Psychiatric Disorders In Primary Care Research Articles

Clinical Predictors of Engagement in Teleintegrated Care and Telereferral Care for Complex Psychiatric Disorders in Primary Care: a Randomized Trial

BackgroundTelepsychiatry Collaborative Care (TCC) and Telepsychiatry/Telepsychology Enhanced Referral (TER) expand the reach of specialty mental health services to underserved populations.ObjectiveAssess clinical predictors of treatment engagement for complex psychiatric conditions in TCC—in which remote specialists consult with primary care teams via an onsite care manager who also provides brief psychotherapy—and TER, in which remote specialists provide direct telehealth treatment.DesignA randomized pragmatic trial from twenty-four primary care clinics without onsite psychiatrists or psychologists.ParticipantsA total of 1,004 adult patients screened positive for posttraumatic stress disorder (PTSD)and/or bipolar disorder were randomized to receive TCC or TER for 1 year.Main MeasuresPsychotherapy engagement was measured by the number of sessions completed, and pharmacotherapy engagement by the medication adherence item from the Schizophrenia Care and Assessment Program Health Questionnaire (SCAP-HQ).Key ResultsEngagement in TCC psychotherapy visits was greater compared to TER. There was no association between the PTSD symptom severity and treatment engagement. The internal state scale (ISS) activation subscale, an indicator of mania, was associated with reduced odds of initiating psychotherapy (odds ratio [OR] = 0.70; 95% CI, 0.59 to 0.84) but not the number of sessions attended once psychotherapy started. The Drug Abuse Screening Test-10(DAST-10) score was associated with receipt of fewer psychotherapy sessions (incidence ratio rate [IRR] = 0.88; 95% CI, 0.81 to 0.95). The number of physical health comorbidities was associated with greater engagement in psychotherapy (IRR = 1.11, 95% CI, 1.03 to 1.19) and pharmacotherapy (OR = 1.54; 95% CI, 1.27 to 1.87). None of the findings varied by intervention group.ConclusionsBoth teleintegrated and telereferral care offer an opportunity to treat patients with complex psychiatric conditions. While there was no difference in clinical characteristics predicting engagement, onsite care managers engaged patients in more psychotherapy sessions than remote therapists.Trial RegistrationClinicalTrials.gov Identifier: NCT02738944

Collaborative Care Model Promotes Justice and Equity

Collaborative Care Model Promotes Justice and Equity

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months. Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing. Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.0; 95% CI, -0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, -1.7 to 5.7; P = .29). In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable. ClinicalTrials.gov Identifier: NCT02738944.

Associations Between Psychiatric Disorders and Alcohol Consumption Levels in an Adult Primary Care Population

BackgroundUnhealthy alcohol use frequently co‐occurs with psychiatric disorders; however, little is known about the relationship between psychiatric disorders and alcohol consumption levels. Understanding varying levels of unhealthy alcohol use among individuals with a variety of psychiatric disorders in primary care would provide valuable insight for tailoring interventions.MethodsWe conducted a cross‐sectional study of 2,720,231 adult primary care patients screened for unhealthy alcohol use between 2014 and 2017 at Kaiser Permanente Northern California, using electronic health record data. Alcohol consumption level was classified as no reported use, low‐risk use, and unhealthy use, per National Institute on Alcohol Abuse and Alcoholism guidelines. Unhealthy use was further differentiated into mutually exclusive groups: exceeding only daily limits, exceeding only weekly limits, or exceeding both daily and weekly limits. Multivariable multinomial logistic regression models were fit to examine associations between 8 past‐year psychiatric disorders (depression, bipolar disorder, anxiety disorder, obsessive–compulsive disorder, schizophrenia, schizoaffective disorder, anorexia nervosa, and bulimia nervosa) and alcohol consumption levels, adjusting for sociodemographic and health characteristics.ResultsIn the full sample [53% female, 48% White, mean (SD) age = 46 (18) years], patients with psychiatric disorders (except eating disorders), compared to those without, had lower odds of reporting low‐risk and unhealthy alcohol use relative to no use. Among patients who reported any alcohol use (n = 861,427), patients with depression and anxiety disorder, compared to those without, had higher odds of exceeding only weekly limits and both limits; patients with bulimia nervosa were also more likely to exceed both limits.ConclusionsFindings suggest that patients with anxiety disorder, depression, and bulimia nervosa who drink alcohol are more likely to exceed recommended limits, increasing risk of developing more serious problems. Health systems and clinicians may wish to consider implementing more robust screening, assessment, and intervention approaches to support these vulnerable subgroups in limiting their drinking.

