DETECTION AND TREATMENT OF PSYCHIATRIC-ILLNESS IN A GENERAL MEDICAL WARD - A MODIFIED COST-BENEFIT-ANALYSIS

This article describes a prospective, randomized, controlled trial of screening and treatment for psychiatric disorder in medical in-patient s. The study has assessed whether increased recognition of psychiatric disorder among medical in-patients improves clinical outcome and redu ces the costs of care, and whether routine involvement of a psychiatri st in the assessment and care of medical in-patients with probable psy chiatric disorder is superior to the efforts of the physicians alone. A total of 218 medical in-patients who scored over the screening thres hold for psychiatric disorder on the General Health Questionnaire were randomly allocated to one of two intervention groups or a control gro up. Six months later their mental health, subjective health status, qu ality of life, and costs of care was reassessed. Mental health and qua lity of life at 6 months were similar in the two intervention groups a nd the control group. Patients whose physicians were told the results of the screening test had lower costs for subsequent admissions, but t his was probably due to differences between the groups in terms of emp loyment status. Treatments recommended by psychiatrists broke down whe n patients were discharged home, leading to inadequate treatment of ps ychiatric disorders. We have not been able to show that routine screen ing for psychiatric disorder produces any benefit, either in better ou tcome for patients or reduced costs for the NHS. Further research shou ld: consider examining a more homogeneous group in terms of costs of c are; screen only for disorders likely to respond to a specific treatme nt; and ensure that treatment recommendations are carried out. (C) 199 8 Elsevier Science Inc.