Disorders In General Practice Research Articles

Acute stress-induced disorders in general practice

Stress defines a cluster of psychophysiological responses aimed at enabling resources to solve difficult situations, as well as restoring and maintaining homeostasis in the body. Stress is a combination of physiological, neuroendocrine, behavioural and emotional responses to new or threatening stimuli and serves as a protective adaptation of the body under physiological conditions. In accordance with the effect on the body, beneficial and negative stress is distinguished. Stress can be divided into “chronic” and “acute”. The intensity of the physiological response to a stressor is highly individual and situationally dependent. Many variables, including personal attributes, coping strategies, social support, and past experiences may modify the physiological stress response in any given situation and can account for the different response of people exposed to the same stressor. Intense and persistent stress can lead to psychological and pathological body injury. Stress has a significant impact on different brain regions, including the hippocampus, hypothalamus, amygdala etc. Depression, anxiety, cognitive deficits, and even stress-induced mental diseases are closely related to functional and structural damage of the related brain regions. Repetitive daily acute stress can be associated with different diseases, first of all cardiovascular diseases, which affect quality of life and can cut short life expectancy. Timely treatment is required to prevent progression of early stress reactions to chronic post-traumatic stress disorder, especially in individuals at high risk. Advanced stress and anxiety management interventions include non-pharmacological and pharmacological treatments.

Anxiety and sleep disorders in general practice

Anxiety and sleep disorders are an urgent problem of modern healthcare, which should be treated at the earliest possible stages, since this would prevent the development of a wide range of complications of these conditions. At the same time, given the bidirectional relationship between anxiety and sleep disorders, the search and development of safe and effective remedies for their correction is becoming increasingly relevant. The prescription of a set of measures of nonmedicamental and medicamental nature is considered to be the main methods of therapy for anxiety and sleep disorders. This article presents diagnostic tools that allow the general practitioner to identify anxiety and sleep disorders (insomnia) in a patient as early as possible, and discusses the therapeutic strategies for using a combination of glycine and melatonin in appropriate patients.

Estimated frequency of somatic symptom disorder in general practice: cross-sectional survey with general practitioners

BackgroundSomatic symptom disorder (SSD) is the successor diagnosis of somatoform disorder in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Relevance and frequency of SSD and its clinical symptoms in general practice are still unknown. We estimate frequencies of patients fulfilling the diagnostic criteria of SSD in general practice.MethodsMailed and online survey with general practitioners (GP) in Germany using a cross-sectional representative sample from registries of statutory health insurance physicians. GPs estimated percentages of their patients who show the clinical symptoms of SSD according to DSM-5; that is, one or more burdensome somatic symptoms (A criterion), excessive symptom- or illness-related concern, anxiety, or behaviour (B criterion), and persistence of the symptoms over at least 6 months (C criterion). Statistical analysis used means and confidence intervals of estimated patient proportions showing SSD symptoms. Frequency of full-blown SSD was based on the products of these proportions calculated for each GP.ResultsResponses from 1728 GPs were obtained. GPs saw the clinical symptoms of SSD fulfilled (A and B criteria) in 21.5% (95% CI: 20.6 to 22.3) of their patients. They further estimated that in 24.3% (95% CI: 23.3 to 25.2) of patients, symptoms would persist, yielding a total of 7.7% (95% CI: 7.1 to 8.4) of patients to have a full-blown SSD.ConclusionsWe estimate a frequency of 7.7% of patients in general practice to fulfil the diagnostic criteria of SSD. This number may figure as a reference for the yet to be uncovered prevalence of SSD and it indicates a high clinical relevance of the clinical symptoms of SSD in general practice.RegistrationGerman Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS).DRKS-ID: DRKS00012942.The date the study was registered: October 2nd 2017.The date the first participant was enrolled: February 9th 2018.

