title: The presence of psychiatric disorders reduces the likelihood of neurologic disease among referrals to a neurology clinic.
abstract: OBJECTIVE
  This study aims to explore the prevalence and impact of psychiatric disorders on the likelihood of an organic, neurological explanation for symptoms among neurology referrals.
  
  
  METHODS
  Consecutive new adult neurology referrals were screened for psychiatric disorders (PRIME-MD) prior to evaluation by neurologists, blinded to these results. Diagnoses were stratified into three categories: no neurological diagnosis, neurological-headache, and neurological-nonheadache.
  
  
  RESULTS
  Of 235 patients enrolled, 79 (34%) received no neurological diagnosis, 54 (23%) headache and 102 (43%) a neurological diagnosis. Overall, 39% had an underlying psychiatric disorder. Patients with psychiatric disorders were less likely to have a neurological diagnosis (RR: 0.66, 95% CI: 0.48-0.90): 25% of patients with a neurological diagnosis had an underlying psychiatric disorder, compared to 43% among those with no diagnosis and 57% among those with headaches.
  
  
  CONCLUSIONS
  Psychiatric disorders are common among neurology referrals, particularly those with headaches and are associated with a decreased likelihood of an underlying neurological process.
authors.affiliation: General Internal Medicine Service, Walter Reed Army Medical Center, Washington, DC, USA. john.ekstrand@cen.amedd.army.mil
authors.forename: John R
authors.initials: JR
authors.lastname: Ekstrand
authors.forename: Patrick G
authors.initials: PG
authors.lastname: O'Malley
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Labutta
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Jackson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009462:Neurology / Q000379:methods*; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology*