Search results for ‘Subject term:"mental health problems"’ Sort:
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Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP)
- Authors:
- TAK Erwin C.P.M., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 31(7), 2016, pp.755-764.
- Publisher:
- Wiley
Objective: Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation. Methods: A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)). Results: GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach's α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas. Conclusion: The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings. (Publisher abstract)
Mental health toolkit
- Author:
- ROYAL COLLEGE OF GENERAL PRACTITIONERS
- Publisher:
- Royal College of General Practitioners
- Publication year:
- 2016
- Place of publication:
- London
This toolkit brings together a range of resources for general practitioners (GPs) and healthcare professionals regarding the diagnosis and treatment of mental health problems. It includes trigger questions, diagnostic tools, and current guidance for healthcare professionals supporting those with mental illness. It also provides resources that may help GPs and primary care health professionals communicate better with patients. Sections of the toolkit include: suicide and crisis care; children and young people's mental health; mental health in palliative care and older adults, including dementia; prevention and wellbeing resources; information for commissioners; and resources to support healthcare professionals manage their own mental health. Links to relevant e-learning resources are also included. (Edited publisher abstract)
The identification of young people's emotional distress: a study in primary care
- Authors:
- HALLER Dagmar M., et al
- Journal article citation:
- British Journal of General Practice, 59(560), March 2009, pp.159-165.
- Publisher:
- Royal College of General Practitioners
Primary care is a key step in young people's pathway to mental health care. Despite the high prevalence of mental disorder in this age group, little is known about the factors that determine the identification of young people's mental disorder in primary care. To provide a detailed description of the factors associated with both `correct' and `excessive' identification of youth mental disorder in primary care. Twenty-six randomly selected general practices in Victoria, Australia were involved in this cross-sectional study. Consecutive young people (16-24 years) were interviewed before their consultation, using a semi-structured interview. They completed Kessler's scale of emotional distress (K10). GPs completed a questionnaire after the consultation. Multinomial logistic regression was used to examine the factors associated with GP identification of mental disorder in those with high and low probability of disorder on the K10. Altogether, 450/501 (90%) of approached young people participated; 36.1% (95% confidence interval [CI] = 32.3 to 40.2%) had high probability of mental disorder on the K10. Young people's perception that they had a mental illness was highly associated with GP identification. Other significantly associated factors were: patient fears, frequent consultations, days out of role, and continuity of care. The latter two were also associated with `over-identification' of young people who had low probability of mental disorder. GP characteristics were not associated with identification. These findings provide guidance for GPs in their clinical work and training. They should also inform the further development of mental health literacy programmes in the community.
Mental health diagnosis by nurses using the Global Mental Health Assessment Tool: a validity and feasibility study
- Authors:
- SHARMA Vimal K., et al
- Journal article citation:
- British Journal of General Practice, 58(551), June 2008, pp.411-416.
- Publisher:
- Royal College of General Practitioners
The Global Mental Health Assessment Tool - Primary Care Version (GMHAT/PC) has been developed to assist health professionals to make a quick and comprehensive standardised mental health assessment. This study aimed to assess the feasibility of using a computer-assisted diagnostic interview by nurses and to examine the level of agreement between the GMHAT/PC diagnosis and psychiatrists' clinical diagnosis. A total of 215 patients between the ages of 16 and 75 years were assessed by nurses and psychiatrists in various settings in England and Wales: 54 in a primary care centre, 98 in a cardiac rehabilitation centre, and 63 in a community mental health clinic. The time taken for the interview, and feedback from patients and interviewers were indicators of feasibility, and the kappa coefficient, sensitivity, and specificity of the GMHAT/PC diagnosis were measures of validity. Mean duration of interview was under 15 minutes. The agreement between nurses' GMHAT/PC interview-based diagnosis and psychiatrists' International Classification of Diseases (ICD)-10 criteria-based clinical diagnosis was 80% It is concluded that the GMHAT/PC can assist nurses to make accurate mental health assessment and diagnosis in various healthcare settings and it is acceptable to patients.
Factors that influence the detection of psychological problems in adolescents attending general practices
- Authors:
- MARTINEZ Rebecca, REYNOLDS Shirley, HOWE Amanda
- Journal article citation:
- British Journal of General Practice, 56(529), August 2006, pp.594-599.
- Publisher:
- Royal College of General Practitioners
The aim of this study was to investigate factors influencing the detection of psychological problems in adolescents visiting general practices, using GP recognition of disorders with a reliable and valid measure: the Strengths and Difficulties Questionnaire (SDQ). An adolescent and parental version of the questionnaire were used. Ninety-eight adolescents were recruited by 13 GPs in Norfolk. The study identified psychological difficulties in almost one-third of adolescents. Three factors significant to the detection of psychological disorders were: adolescents' perceptions of difficulties according to the self-report SDQ, the severity of their problems as indicated by the self-report SDQ, and whether psychological issues were discussed in the consultation. GPs did not always explore psychological problems with adolescents, even if the GPs perceived these to be present. It is concluded that GPs are in a good position to identify psychological issues in adolescents, but GPs and adolescents seem reluctant to explore these openly. Open discussion of psychological issues in GP consultations was found to be the most important factor in determining whether psychological difficulties in adolescents are detected by GPs.
Primary care clinicians’ use of standardized psychiatric diagnoses
- Authors:
- GARNER W., et al
- Journal article citation:
- Child: Care, Health and Development, 30(5), September 2004, pp.401-412.
