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Implications of Epidemiological Findings for the Management of Mental Disorders Encountered in Primary Care Settings

Published online by Cambridge University Press:  16 April 2020

D Goldberg
D Goldberg*
Affiliation:
Institute of Psychiatry, de Crespigny Park, London SE5 8AF, UK
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Summary

Recent epidemiological surveys that have attempted to include the need for treatment of mental disorders are reviewed, and it is concluded that the greatest unmet need is for those with non-psychotic disorders. Recent studies on factors that influence the natural history of such disorders reveal that these are largely social and environmental; one study suggests that genetic factors are only important in the group that have longer time courses. Those factors within the medical encounter that produce better outcomes are reviewed, and non-specific factors and supportive therapy are found to be important. Some additional advantages are to be obtained with specific antidepressant treatments (either pharmacological or problem-solving) and with re-attribution skills for psychologically determined somatic symptoms. The implications of these findings are discussed from the standpoint of the primary care team, the community mental health team and self-help materials.

Keywords

epidemiologymental disordersprimary caremanagement
Type
Symposia
Information
European Psychiatry , Volume 12 , Issue S2 , 1997 , pp. 56s - 62s

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References

Bebbington, PMarsden, LBrewin, CThe need for psychiatric treatment in the general population: the Camberwell Needs for Care Survey. Psychol Med 1997 in pressGoogle Scholar
Blackburn, IBishop, SGlen, AThe efficacy of cognitive therapy in depression. Br J Psychiatry 1981; 139: 181–189CrossRefGoogle ScholarPubMed
Blashki, TGMowbray, RDavies, BControlled trial of amitryptiline in general practice. Br Med J 1971; i: 133–138CrossRefGoogle Scholar
Brown, GWMoran, PClinical and psychosocial origins of chronic depressive disorder. Br J Psychiatry 1994; 165: 447–456CrossRefGoogle Scholar
Brown, GWMoran, PSingle mothers, poverty and depression. Psychol Med 1997; 27: 21–33CrossRefGoogle ScholarPubMed
Brown, GWAdler, ZBifulco, ALife events, Difficulties and the recovery from depression. Br J Psychiatry 1988; 152: 487–492CrossRefGoogle ScholarPubMed
Brown, GWHarris, TOHepworth, CRobinson, RClinical and psychosocial origins of chronic depressive episodes. 2. A patient enquiry. Br J Psychiatry 1994; 165: 457–465CrossRefGoogle Scholar
Brown, WAPlacebo as a treatment for depression. Neuropsychopharmacology 1994; 10: 265–269CrossRefGoogle ScholarPubMed
Brown, WADornseif, BEWernicke, JFPlacebo response in depression: a search for predictors. Psychiatry Res 1988; 26: 259–264CrossRefGoogle ScholarPubMed
Depression Guideline Panel(1993). depression in Primary Care. Volume 2. Treatment of major depression. Rockville, Maryland: US Department of Health and Human Services AHCPR Publication 93-0551, 1993 pages 186Google Scholar
Goldberg, DPHuxley, PCommon Mental Disorders. A Biosocial Model. London: Routledge, 1992;194ppGoogle Scholar
Goumay, KBrooking, J (1995). An economic analysis of the work of mental health nurses in primay care. Journal of Advanced Nursing 22: 769–778Google Scholar
Johnstone, AGoldberg, DPPsychiatric illness in general practice, a controlled trial. Lancet 1976;i:605–608CrossRefGoogle Scholar
Johnstone, AShepley, M (1986). The Outcome of hidden neurotic Illness treated in general practice. J Royal College of General Practitioners. 36: 413–415Google ScholarPubMed
