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Anxiety Disorders and Concomitant Characteristics of Inpatients Referred for Psychiatric Consultation in a University Hospital
Yasuhiro Kishi, MD
Susan E. Swigart, MD
William H. Meller, MD
Roger G Kathol, MD
Department of Psychiatry
F282/2A West Building
2450 Riverside Avenue
Minneapolis, Minnesota USA
Steven Thurber, Ph.D., ABPP
Department of Psychology
1125 SE Sixth Street
Willmar, Minnesota, USA 56201
Patients with anxiety disorders are among the most challenging individuals seen by consultation psychiatrists. Yet, there have been few systematic studies of psychiatric consultations for anxiety within general hospital settings. The number of medical/surgical patients in general hospitals who evince anxiety problems may be substantial. This relates, in part, to the relationship between anxiety and medical conditions. In a survey of National Hospital Discharge in the United States, one percent of patients with a principal medical or surgical diagnosis were found to have concurrent anxiety classifications (reported in Fulop, 1990). More recently, Yates (1999) found that 4-6% of general hospital patients received an anxiety disorder classification as a primary psychiatric diagnosis.
The aims of this study were threefold: (A) to examine the extent to which psychiatric referrals among patients in a university hospital evinced anxiety disorders; (B) to explore concomitant psychiatric and demographic characteristics of referred patients with and without anxiety disorders; (C) to compare patients with co-morbid anxiety and depression to those with depression alone.
During a one year period, 541 patients (242 males; 299 females; mean age = 51.7) in a public university teaching hospital were referred for psychiatric consultation. The hospital is located in the 15th largest metropolitan area in the United States with approximately three million people, and approximately 15% non-Caucasian minority persons. Of the referrals, 69 (13.3%) met DSM-IV criteria for an anxiety disorder.
|Anxiety disorder, NOS||31|
|Generalized anxiety disorder||9|
|Post traumatic stress disorder||6|
|Social anxiety disorder||5|
|Obsessive compulsive disorder||2|
There was no difference between anxious and non-anxious referrals in concurrent medical conditions (x2 = 17.4, df = 14, p = .24). Anxious patients tended to be depressed (61.8%), have problems with alcohol usage (26.5%) and other drugs (10.3%). There were more anxious females; they tended to have a longer psychiatric history, to be seen earlier for psychiatric consultation (mean = 4.48 days), and have a shorter length of hospital stay (approximately 12 days). They were more likely to have been referred for anxiety problems, somatic complaints, and chemical dependence than non-anxious persons.
Only 12 of the patients with anxiety disorders did not evince psychiatric comorbidity. Of note, there were no significant differences between anxiety and non-anxiety referrals in marital status, employment, or age. Patients with combined anxiety and depression (negative affectivity, N = 42) were more likely to be female, to have a longer psychiatric history, to be younger in age (mean = 43.7), to have shorter hospitalization (10 days), and to have been referred earlier for psychiatric consultation than non-anxious depressed persons (mean = 3.6 days). A reasonable inference is that general hospital physicians perceived greater need or urgency in addressing problems in these patients.
Our findings are similar to the prevalence of anxiety problems in a university setting reported by Gerdes, Yates, & Clancy (1995), approximately a decade ago. These data are also congruent with studies in non-medical settings that suggest anxiety comorbidity in excess of 90%, with mood disorder and substance abuse being prominently represented (Kaufman and Charney, 2000). It should also be noted that prior investigations have found that patients with combined anxiety and depression have greater symptom severity, greater functional impairments, more extensive use of health care resources, and higher rates of suicide (Gorman, 1996; Kaufman & Charney, 2000). Our findings are in accord with inferences regarding lowered adaptive functioning in patients with negative affectivity.
During their typically brief hospitalizations, physicians in general hospitals are confronted by a fairly substantial number of patients with anxiety disorders who present with a history of psychiatric treatment, attendant drug problems, persistent, unexplained somatic complaints and, in particular, depression. These “hard to treat” patients are likely referred for psychiatric consultation.
Consultants in general hospitals should be aware of the constellation of problems that
tend to co-occur with anxiety disorders. In addition to comorbidity, they should also be cognizant of possible long-term sequelae of anxiety in medical patients not addressed in the current study: Coronary heart disease, sudden cardiac death, and recurrent cardiac events after myocardial infarction (Kawachi, sparrow, Vokonas, & Weiss, 1994; Frasure-Smith, Lesperance, & Talajic, 1995).
Frasure-Smith N, lesperance F, Talajic M. (1995). The impact of negative emotions on prognosis following myocardial infarction: Is it more than depression? Health Psychology, 14, 388-398.
Fulop G. (1990). Anxiety disorders in the general hospital setting. Psychiatric Medicine, 8, 187-195.
Gerdes T, Yates WR, Clancy G. (1995). Increasing identification and referral of panic disorder over the past decade. Psychosomatics, 36, 480-486.
Gorman JM. (1996). Comorbid depression and anxiety spectrum disorders. Depression and Anxiety, 4, 160-168.
Kaufman J, Charney D. (2000). Comorbidity of mood and anxiety disorders. Depression and Anxiety, 12, 69-76.
Kawachi I, Sparrow D, Vokonas PS, Weiss ST (1994). Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study. Circulation, 90, 2224-2259.
Yates WR. (1999). Epidemiology of psychiatric disorders in the medically ill. In Yates WR editor. Psychiatric treatment of the medically ill. New York: Marcel Dekker, pp 41-64.
First Published February 2006