VIII. The Usefulness of Na-CI for the Differentiation of Acid Base Disorders in General Practice and Precautions for Its Use

VIII. The Usefulness of Na-CI for the Differentiation of Acid Base Disorders in General Practice and Precautions for Its Use

Anxiety and depressive disorders in general practice

The problem of anxiety and depressive disorders (ADD) is one of the most urgent in modern general medical practice. ADD are widespread both in the general population and in the hospital network, especially in outpatient general practice. The article presents the main clinical manifestations of anxiety and depression, emphasizes their polysystemic somatic manifestations and concurrence with cardiovascular diseases. The pathophysiology of the clinical manifestations of anxiety and depression is discussed. A detailed analysis of their diagnosis and main treatment methods is given.

Increased medical utilization and psychiatric comorbidity following a new diagnosis of methamphetamine use disorder

ABSTRACT Background: Evidence of patterns of medical utilization and distribution of comorbidities among individuals using methamphetamine remains limited Objective: This study aims to investigate changes in medical utilization and comorbidities before and after a diagnosis of methamphetamine use disorder. Methods: A total of 3321 cases (79% were male) of methamphetamine use disorder between January 1, 1996, and December 31, 2012, were identified from Psychiatric Inpatient Medical Claims database in Taiwan. Information was collected on demographics, diagnoses, and medical utilizations. The date of newly diagnosed with methamphetamine use disorder was defined as the baseline. Mirror-image study design was used to compare changes in medical utilization and comorbidities between the pre-baseline period (within 1 year before diagnosis) and the post-baseline period (within 1 year after diagnosis). Conditional logistic regression was used to estimate changes in medical utilization and comorbidities. Results: Most cases (77%) were first identified in a psychiatric department. There is a significant increase (P < .001) in psychiatric admission (odds ratio[OR] = 2.19), psychiatric emergency visits (OR = 1.31), and psychiatric outpatient visits (OR = 1.15) after diagnosis. Multivariable analysis revealed significantly increased risks (P < .001) of non-methamphetamine drug induced mental disorders (adjusted OR[aOR] = 29.47), schizophrenia (aOR = 2.62), bipolar disorder (aOR = 2.14), organic mental disorder (aOR = 1.82), and upper respiratory tract infection (aOR = 2.03) after diagnosis. Conclusions: We found significant increases of medical utilization and psychiatric comorbidities after diagnosed with methamphetamine use disorder. These findings may reflect the problem of delayed diagnosis and treatment. Enhancement of early identification of methamphetamine use disorder in general practice is required for early intervention and decreased subsequent morbidities.

Somatic symptoms and associations with common psychological diagnoses: a retrospective cohort study from Norwegian urban general practice.

Patients with mental health problems often present with somatic symptoms when visiting their general practitioner (GP). Somatic presentations may challenge correct diagnosing of mental health disorders in general practice, where most of these disorders are treated. Explore the associations between common psychological diagnoses and somatic symptom diagnoses in Norwegian urban general practice. A retrospective cohort study including electronic medical data from 15 750 patients aged 16-65 years from 35 GPs in six GP offices in Oslo, Norway, during 12 months in 2014-2015. We explored prevalences and associations between anxiety-, depression-, and stress-related diagnoses, and somatic symptom diagnoses. Patients with anxiety-, depression- and stress-related diagnoses had a mean number of 2.9±3.6 somatic symptom diagnoses during the 12 months, compared to 1.9±2.5 for patients without any psychological diagnoses (P < 0.001). The mean number of somatic symptoms was significantly higher for the different psychological diagnoses viewed separately, for both sexes and different age groups. There was an increase in probability for anxiety, depression, or stress-related diagnoses with an increasing number of somatic symptom diagnoses during the 12 months. We found a significant increase in somatic symptom diagnoses from ICPC-2 chapters: General and unspecified, digestive, cardiovascular, musculoskeletal, neurological, urological, female genital disorders and social problems. Associated symptom patterns were different for each of the included psychological diagnoses. This study shows that patients with anxiety, depression- and stress-related diagnoses present with increased and characteristic somatic symptoms compared to patients without these diagnoses in general practice.

