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Objective: The hospitalization of patients for medical reasons potentially generates enormous psychological stress and may evoke psychiatric pathology of the affective/anxiety-spectrum. It is well known that affective disorders are very common diagnoses among somatically ill patients. Here, we further investigated the characteristics of depression and anxiety in hospital patients by studying data from a large sample of psychiatric consultations of medical inpatients. Methods: In a prospective, observational design we collected and analyzed data from 890 psychiatric consultations of somatically ill hospital patients, who required psychiatric assessment by consultation-liaison services due to acute psychopathology. Only data that were collected as part of the routine psychiatric care were processed for this study. Patients were seen in two German hospitals, Klinikum Forchheim and University Clinic Erlangen. More than 90% of consultations were carried out by the same three psychiatrists. Results: Affective disorders were the most common diagnoses given to patients as a result of the consultation (39.2%). A further 10.4% of patients suffered from reaction to severe stress and adjustment disorders and 7.7% suffered from anxiety disorders. More than 80% of patients with disorders of the affective/anxiety spectrum required further treatment following the consultation, and 36.1% of patients with affective disorders required inpatient psychiatric treatment. Relatively few patients had received regular psychiatric treatment or psychotherapy prior to the hospital stay (24.8% for affective disorders, 19.1% for anxiety disorders and 9.2% for reaction to severe stress and adjustment disorders), yet 82.5% of patients had a pre-existing psychiatric diagnosis. Conclusion: Our findings underline the potential of a medical hospital stay to trigger substantial psychiatric symptoms in patients with and without a pre-known psychiatric diagnosis. Patients with a pre-existing diagnosis of affective or anxiety disorders seem to be at particular risk of developing psychopathology in the course of a somatic hospital stay. Better routine psychiatric care is needed to prevent the development or exacerbation of psychopathology in hospital patients.