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La morbilità psichiatrica nella medicina di base: aspetti concettuali e diagnostici

Published online by Cambridge University Press:  11 October 2011

Marco Piccinelli*
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
Aloisia Ferraris
Affiliation:
Servizio di Psicologia Medica, Istituto di Psichiatria, Università di Verona, Verona
*
Indirizzo per la corrispondenza: Dr. M. Piccinelli, Servizio di Psicologia Medica, Istituto di Psichiatria, Ospedale Pohchnico, 37134 Verona Fax (+39) 045-585.871

Abstract

Riassunto

Gli Autori affrontano alcuni aspetti concettuali e metodologici legati allo studio della morbilità psichiatrica nella medicina di base. Vengono discussi i concetti di «malattia» in generale e di «caso psichiatrico» in particolare, con le ripercussioni che tali definizioni possono avere sull'attività di ricerca. Sono presentati i risultati di alcuni studi che hanno utilizzato i modelli statistici basati sulla latent trait theory per indagare i disturbi emotivi di comune riscontro tra i pazienti del medico di base. È stato cosi possibile evidenziare che tali disturbi tendono a distribuirsi lungo un continuum in assenza di punti di interruzione o di rarità. I problemi diagnostici tuttora presenti nella medicina di base sono considerati alia luce delle difficoltà nell'applicazione delle tradizionali categorie diagnostiche e delle prospettive aperte dai recenti sistemi multiassiali di classificazione.

Parole chiave

medicina di base, disturbi emotivi, diagnosi.

Summary

The Authors examine some conceptual and methodological issues involved in the study of psychiatric morbidity in primary care settings. The concept of «disease» in general and that of «psychiatric case» in particular are discussed together with the implications that such definitions may have in research activity. Some studies are reviewed which have employed statistical models based on latent trait theoryto investigate the emotional disorders commonly found among subjects who consult the general practitioner. It becomes apparent that these disorders tend to distribute along a continuum with no rarity points or interruptions. Diagnostic problems still present in primary care settings are considered paying attention to the difficulties in the application of traditional diagnostic categories and to the new perspectives disclosed by recent multiaxial systems of classification.

