Summary
Objective
There are different data on the frequency of psychiatric diagnosis in emergency medicine. The reported data range from 3 to 10% based on the records of the emergency physicians. Studies in GPs’ primary care showed a psychiatric diagnosis in more than 40% of patients.
Question
Is it possible to find better data of psychiatric diagnosis in emergency medicine using a special psychiatric instrument (patient health questionnaire, PHQ)?
Methods
A total of 169 patients of an emergency medical service in Germany were asked about their psychopathologic condition using PHQ. We made a comparison of these data with the records written by the emergency physicians.
Results
In all 48 records could be used in the complete analysis. Findings of psychiatric distinctive features were 53.6% (male) and 65.0% (female) respectively. In detail, rates for depression were 32.1% (male) and 55.0% (female), rates for panic disorder were 21.4% (m) and 50.0% (f), and for anxiety 14.3% (m) and 50.0% (f).
Discussion
A psychiatric diagnostic instrument could be useful when diagnosing psychiatric basics of emergency medical patients. It could be helpful for economical use of resources.
Zusammenfassung
Einleitung
Die Häufigkeit von Patienten mit psychiatrischen Diagnosen und ihre Relevanz im Notarztdienst ist umstritten. Die veröffentlichten Zahlen bewegen sich zwischen 3 und 11%. Als Basis solcher Auswertungen dienten bislang die Angaben der Notärzte im Einsatzprotokoll. In Allgemeinarztpraxen finden sich bei geeigneter Untersuchungstechnik dagegen bei bis zu 40% der akut vorgestellten Patienten eine relevante psychiatrische Störung.
Fragestellung
Lassen sich durch Einsatz eines Untersuchungsinstrumentes (Patient Health Questionnaire, PHQ) neue Daten zu Häufigkeit und Bedeutung psychiatrischer Diagnosen im Notarztdienst erheben?
Methodik
169 Notarztpatienten wurden bezüglich psychiatrischer (Co-)Diagnosen mittels PHQ retrospektiv befragt und die Ergebnisse mit den Angaben auf dem Notarzteinsatzprotokollen verglichen.
Ergebnisse
Bei 48 Patienten konnten die Antworten ausgewertet werden. Es fanden sich bei 53,6% der Männer und 65,0% der Frauen Hinweise auf das Vorliegen einer oder mehrerer psychiatrischer Erkrankungen.
Diskussion
Die erhobenen Zahlen weichen deutlich von den epidemiologischen Angaben ab, die aufgrund der Notarzteinsatzprotokolle bislang veröffentlicht wurden. Der Gebrauch eines diagnostischen Instrumentes wie es der PHQ darstellt, kann auch dem psychiatrisch wenig Erfahrenen helfen, wenig offensichtliche psychiatrische (Co-)Diagnosen zu detektieren. In der Notfallmedizin lassen sich dadurch Ressourcen möglicherweise optimaler nutzen.
Similar content being viewed by others
References
Arolt V, Driessen M, Bangert-Verleger A, Neubauer H, Schurmann A, Seibert W (1995) Psychiatric disorders in hospitalized internal medicine and surgical patients. Prevalence and need for treatment. Nervenarzt 66:670–677
Ballas CA, Staab JP (2003) Medically unexplained physical symptoms: toward an alternative paradigm for diagnosis and treatment. CNS Spectr 8:20–26
Cavanaugh SV (1986) Psychiatric emergencies. Med Clin North Am 70:1185–1202
Chan KS, Orlando M, Ghosh-Dastidar B, Duan N, Sherbourne CD (2004) The interview mode effect on the Center for Epidemiological Studies Depression (CES-D) scale: an item response theory analysis. Med Care 42:281–289
Dammen T, Ekeberg O, Arnesen H, Friis S (1999) The detection of panic disorder in chest pain patients. Gen Hosp Psychiatry 21:323–332
De Clercq M, Dubois V, Brusselmans M, Heymans JP, Hoyois P, el Gariani A, Marion E, Meert P (1996) Emergencies and somatization. Acta Clin Belg 51:135–143
Edlund MJ, Unutzer J, Wells KB (2004) Clinician screening and treatment of alcohol, drug, and mental problems in primary care: results from healthcare for communities. Med Care 42:1158–1166
Gregory RJ, Nihalani ND, Rodriguez E (2004) Medical screening in the emergency department for psychiatric admissions: a procedural analysis. Gen Hosp Psychiatry 26:405–410
Halverson J, Chan C (2004) Screening for psychiatric disorders in primary care. Wmj 103:46–51
Johnson JG, Harris ES, Spitzer RL, Williams JB (2002) The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health 30:196–204
Knockaert DC, Buntinx F, Stoens N, Bruyninckx R, Delooz H (2002) Chest pain in the emergency department: the broad spectrum of causes. Eur J Emerg Med 9:25–30
