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Detection and management of mental distress and psychiatric disorders in primary care settings1

Published online by Cambridge University Press:  11 October 2011

Stefano Pini  and
Michele Tansella
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Summary

Objective – Epidemiological and clinical studies indicate that 10–50% of primary care patients suffering from clinically relevant psychiatric distress are not diagnosed by their physician and only a minority of them receive an appropriate treatment. The improvement of physicians' ability to detect mental distress and psychiatric disorder, in their routine clinical activity, represents a crucial point to reduce the social impact of mental illnesses, prevent their worsening and chronicity and, eventually, relieve mental health services of an excessive burden of care and costs. The aim of this article is to examine a number of factors which intervene in the process of detection of mental distress by the physician. Then, we will examine factors related to the management of psychiatric disorders most commonly co-occurring with physical illness in general health care sector. Method – The method used for this review was essentially a recension of the literature concerning detection and treatment of psychiatric disorders in primary care settings, having in view to see the factors connected with these processes. Results – Among factors intervening in the process of identification of mental distress in primary care settings, both the characteristics of the physician and the characteristics of the patient should be taken into account. Primary care physicians and psychiatrists are being asked to work together more frequently in this era of community care. The principal aim of such invoked collaboration is the amelioration of quality of care and reduction of costs for mentally ill patients. An important issue within this collaboration is the referral by primary care physicians to specialist services.

Riassunto

Scopo – Numerosi studi epidemiologici e clinici indicano che il 10-50% dei pazienti che si rivolgono al medico di medicina generale presentano disturbi psichiatrici. Tuttavia, solo un'esigua percentuale di questi disturbi viene adeguatamente identificata e curata. La possibilità di migliore le capacità del medico di medicina generale di identificare questa quota di patologia psichiatrica è quindi cruciale sia per ridurne l'impatto sociale sia per prevenire il peggioramento e la cronicizzazione di forme psicopatologiche attenuate. In ultima analisi, questo processo dovrebbe riflettersi in un minor carico assistenziale ed in costi phi bassi per le strutture psichiatriche. Metodo – Il metodo usato in questo articolo si basa sulla revisione della letteratura relativa al problema dell'identificazione e gestione dei disturbi mentali nei setting di medicina generale. Risultati – Tra i fattori implicati nel processo di identificazione della patologia mentale nella medicina generale vi sono numerose caratteristiche sia del medico che del paziente. Psichiatri e medici generali devono operare in stretta collaborazione in questo particolare settore della psichiatria. Infatti, solo un'efficace interscambio tra specialista e medico generale può portare ad una migliore qualità dell'assistenza e ad una riduzione significativa dei costi connessi con la cura delle malattie mentali. Un elemento essenziale, all'interno di tale collaborazione, è rappresentato dall'invio allo psichiatra del paziente con sintomi psichici da parte del medico generale.

Keywords

Primary carepsychiatric disordercomorbitydetectionmanagementMedicina generaledisturbi psichiatricicomorbilitaidentificazionetrattamento.
Type
Invited Papers
Information
Epidemiology and Psychiatric Sciences , Volume 8 , Issue 2 , June 1999 , pp. 92 - 104
Copyright
Copyright © Cambridge University Press 1999

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Footnotes

1

The Spanish version of this paper was published in Psiquiatria en Atencion Primaria (ed J.L. Vazquez-Barquero), pp. 73-87, Aula Medica: Madrid, 1998.

