Cognitive screening tests for organic mental disorders in psychiatric inpatients. A hopeless task?

Bedside cognitive screening tests have been suggested as a way to quickly determine the likelihood of a patient's having an organic mental disorder (OMD). The Mini-Mental State (MMS) examination and a number of separate bedside neurobehavioral tests were administered to 206 patients who were consecutively admitted to the University of Iowa Psychiatric Hospital. Both examinations were completed by 150 subjects. Of the sample, 7% had an OMD diagnosis. The most frequent neurological causes of OMD were probable Alzheimer's and closed head trauma. The predictive value positive, predictive value negative, specificity, and sensitivity of the MMS were examined for a number of different cutoff scores. The maximum sensitivity was 75% with a cutoff score of 30. The maximum specificity was 100% with a cutoff of 12. However, only two OMD patients had scores less than 12. There was no cutoff that resulted in a clinically useful screening test. A stepwise multiple logistic regression model using the separately administered bedside tests as independent variables and OMD as the dependent variable resulted in two significant predictors of an OMD diagnosis: the alternating sequence test and a reading test. This model was not appreciably better than the MMS in predicting an OMD diagnosis. A number of problems make the development of a clinically useful cognitive screening test for OMD in inpatients unlikely. These include poor cooperation of the patients, the rarity of OMD in psychiatric inpatients, the heterogeneity of OMD etiologies, and the confounding neuropsychological deficits of a number of common psychiatric disorders.

Memory complaints and memory deficits in young and old psychiatric inpatients

Memory complaints and memory deficits were investigated in 206 consecutively admitted psychiatric inpatients at the University of Iowa Psychiatric Hospital. Forty-five percent of patients over age 60 years and 29% of patients less than 60 years old had severe memory complaints. Patients with complaints of memory loss were no more likely than patients without such complaints to have a memory deficit. In patients over age 60 years, memory complaint was more common in depression than in dementing and amnestic disorders (73% v 43%), while in younger patients memory complaint was slightly more common in dementing and amnestic disorders than in depression (57% v 41%). Increasing age was significantly correlated with increasing likelihood of memory complaint for depressed patients but not for nondepressed patients. As a result of these findings, memory complaint was found to be a statistically significant marker for depression in the elderly (sensitivity = 73%, specificity = 75%) but not in younger patients. Our results confirm the clinical observation that memory complaints are a useful marker for depressed states in the elderly.

Somatization, depression and medical illness in psychiatric inpatients

In a study to determine the relationship between somatic symptoms and psychiatric diagnosis, 206 consecutively admitted inpatients at the University of Iowa Psychiatric hospital were given a structured medical history (MH) and physical examination (PE). Depressed patients were significantly older, had an increase in number of medical diagnoses (NDX), and were found to have a significant increase in somatic symptoms in which there was no confirmatory evidence on the PE and in which there was confirmation on the PE. When age, sex, and NDX were controlled for, depressed patients did not have an increase in either of the types of somatic symptoms noted above but did have a slight increase in the vague somatic symptoms in which PE findings would be unlikely. Our results suggest that the majority of the increases in somatic symptoms in depressed patients may not be due to depressive psychopathology but rather to their increased number of medical problems and increased age.