Psychological Medicine, 1980,10, 125-132 Printed in Great Britain Psychiatric screening on a neurological ward J. RAYMOND DEPAULO, 1 MARSHAL F. FOLSTEIN AND BARRY GORDON From the Department of Psychiatry and Behavioral Sciences and the Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA SYNOPSIS Two psychiatric screening instruments, the Mini-Mental State (MMS), a test for cognitive disturbance, and the General Health Questionnaire (GHQ), were administered to 197 neurological in-patients. The results suggest a high rate of psychiatric disturbance. The highest rate of cognitive disturbance detected by the MMS was found in patients with Parkinson's disease. The highest rates of emotional disturbance indicated by GHQ scores were found in patients with myas- thenia gravis and multiple sclerosis. MMS scores but not GHQ scores were related to standard tests of cognition, the diagnosis of cerebral pathology, and CAT scan abnormality. The results also demonstrate that the GHQ does not adequately detect patients with cognitive impairment. It is concluded that in populations at high risk for cognitive impairment a tandem screening procedure utilizing tests for both cognitive and emotional disorders is needed. INTRODUCTION Medically ill patients frequently suffer from psychiatric disorders. New methods for psy- chiatric screening permit studies of psychiatric morbidity in large populations (Goldberg, 1972; Goldberg et al. 1976; Derogatis et al. 1976), including medically ill patients unable to co- operate with more detailed methods of testing. Several previous screening surveys of medically ill populations have been limited to screening for emotional disturbances (Maguire et al. 1974; Eastwood & Trevelyan, 1972). Since medically ill patients suffer high rates of cognitive defects (Jacobs et al. 1977; Knights & Folstein, 1977), psychiatric screening instruments which detect cognitive defects as well as those which detect depression and anxiety are needed to define the rate of psychiatric morbidity in a medical setting. Whether or not screening tests for emotional symptoms also detect patients with cognitive defects in medical or neurological populations is unknown. The special problem of psychiatric morbidity in neurological patients has received the atten- tion of the American Board of Psychiatry and Neurology (Trufant & Landau, 1975) and recent British and American publications (Lishman, 1 Address for correspondence: Dr J. Raymond DePaulo, Department of Psychiatry, Baltimore City Hospital, Balti- more, Maryland 21224, USA. 125 0033-2917/80/2828-4940 $01.00 ©1980 Cambridge University Press 1978; Benson & Blumer, 1975). However, we know from an earlier study that psychiatric disorders are not always clinically recognized by neurologists and, hence, do not always receive adequate diagnosis and treatment (DePaulo & Folstein, 1978). Determining the relative risk of psychiatric morbidity in patients with a variety of neurological disorders would allow high-risk neurological conditions to be identified and, thus, increase the alerted physi- cian's detection of psychiatric morbidity in patients with these disorders. In addition, the identification of high-risk groups in a neurological setting would help to establish the association of psychopathology with particular neurological disorders, since associations reported from psy- chiatric facilities are flawed by the bias of ascertainment. In this study on a neurological ward we evaluated the clinical utility and efficiency of a tandem screening procedure with two psychiatric screening instruments: the Mini-Mental State Examination (MMS) for cognitive disorder and the General Health Questionnaire (GHQ) for emotional disorder. One hundred and ninety-seven patients in a neurological setting were tested for the presence of cognitive or emotional disturb- ance, and those diagnostic groups which were detected most frequently by the screening tests were identified.