References

REFERENCES

American Psychiatric Association (1995). Diagnostic and Statistical Manual of mental Disorders (4th ed.). Primary Care Version. APA: Washington, DC.Google Scholar
Arreghini, E., Agostini, C. & Wilkinson, G. (1991). General practitioner referral to specialist psychiatric services: a comparison of practices in North and South-Verona. Psychological Medicine 21, 485–494.CrossRefGoogle ScholarPubMed
Bridges, J. & Goldberg, D. (1985). Somatic presentation of DSMIII psychiatric disorders in primary care. Journal of Psychosomatic Research 29, 563–569.CrossRefGoogle Scholar
Brown, W.A., Dornseif, B.E. & Wemicke, J.F. (1988). Placebo response in depression: a search for predictors. Psychiatry Research 26, 259–264.CrossRefGoogle ScholarPubMed
Brown, C, Schulberg, H.C., Madonia, M.J., Shear, M.K. & Houck, P.R. (1996). Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders. American Journal of Psychiatry 153, 1293–1300.Google ScholarPubMed
Coulehan, J., Schulberg, H., Block, M.R., Janosky, J.E. & Arena, V.C. (1900). Medical comorbidity of major depressive disorder in a primary medical practice. Archives of Internal Medicine 150, 2363–2367.CrossRefGoogle Scholar
Coyne, J.C., Fechner-Bates, S. & Schwenck, T.L. (1994). Prevalence, nature, and comorbidity of depressive disorders in primary care. General Hospital Psychiatry 16, 267–276.CrossRefGoogle ScholarPubMed
Coyne, J.C., Schwenck, T.L. & Fechner-Bates, S. (1995). Nondetection of depression by primary care physicians reconsidered. General Hospital Psychiatry 17, 3–12.CrossRefGoogle ScholarPubMed
Del Piccolo, L., Saltini, A. & Zimmermann, Ch. (1998). Which patients talk about stressful life events and social problems to the general practitioner? Psychological Medicine 28, 1289–1299.CrossRefGoogle ScholarPubMed
Docherty, J.P. (1997). Barriers to the diagnosis of depression in primary care. Journal of Clinical Psychiatry 58, Suppl. 1, 5–10.Google Scholar
Elkin, I., Shea, M.T. & Watkins, J.T. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of General Psychiatry 46, 971–982.CrossRefGoogle ScholarPubMed
Fifer, S.K., Mathias, S.D., Patrick, D.L., Mazonson, P.D., Lubeck, D.P. & Buesching, D.P. (1991). Untreated anxiety among adult primary care patients in a Health Maintenance Organization. Archives of General Psychiatry 51, 740–750.CrossRefGoogle Scholar
Goldberg, D. (1992). Early diagnosis and secondary prevention. In The Prevention of Depression and Anxiety (ed. Jenckins, R., Newton, J. and Young, R.). HMSO: London.Google Scholar
Goldberg, D. (1997). Implications of epidemiological findings for the management of mental disorders encountered in primary care settings. European Psychiatry 12, Suppl. 2, 56–62.CrossRefGoogle Scholar
Goldberg, D. & Gournay, K. (1997). The General Practitioner, the Psychiatrist, and the Burden of Mental Health Care. Maudsley Discussion Paper No. 1. Institute of Psychiatry: London.Google Scholar
Goldberg, D., Steele, J.J. & Smith, C. (1980). Teaching psychiatric interview tecniques to family doctors. Acta Psychiatrica Scandinavica 62, Suppl. 285, 41–46.CrossRefGoogle Scholar
Goldberg, D., Steele, J.J., Johnson, A. & Smith, C. (1982). Ability of primary care physicians to make accurate ratings of psychiatric symptoms. Archives of General Psychiatry 39, 829–833.CrossRefGoogle ScholarPubMed
R, Jenckins, Newton, J. & Young, R. (Eds.) (1992). The Prevention of Depression and Anxiety. HMSO: London.Google Scholar
Jencks, S.F. (1985). Recognition of mental distress and diagnosis of mental disorder in primary care. Journal of American Medical Association 253, 1903–1907.CrossRefGoogle ScholarPubMed
