INTRODUÇÃO: A interconsulta psiquiátrica (ICP) pode ser considerada um instrumento de pesquisa, ensino e assistência, que beneficia paciente, equipe de saúde e instituição. A sua utilização no Brasil é ainda pequena. Sabe-se que 30% a 50% dos pacientes internados em hospital geral (HG) podem apresentar uma patologia psiquiátrica, mas que apenas 1% a 12% destes são encaminhados para avaliação. Pretendeu-se com este trabalho caracterizar os transtornos psiquiátricos no HG; identificar as diferenças entre pacientes encaminhados e um grupo controle. MÉTODO: Realizou-se um estudo caso-controle de 141 pacientes (47 casos e 94 controles), analisando variáveis sócio-demográficas, clínicas, informação quanto à doença, procedimentos diagnósticos e terapêuticos; e relação pacientes- equipe de saúde. Utilizou-se o Self Report Questionnaire (SRQ), o CAGE e o Brief Psychiatric Rating Scale (BPRS), além de um questionário elaborado para o estudo. RESULTADOS: Observou-se que alterações de comportamento com manifestações de exaltação e depressivas motivaram os pedidos de ICP; 95,8% dos casos e 27,7% dos controles receberam um diagnóstico psiquiátrico; transtornos orgânicos e alcoolismo prevaleceram no grupo I (casos), e os transtornos de ansiedade e transtornos depressivos no grupo II (controles). Pacientes do grupo controle estavam mais bem informados e estabeleceram relacionamentos mais adequados com a equipe de saúde que os casos. A regressão logística mostrou que pacientes com CAGE positivo têm 12,85 vezes mais chances de serem encaminhados para ICP; os sem ocupação 2,44 vezes; ou seja, alcoolismo e alterações cognitivas foram os principais responsáveis pelo encaminhamento à ICP. DISCUSSÃO: O uso de instrumentos de triagem, como o SRQ e o CAGE, pode ser útil na formação do clínico geral. Pesquisas adicionais deverão ser feitas para avaliar de que maneira o serviço de ICP implantado melhorou as habilidades de diagnóstico e tratamento de transtornos psiquiátricos neste hospital geral universitário.

INTRODUCTION: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). METHODS: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD-10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. RESULTS: Behavioral alterations, either of elation or of depression, were the main for requesting a PC ; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). DISCUSSION: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Obsessive-compulsive disorder is a very heterogeneous condition, not always easy to be identified. Obsessions are intrusive thoughts, impulses or images that cause anxiety or other emotional discomfort, whereas compulsions are repetitive behaviors or mental acts voluntarily performed to counterbalance or minimize the discomfort, or magically prevent any feared events. The most common symptoms are contamination, aggressive, somatic and sexual obsessions and washing, checking, repeating, counting and ordering compulsions. Patients usually have multiple symptoms simultaneously, which often change over time. Although the insight is typically preserved, it varies among patients and also fluctuates in the same patient in different ocasions. The main features are: exacerbated appraisal of risks, pathological doubts and incompleteness, as well as excessive sense of responsibility and guilt and thought/action fusion. As patients frequently feel ashamed of their symptoms, they can be reticent about them. Consequently, it usually takes time till they get adequate treatment.