Psychiatric symptoms among patients with acute abdominal pain

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, ‘Length of stay’ (LOS) and perceived health.Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain; p = .017, dizziness; p = .004, palpitations; p = .005, insomnia; p = .005 and worries; p = .001), and summarized anxiety and depression symptoms (p = .001–0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group.Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.

Prevalence of neurodevelopmental, behavioural and learning disorders in paediatric primary care

Abstract Objectives To determine the prevalence of psychiatric disorders in primary care paediatrics in Atlantic Galicia. Methods An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruna and Pontevedra with a population of 8,293 children between September and November 2015. A total of 1,286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorisation was obtained from the Research Ethics Committee of Galicia number 2015/427. Results 148 of 1,286 patients presented psychiatric pathology (11.5% IC 95% 9.73–13.29), 68% male. Between 0 and 5 years, the prevalence was 4.5%; between 6 y and 10 y, 18.5% and between 11 y and 14 y, 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behaviour disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment. Conclusions The prevalence of psychiatric disorders in paediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources.

Prevalence of neurodevelopmental, behavioural and learning disorders in Pediatric Primary Care

To determine the prevalence of psychiatric disorders in primary care pediatrics in Atlantic Galicia. An observational, descriptive, cross-sectional prevalence study was carried out in 9 outpatient clinics in A Coruña and Pontevedra with a population of 8293 children between September and November 2015. A total of 1286 randomly selected patients from 0 to 14 years of age were included. From the medical history was registered: age, sex, psychiatric diagnosis established by DSM-IV-TR criteria in its five axes, professionals who participated in the diagnosis and treatment of the process and what type of treatment was received. Authorization was obtained from the Research Ethics Committee of Galicia number 2015/427. 148 of 1286 patients presented psychiatric pathology (11,5% IC 95% 9.73-13,29), 68% male. Between 0 and 5years, the prevalence was 4.5%; between 6y and 10y, 18.5% and between 11y and 14y 22%. Symptoms lasted a median of 25 months. The most frequent pathologies in 1286 patients were ADHD (5.36%), language disorders (3.42%), learning disorders (3.26%), anxiety-depressive disorders (2.4%) and behavior disorders (1.87%). Of the 148 cases, 47% had comorbidity with another mental disorder. Most of them required attention by multiple social, health and educational professionals; 33% received psychopharmacological treatment. The prevalence of psychiatric disorders in pediatric primary care is frequent, chronic and complex, increases with age and requires many health, educational and social resources.

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.

Descriptive study of adjustment disorders in a mental health unit.

IntroductionAdjustment disorders are a common psychiatric disorder in primary care and mental health units, with point prevalence estimates ranging from 0.9% to 2.3%. These disorders have been recently defined as a stress response syndrome in the fifth edition of the DSM, causing emotional and social difficulties and also a large economic burden on society.ObjectivesThe aim of this descriptional study was to analyse the socio-demographic characteristics and treatment of the patients diagnosed with adjustment disorders in the first visit in a mental health unit.MethodsThe study sample consisted of 128 patients admitted for a psychiatric consultation in a mental health unit in Alicante (Spain) from their primary care physician, between February and July 2016. Variables of gender, age, current employment status, diagnosis and treatment were measured. Data analysis was conducted using SPSS software.ResultsThe data from 31 patients who were diagnosed with adjustment disorders meant a 24% of the sample. The median age was 47 years old in the adjustment disorders group. Among those with adjustment disorders, 61% were women, and 52% of them were unemployed. Almost 60% of them had at least one pychotropic prescription and only 22% were derived to psychology.ConclusionsAdjustment disorders are considered as an intermediate category between no mental disorder and affective disorders. Most authors recommend to start with a psychotherapeutic intervention. Despite starting with medication has not proved effectiveness in the studies, most of the patients had at least one psychotropic prescription before the psychiatric evaluation.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Management of Current Psychiatric Disorders