Knusel H (1993) Emergency: the internist as psychiatrist. Schweiz Med Wochenschr 123:807–811
Konig F, Konig E, Wolfersdorf M (1996) Zur Häufigkeit des psychiatrischen Notfalls im Notarztdienst. Notarzt 12:12–17
Kroenke K, Spitzer RL, Williams JB (2002) The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 64:258–266
Lowe B, Grafe K, Zipfel S, Spitzer RL, Herrmann-Lingen C, Witte S, Herzog W (2003) Detecting panic disorder in medical and psychosomatic outpatients: comparative validation of the Hospital Anxiety and Depression Scale, the Patient Health Questionnaire, a screening question, and physicians’ diagnosis. J Psychosom Res 55:515–519
Lowe B, Grafe K, Zipfel S, Witte S, Loerch B, Herzog W (2004) Diagnosing ICD-10 depressive episodes: superior criterion validity of the Patient Health Questionnaire. Psychother Psychosom 73:386–390
Lowe B, Spitzer RL, Grafe K, Kroenke K, Quenter A, Zipfel S, Buchholz C, Witte S, Herzog W (2004) Comparative validity of three screening questionnaires for DSM-IV depressive disorders and physicians’ diagnoses. J Affect Disord 78:131–140
Moecke H, Dirks B, Friedrich HJ, Hennes HJ, Lackner CK, Messelken M, Neumann C, Pajonk FG, Reng M, Schachinger U, Violka T (2000) DIVI emergency medicine protocol, version 4.0. Anaesthesist 49:211–213
Pajonk FG, Bartels HH, Biberthaler P, Bregenzer T, Moecke H (2001) Psychiatric emergencies in preclinical emergency service; incidence, treatment and evaluation by emergency physicians and staff. Nervenarzt 72:685–692
Pajonk FG, Grunberg KA, Paschen HR, Moecke H (2001) Psychiatric emergencies in the physician-based system of a German city. Fortschr Neurol Psychiatr 69:170–174
Pajonk FG, Lubda J, Sittinger H, Moecke H, Andresen B, Von Knobelsdorff G (2004) Assessment of psychiatric emergencies by physicians in the pre-hospital emergency medical systemA re-evaluation after 7 years. Anaesthesist 53:709–716
Pajonk FG, Riemenschneider O, Moecke H (2001) Evaluation of a training program “Psychiatry for EmergencyPhysicians”. Anasthesiol Intensivmed Notfallmed Schmerzther 36:105–109
Picardi A, Amerio P, Baliva G, Barbieri C, Teofoli P, Bolli S, Salvatori V, Mazzotti E, Pasquini P, Abeni D (2004) Recognition of depressive and anxiety disorders in dermatological outpatients. Acta Derm Venereol 84:213–217
Poloczek S, Schmitt TK, Pajonk FG (2001) Psychiatrische Notfälle und psychosoziale Krisen. Notfall, Rettungsmedizin 2001:352–358
Purcell TB (1991) The somatic patient. Emerg Med Clin North Am 9:137–159
Rief W, Nanke A, Klaiberg A, Braehler E (2004) Base rates for panic and depression according to the Brief Patient Health Questionnaire: a population-based study. J Affect Disord 82:271–276
Ronckers C, Land C, Hayes R, Verduijn P, van Leeuwen F (2004) Factors impacting questionnaire response in a Dutch retrospective cohort study. Ann Epidemiol 14:66–72
Russell AS, Hui BK (2005) The use of PRIME-MD questionnaire in a rheumatology clinic. Rheumatol Int 25:292–295
Sefrin P (2003) Der Notarztdienst als interdisziplinäre Aufgabe—Notärzte entstammen allen Fachgebieten. Notfall Medizin 29:528–529
Spitzer RL, Kroenke K, Williams JB (1999) Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Jama 282:1737–1744
Staab JP, Datto CJ, Weinrieb RM, Gariti P, Rynn M, Evans DL (2001) Detection and diagnosis of psychiatric disorders in primary medical care settings. Med Clin North Am 85:579–596
Tonn P, Reuter S, Treder B, Dahmen N (2004) Die präklinische Behandlung von akut erregten, deliranten oder psychotischen Patienten durch den Notarzt. Notfall, Rettungsdienst 7:484–492
Weich S, Lewis G, Donmall R, Mann A (1995) Somatic presentation of psychiatric morbidity in general practice. Br J Gen Pract 45:143–147
Williams LS, Brizendine EJ, Plue L, Bakas T, Tu W, Hendrie H, Kroenke K (2005) Performance of the PHQ-9 as a screening tool for depression after stroke. Stroke 36:635–638
Wincata J, Weiss M, Marquart B, Alexandrowicz R (2004) Screening instruments for general hospital and primary care patients. Adv Psychosom Med 26:74–97
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tonn, P., Gerlach, N., Reuter, S. et al. Häufigkeit von psychiatrischen Diagnosen in der retrospektiven Untersuchung von Notarztpatienten. Intensivmed 43, 123–129 (2006). https://doi.org/10.1007/s00390-006-0650-0
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00390-006-0650-0