Cornell Psychiatric Screen Validated: A Newsmaker Interview With Stephen J. Ferrando, MD - Commentary by Fred A. Baughman Jr., MD

[Fred A. Baughman Jr., MD:
In reading this be aware the esteemed New
York-Presbyterian Hospital funded this study. Dr. Ferrando has
received honoraria from Pfizer, Merck, Sharp & Dohme, and Bristol-Myers
Squibb. The article appeared in Psychosomatics. 2003:44:382-387

Also be aware of the caveat from Vera Sharav: "The unthinkable is possible
when medicine deviates from the physician's personal oath to patients to "do
no harm." When medicine serves government or corporate agendas illegitimate
medical practices are concealed by a veil of secrecy and protected by a
fraternal culture of silence."

In private practice it is not uncommon to find admitting physicians
"gifting" their consultant friends, ordering consultations whether they are
need or not.
This is much the same thing. What if their was a "screen" for problems
within every specialty? With 43 million Americans unable to afford health
care insurance, this "padding" to the benefit both of psychiatry and, more
importantly to the almightly pharmaceutical industry will only result in
psychiatric labels and drugs for persons whose primary problems are medical
(and surgical), to the detriment of their financial situation and, to the
detriment of their medical/surgical situation, since no psychiatric
condition is an actual disease, and psychiatric drugs can only stand to
complicate their medical or surgical conditions.

The New York-Presbyterian Hospital, Cornell and Medscape should be ashamed
of themselves. Colluding thusly they have become part of the biggest of all
drug cartels in the name of psychiatric diagnosis and treatment. None of
these parties are patient advocates any longer. Having sold their souls to
Big Pharma they cannot be.]

http://www.medscape.com/viewarticle/462577

 
  Cornell Psychiatric Screen Validated: A Newsmaker Interview With Stephen
  J. Ferrando, MD
 
  Laurie Barclay, MD
 
  Oct. 7, 2003 - Editor's Note: The Cornell Psychiatric Screen suggests
  that many medical inpatients 

[Fred A. Baughman Jr., MD:
persons with real diseases. Who is
behind this?]

would benefit from psychiatric services,
  according to the results of a preliminary validation study published in
  the September-October issue of Psychosomatics.
 
  This brief, reliable, and valid 

[Fred A. Baughman Jr., MD:
Valid for what, the placement of
DSM-IV labels that stick, making them psychiatric patients in
perpetuity]

screening tool includes items assessing
  cognition and behavior, depressive symptoms, anxiety, drug and alcohol
  history, and the patient's desire to see a psychiatrist. Among patients
  in whom the screen suggested possible psychopathology 

[Fred A. Baughman Jr., MD:
There is no
such thing as pathology = physical abnormality = disease, in psychiatry;
saying "psychopathology" they coopt the language of medicine to make the
patient/pyblic think they dx. and rx actual diseases when none are]

,
  89% had
  documented psychiatric comorbidity according to Diagnostic and
  Statistical Manual of Mental Disorders, Fourth Edition, criteria.
 
  To learn more about how this screen should be used, Medscape's Laurie
  Barclay interviewed Stephen J. Ferrando, MD, an associate professor of
  psychiatry at the Weill Medical College of Cornell University in New
  York City and the director of the psychiatric consultation liaison
  service at New York-Presbyterian Hospital.
 
  Medscape: Why is a psychiatric screen needed for hospitalized medical
  patients?
  Dr. Ferrando: The prevalence of psychiatric comorbidity is very high in
  medical inpatients, up to 40% to 50% in some studies 

[Fred A. Baughman Jr., MD:
Dr. Ferrando
claims 40-50 percent of those in the hospital for medical diagnoses such as
cancer, stomach ulcer, diabetes, stroke, multiple sclerosis etc.have a
co-morbid (co-existent) psychiatric diagnosis (or 2 or 3 or more) Might
their psychiatric problem be related to the medical problem that has landed
them in the hospital?]

. Despite that, the
  rate of psychiatric consultation is very low, usually less than 5%.

[Fred A. Baughman Jr., MD:
Apparently, most of their primary physicians think their psychiatric
problems are explained by the medical problem that got them into the
hospital, feeling that just 5% need psychiatric consultation.]

