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Consultation-Liaison Psychiatrists' Management of Depression

Received May 30, 1997; revised August 25, 1997; accepted September 16, 1997. From the Consultation-Liaison Psychiatry Research Unit, Monash University, Department of Psychological Medicine, Melbourne, Australia. Address reprint requests to Dr. Smith, Monash University Department of Psychological Medicine, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.

Prospective data on 1,360 consecutive inpatients referred to the consultation-liaison psychiatry service of 2 metropolitan general teaching hospitals and diagnosed as having a Depressive Illness Spectrum Disorder were collected by using the MICRO-CARES clinical database system. The distribution of DSM-III-R diagnoses was major depression (MD) 49%; dysthymia (DYS) 15%; organic or substance-induced mood disorder or depressive disorder not otherwise specified (ORG/NOS) 14%; and adjustment disorder with depressed mood (AD) 29%. Antidepressants were prescribed in 59% of the MD cases, 40% of the DYS cases, 36% of the ORG/NOS cases, and 17% of the AD cases. In confirmed MD, antidepressants were prescribed in 69%, and significantly more often in those who were older, female, had a prior history of physical illness, had a neoplasm or a disorder of the nervous or musculoskeletal systems, had higher Axis IV scores, or were referred because of pain or terminal illness. The patients with confirmed MD prescribed antidepressants had a longer length of stay and were referred later than those not prescribed antidepressants. The results illustrate the importance of all of the forms of depression in consultation-liaison psychiatry and the vigor with which all forms are treated.

Key Words: Consultation-Liaison Psychiatry • Depression

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