Type
Articoli
Copyright
Copyright © Cambridge University Press 1992

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References

BIBLIOGRAFIA

Akiskal, H. S. Toward a clinical understanding of the relationship of anxiety and depressivedisorders. In Comorbidity in Anxiety and Mood Disorders (ed. Maser, J. and Cloninger, R.). American Psychiatric Press: Washington (in stampa).Google Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, (3rd ed.). American Psychiatric Association: Washington.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, (3rd ed. revised). American Psychiatric Association: Washington.Google Scholar
Barrett, J. (1990). Issues of criterion validity for screening measures for depressive disorders in primary care. In Depression in Primary Care. Screening and Detection (ed. Attkisson, C. C. and Zich, J. M.), pp. 2742. Routledge: New York.Google Scholar
Barrett, J. E., Barrett, J. A., Oxman, T. E. & Gerber, P. D. (1988). The prevalence of psychiatric disorders in a primary care practice. Archives of GeneralPsychiatry 45, 11001106.CrossRefGoogle Scholar
Cawley, R. (1983). Concept and classification. In The Neurosis and Personality Disorders. Handbook of Psychiatry 4 (ed. Russel, G. F. and Hersow, L. A.), pp. 37. Cambridge University Press: Cambridge.Google Scholar
Copeland, J. (1981). What is a «case»? A case for what? In What is a Case? (ed. Wing, J. K., Bebbington, P. and Robins, L. N.), pp. 911.Grant Mclntyre: London.Google Scholar
de Jong, A., Giel, R., Lindeboom, E. G., Sloof, C.J & Wiersma, D. (1985). Foulds' hierarchical model of psychiatric illness in a Dutch cohort: a re-evaluation. Psychological Medicine 14, 647654.CrossRefGoogle Scholar
Duncan-Jones, P. (1981). The natural history of neurosis: probability models. In What is a Case? (ed. Wing, J. K., Bebbington, P. and Robins, L. N.),pp. 161180. Grant Mclntyre: London.Google Scholar
Duncan-Jones, P., Grayson, D. A. & Moran, P. A. P. (1986). The utility of latent trait models in psychiatric epidemiology. Psychological Medicine 16, 391405.CrossRefGoogle ScholarPubMed
Eaton, W. W. & Chilcoat, H. D. (1989). The Latent Structure of Anxiety and Depression in Treated and Untreated Populations. John Hopkins University: Baltimore.Google Scholar
Eaton, W. W. & Kessler, L. G. (ed.) (1985). Epidemiologic Field Methods in Psychiatry. The NIMH Catchment Area Program. Academic Press: Orlando.Google Scholar
Eysenck, H. J. (1986). A critique of contemporary classification and diagnosis. In Contemporary Directions in Psychopathology. Toward the DSMIV (ed. Millon, T. and Klerman, G. L), pp. 7398. The Guilford Press: New York.Google Scholar
Finlay-Jones, R., Brown, G. W., Duncan-Jones, P., Harris, J., Murphy, E. & Prudo, R. (1980). Depression and anxiety in the community: replicating thediagnosis of a case. Psychological Medicine 10, 445454.CrossRefGoogle Scholar
Foulds, G. A. (1964). Personal continuity and psychopathological disruption. British Journal of Psychology 55, 269276.CrossRefGoogle ScholarPubMed
Foulds, G. A. (1965). Personality and Personal Illness. Tavistock: London.Google Scholar
Foulds, G. A. (1971). Personality deviance and personal symptomatology. Psychological Medicine 1, 222233.CrossRefGoogle ScholarPubMed
Foulds, G. & Bedford, A. (1975). Hierarchy of classes of personal illness. Psychological Medicine 5, 181192.CrossRefGoogle ScholarPubMed
Goldberg, D. (1982). The concept of a psychiatric «case» in general practice. Social Psychiatry, 17, 6165.CrossRefGoogle Scholar
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders. A Biosocial Model. Routledge: London.Google Scholar
Goldberg, D. & Williams, P. (1988). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.Google Scholar
Goldberg, D., Bridges, K., Duncan-Jones, P. & Grayson, D. A. (1987). Dimensions of neuroses seen in primary-care settings. Psychological Medicine 17, 461470.CrossRefGoogle ScholarPubMed
Goldberg, D. P. (1972). The Detection of Psychiatric Illness by Questionnaire. Oxford University Press: London.Google Scholar
Grayson, D. A. (1986). Latent trait analysis of the Eysenck Personality Questionnaire. Journal of Psychiatric Research 20, 217235.CrossRefGoogle ScholarPubMed
Grayson, D. A., Bridges, K., Duncan-Jones, P. & Goldberg, D. P. (1987). The relationship between symptoms and diagnoses of minor psychiatric disorder in general practice. Psychological Medicine 17, 933942.CrossRefGoogle ScholarPubMed
Grayson, D., Bridges, K, Cook, D. & Goldberg, D. (1990). The validity of diagnostic systems for common mental disorders: a comparison between the ID-CATEGO and the DSM-III systems. Psychologic! Medicine 20, 209218.CrossRefGoogle ScholarPubMed
Guimon, J. (1989). The biases of psychiatric diagnosis. In Psychiatric Diagnosis (ed. Guimon, J., Berrios, G. E. and Mezzich, J. E.). British Journalof Psychiatry, Supplement No. 4, vol. 154, pp. 3337.Google Scholar
Helmchen, H. (1980). Multiaxial systems of classification. Types of axes. Acta Psychiatrica Scandinavica 61, 4355.CrossRefGoogle ScholarPubMed