Objective: Describe and analyse the experience of family physicians in managing current psychiatric disorders to obtain a better understanding of the underlying reasons of under-detection and inadequate prescribing identified in studies. Methods: A qualitative study using in-depth interviews. Sample of 15 practicing family physicians, recruited by telephone from a precedent cohort (Sesame1) with a maximum variation: sex, age, single or group practice, urban or rural. Qualitative method is inspired by the completed grounded theory of a verbatim semiopragmatic analysis from 2 experts in this approach. Results: Family physicians found that current psychiatric disorders were related to psychological symptoms in reaction to life events. Their role was to make patients aware of a psychiatric symptom rather than establish a diagnosis. Their management responsibility was considered in contrasting ways: it was claimed or endured. They defined their position as facilitating compliance to psychiatrist consultations, while assuring a complementary psychotherapeutic approach. Prescribing medication was not a priority for them. Conclusions: The identified under-detection is essentially due to inherent frontline conditions and complexity of clinical forms. The family physician role, facilitating compliance to psychiatrist consultations while assuring a support psychotherapy is the main result of this study. More studies should be conducted to define more accurately the clinical reality, management and course of current psychiatric disorders in primary care.

Distinguishing between emotional distress and psychiatric disorder in primary care attenders: A cross sectional study of the four-dimensional symptom questionnaire (4DSQ)

BackgroundDetection of psychiatric disorder in primary care is a complex issue. Distinctions between ‘normal’ emotional distress and psychiatric disorder depend on how disorder is conceptualized. Our aim was to explore two different conceptualizations by examining patients' scores on one-dimensional depression measures and scores on the Four Dimensional Symptom Questionnaire (4DSQ), a measure that uniquely has separate dimensions for general distress and depressive disorder. MethodsThis was a cross sectional study of 487 primary care patients attending general clinics in Hampshire, UK. Patients completed the 4DSQ, Patient Health Questionnaire-9 (PHQ-9), General Health Questionnaire-12 (GHQ-12) and the Hospital Anxiety and Depression Scale (HADS) whilst in the waiting room. ResultsThe 4DSQ classified 26% (126/485) of patients as having heightened distress levels and 8% (38/468) as possible cases of depressive disorder. Casesness was consistently higher across the one-dimensional measures (PHQ-9: 16%, GHQ-12: 28%, HADS-D: 13%). Of those patients deemed possible cases by the PHQ-9 (≥10), the 4DSQ classified 91% (71/78) as having heightened distress and 44% (32/72) as possible cases of depressive disorder. LimitationsThe sample was predominately older and white, which may limit generalizability of the findings to more diverse patient groups. There are limits to self-report measures in the assessment of complex diagnostic issues. ConclusionsInclusion of a distinct general distress dimension alongside a dimension focusing on specific depression symptomatology lowered the number of primary care patients classified as possible cases of disorder. This view of symptoms may have implications for the targeting of existing treatments, and may be useful in guiding the development of novel self-management interventions.

Primary prevention of anxiety disorders in primary care: A systematic review

ObjectiveAnxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care. MethodsA literature search was carried out in four databases—PubMed, PsycInfo, Cochrane, and Web of Science—from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire. ResultsNo high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child–adolescent population or on other types of interventions, usually as secondary prevention. ConclusionThis study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.

İstanbul ili genelinde görev yapan aile hekimlerinin antidepresan reçetelemesini etkileyen faktörler

Factors affecting prescribtion of antidepressant medications by family physicians in Istanbul province Objective: In the family physician system, depression and anxiety disorders are frequently encountered and antidepressant medications are often prescribed in recent years. Therefore, we aimed to investigate the factors affecting the prescription of antidepressants by family physicians. Methods: In our study, 120 family physicians working at six districts in Istanbul were contacted and the data were collected by administering a 30-item questionnaire prepared by the investigators. Results: Eighty point eight percent of the participating family physicians reported that they had sufficient education and practice for diagnosing depression. Fourty seven point five percent of them found their education inadequate for the treatment of patients. Only 1.5% of them were able to define all of the symptoms of depression. Eighty nine point two percent pointed out that they needed regular training about the use of antidepressants in treatment. We found that 81.7% of the physicians preferred prescribing the same antidepressant molecule as their primary option. Sixty six point seven percent stated that they believed the antidepressants could cause dependency and 72.2% believed that a large number of patients would recover without any medication. Conclusion: With the introduction of family physician practice across the country as of the end of 2010, we entered a new era in terms of the management of psychiatric disorders in primary care. We can suggest that new measures and arrangements are needed to improve the knowledge and attitudes of family physicians about the diagnosis and treatment of psychiatric disorders.