- Publisher:
- Wiley
Treatment of child mental health (MH) problems should be informed by psychiatric diagnosis. Whether primary care clinicians (PCCs) use standardized psychiatric diagnostic criteria to direct the treatment of child MH problems is unknown. This study investigated PCCs’ use of Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria during office visits. The data were obtained from 3674 children ages 4–15 years who were recognized as having one or more MH problems during office visits by clinicians participating in the Child Behaviour Study. Parents completed questionnaires before seeing the clinician. Clinicians completed a survey after the visit. The primary outcome was whether PCCs used standardized criteria to generate a diagnosis for children with recognized MH problems. Clinicians used DSM criteria in 23% of visits in which a psychosocial problem was recognized, and 57% of PCCs reported no use of DSM. DSM criteria were used most frequently (38% of visits) when PCCs reported attention problems. Medications were much more likely to be prescribed during visits when PCCs diagnosed using DSM criteria (63% of visits vs. 19% when criteria were not used). However, only 51% of psychotropic medication prescriptions were based on a DSM diagnosis. Clinicians used standardized criteria infrequently, and primarily to diagnose attention problems.
Detection of child mental health disorders by general practitioners
- Authors:
- SAYAL Kapil, TAYLOR Eric
- Journal article citation:
- British Journal of General Practice, 54(502), May 2004, pp.348-352.
- Publisher:
- Royal College of General Practitioners
This study compares GP recognition of disorders with child mental health data and examines factors affecting recognition, in particular whether recognition is enhanced if the parent expresses concern during the consultation. The study involved a two-phase design involving an initial community survey of children between the ages of 5 and 11 years. In the second phase, primary care attenders who were regarded by their GP as having a mental health disorder were compared with those who were not. For 186 children attending primary care, GP recognition was compared with the results of a child mental health questionnaire completed by parents. Accuracy and predictors of GP recognition were examined. Seventy four percent of children meeting criteria for caseness were not recognised by GP's as having a mental health disorder. The expression of parental concern in the consultation about a mental health problem increased the sensitivity of recognition from 26% to 88%. Expression of concern also increased GP recognition of non-cases; this reflected GP identification of other mental health and learning problems. Only a third of parents who had concerns expressed these during the consultation.
The Hopkins Symptom Checklist-25 is a sensitive case-finder of clinically important depressive states in elderly people in primary care
- Authors:
- FROJDH Karin, HAKASSON Anders, KARLSSON Ingvar
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(4), April 2004, pp.386-390.
- Publisher:
- Wiley
No depression rating scale has yet been designed to identify all clinically important depressive states in elderly. Therefore, this study investigated the Hopkins Symptom Checklist-25 (HSCL-25), a self-rating scale for depression, to see if it was a sensitive indicator of major, minor and subsyndromal depression. Structured interviews of 37 people with a high depressive score and an age and sex matched control group comprised of 37 persons with a low depressive score in HSCL-25, in order to compare the HSCL-25 ratings with the Montgomery- Åsberg-Depression Rating Scale (MADRS) as well as with the criteria for major, minor and subsyndromal depression. The sensitivity for identifying any depression was 94% and the specificity was 94% for HSCL-25 compared to the diagnostic criteria for depressive disorders. HSCL-25 is a sensitive case-finder of any depressive disorder and may be useful in general practice and for screening studies of depression in elderly people
CBT and the challenge of primary care: developing effective, efficient, equitable, acceptable and accessible services for common mental health problems
- Author:
- WHITE Jim
- Journal article citation:
- Journal of Public Mental Health, 7(1), August 2008, pp.32-41.
- Publisher:
- Emerald
Recent guidelines suggest that cognitive behavioural therapy has a pivotal role to play in the treatment of common mental health problems. There is a danger that we ask for 'more of the same' instead of looking at all the current limitations preventing individuals from accessing appropriate help. This paper suggests that progress in primary care mental health has been much more limited than mental health workers and, in particular, researchers often acknowledge. It looks at the major obstacles barring the way to the development of services that could meet the needs of the very large number of people in our communities with common mental health problems.
Poor mental and physical health differentially contributes to disability in hospitalized geriatric patients of different ages
- Authors:
- MARENGONI Alessandra, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(1), January 2004, pp.27-34.
- Publisher:
- Wiley
This article seeks to evaluate the relationship between depressive symptoms, cognition and somatic diseases on functional status of geriatric patients at hospital discharge. Patients 65+ years consecutively admitted to the acute care geriatric ward of the Internal Medicine Department I, Civil Hospital of Brescia, Italy, from February 1998 to December 2000 (n = 830) were examined. Functional disability was defined as need of physical assistance in at least one of the basic Activities of Daily Living (ADL). The Greenfield Index of Disease Severity (IDS) and the Geriatric Index of Comorbidity (GIC) were used to measure number and severity of diseases. The Mini-Mental State Examination (MMSE) assessed cognitive status and the Geriatric Depression Scale (GDS) measured depressive symptoms. Prevalence of functional disability at discharge was 29.3% in the younger age group (65-74 years) and 55.2% in the older age group (75+ years). Using logistic regression models, older age, poorer cognitive status, and depressive symptoms were independently associated with functional disability in the younger and older age group, respectively. Additionally cognitive impairment and depressive symptoms showed an additive association with disability, especially in younger patients, while comorbidity was correlated with functional status only in the oldest old, in particular among those who were cognitively impaired. Functional disability after acute hospitalization is highly prevalent in geriatric patients. Depressive symptoms, comorbidity, and cognitive impairment often coexist, interact and are differentially associated with function depending on age. Considering that depressive symptoms are a modifiable problem, their detection in hospital settings may help clinicians in targeting subjects at high risk of functional disability.