Johnstone, A. & Goldberg, D. (1976). Psychiatric screening in general practice: a controlled trial. Lancet i, 605–609.CrossRefGoogle Scholar
Joukamaa, M., Lethinen, V. & Karlsson, H. (1995). The ability of general practitioner to detect mental disorders in primary health care. Acta Psychiatrica Scandinavica 91, 52–56.CrossRefGoogle ScholarPubMed
Raton, W. (1995). Will improving detection of depression in primary care lead to improved depressive outcomes? General Hospital Psychiatry 17, 1–2.Google Scholar
Katon, W. & Schulberg, H. (1992). Epidemiology of depression in primary care. General Hospital Psychiatry 14, 237–247.CrossRefGoogle ScholarPubMed
Katon, W. & Sullivan, M.D. (1990). Depression and chronic medical illness. Journal of Clinical Psychiatry 51, Suppl. 6, 3–11.Google Scholar
Katon, W., Von Korff, M., Lin, E., Bush, T., Russo, J., Lipscomb, P. & Wagner, E. (1992). A randomized trial of psychiatric consultation with distressed high utilizers. General Hospital Psychiatry 14, 86–98.CrossRefGoogle ScholarPubMed
Katon, W., Lin, E., Von Korff, M., Bush, T., Walker, E., Simon, G. & Robinson, P. (1994). The predictors of persistence of depression in primary care. Journal of Affective Disorders 31, 81–90.CrossRefGoogle ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Walker, E., Simon, G.E., Bush, T., Robinson, P. & Russo, J. (1995). Collaborative management to achieve treatment guidelines. Impact on depression in primary care. Journal of American Medical Association 273 (13), 1026–1031.CrossRefGoogle ScholarPubMed
Katon, W., Von Korff, M., Lin, E., Unutzer, J., Simon, G., Walker, E., Ludman, E. & Bush, T. (1997). Population-based care of depression: effective disease management strategies to decrease prevalence. General Hospital Psychiatry 19, 169–178.CrossRefGoogle ScholarPubMed
Kendrick, T., Tylee, A. & Burns, T. (1994). Teamwork in the community. In Psychiatry and General Practice Today (ed. Pullen, I. et al. ). Bell & Bain: Glasgow.Google Scholar
Klinkman, M.S. (1997). Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. General Hospital Psychiatry 19, 98–111.CrossRefGoogle Scholar
Marks, J.N., Goldberg, D.P. & Hillier, V.F. (1979). Determinants of the ability of general practitioners to detect psychiatric illness. Psychological Medicine 9, 337–353.CrossRefGoogle ScholarPubMed
Maser, J. & Cloninger, R. (Eds.) (1990). Comorbidity of Mood and Anxiety Disorders. APA: Washington, DC.Google Scholar
Montano, C.B. (1994). Recognition and treatment of depression in a primary care setting. Journal of Clinical Psychiatry 55, Suppl. 12, 18–34.Google Scholar
NIH consensus conference. Diagnosis and treatment of depression in late life (1992). Journal of American Medical Association 268, 1918–1024.Google Scholar
Olfson, M., Broadhead, W.E., Weissman, M.M., Leon, A.C., Farber, L., Hoven, C. & Kathol, R. (1996). Subthreshold psychiatric symptoms in a primary care group practice. Archives of General Psychiatry 53, 880–886.CrossRefGoogle Scholar
Ormel, J. & Tiemens, B. (1995). Recognition and treatment of mental illness in primary care. Towards a better understanding of a multifaceted problem. General Hospital Psychiatry 17, 160–164.CrossRefGoogle ScholarPubMed
Ormel, J., Koeter, M.W.J., van den Brink, W. & van de Willige, G. (1991). Recognition, management, and course of anxiety and depression in general practice. Archives of General Psychiatry 48, 700–706.CrossRefGoogle ScholarPubMed
