Delay of diagnosis and treatment in psychiatric patients applying for a disability pension - a challenge for all of us.
In an earlier study in 2002 we showed that of 101 persons applying for a disability pension for psychiatric reasons, a psychiatric diagnosis that affected their ability to work, could only be confirmed in 83%. Furthermore, and even more importantly, only 64% of these cases were receiving any psychiatric treatment and only 20% adequate drug therapy. Since this time there has been a great deal of discussion on the increasing numbers of people receiving a disability allowance in Switzerland.


OBJECTIVE
We evaluated whether, compared to the 2002 situation, application behaviour, expressed in more accurate diagnoses and treatment plans before filing the application for disability pension, has changed.


METHODS
We examined 124 of 132 subjects who were assessed for the Swiss Invalidity Insurance at the psychiatric outpatient department of the University Hospital, Basel in 2004. Eight persons did not agree to participate in the study. The results were compared with the results of our earlier study.


RESULTS
There were some significant differences between the 2002 and 2004 applicants. In 2004, there was a tendency to an even lower proportion of subjects with a psychiatric diagnosis affecting their ability to work (73% vs 83%, p <.1). Of these applicants, significantly more than in the previous study reported taking specific psychiatric medication (74% vs 50%, p <.01). However, the proportion of patients, who were sufficiently medicated as documented by adequate drug serum levels (37%) or who were receiving any form of psychotherapy in a broad sense (30%), was still fairly low. Furthermore, there was a lower proportion of affective disorders as the primary diagnosis (49% vs 62%, p <.1).


CONCLUSIONS
The findings from our earlier study, namely, that psychiatric applicants for a disability pension were not sufficiently diagnosed and treated before the application, could largely be replicated. Only minor changes could be observed over the last couple of years, with psychotropic medications being taken by more applicants, which might partly be due to the ongoing discussion.
Private Psychiatric Hospital Hohenegg, Meilen, Switzerland. tabea.apfel@hohenegg.ch
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T
Apfel
Anita
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Richer-Rössler
D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000628:therapy; D010415:Pensions / Q000706:statistics & numerical data; D011613:Psychotherapy; D013557:Switzerland; D013997:Time Factors; D014938:Work Capacity Evaluation