Abstract
Background: Physical and psychiatric disorder frequently co-exist in general hospital, primary care and community studies. Patients with chronic medical conditions are twice as likely to report psychiatric disorder as controls. Of general practice (GP) patients with psychiatric disorder, two-thirds will have a co-morbid physical condition. This increase cannot be entirely explained by differences in help seeking behaviour or recognition rates. The presence of physical illness in patients attending their GP for psychiatric disorders predicts poor outcome one-year later. Whereas just over half of patients with no medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to only 20% in patients with five or more medically explained symptoms.
Conclusions: Physical ill-health makes an independent contribution to psychological outcome. Recognition is improved by using diagnostic criteria and instruments that take into account the overlap between physical and psychiatric symptoms such as changes in memory, concentration and energy. Other interventions include the use of newer anti-depressants which are tolerated more readily by physically ill patients and CBT. Consultation-liaison services in primary care need to address the specific needs of patients with psychiatric and physical co-morbidity in a similar way to consultation-liaison services in general hospitals.