Ormel, J., VonKorff, M., Ustun, T.B., Pini, S., Korten, A. & Oldehinkel, T. (1994). Common mental disorders and disability across cultures: results from the WHO collaborative study on psychological problems in general health care. Journal of American Medical Association 272, 1741–1748.CrossRefGoogle Scholar
Pini, S., Piccinelli, M. & Zimmerman-Tansella, Ch. (1995). Social problems as factor affecting medical consultation: a comparison between general practice attenders and community probands with emotional distress. Psychological Medicine 25, 33–41.CrossRefGoogle ScholarPubMed
Pini, S., Berardi, D., Rucci, P., Piccinelli, M., Neri, C, Tansella, M. & Ferrari, G. (1997a). Identification of psychiatric distress by primary care physicians. General Hospital Psychiatry 19, 411–418.CrossRefGoogle ScholarPubMed
Pini, S., Cassano, G.B., Simonini, E., Savino, M., Russo, A. & Montgomery, S.A. (1997b). Prevalence of anxiety disorders comorbidity in bipolar depression, unipolar depression and dysthymia. Journal of Affective Disorders 42, 145–153.CrossRefGoogle ScholarPubMed
Regier, D.A., Narrow, W.E., Rae, D.S., Manderscheid, R.W., Locke, B.Z. & Goodwin, F.K. (1993). The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Archives of General Psychiatry 50, 85–94.Google Scholar
Robbins, J.M., Kirmayer, L.J., Cathebras, P., Yaffe, M.J. & Dworkind, M. (1994). Physicians characteristics and the recognition of depression and anxiety in primary care. Medical Care 32, 795–812.CrossRefGoogle ScholarPubMed
Rush, A.J. (1990). Problems associated with the diagnosis of depression. Journal of Clinical Psychiatry 51, Suppl. 6, 5–22.Google Scholar
Schulberg, H.C. (1992). Mental disorders in the primary care settings. Research priorities for the 1990s. General Hospital Psychiatry 13, 156–164.CrossRefGoogle Scholar
Schulberg, H.C., Coulehan, J.L., Block, M.R., Scott, C.P., Imber, S.D. & Perel, J.M. (1991). Strategies for evaluating treatments for major depression in primary care patients. General Hospital Psychiatry 13, 9–18.CrossRefGoogle ScholarPubMed
Shepherd, M. (1995). Primay care psychiatry. Health service research is not enough. British Journal of Psychiatry 166, 1–3.CrossRefGoogle Scholar
Sherbourne, C.D., Wells, K.B., Meredith, L.S., Jackson, C.A. & Camp, P. (1996). Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Archives of General Psychiatry 53, 889–895.CrossRefGoogle ScholarPubMed
Simon, G.E. & Von Korff, M. (1995). Recognition, management and outcome of depression in primary care. Archives of Family Medicine 4, 99–105..CrossRefGoogle ScholarPubMed
Teasdale, J., Fennel, M., Hibbert, G. & Amies, P. (1984). Cognitive therapy for major depressive disorder in primary care. British Journal of Psychiatry 144, 400–406.CrossRefGoogle ScholarPubMed
Thornicroft, G. & Tansella, M. (1999). The Mental Health Matrix. A Manual to Improve Services. Cambridge University Press: Cambridge.CrossRefGoogle Scholar
Tiemens, B.G., Ormel, J. & Simon, G.E. (1996). Occurrence, recognition, and outcome of psychological disorders in primary care. American Journal of Psychiatry 153, 636–644.Google ScholarPubMed
Ustun, T.B. & Sartorius, N. (Eds.) (1995). Mental Illness in General Health Care. An International Study. John Wiley and Sons: Chichester.Google Scholar
Wells, K.B. (1997). Caring for depression in primary care: defining and illustrating the policy context. Journal of Clinical Psychiatry 58, Suppl. 1, 24–27.Google Scholar
Zimmermann, Ch. & Tansella, M. (1996). Psychosocial factors and physical illness in primary care. Promoting the biopsychosocial model in medical practice. Journal of Psychosomatic Research 40, 351–358.CrossRefGoogle ScholarPubMed