Psychotic symptoms in an urban general medicine practice

Mark Olfson, Roberto Lewis-Fernández, Myrna M. Weissman, Adriana Feder, Marc J. Gameroff, Daniel Pilowsky, Milton Fuentes

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Abstract

Objective: The authors' goals were to estimate the prevalence of psychotic symptoms among adults attending an urban general medical practice that serves a low-income population and to describe the mental health, social and occupational functioning, and mental health treatment of these patients. Method: Data were drawn from a recent study of adult primary care patients (N = 1,005) in a large, urban, university-affiliated general medicine practice. During a medical visit, patients completed the psychotic disorders section of the Mini International Neuropsychiatric Interview, the Primary Care Evaluation of Mental Disorders, a drug use disorders screen, the Sheehan Disability Scale, and a questionnaire that probed demographic characteristics, health status, and mental health treatment. Results: Two hundred ten (20.9%) patients reported one or more psychotic symptoms, most commonly auditory hallucinations. There was an inverse correlation between family income and the prevalence of psychotic symptoms and a positive association between prevalence and Hispanic ethnicity. Compared with patients without psychotic symptoms, patients with psychotic symptoms were significantly more likely to have major depression (42.4% versus 12.6%), panic disorder (24.8% versus 4.0%), generalized anxiety disorder (38.6% versus 8.4%), and alcohol use disorder (12.9% versus 5.0%). They were also more likely to report current suicidal ideation (20.0% versus 3.5%), recent work loss (55.0% versus 35.6%), and marital distress (28.6% versus 13.0%). Approximately one-half of the patients with psychotic symptoms (47.6%) had taken a prescribed psychotropic medication during the last month. Conclusions: Psychotic symptoms were highly prevalent in this primary care practice. These patients were at risk for several common mental disorders and often reported impaired work and social functioning. Future research should clarify the extent to which psychotic symptom reports among Hispanic patients are affected by culturally patterned idioms of distress. Clinicians who work in primary care practices that serve low-income patient populations should routinely inquire about psychotic symptoms.

Original languageEnglish
Pages (from-to)1412-1419
Number of pages8
JournalAmerican Journal of Psychiatry
Volume159
Issue number8
DOIs
StatePublished - 12 Aug 2002

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General Practice
Medicine
Primary Health Care
Mental Health
Poverty
Hispanic Americans
Mental Disorders
Suicidal Ideation
Panic Disorder
Hallucinations
Occupational Health
Anxiety Disorders
Psychotic Disorders
Health Status
Substance-Related Disorders
Alcohols
Demography
Interviews
Depression
Therapeutics

Cite this

Olfson, M., Lewis-Fernández, R., Weissman, M. M., Feder, A., Gameroff, M. J., Pilowsky, D., & Fuentes, M. (2002). Psychotic symptoms in an urban general medicine practice. American Journal of Psychiatry, 159(8), 1412-1419. https://doi.org/10.1176/appi.ajp.159.8.1412
Olfson, Mark ; Lewis-Fernández, Roberto ; Weissman, Myrna M. ; Feder, Adriana ; Gameroff, Marc J. ; Pilowsky, Daniel ; Fuentes, Milton. / Psychotic symptoms in an urban general medicine practice. In: American Journal of Psychiatry. 2002 ; Vol. 159, No. 8. pp. 1412-1419.
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abstract = "Objective: The authors' goals were to estimate the prevalence of psychotic symptoms among adults attending an urban general medical practice that serves a low-income population and to describe the mental health, social and occupational functioning, and mental health treatment of these patients. Method: Data were drawn from a recent study of adult primary care patients (N = 1,005) in a large, urban, university-affiliated general medicine practice. During a medical visit, patients completed the psychotic disorders section of the Mini International Neuropsychiatric Interview, the Primary Care Evaluation of Mental Disorders, a drug use disorders screen, the Sheehan Disability Scale, and a questionnaire that probed demographic characteristics, health status, and mental health treatment. Results: Two hundred ten (20.9{\%}) patients reported one or more psychotic symptoms, most commonly auditory hallucinations. There was an inverse correlation between family income and the prevalence of psychotic symptoms and a positive association between prevalence and Hispanic ethnicity. Compared with patients without psychotic symptoms, patients with psychotic symptoms were significantly more likely to have major depression (42.4{\%} versus 12.6{\%}), panic disorder (24.8{\%} versus 4.0{\%}), generalized anxiety disorder (38.6{\%} versus 8.4{\%}), and alcohol use disorder (12.9{\%} versus 5.0{\%}). They were also more likely to report current suicidal ideation (20.0{\%} versus 3.5{\%}), recent work loss (55.0{\%} versus 35.6{\%}), and marital distress (28.6{\%} versus 13.0{\%}). Approximately one-half of the patients with psychotic symptoms (47.6{\%}) had taken a prescribed psychotropic medication during the last month. Conclusions: Psychotic symptoms were highly prevalent in this primary care practice. These patients were at risk for several common mental disorders and often reported impaired work and social functioning. Future research should clarify the extent to which psychotic symptom reports among Hispanic patients are affected by culturally patterned idioms of distress. Clinicians who work in primary care practices that serve low-income patient populations should routinely inquire about psychotic symptoms.",
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Olfson, M, Lewis-Fernández, R, Weissman, MM, Feder, A, Gameroff, MJ, Pilowsky, D & Fuentes, M 2002, 'Psychotic symptoms in an urban general medicine practice', American Journal of Psychiatry, vol. 159, no. 8, pp. 1412-1419. https://doi.org/10.1176/appi.ajp.159.8.1412

Psychotic symptoms in an urban general medicine practice. / Olfson, Mark; Lewis-Fernández, Roberto; Weissman, Myrna M.; Feder, Adriana; Gameroff, Marc J.; Pilowsky, Daniel; Fuentes, Milton.

In: American Journal of Psychiatry, Vol. 159, No. 8, 12.08.2002, p. 1412-1419.

Research output: Contribution to journalArticleResearchpeer-review

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Olfson M, Lewis-Fernández R, Weissman MM, Feder A, Gameroff MJ, Pilowsky D et al. Psychotic symptoms in an urban general medicine practice. American Journal of Psychiatry. 2002 Aug 12;159(8):1412-1419. https://doi.org/10.1176/appi.ajp.159.8.1412