Psychiatric disorders in primary care.

Psychiatric disorders in primary care.

Family Influences on the Use of Mental Health Services among African Americans.

We examine how families influence mental health service (MHS) utilization among African Americans by drawing on the concept of family ambivalence, which encompasses both family support and stress, and by placing utilization within the context of family histories of psychiatric disorder and treatment. Data are from the 2001-2003 National Survey of American Life, a nationally representative sample of African American adults (n = 3,149), including a clinical need subsample (n = 605) of respondents with a disorder. Negative family interactions have indirect positive effects on use of any MHS through need for care, whereas family social support lacks any effect. Although poor self-rated mental health (SRMH) is associated with greater utilization of any and specialty MHS given family histories of no disorder or treated disorder, utilization is low given a family history of untreated disorder, irrespective of SRMH. Screening for family histories of psychiatric disorder in primary care is recommended.

Bipolar Patients in Integrated Systems May Need More-Intensive Care

Back to table of contents Previous article Next article Professional NewsFull AccessBipolar Patients in Integrated Systems May Need More-Intensive CareMark MoranMark MoranSearch for more papers by this authorPublished Online:12 May 2014https://doi.org/10.1176/appi.pn.2014.5b12AbstractFederally qualified primary care clinics, as well as primary care clinics where both uninsured and Medicaid patients are treated, are likely to have a significant percentage of patients with bipolar illness.Primary care patients with bipolar disorder may require more-intensive services—including direct psychiatric care—than is currently provided in a collaborative care primary care model.That’s the finding from the study “Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder,” published April 15 in Psychiatric Services in Advance.“Primary care patients with bipolar disorder experienced persistent depressive and anxiety symptoms despite higher-intensity collaborative care treatment, but they were infrequently referred to a community mental health center,” the researchers stated. “Successful treatment of bipolar disorder in primary care may require additional clinical interventions aimed at either further improving the care delivered to patients in primary care or through more effective referrals to community mental health centers.”The authors were Joseph Cerimele, M.D., Ya-Fen Chan, Ph.D., Lydia Chwastiak, M.D., Marc Avery, M.D., Wayne Katon, M.D., and Jürgen Unützer, M.D., M.P.H., of the University of Washington, who have pioneered the development of collaborative care models integrating behavioral and general medical care. Key PointsBottom Line: Primary care patients with bipolar disorder may require more intensive care, or better outreach with specialty mental health clinics, than is currently provided in a collaborative care system.Only about one-third of primary care patients in a statewide mental health integrated care program who had bipolar disorder and baseline PHQ-9 scores of 10 or more experienced significant clinical improvement in depressive symptoms.More than half of the patients reported concerns about housing, and 15 percent reported homelessness, while 22 percent reported lack of a support person.Only one-third of the patients were referred to a specialty mental health clinic.They identified 740 primary care patients with bipolar disorder in the statewide mental health integration program (MHIP) between January 2008 and December 2011 using the Composite International Diagnostic Interview and clinician diagnosis. The MHIP uses collaborative care based on the IMPACT model (Improving Mood–Promoting Access to Collaborative Treatment), which was developed at the University of Washington to improve recognition and systematic treatment of patients with psychiatric disorders in primary care settings.Primary care patients with bipolar disorder had high symptom severity on both depression and anxiety measures using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale. Only about one-third of patients with bipolar disorder with baseline PHQ-9 scores of 10 or more experienced significant clinical improvement in depressive symptoms (with a PHQ score of less than 10 or a reduction in PHQ-9 score by 50 percent or more) during the time from initial MHIP assessment until treatment in MHIP or until the study ended.Psychosocial problems were common, with approximately 53 percent reporting concerns about housing, 15 percent reporting homelessness, and 22 percent reporting lack of a support person. Yet only 26 percent of patients were referred to specialty mental health treatment. The average time from initial assessment to psychiatric consultation was 5.7 weeks among patients with bipolar disorder.Wayne Katon, M.D., says integration of psychiatrists, on site or by telemedicine, may be necessary for the care of bipolar patients in collaborative care systems.Courtesy of Wayne Katon, M.D.Katon, vice chair of the Department of Psychiatry at the University of Washington, told Psychiatric News that the study indicates that these patients may need more-intensive care than is currently provided in a collaborative care model, in which a care manager, supervised by a psychiatrist, provides the direct patient care.“The importance of this article is that the U.S. federally qualified primary care clinics, as well as many primary care clinics that treat both uninsured and Medicaid patients, are likely to have a significant percentage of patients with bipolar illness, especially bipolar II illness,” Katon said. “This article emphasizes that despite the fact that only about one-third improve with treatment in these clinics, few are being referred to community mental health clinics or actually attend when referred. These clinics already had integrated collaborative care—that is, the use of a care manager supervised by a psychiatrist—so the inference is that these patients may need more-intensive psychiatric treatment, which could occur if psychiatrists are integrated into the clinics either in person or via telemedicine. Alternatively, the clinics need to establish better links with community mental health.” ■“Bipolar Disorder in Primary Care: Clinical Characteristics of 740 Primary Care Patients With Bipolar Disorder” is posted here. ISSUES NewArchived