  Identifying psychiatric disease in this population is important because
  psychopathology increases length of stay and medical morbidity and
  results in poor functional outcomes. The idea of the screen is to
  identify these patients and to intervene early to improve outcomes

[Fred A. Baughman Jr., MD:
Suggesting that it would be best if all of the 40-50 percent had
psychiatric consultation, dx. and rx.]

.
 
  Medscape: What were the main findings of this study?
  Dr. Ferrando: The study's intent was to develop this screening
  instrument, which we did, as well as to validate it. We started with a
  large number of questions, then honed it down to seven items, five of
  which are self-reported, and the other two are rated by a
  paraprofessional, nurse, or an attendant who is trained to ask simple
  but directed questions. This screen gives the patient a mental health
  severity rating and only takes about five minutes to administer.
 
  We looked at the predictive value of the instrument and developed cutoff
  criteria. When the score met the criteria, the screen was accurate 90%
  of the time in predicting psychiatric disease. The absolute score also
  correlated with the length of stay. Now we're using this screening
  instrument in a randomized trial of early psychiatric intervention
  versus standard care, with 200 medically ill patients in each group. The
  results are in preparation.
 
  Medscape: Could psychiatric symptoms associated with medical illness,
  such as fatigue associated with cancer or hallucinations accompanying
  metabolic delirium, confound the results of this screen?
  Dr. Ferrando: Not really. Any of these symptoms can be associated with
  overall medical morbidity, but the psychiatrists still have to deal with
  it. With the symptom of fatigue in a cancer patient, for example, the
  primary medical team is pushing chemotherapy while the psychiatrist
  should be addressing quality-of-life issues, perhaps prescribing a
  stimulant like Provigil or suggesting other ways to cope with the
  fatigue. So even though the psychiatric symptoms may have a medical
  basis, the psychiatrist can still be helpful.
 
  Medscape: Does the screen help distinguish patients with psychopathology
  who are not in need of acute psychiatric intervention from those who
  could benefit from psychiatric consultation while hospitalized for other
  conditions?
  Dr. Ferrando: It's possible that the screen could detect patients with
  psychopathology mild enough not to require intervention. We tried to
  minimize that by setting the cutoff to reflect greater severity. To get
  counted toward the total score, for example, symptoms had to be present
  most or all of the time.
 
  Medscape: Should all hospitalized medical patients be screened, or are
  there certain criteria that identify groups at high risk?
  Dr. Ferrando: For this study, we chose patients in the moderate range of
  medical severity, because the impact of psychiatric comorbidity is
  probably greatest in these patients in the middle of the spectrum.
  Patients with less severe medical problems are in and out of the
  hospital too quickly for psychiatric intervention, and those with very
  severe problems have more pressing medical issues that must be addressed
  first.
 
  Medscape: What are the limitations of this screen in detecting mental
  illness?
  Dr. Ferrando: Our study was not designed to test the false-negative rate
  of the screen, because we didn't do a psychiatric evaluation on every
  patient, but only on those in whom the screen was positive. That's a
  very important limitation of our study. It is certainly possible that
  subtle manifestations of mental illness could be missed.
 
  Medscape: Are there any potential negative consequences of this screen,
  such as having a fragile but compensated individual decompensate under
  the stress of discussing psychiatric disease, creating concern in a
  patient that the doctor thinks their medical illness is "all in their
  head," or otherwise alienating the staff from the patient?
  Dr. Ferrando: It's theoretically possible, but we just didn't find that
  at all. The literature also suggests that screening instruments tend to
  decrease rather than increase patient stress. We've tested the screen in
  more than 400 patients, and it is generally very well accepted when we
  present it as a part of their overall comprehensive, holistic care.
 
  New York-Presbyterian Hospital funded this study. Dr. Ferrando has
  received honoraria from Pfizer, Merck, Sharp & Dohme, and Bristol-Myers
  Squibb.
 
  Psychosomatics. 2003:44:382-387
 
  Reviewed by Gary D. Vogin, MD
  ----------------------------------------------------------------------
  Laurie Barclay, MD Writer for Medscape Medical News
 
  Medscape Medical News is edited by Deborah Flapan, assistant managing
  editor of news at Medscape. Send press releases and comments to
  news@webmd.net.