Kaaya, SGoldberg, DGask, LManagement of somatic presentations of psychiatric illness in general medical settings: evaluation of a new training course for general practitioners. Med Educ 1992; 26: 138–144CrossRefGoogle ScholarPubMed
Katon, WVon Korff, MLin, EWalker, ESimon, GBush, Tet al.Collaborative management to achieve treatment guidelines. JAMA 1995; 273: 1026–1031CrossRefGoogle ScholarPubMed
Kendler, KSWalters, EEKessler, RCThe prediction of length of major depressive episodes: results from an epidemiological sample of female twins. Psychol Med 1997; 27: 107–117CrossRefGoogle ScholarPubMed
Lehtinen, VJoukamaa, MJyrkinen, Eet al.Need for mental health services of the adult population in Finland: results from the mini-Finland Health Survey. Acta Psychiatr Scand 1990; 81: 426–431CrossRefGoogle ScholarPubMed
Melzer, HGill, BPetticrew, MHinds, KPhysical Complaints, Service Use and Treatment of Adults with Psychiatric Disorders. OPCS surveys of psychiatric morbidity in Great Britain report 2. London: HMSO, 1995;81ppGoogle Scholar
Miranda, JMunoz, RIntervention for minor depression in primary care patients. Psychosom Med 1994; 56: 136–141CrossRefGoogle ScholarPubMed
Mynors-Wallace, LGath, DLloyd Thomas, ATomlinson, DRCT comparing problem solving treatment with amitryptiline and placebo for major depression in primary care. Br Med J 1995;310: 441–445CrossRefGoogle Scholar
Ormel, JHOldehinkel, TBrilman, Evan den Brink, WOutcome of depression and anxiety in primary care. Arch Gen Psychiatry 1993; 50: 759–766CrossRefGoogle ScholarPubMed
Paykel, ESHollyman, JAFreeling, PSedgwick, PPredictors of therapeutic benefit from amitryptiline in mild depression: a general practice placebo-controlled trial. J Affect Dis 1988; 14: 83–95CrossRefGoogle Scholar
Porter, AMWDepressive illness in general practice. A demographic study and a controlled trial of imipramine. Br Med J 1970;i:773–778CrossRefGoogle Scholar
Rickeis, KChung, HRCsanalosi, IBet al.Alprazolam, diazepam, imipramine and placebo in out-patients with major depression. Arch Gen Psychiatry 1987; 44: 862–866CrossRefGoogle Scholar
Robinson, LABerman, JSNeimeyer, RAPsychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychol Bull 1990; 108: 30–49CrossRefGoogle ScholarPubMed
Robinson, PBush, TVon Korff, Met al.Primary care physician use of cognitive behavioural techniques with depressed patients. Fam Practice 1995; 40: 352–357Google ScholarPubMed
Ross, SScott, MAn evaluation of the effectiveness of individual and group cognitive therapy in the treatment of depressed patients in an inner city health centre. JR Coll Gen Practit 1985; 35: 239–242Google Scholar
Simon, GVon Korff, MRecognition, management and outcomes of depression in primary care. Arch Fam Med 1995; 4: 99–105CrossRefGoogle ScholarPubMed
Surtees, PSashidharan, SPThe epidemiology of affective disorders: national secular trends and local findings. Psychiatr Psychobiol 1989; 4: 287–298CrossRefGoogle Scholar
Tan, RSBarlow, RJAbel, CReddy, SPalmer, AJFletcher, AENicholl, CGPitt, BMBulpitt, CJThe effect of low dose lofe- pramine in depressed elderly patients in general medical wards. Br J Clin Pharmacol 1994;37 (4):321–324CrossRefGoogle Scholar
Teasdale, JFennell, MHibben, GCognitive therapy for major depression in primary care. Br J Psychiatry 1984; 144: 400–406CrossRefGoogle ScholarPubMed
Thomas, KBGeneral practice consultations: is there any point in being positive? Br Med J 1987;294:1200–1202CrossRefGoogle ScholarPubMed
Ustun, BSartorius, NMental Disorders in General Medical Settings. Chichester: John Wiley, 1995;398ppGoogle Scholar
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