The diagnostic status of patients with conspicuous psychiatric morbidity in primary care

1984 ◽  
Vol 14 (3) ◽  
pp. 673-681 ◽  
Author(s):  
Patricia R. Casey ◽  
S. Dillon ◽  
P. J. Tyrer
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Personality Disorder ◽  
Mental State ◽  
Depressive Disorders ◽  
Psychiatric Morbidity ◽  
Epidemiological Studies ◽  
Detailed Assessment ◽  
One Year ◽  
Primary Problem

SynopsisA 7% one-year prevalence rate of conspicuous psychiatric morbidity was found in patients attending a single general practice. The nature of the morbidity was examined by a detailed assessment of mental state and personality, using interview schedules administered by a psychiatrist. Depressive disorders were presented by nearly half of the patients. The overall sex incidence of the disorders was equal, but alcohol abuse was more common in males. A personality disorder was present in 33·9% of all patients seen, although it was rarely diagnosed as the primary problem and was linked to the diagnosis of anxiety states, rather than depressive neurosis. These findings are discussed in relation to other epidemiological studies in primary care.

The effect of physical ill health on the course of psychiatric disorder in general practice

1997 ◽  
Vol 170 (6) ◽  
pp. 536-540 ◽  
Author(s):  
S. R. Kisely ◽  
D. P. Goldberg
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Psychiatric Disorder ◽  
Psychiatric Morbidity ◽  
Somatic Symptoms ◽  
Psychological Outcome ◽  
Stage Design ◽  
Independent Contribution ◽  
One Year ◽  
Physical Morbidity

BackgroundThe aim of this study was to determine the effect of physical morbidity on the outcome of patients with psychiatric disorder, and to compare the effects of non-medically and medically explained symptoms.MethodOne hundred and fifty psychiatric cases were recruited using a two-stage design from 1620 consecutive patients attending their GP. Subjects were assessed at the time of screening, and one year subsequently, using the Composite International Diagnostic Instrument adapted for use in primary care (CIDI - PHC) and the Groningen Social Disability Schedule (GSDS). Assessments of psychiatric morbidity were also obtained from GPs.ResultsMedically explained somatic symptoms were strongly related to psychological outcome one year later. Whereas just over a half of patients with no medically explained symptoms had recovered from a psychiatric disorder, the percentage recovery fell to 41% in those with 1 −4 medically explained symptoms, and only 21% in patients with five or more medically explained symptoms.ConclusionsPhysical ill-health has been shown to make an independent contribution to psychological outcome. The specific needs of these patients should receive greater attention.

Depressive Disorder in Primary Care

1987 ◽  
Vol 150 (6) ◽  
pp. 737-751 ◽  
Author(s):  
C. V. R. Blacker ◽  
A. W. Clare
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Psychiatric Morbidity ◽  
Depressive Illness ◽  
Psychiatric Disturbance ◽  
Collaborative Studies ◽  
Effect Of Treatment ◽  
Precise Relationship ◽  
The Relationship

Since the pioneering study of psychiatric morbidity in primary care by Shepherdet alin 1966, it has become increasingly apparent that a substantial proportion (between 20% and 25%) of patients consulting their GP are suffering from some form of psychiatric disturbance (Goldberg & Blackwell, 1970; Hoeperet al,1979). The composition of this psychiatric morbidity has been shown to be almost wholly affective in nature and largely mild in degree. In their important review Jenkins & Shepherd (1983) recently summarised the now extensive findings relating to overall minor psychiatric morbidity in primary care. However, recent collaborative studies between psychiatrists and GPs have identified that within this dilute pool of minor disorders, lurks a significant but poorly served population of patients suffering from depressive disorders which are by no means minor in degree. A number of crucial issues regarding this depression in primary care emerge which the present paper aims to review. In particular, how common is it, and how severe? How does it present and what, if any, are its special characteristics? What is the precise relationship between depressive symptoms and depressive illness presenting to the GP and what is the relationship between physical illness and depression? And finally, what is the course and outcome of depression in this setting and what are the indications for and effect of treatment?

Psychiatric morbidity, disability and service use amongst primary care attenders in France

2004 ◽  
Vol 19 (3) ◽  
pp. 164-167 ◽  
Author(s):  
J. Norton ◽  
G. de Roquefeuil ◽  
A. Benjamins ◽  
J.-P. Boulenger ◽  
A. Mann
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Service Use ◽  
Response Rate ◽  
Psychiatric Morbidity ◽  
Initial Study ◽  
Physical Illness ◽  
Accurate Detection ◽  
Domains Of Life

AbstractAttenders (n = 124, response rate 84%) of five GPs in Montpellier completed questionnaires on health (reason for visit, cause of problem, GHQ-12), disability (WHODAS II) and service use (CSRI). For each patient, the GP filled in a brief form including a rating of severity of physical and psychological illness. Overall 30.6% of patients were classified as GHQ cases indicating probable non-psychotic psychiatric morbidity and 58.9% were rated as having a physical illness by the GP. Patients with psychiatric morbidity showed as high levels of disability as those with a physical illness, with however a greater number of domains of life affected. They also had a greatly increased number of disability days and used services to a greater extent than those without psychiatric morbidity, these links being stronger than with physical illness. Use of the WHODAS II and the CSRI has not been previously reported in France. This study shows that they could be useful instruments for depicting disability and service use in general practice. The findings from this initial study indicate the need for greater research in primary care focusing on accurate detection and treatment of patients so that disability and excess service use associated with psychiatric morbidity might be reduced.

