내과에 입원하여 정신과에 자문의뢰된 우울증 환자의 임상양상

Clinical Characteristics of Consulted Medical Inpatients with Depression

In an attempt to establish some guidelines for psychiatric consultants who work in a general hosp ital setting who frequently are encountered with depressed medical inpatients, authors evaluated a few outstanding clinical characteristics of them . We discussed why these patients seek help at the internal medicine instead of seeking more than adequate help at the psychiatric service. We also tried to visualize who they are. Authors tried to suggest some specific future guidelines for those who work with this kind of patients. The subjects were consisted of 51 medical inpatients who were admitted at the Kang-Nam St.Mary ’s Hospital from Apr. 1，1983 to Jul. 31，1984，who were seen on psychiatric consultation and were apparently suffering from clinical depression. Their clinical characteristics were compared with randomly selected 48 psychiatric inpatients with depression who were hospitalized at the same hospital for the same period. The conclusions were as follows： 1. For their age distribution, medical inpatients with depression group with age over 60(23.5%) were two times greater than psychiatric inpatients with depression group for the same age bracket (10.4%). This result shows current trend that senile depressed patients tend to seek medical help rather than to seek psychiatric help. 2. For their medical diagnostic distribution, medical inpatients with depression frequently received one of the gastrointestinal disorder diagnoses (26. 6%) at the in ternal medicine. After psychiatric consultation,“medical diagnoses，’decreased from 77 .1% to 63.2% and diagnoses of “depression” increased from 6.4% to 27.6% for the medical inpatients. 3. For the depressed female medical inpatients who were seen on psychiatric consultation, marital problems were the most frequently observed psychiatric problems which needed psychiatric attention. This finding appears to reflect women’s trend to express their emotional conflicts in a more subtle and vague physical symptoms of depressive equivalents rather than outright depressed affect itself. 4. Most of the chronic dysthymic disorder patients with multiple physical complaints (62.7%) usually seek medical help rather than psychiatric help. W he compared with this, patients who suffer from depressed affect itself rather than physical symptoms of depression came directly to psychiatric service. 5. Regarding their physical symptom s, both of the depressed medical inpatients and depressed psychiatric inpatients frequently complained of gastrointestinal symptoms, 39.9% and 41.9% respectively. For their frequency and number of phys-ical symptoms, depressed medical in patients complained more of them (3.7 6 ± 1.70) than those of depressed psychiatric inpatients (1.7 3 ± 1 .9 4 ). 6. While they were admitted at the internal medicine, depressed medical inpatien ts frequently recieved antianxiety drugs (80.4%). However, very few of them (9.8%) recieved less than therap-eutic dose of antidepressants before psychiatric consultation. After psychiatric consultation, 74.4% of the recieved antidepressant medication and 45.2% of them were followed-up by psychiatric consultants. Psychiatric diagnosis of“depression” was officially adopted on discharge summary for 44.0% of them . 7. Eventually, 80.096 of the depressed medical in patients who were recommended transfer for psychiatric treatment were transferred to the psychiatric service for proper psychiatric treatment. However, their duration of hosptalization (23.8 ± 14.41 days) was shorter than that of depressed psychiatric inpatients (31.21±21.91 days). These transferred depressed patients who originally seek medical help tends to discharge early as soon as their physical symptoms clear up and before gaining any insight. Those