Clinical Predictors of Psychopathology

Abstract

Psychiatric disorders affect up to one third of patients with non-psychiatric diseases.1-5 Nevertheless, despite the high prevalence of psychopathology in general medical patients, only between 30-50% of all cases are detected.2,6-8 Some have suggested that the difficulty in the detection and diagnosis of mental disorders among patients who seek medical attention for other reasons, lies in the lack of screening questions that might alert the physician to the possibility of a psychiatric co-morbidity.9 Such questions would identify medical patients at high risk of psychiatric problems. Previous work on clinical predictors of psychopathology have identified the following: specific physical symptoms10-11; patient report of severity of illness11; recent stress12,13; low self-perception of health status13; and age less than 50.14 Two specific studies on the detection of psychopathology in the general medical population are worth highlighting. The first, by Jackson and his research team13 updating a 2001 study evaluating a prediction model with four parameters (recent stress, severity of physical symptoms, five or more specific symptoms, self-assessment of physical condition). They found that those patients who report recent stress, have five or more physical symptoms or a low self-perception of their health state are at a higher risk of having a psychiatric disorder. The second study, by Lowe et al. published in 2003,9 examines a series of factors that could serve as indicators of psychopathology in ambulatory medical (i.e. non-psychiatric) patients. After evaluating several different models they found that the combination of four of factors (taken as a group) had a high sensitivity (86%), specificity (100%), positive predictive value (100%), and negative predictive value (91%). This suggests that a physician could use the combination of these four indicators to evaluate for the presence of co morbid mental disorders. These factors are: self-reported tension/anxiety/stress present at least 14 days of the past four weeks, a sensation of sadness/despair at least 14 days of the past two weeks, three or more physical symptoms, and relationships troubles. This research sought to identify clinical characteristics associated with psychopathology in a sample of Mexico City’s general population. Our goal was to find predictors that would in the detection of mental health problems amongst non-psychiatric patients.