Neurological disease, emotional disorder, and disability: they are related: a study of 300 consecutive new referrals to a neurology outpatient department

Objectives-To determine the prevalence of anxiety and depressive disorders in patients referred to general neurology outpatient clinics, to compare di sability and number of somatic symptoms in patients with and without emotio nal disorder, the relation to neurological disease, and assess the need for psychiatric treatment as perceived by patients and doctors. Methods-A prospective cohort study set in a regional neurology service in E dinburgh, Scotland. The subjects were 300 newly referred consecutive outpat ients who were assessed for DSM IV anxiety and depressive disorders (PRIME- MD, and HAD), health status, and disability (SF-36), and patients', GPs' an d neurologists' ratings of the need for patient to receive psychiatric or p sychological treatment. Results-Of 300 new patients, 140 (47%) met criteria for one or more DSM IV anxiety or depressive diagnosis. Major depression was the most common (27%) , A comparison of patients with and without emotional disorder showed that physical function, physical role functioning, bodily pain, and social funct ioning were worse in patients with emotional disorders (p<0.0005). The medi an number of somatic symptoms was greater in patients with emotional disord ers (p<0.0005). These differences were independent of the presence of neuro logical disease. Few patients wished to receive psychiatric or psychologica l treatments. Both general practitioners and neurologists were more likely to recommend psychiatric treatment when the patients' symptoms were medical ly unexplained. Conclusions-Almost half of new referrals to general neurology clinics met c riteria for a DSM IV psychiatric diagnosis. These patients were more disabl ed, and had more somatic symptoms. They expressed little enthusiasm for rec eiving psychiatric treatment.