NEWLY IDENTIFIED PSYCHIATRIC-ILLNESS IN ONE GENERAL-PRACTICE - 12-MONTH OUTCOME AND THE INFLUENCE OF PATIENTS PERSONALITY

Background. Relatively little is known about the natural history and o utcome of psychological problems in patients who present to general pr actioners. Only a small proportion of such patients are seen by specia lists. Clinical experience suggests that patient personality is one of the factors influencing outcome in patients diagnosed as having psych iatric illness. Aim. This study set out to examine prospectively the p rogress and 12-month outcome of patients with newly identified psychia tric illness, and the association of patients' personality with outcom e. Method. One hundred and seventy one patients with clinically signif icant psychiatric illness attending one practice in a Scottish new tow n were followed up prospectively (96 presented with psychological symp toms and 75 with somatic symptoms), and were compared with a group of 127 patients with chronic physical illness. Patients were assessed in terms of psychiatric state, social problems and personality using both computer-based and pencil and paper tests in addition to clinical ass essments at each consultation during the follow-up year and structured interview one year after recruitment. Results. Most of the improvemen t in psychiatric state scores on the 28-item general health questionna ire occurred in the first six months of the illness. Of the 171 patien ts with psychiatric illness 34% improved quickly and remained well, 54 % had an intermittent course but had improved at 12-month follow up wh ile 12% pursued a chronic course without improvement. The mean number of consultations in the follow-up year was 8.4 for patients presenting with psychological symptoms, 7.2 for those presenting with somatic sy mptoms and 6.6 for patients with chronic physical illness. The Eysenck N score proved a strong predictor of the outcome of new psychiatric i llness. Conclusion. Only one in three patients with newly identified p sychiatric illness improved quickly and and remained well, reflecting the importance of continuing care of patients with psychological probl ems. This study has confirmed the feasibility of simple personality te sting in everyday practice and shown a link between Eysenck N score an d the outcome of new psychiatric illness. The predictive value of the Eysenck N score in general practice requires further research.