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Psychiatric comorbidity is common among patients admitted to the general medicine service of a hospital with the prevalence ranging anywhere from 15% to 50%. These patients receive more diagnostic tests, have longer lengths of stay, and have higher hospital costs compared with patients who have no comorbidity. Researchers from New York-Presbyterian Hospital Weill Medical College of Cornell University have developed a screening tool to assess a range of psychiatric conditions in medical patients, including cognition and behavior, depressive symptoms, anxiety, drug and alcohol history, and the patient's desire to see a psychiatrist. The Cornell Psychiatric Screen is published in the current issue of Psychosomatics.
This brief screening instrument was designed to be administered by nonpsychiatrists. It consists of seven items requiring information that is readily available upon admission and can quickly and reliably identify hospitalized patients with underlying psychiatric comorbidity who are in need of a psychiatric evaluation. The questionnaire was developed and tested in four phases: selection of candidate items, test-retest reliability, selection of final items, and validation. After the scale was developed, its properties were tested among three independent cohorts of patients (N=106, N=299, N=206).
The Cornell screen is short and easy to administer. Two of the questions are clinician observations (noting confusion or hallucinations/delusions/bizzare thoughts) and 5 are self report by the patient (questions about feeling nervous, depressed, alcohol or substance abuse and desire to see a psychiatrist)
A number of studies of psychiatric screening and consultation have shown improved psychiatric outcomes, earlier discharge, and cost savings to the hospital. The earlier the consultation, the better the results. The reality in everyday practice is that fewer than 5% of medical inpatients receive psychiatric intervention. It is suggested that this is due to factors such as underidentification of psychiatric symptoms and stigmatization of psychiatric intervention by physicians and patients.
Some of the positive aspects of the screener e.g. that it is brief, easy to administer and has a self-report component built in, may be the very drawbacks that can limit it. Relying on patient self-report and not on clinician findings has always been questioned as consistent and reliable data and the brevity of the scale can result in certain conditions not being detected (adjustment disorders, panic disorder, and suicide attempts). In spite of these limitations, of the medical patients that were identified by the Cornell Psychiatric Screen as having psychopathology, 89% had documented psychiatric comorbidity according to DSM-IV criteria.
In the absence of any other brief screening tool that medical staff can use to screen for the presence of psychiatric issues, this appears to be a useful tool for identifying patients who require a psychiatric evaluation. The ultimate goal is to improve the quality of medical care and reduce the length of stay.
Medscape Medical News recently conducted an interview with one of the authors of the study, Stephen J. Ferrando, M.D. (registration free but required)
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