bulunmas›na karfl›n, alkol-madde kullan›m bozukluklar›na %79.2 oran›nda do¤ru tan› konmufltur. Anksiyete bozukluklar› ve somatoform bozukluklar için do¤ru tan›nma oranlar› s›ras›yla %26.5 ve %41.2 bulunmufltur. Madde kullan›m bozukluklar› tan›s› koymada iki hekim aras›ndaki uyum yüksek (kappa de¤eri=0.718), geri kalan dört tan› kategorisinde (depresif bozukluklar, kognitif bozukluklar, anksiyete bozukluklar›, somatoform bozukluklar) tan› uyumu orta ya da düflük düzeyde bulunmufltur. Tart›flma: Bu çal›flma madde kullan›m bozukluklar›n›n hastan›n birincil bak›m›ndan sorumlu hekimlerce iyi tan›nd›¤›n› göstermesine karfl›n, yatan hastalarda daha s›k gözlenen depresyon ve anksiyete bozukluklar›n›n do¤ru tan›nmas›n›n zay›f düzeyde oldu¤unu göstermifltir