Depression in general hospital inpatients: challenges for consultation-liaison psychiatry

Abstract

The Study of Brief Opportunity Intervention (EIBO) performed a series of randomized clinical trials with patients admitted to the Clinical Hospital of the State University of Campinas (UNICAMP) in Brazil. As part of this research project we screened all patients by means of the Hospital Anxiety and Depression Scale (HAD). The first 50 cases of depressive episode confirmed by the Mini International Neuropsychiatric Interview were given standardized information about depression and referred to a public health service to start treatment for depressive disorder. In spite of the limitations of this assessment strategy, it made possible to contact all patients, including those living far from the hospital. The criterion used for depression improvement was a decrease of at least 50% on the HAD depression score. Statistical analyses were performed using STATA version 7.0. Patients' mean age was 49.3 years old. Infections, malign neoplasms, renal and gastrointestinal diseases were the major reasons for hospitalization, most of which were associated with underlying diseases. After six months of discharge, five patients died, six could not be contacted by telephone and one refused to participate in a new interview. Out of 38 reassessed patients, 44.7% received treatment for depression, 58% of whom an antidepressant medication. Our findings raise the awareness of psychiatrists to create politically effective strategies in order to claim workspaces in general hospitals, in addition to university services. Regarding depressive disorders, there are three challenges for the consultation liaison psychiatrist: a) to accurately diagnose depressive disorders in comorbidity situations; b) to teach health professionals about how depression is related to other clinical diseases; and c) to define who treats, and in which way, depressive episodes in comorbid physical diseases. (PsycINFO Database Record (c) 2016 APA, all rights reserved)