Jenkins, R., Smeeton, N. & Shepherd, M. (1988). Classification of Mental Disorder in Primary Care. Psychological Medicine, Monograph Supplement No. 12. Cambridge University Press: Cambridge.CrossRefGoogle ScholarPubMed
Kendell, R. E. (1988). What is a case? Food for thought for epidemiologists. Archives of General Psychiatry 45, 374376.CrossRefGoogle ScholarPubMed
Klerman, G. L. (1989). Depressive disorders: further evidence for increased medical morbidity and impairment of social functioning. Archives of General Psychiatry 46, 856858.Google ScholarPubMed
Lobo, A. (1989). On multiaxial psychiatric diagnosis for general medical patients. In Psychiatric Diagnosis (ed. Guimon, J., Berrios, G. E. and Mezzich, J. E.). British Journal of Psychiatry, Supplement No. 4, vol. 154, pp. 3841.Google Scholar
Longabaugh, R., Stout, R., Kriebel, G. W., McCullough, L. & Bishop, D. (1986). DSM-III and clinically identified problems as a guide to treatment. Archives of General Psychiatry 43, 10971103.CrossRefGoogle ScholarPubMed
Mann, A. H., Jenkins, R. & Belsey, E. (1981). The twelve month outcome of patients with neurotic illness in general practice. Psychological Medicine 11,535550.CrossRefGoogle ScholarPubMed
Mezzich, J. E. (1979). Patterns and issues in multiaxial psychiatric diagnosis. Psychological Medicine 9, 125137.CrossRefGoogle ScholarPubMed
Mezzich, J. E. (1989). An empirical prototypical approach to the definition of psychiatric illness. In Psychiatric Diagnosis (ed. Guimon, J., Berrios, G. E. and Mezzich, J. E.). British Journal of Psychiatry, Supplement No. 4, vol. 154, pp. 4246.Google Scholar
Morey, L. C. (1985). A comparative validation of the Foulds & Bedford hierarchy of psychiatric symptomatology. British Journal of Psychiatry 146, 424428.CrossRefGoogle ScholarPubMed
Morey, L. C. (1987). The Foulds hierarchy of personal illness: a review of recent research. Comprehensive Psychiatry 28, 159168.CrossRefGoogle ScholarPubMed
Pincus, H. A. (1991). What's in a name? «Mental» or «Physical», «Psychiatric» or «Medical»? General Hospital Psychiatry 13, 289290.CrossRefGoogle ScholarPubMed
Rasch, G. (1960). Probabilistic Models for Some Intelligence and Attainment Tests.Danish Institute of Educational Research: Copenaghen.Google Scholar
Robins, L. N., Helzer, J. E., Croughan, J. & Ratcliff, K.S (1981). National Institute of Mental Health Diagnostic Interview Schedule. Archives of General Psychiatry 38, 381389.CrossRefGoogle ScholarPubMed
Scadding, J. G. (1990). The semantic problems of psychiatry. Editorial. Psychological Medicine 20, 243248.CrossRefGoogle Scholar
Seneca, L. A. (62 d.C. circa). Lettere a Lucilio 108, 29.Google Scholar
Shapiro, S., Skinner, E. A., Kessler, L. G., von Korff, M., German, P. S., Tischler, G. L., Leaf, P. J., Benham, L., Cottier, L. & Regier, D. A. (1984). Utilization of health and mental health services. Three epidemiologic catchment area sites. Archives of General Psychiatry 41, 971978.CrossRefGoogle ScholarPubMed
Sharp, D.J & King, M. B. (1989). Classification of psychosocial disturbance in general practice. Editorial. Journal of the Royal College of General Practitioners 9, 356358.Google Scholar
Shepherd, M. & Wilkinson, G. (1988). Prymary care as the middle ground for psychiatric epidemiology. Editorial. Psychological Medicine 18, 263267.CrossRefGoogle Scholar
Sokal, R. R. (1974). Classification: purposes, principles, progress, prospects. Science 185, 11151123.CrossRefGoogle Scholar
Sturt, E. (1981). Hierarchical patterns in the distribution of psychiatric symptoms. Psychological Medicine 11, 783794.CrossRefGoogle ScholarPubMed
Wilkinson, G. (1986). Overview of Mental Health Practices in Primary Care Settings, With Recommendations for Further Research. National Institute of Mental Health: Washington.Google Scholar
Williams, P. (1979). Deciding how to treat – the relevance of psychiatric diagnosis. Psychological Medicine 9, 179186.CrossRefGoogle ScholarPubMed
Williams, P., Tarnopolsky, A. & Hand, D. (1980). Case definition and case identification in psychiatric epidemiology: review and assessment. Psychological Medicine 10, 101114.CrossRefGoogle Scholar
Wilmink, F. (1989). Patient, Physician, Psychiatrist. An Assessment of Mental Health Problems in Primary Care. Phais: Glimmen, The Netherlands.Google Scholar
Wing, J. K. & Sturt, E. (1978). The PSE - ID - CATEGO System: Supplementary Manual. MRC Social Psychiatry Unit, Institute of Psychiatry: London.Google Scholar
Wing, J. K., Bebbington, P. & Robins, L. N. (1981). Theory-testing in psychiatric epidemiology. In What is a Case? (ed. Wing, J. K., Bebbington, P. and Robins, L. N.), pp. 18. Grant Mclntyre: London.Google Scholar
World Health Organization (1977). International Classification of Diseases, 9th Revision. WHO: Geneva.Google Scholar
World Health Organization (1992). International Classification of Diseases, 10th Revision. WHO: Geneva.Google Scholar
World Organization of National Colleges, Academies and Academic Associations of General Practicioners/Family Physicians (1979). International Classification of Health Problems in Primary Care, (2nd ed.). Oxford University Press: Oxford.Google Scholar