LONG-TERM OUTCOME OF PATIENTS WITH NEUROTIC ILLNESS IN GENERAL-PRACTICE

Objective-To determine the 11 year outcome of neurotic disorder in gen eral practice. Design-Cohort study over 11 years. Setting-Two general practices in Warwickshire England. Subjects-100 patients selected to b e representative of those identified nationally by general practitione rs as having neurotic disorders. Main outcome measures-Mortality, morb idity, and use of health services. Results-At 11 years 87 subjects wer e traced. The 11 year standardised mortality ratio was 173 (95% confid ence interval 164 to 200). 47 were cases on the general health questio nnaire, 32 had a relapsing or chronic psychiatric course, and 49 a rel apsing or chronic physical course. Treatment for psychiatric illness w as mainly drugs. The mean number of consultations per year was 10.8 (m edian 8.7). A persistent psychiatric diagnosis at one year follow up w as associated with high attendance (>12 visits a year for 11 years) at follow up after age, sea, and physical illness were adjusted for. Sev erity of psychiatric illness (general health questionnaire score) at o utset predicted general health questionnaire score at 11 year follow u p, course of psychiatric illness, and high consultation rate. Conclusi on-These data support the view that a neurotic illness can become chro nic and is associated with raised mortality from all causes and high u se of services. Such patients need effective intervention, particularl y those with a more severe illness who do not recover within one year.