Validation of the Four-Dimensional Symptom Questionnaire (4DSQ) in a mental health setting

ABSTRACT Mental health problems are highly prevalent in primary care. Validated tools to detect mental disorders in general practice are needed. The Four-Dimensional Symptom Questionnaire (4DSQ) was designed to help GPs differentiating between psychological distress and psychopathological conditions (depression, anxiety, somatization). The aim of the current study was to examine psychometric properties of the 4DSQ in a mental health setting. Reliability, factorial, construct, and criterion validity of the English translation of the 4DSQ were analyzed in an American sample of 159 patients attending a psychotherapy outpatient clinic. Measurement equivalence across languages was determined by analyzing differential item functioning (DIF) and differential test functioning (DTF) in the American sample and a Dutch mental health sample, matched by age and sex. A confirmatory factor analysis confirmed all 4DSQ subscales to be unidimensional. All 4DSQ subscales revealed excellent reliability (Cronbach’s alpha and McDonald omega ≥.90) and high correlations with a symptom distress subscale of an instrument that is commonly used to monitor psychotherapy progress, the Outcome Questionnaire-45. Eight items were flagged with DIF. The Depression subscale was free of DIF. DTF analyses showed an impact of DIF on scale level for the lower cutoff score of the Distress scale. The 4DSQ Distress score was the best predictor of a mood disorder diagnosis and the Anxiety score outperformed other 4DSQ scales to predict an anxiety disorder. In conclusion, the 4DSQ demonstrates excellent reliability and validity in a mental health setting. Further research is needed to determine reliable cutoff values on 4DSQ subscales to predict psychiatric diagnoses.

Evaluation of a Blended Relapse Prevention Program for Anxiety and Depression in General Practice: Qualitative Study.

BackgroundExisting studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions.ObjectiveThis study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice.MethodsSemistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis.ResultsParticipants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative.ConclusionsThe implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs.International Registered Report Identifier (IRRID)RR2-10.1186/s12888-019-2034-6

Clinical Application of the Ratio of Serum Bone Isoform to Total Alkaline Phosphatase in General Practice.

Alkaline phosphatase (ALP) is an enzyme that is expressed in a variety of tissues. Among the isoforms of ALP, bone-specific alkaline phosphatase (BAP) is used as a marker for evaluating bone metabolism. We investigated the clinical usefulness of the ratio of serum BAP to total ALP for the diagnosis of various disorders in general practice. We retrospectively analyzed the cases of 107 Japanese patients whose serum BAP levels were exam-ined, focusing on clinical characteristics. We observed that the BAP/ALP ratios of the patients with fever and those with inflammatory diseases were significantly lower than the ratios of other patient groups. The BAP/ALP ratios of the patients with osteoporosis and those with metabolic bone diseases were higher than those of the patients with other conditions. The BAP/ALP ratio was found to be negatively correlated with age, a cor-relation that has not been found in other ethnicities. The serum BAP/ALP ratio was inversely correlated with serum CRP levels but was positively correlated with serum albumin levels and hemoglobin concentrations. Collectively, our results suggest that the BAP/ALP ratio could be a useful predictor for important geriatric con-ditions seen in general practice.

Identifying and managing care for children with autism spectrum disorders in general practice: A systematic review and narrative synthesis

Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients.

Management of work-related common mental disorders in general practice: a cross-sectional study

BackgroundGeneral practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs’ management and patterns of referral to other health professionals of patients with work-related CMD and associated factors.MethodWe used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord – Pas-de-Calais region in France (April – August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients’ symptoms. Associations between patient, work, GP and contextual characteristics and GPs’ management were explored using modified Poisson regression models with robust variance.ResultsAmong the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients’ characteristics (occupational and sociodemographic), GPs’ characteristics and environmental data were associated with the type of management used by the GP.ConclusionOur study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.

Factor Structure of the 12-item General Health Questionnaire (GHQ-12) Among Korean University Students

