Psychotic symptoms in an urban general medicine practice.
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.


METHODS
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.
Olfson
Mark
M
College of Physicians and Surgeons of Columbia University and New York State Psychiatric Institute, New York 10032, USA. mo49@columbia.edu
Lewis-Fernández
Roberto
R
Weissman
Myrna M
MM
Feder
Adriana
A
Gameroff
Marc J
MJ
Pilowsky
Daniel
D
Fuentes
Milton
M
D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D006304:Health Status; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011619:Psychotropic Drugs / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data*
D011619:Psychotropic Drugs