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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.
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
Recommendations for primary care provided by psychiatrists
- Authors:
- SOWERS Wesley, ARBUCKLE Melissa, SHOYINKA Sosunmolu
- Journal article citation:
- Community Mental Health Journal, 52(4), 2016, pp.379-386.
- Publisher:
- Springer
Recent studies have shown that people with severe mental illness have a dramatically lower life expectancy than the general population. Psychiatrists have not traditionally been very attentive to or involved with physical health issues and there has been growing emphasis on integrated care for physical and mental health and access to primary care for all members of the population. This paper examines the role of psychiatrists in the provision of primary care to the patients they treat. Some recommendations are offered for their involvement in the provision of primary care at three levels of complexity: Level 1—Universal Basic Psychiatric Primary Care; Level 2—Enhanced Psychiatric Primary Care; and Level 3—Fully Integrated Primary Care and Psychiatric Management. Some of the obstacles to the provision of primary care by psychiatrists are considered along with some suggestions for overcoming them. (Publisher abstract)
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.
Identification of psychological morbidity in older people in primary care by practice nurses
- Authors:
- CAPE J., et al
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.446-451.
- Publisher:
- Taylor and Francis
Older people with psychological morbidity generally first present to health services in primary care, where they are increasingly seen by primary care nurses. In order to evaluate primary care nurses' identification of psychological morbidity, 190 older patients attending eight practice nurses completed the General Health Questionnaire (GHQ) and the practice nurses made an assessment as to the presence or absence of psychological problems. The practice nurses identified only 26% of probable cases of psychological morbidity identified by the GHQ. Their threshold for identification was high, rating only 12% of patients as experiencing psychological problems compared to 29% probable cases identified by the GHQ, and their accuracy was low (kappa for agreement between GHQ and nurse ratings = 0.23). Likelihood of identification depended on length and type of visit. The findings suggest that it may be unrealistic to expect practice nurses, without additional training and reorganisation of their work, to identify more than a minority of older patients with psychological morbidity in the course of their routine work.
Drug and alcohol misuse among in-patients with psychotic illnesses in three inner-London psychiatric units
- Authors:
- PHILLIPS Prashant, JOHNSON Sonia
- Journal article citation:
- Psychiatric Bulletin, 27(6), June 2003, pp.217-220.
- Publisher:
- Royal College of Psychiatrists
Ward staff were asked to rate whether in-patients with a diagnosis of functional psychotic illness also met criteria for a diagnosis of alcohol or drug misuse or dependence during the preceding 6 months. Those who demonstrated such evidence were then asked to report the nature and extent of their substance use and whether they continued to use as in-patients. 264 in-patients with psychotic illness were screened for evidence of recent or current alcohol or drug misuse. According to staff reports, 127 (48.9%) met the criteria for substance misuse or dependence. The mean age of those with 'dual diagnosis' was 34.7 years and 72% were male. Eighty-three (83%) of those with a history of current or recent alcohol or drug misuse reported that they had continued to use alcohol and/or illicit drugs in the in-patient wards during their current admission. It appears difficult to prevent in-patients with drug or alcohol misuse problems from continuing to use substances in hospital. Further consideration and investigation of how best to manage this group is therefore required.
Geriatric depression in Nigerian primary care attendees
- Authors:
- SOKOYA Olukunle, BAIYEWU Olusegun
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.506-510.
- Publisher:
- Wiley
202 older people were screened using the Geriatric Depression Scale (GDS). The Geriatric Mental State schedule (GMS) was administered to participants who scored above the cut-off on the GDS in order to assess psychopathology. Diagnosis of depression was based on ICD-10 criteria as well as the GMS-AGECAT programme. The rate of geriatric depression in primary care was found to be 7.4%. Severe depression was only 1.5%. Very low income and subjective report of poor health were significantly associated with depression in the cohort. AGECAT recognition of depression was comparable to that by the ICD-10 (k = 0.7). The study is the first known study of geriatric depression in primary care in Nigeria. The rates are comparable with rates obtained in other countries. Specific correlates of depression in the older Nigerians identified included poor self-assessed health and low income.
Child psychiatric disorders among primary mental health service attenders
- Authors:
- ARCELUS Jon, VOSTANTIS Panos
- Journal article citation:
- British Journal of General Practice, 53(488), March 2003, pp.214-216.
- Publisher:
- Royal College of General Practitioners
The aim of this study was to establish the range of psychiatric disorders and psychiatric comorbidity among children and adolescents attending a primary mental health service (PMHS). The main psychiatric diagnostic categories were: oppositional defiant disorders (ODDs) (75.3%), anxiety disorders (36.1%), mood disorders (35.1%), and attention deficit hyperactivity disorders (ADHDs) (28.9%). The study found high rates (61.8%) of psychiatric comorbidity. It concludes that training in the recognition of likely psychiatric comorbidity in this population is essential for professionals working in the interface between primary and specialist services.
Mental health care in prisons
- Author:
- REED John
- Journal article citation:
- British Journal of Psychiatry, 182(4), April 2003, pp.287-288.
- Publisher:
- Cambridge University Press
Admission to prison offers a unique opportunity to assess and to start to meet the health care needs of a population with high levels of physical and psychiatric morbidity, many of whom rarely come into contact with the NHS. Drug and alcohol problems can be addressed. However, prisons are not hospitals, and (unlike prisoners with serious physical illness) many prisoners with serious mental illnesses requiring NHS in-patient care remain in prison.
Would older people use psychological services?
- Authors:
- AREAN Patricia A., et al
- Journal article citation:
- Gerontologist, 42(3), June 2002, pp.392-398.
- Publisher:
- Oxford University Press
This article examines older patient preferences for psychological services, including the types of services they would be interested in and who should provide them. Seventy-nine percent of the sample surveyed said they would use any of the psychological services which were presented to them. Seventy-two percent preferred to talk to their primary care provider, and 46% of the sample indicated that they would also speak with a mental health worker or nurse about their problems. Few older people said they would attend group psychotherapy, but 69% said they would attend psychoeducational classes. Implications: Our findings suggest that older adults would be amenable to psychosocial services, particularly individual services and psychoeducational programming.