Why Adolescent Depression Is a Global Health Priority and What We Should Do About It

Why Adolescent Depression Is a Global Health Priority and What We Should Do About It

Consultoría psiquiátrica en atención primaria

Medwave es una revista electrónica revisada por pares y de acceso gratuito, que contiene artículos originales de revisión sobre determinantes clínicos, sociales, políticos y económicos en salud, y de investigación en el ámbito clínico y biomédico. Medwave is an online-only, peer-reviewed and open Access biomedical general journal with original review articles con clinical, social, political and economic determinants of health, and research articles on clinical and biomedical aspects.

P03-525 - Shared care between specialized psychiatric services and primary care - the experiences and expectation of primary care physicians in Ireland

ObjectiveThe study aims to explore the views of primary care physicians in Ireland on shared care of psychiatric patients between primary and secondary services.MethodsA self-administered questionnaire was posted to a random cross-section primary care physicians working in Ireland. Data were compiled and analyzed using descriptive statistics and analysis of variance.Results145 out of 300 questionnaires were returned giving a response rate of 48%. Overall, 77.9% of respondents reported that they completed a psychiatric rotation as part of their general practice training. Most General Practitioners expressed confidence in their ability to recognize and manage psychiatric disorders in primary care (on a confidence scale of 1 to 5, mean was 3.97, SD 0.699). There was a statistically, significant difference in confidence scores between those who had took a rotation in psychiatry as part of their GP training and those who did not, with the former reporting higher scores (4.04 vs. 3.72, F = 1.801, t = 2.363, p = 0.02)Regarding shared care, 95.8% of GPs were in favour of a formal shared care policy; however 42.8% expressed reservations regarding the implications of implementing such a policy. The most frequently expressed concerns related to the lack of resources in primary care for psychiatric patients (55.9%), financial implications for some patients (48.3%), and concern over communication with psychiatric services (42%).ConclusionThe majority of Primary Care physicians in Ireland would support a policy of shared care of psychiatric patients’; however they raise some concerns regarding practical implications of such a policy.

Frequency of psychological and somatic symptoms in patients with major depressive disorder

Major depressive disorder (MDD) is one of the most commonly encountered psychiatric disorders in primary care. Depression is primarily a psychological illness; however, patients usually present with somatic symptoms. This pattern of presentation quite often poses a risk for patients with MDD due to the fact that general practitioners commonly attribute the cause of somatic symptoms to organic illnesses, thereby misdiagnosing patients. The current study focuses on the frequency of psychological and somatic symptoms in patients with major depressive disorder. The study is a cross-sectional survey using non-probability purposive sampling technique. The authors administered a self-developed questionnaire on 900 patients (male and female) diagnosed with major depressive disorder based on Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR). The data was analyzed using Statistical Package for Social Sciences-10 (SPSS-10). Females presented with a higher frequency of somatic symptoms as compared to psychological symptoms, whereas males presented with a higher frequency of psychological symptoms as compared to somatic symptoms. These findings emphasize the imperative need for health care professionals to have a thorough understanding of major depressive disorder. The disabling effects of depression can be minimized and prognosis of such patients improved to the point of remission if depression is promptly diagnosed without ambiguity, and intensively treated based on the physician's comprehensive knowledge of the symptomatology of major depressive disorder.