Psychiatric morbidity among medical out-patients in Spain: a case for new methods of classification

A study was carried out to document the psychiatric disturbances among consecutive first-day attenders to an internal medicine out-patient clinic in Spain. Subjects were interviewed in three different stages using standardized procedures, basically the Clinical Interview Schedule (CIS). As hypothesized, the rate of disturbances was high (46.9%) and their classification with ICD-9 criteria was problematic. Minor affective disturbances were the most common diagnoses; the distribution of anxiety and depression scores followed the 'two correlated dimensions' model. The psychopathological differences between 'cases' and 'non-cases' seemed quantitative rather than qualitative. Absence of organicity, a pattern of multiple consultations and social problems were more frequent among the 'cases'. These data support the use of multiaxial classificatory systems. Ten supervised interviews significantly improved the internist recognition of 'cases' and the suggestion is made that a single routine question about the patients' mood would sensibly improve the detection rates.