Background: The prevalence of mental health issues among university student populations is a growing concern. Therefore, a reliable standardized instrument is important for identifying students’ symptoms. The General Health Questionnaire (GHQ-12), a 12-item self-report measure, designed to screen for mental disorders in general practice and community settings, is a promising instrument. Although the GHQ-12’s underlying factor structure has been investigated internationally in a variety of settings, the best factor structure is still unclear in South Korea, particularly in university settings. Therefore, this study investigated the GHQ-12’s factor structure for a sample of South Korean university students. Methods: In this research, 504 undergraduate students participated; they were aged 18–28 years and attended a four-year university course in South Korea. The collected data were subjected to confirmatory factor analysis (CFA), which tested previously proposed factor structures for the GHQ-12, including single-factor, correlated two-factor, and three-factor models. Results: Confirmatory factor analysis indicated that Graetz’s three-factor model, representing anxiety and depression, social dysfunction, and loss of confidence, fitted the data better than a unidimensional model or correlated two-factor models. Reliability analysis showed that the total GHQ-12 had adequate internal consistency. . Conclusions: The current study suggests that Graetz’s three-factor solution provided the best fit to our data and that the Korean version of the GHQ-12 is a robust measure of general psychological distress symptoms. Moreover, our results further indicate the potential utility of also using the overall GHQ-12 score as a measure of general psychological distress, thus yielding significant advantages in both research and university settings.

Collaborative care vs consultation liaison for depression and anxiety disorders in general practice: study protocol for two randomized controlled trials (the Danish Collabri Flex trials)

BackgroundModels of collaborative care and consultation liaison propose organizational changes to improve the quality of care for people with common mental disorders, such as anxiety and depression. Some literature suggests only short-term positive effects of consultation liaison on patient-related outcomes, whereas collaborative care demonstrates both short-term and long-term positive effects. To our knowledge, only one randomized trial has compared the effects of these models. Collaborative care was superior to consultation liaison in reducing symptoms of depression for up to 3 months, but the authors found no difference at 9-months' follow-up. The Collabri Flex Trial for Depression and the Collabri Flex Trial for Anxiety aim to compare the effects of collaborative care with those of a form of consultation liaison that contains potential contaminating elements from collaborative care. The trials build on knowledge from the previous cluster-randomized Collabri trials.MethodsTwo randomized, investigator-initiated, parallel-group, superiority trials have been established: one investigating the effects of collaborative care vs consultation liaison for depression and one investigating the effects of collaborative care vs consultation liaison for generalized anxiety, panic disorder and social anxiety disorder at 6-months' follow-up. Participants are recruited from general practices in the Capital Region of Denmark: 240 in the depression trial and 284 in the anxiety trial. The primary outcome is self-reported depression symptoms (Beck Depression Inventory (BDI-II)) in the depression trial and self-reported anxiety symptoms (Beck Anxiety Inventory (BAI)) in the anxiety trial. In both trials, the self-reported secondary outcomes are general psychological problems and symptoms (Symptom Checklist 90-Revised), functional impairment (Sheehan Disability Scale) and general well-being (World Health Organization-Five Well-Being Index). In the depression trial, BAI is an additional secondary outcome, and BDI-II is an additional secondary outcome in the anxiety trial. Explorative outcomes will also be collected.DiscussionThe results will supplement those of the cluster-randomized Collabri trials and provide pivotal information about the effects of collaborative care in Denmark.Trial registrationClinicalTrials.gov, NCT03113175 and NCT03113201. Registered on 13 April 2017.

Socio-demographic co-relates of depression among housewives in rural area of district Ludhiana

Background: Depression is the most common psychiatric disorder in general practice. It is much more common among women than men, with female/male ratio roughly 2:1. In today’s hectic life, stress is increasing in housewives. Very few data is available on depression among housewives in India. So the present study is aimed to assess the prevalence of depression and study its epidemiological co-relates among housewives aged 18-59 years in rural area of district Ludhiana. Objectives were to assess depression among housewives aged 18-59 years in a rural area and determine the association of depression with socio-demographic co-relates.Methods: This study is a community based cross-sectional study carried out in the field practice area of Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab. 300 subjects were selected by systematic random sampling. Assessment of depression among the housewives was done by using Patient Health Questionnare-9 (PHQ-9).Results: In the present study, 43% of the subjects were found to have depression. Mean age of subjects with depression was found to be 42.4 (±10.3) years. There was an increasing trend of depression among housewives with increasing age (p=0.000). Inverse relationship was found between level of education and depression (p=0.000). Lower socio-economic status was found to be associated with higher rates of depression (p=0.039).Conclusions: Depression was seen to be on higher side among housewives in rural area of Ludhiana. Housewives should be educated about warning signs and symptoms of depression and motivated to avail the primary health care services.

