John J. Schwab

Diagnosing Depression in Medical Inpatients

Excerpt Since the days of hippocrates, depression has been recognized as a distinctive psychobiologic mode. Engel (1) said that depression, developmentally, is the latter of two basic biologic reac...

THE BECK DEPRESSION INVENTORY WITH MEDICAL INPATIENTS

INTRODUCTION The purpose of this investigation is to report the use of the Beck Depression Inventory, Beck (1961), in a general medical inpatient population. This study is one segment of a comprehensive evaluation of depression in medical patients. The Beck Depression Inventory (BDI) was used because it was clinically derived. In reporting its validity and reliability with psychiatric patients, Beck indicated that it should have value in research on depression. Although the BDI was designed to measure depression in psychiatric patients, the possibility of extending its use to the area of general medicine is appealing. Diagnosing depression in medical patients depends too much on clinicians’ subjective evaluations. The need for objective criteria is critical. In addition, the use of the instrument with different types of subjects refines its applicability. MATERIAL The BDI was developed to provide an objective instrument for assessing depression in patients by measuring their behavioral manifestations of depression. Beck and his colleagues were concerned with identifying and objectively quantifying depression, rather than distinguishing among various types of depression or diagnostic categories. The inventory contains twenty-one symptom attitude categories (see Table 6). For each, there are four to five statements of inoreasing severity. The patient reads the scale and chooses the statement which he feels is most applicable to himself at that particular time. The score on each item may range from 0-3 depending on the severity; the total score falls between 0 and 62. Cutting scores were estabIished by Beck (1963), and wiIl be presented in the section on results.

Current Concepts of Depression: the Sociocultural

Our concern with the current sociocultural concepts of depression suggests that these change with time. Such a perspective requires that we look back in history, scan the present, and glimpse the future. Although widespread interest in the sociology of mental illness is a late development, it has at least two visible antecedents. As individuals, the great physicians have always understood the relevance of social influences to illness; and the public health movement of the 19th Century showed that these influences could be directed so that they benefited the state.l However, for several reasons, psychiatry’s involvement in these developments has lagged. As it attempted to justify its existence as a medical specialty. psychiatry adhered to a rigid medical model, focusing on the phenomenological aspects of psychopathology and searching for anatomical lesions. Also, the sociology of mental illness was neglected because the tools of psychoanalysis dealt with the intra-psychic, and these engaging discoveries occupied the attention of

The psychiatric consultation patient.

Growing numbers of psychiatric services in general hospitals emphasize the importance of psychiatric consultation as part of comprehensive medical care. The literature supports the high prevalence rate of emotional distress in general medical and surgical patients. This paper underscores the need for appropriate selection of patients for consultation, and the means of referral. The psychiatrist is faced with the important challenge of bringing the humanizing force of consultation to forms of medical treatment which are becoming increasingly technological.

Treating Anxiety and Depression

The anxious or depressed patient not only disrupts his own life but also distresses his family and the community. The physician, then, must consider many factors before deciding whether to use psychotherapy, drugs, hospitalization, or a combination of these. He should also counsel the patients family and marshal community resources to help his patient.