[Treatment recommendations in psychiatric disability insurance expertises: are they helpful].

Background: In recent years the total number of people drawing a pension - especially for psychiatric reasons - from Switzerland's Federal Disability Insurance ("IV") has been steadily climbing. As we have revealed in earlier studies of persons applying for a disability pension for psychiatric reasons only 64 % had received psychiatric treatment and only 20 % adequate drug treatment .
Hypothesis: In this study we examined whether, treatment recommendations given by medical experts were followed and if so, how successfully.
Methods: In 40 patients who had got a psychiatric expertise in 2004 at the Psychiatric Outpatient Department, University of Basel, on behalf of the Swiss Disability Insurance, a 1-year follow-up was done and the results were compared.
Results: At reassessment significantly more patients (58 %) were in psychiatric-psychotherapeutic treatment than at first assessment (32 %). The recommended drug treatments were fully complied with in only 43 % of the cases; the recommended psychotherapy in only 9 % of the cases; and recommended in-patient treatment at a psychiatric hospital in only 14 % of the cases. During the time between evaluations, the seriousness of the condition had altered in a number of cases: in 33 % the condition had noticeably improved (e. g. from severe to mild depression) or was no longer present, and in 9 % the condition had worsened (e. g. from mild to severe depression). No significant relationship was found between compliance (full, partial or no implementation of recommended treatments) and change in illness severity. Partnership has been identified as the factor with the strongest influence on illness severity: in subjects who were married or living with a partner illness course was much better than in subjects without a stable partnership.