Anxiety Disorders in General Practice

Anxiety disorders are a variant of borderline mental pathology belonging to the group of neurotic disorders, that is, to psychogenically caused by painful conditions characterized by a variety of clinical manifestations. Timely diagnosis and early start of adequate treatment of anxiety spectrum disorders can significantly improve the quality of life of patients.The article discusses the phenomenological aspects of anxiety disorders, especially the diagnosis and treatment in the general medical network, in particular, the currently recommended regimens for using the drug Eglonil and the advantages of this drug are described. Eglonil demonstrates the possibility of widespread use in various types of anxiety disorders, which gives the drug a special status among other psychotropic compounds.

General practitioners' perspectives on the use of nonpharmacological home remedies in two regions in Switzerland and France.

Nonpharmacological home remedies offer the potential for easily accessible and well-accepted management of common disorders in general practice. We aimed to assess general practitioners' (GPs') perspectives on these remedies in two French-speaking European countries. In 2017, we conducted a cross-sectional study among community-based GPs in the Geneva (Switzerland) and Grenoble (France) regions. They completed an anonymous questionnaire about forty common home remedies. We asked how often they prescribed each type of remedy and how effective they found them. Descriptive statistics (proportions with 95% confidence intervals [CIs]) were used to summarise the data. 349 GPs returned the questionnaire (172 of 500 Swiss and 177 of 500 French; participation rate 35%; male:female ratio 1:1). In the week before the study, GPs had advised 8.2% patients to use at least one remedy. The remedies that were most frequently prescribed were saline water to treat common colds (69%), mobilising and/or stretching exercises for low back pain (67%) and applying cold water or cold pads for burns (60%). The remedies that were perceived to be most effective were squatting during defaecation as a treatment for constipation (89%), phoning a traditional healer to treat skin diseases or burns (84%) and applying cold water or pads for burns (82%). These findings suggest that GPs find certain nonpharmacological remedies very useful, even though they do not frequently prescribe them in practice. These remedies should receive more attention from researchers, as they could be considered by GPs as useful to treat a large number of benign conditions in primary care.

Common mental health disorders in general practice

Practice nurses are likely to see a range of common mental health disorders in day-to-day practice. Sheila Hardy provides an overview of these conditions and the treatment their patients will be offered Common mental health disorders cause human distress and large costs for society. According to the National Institute for Health and Care Excellence, common mental health disorders include depression, generalised anxiety disorder, social anxiety disorder, panic disorder, obsessive compulsive disorder, and post-traumatic stress disorder. Practice nurses will see many patients with common mental health disorders and, while not every nurse will be involved in treatment, it is useful to have brief knowledge of the available treatment options. In this article, the definitions and treatments of each disorder are described, and the responsibilities of health professionals looking after people with common mental health disorders in primary care are explained.

Prevalence of work-related common psychiatric disorders in primary care: The French Héraclès study

General practitioners (GP), on the frontline for individuals with mental health problems, often deal with work-related common psychiatric disorders. We aimed to determine the prevalence of work-related common psychiatric disorders in general practice and associated patients’ and GPs’ characteristics.HERACLES, a cross-sectional study among 2019 working patients of 121 GPs in the Nord – Pas-de-Calais region in France. Common psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview, patient-perceived psychological distress and GP-diagnosed psychiatric disorders. The work-relatedness of common psychiatric disorders was ascertained by the GP and/or the patient. Prevalence rates adjusted on age were calculated by sex and associated characteristics were ascertained using multilevel Poisson regression models.The prevalence of work-related common psychiatric disorders ascertained using the MINI was estimated at 25.6% [23.7–27.5], 24.5% [22.6–26.4] for self-reported psychological distress and 25.8% [23.9–27.7] for GP-diagnosed psychiatric disorders. Age, history of psychiatric disorders, consultation for psychological purpose and GP’s characteristics were associated with MINI-identified psychiatric disorders.The prevalence of work-related common psychiatric disorders among working adults seen in general practice is high but further studies are needed to support this results.

099Diagnosing Cognitive Disorders in General Practice

099Diagnosing Cognitive Disorders in General Practice