Suicidal behaviour among primary-care patients with depressive disorders

2005 ◽  
Vol 36 (2) ◽  
pp. 203-210 ◽  
Author(s):  
M. S. VUORILEHTO ◽  
T. K. MELARTIN ◽  
E. T. ISOMETSÄ
Keyword(s):  
Primary Care ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Depressive Disorder ◽  
Suicidal Behaviour ◽  
Depressive Disorders ◽  
Psychiatric Treatment ◽  
Central Position ◽  
Primary Care Patients ◽  
Axis I

Background. Most national suicide prevention strategies set improved detection and management of depression in primary health care into a central position. However, suicidal behaviour among primary-care patients with depressive disorders has been seldom investigated.Method. In the Vantaa Primary Care Depression Study, a total of 1119 primary-care patients in the City of Vantaa, Finland, aged 20 to 69 years, were screened for depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire. Depressive disorders were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the 137 patients with depressive disorder were included in the study. Suicidal behaviour was investigated cross-sectionally and retrospectively in three time-frames: current, current depressive episode, and lifetime. Current suicidal ideation was measured with the Scale for Suicidal Ideation (SSI), and previous ideation and suicide attempts were evaluated based on interviews plus medical and psychiatric records.Results. Within their lifetimes, 37% (51/137) of the patients had seriously considered suicide and 17% (23/137) attempted it. Lifetime suicidal behaviour was independently and strongly predicted by psychiatric treatment history and co-morbid personality disorder, and suicidal behaviour within the current episode was predicted most effectively by severity of depression.Conclusions. Based on these findings and their convergence with studies of completed suicides, prevention of suicidal behaviour in primary care should probably focus more on high-risk subgroups of depressed patients, including those with moderate to severe major depressive disorder, personality disorder or a history of psychiatric care. Recognition of suicidal behaviour should be improved. The complex psychopathology of these patients in primary care needs to be considered in targeting preventive efforts.

scholarly journals Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England

2018 ◽  
Vol 68 (669) ◽  
pp. e234-e244 ◽  
Author(s):  
Hilary Davies-Kershaw ◽  
Irene Petersen ◽  
Irwin Nazareth ◽  
Fiona Stevenson
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Public Health Problem ◽  
Clinical Decision ◽  
Epidemiological Studies ◽  
Drug Misuse ◽  
Electronic Patient Records ◽  
National Surveys ◽  
Qualitative Interview Study ◽  
Face Complex

BackgroundDrug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower.AimTo explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies.Design and settingA semi-structured qualitative interview study of GPs working in general practices across England.MethodPurposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs’ actions if a patient asks for the information not to be recorded, and GPs’ actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis.ResultsThe complexity of asking about drug misuse preceded GPs’ decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR.ConclusionWhen making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.

A 15–20 Year Follow-Up of Adult Psychiatric Patients

1995 ◽  
Vol 167 (3) ◽  
pp. 315-323 ◽  
Author(s):  
David Quinton ◽  
Lesley Gulliver ◽  
Michael Rutter
Keyword(s):  
Personality Disorder ◽  
Social Functioning ◽  
Depressive Disorders ◽  
Psychiatric Patients ◽  
Reliability And Validity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Systematic Assessment ◽  
One Year

BackgroundAn exploratory study was undertaken of the importance of personality disorder in predicting the long-term outcome for both episodic disorders and social functioning.MethodIn 1966–67, a representative series of patients with children, free of episodic illness for at least one year, was sampled from the Camberwell Psychiatric Register and systematically assessed over a four-year period, using measures of known reliability and validity. Psychiatric disorder was measured using a PSE-compatible instrument. The follow-up after 15–20 years used the PSE and a systematic assessment of social functioning.ResultsOverall outcomes were similar across diagnoses, but an initial categorical diagnosis of personality disorder predicted much poorer outcomes on psychiatric and social measures for patients with unipolar depressive disorders than for those with other diagnoses.ConclusionsThe findings indicate the importance for prognosis of including a systematic assessment of personality disorder in the clinical assessment of patients with depressive disorder.

One-year outcome of unexplained fatigue syndromes in primary care: results from an international study

2003 ◽  
Vol 33 (5) ◽  
pp. 857-866 ◽  
Author(s):  
P. SKAPINAKIS ◽  
G. LEWIS ◽  
V. MAVREAS
Keyword(s):  
Primary Care ◽  
Psychiatric Morbidity ◽  
Collaborative Study ◽  
International Study ◽  
Composite International Diagnostic Interview ◽  
Chronic Fatigue ◽  
Diagnostic Interview ◽  
One Year ◽  
Definition Of ◽  
Stages Of Economic Development

Background. Outcome studies of chronic fatigue, neurasthenia and other unexplained fatigue syndromes are few and have been carried out in developed Western countries. This paper aimed to study the outcome of unexplained fatigue syndromes in an international primary care sample and to identify risk factors for persistence.Method. We used data from the WHO collaborative study of psychological problems in general health care, in which 3201 primary care attenders from 14 countries were followed-up for 12 months. The assessment included a modified version of the Composite International Diagnostic Interview.Results. Unexplained fatigue persisted in one-fifth to one-third of the subjects depending on the definition of fatigue. From the factors studied only severity of fatigue and psychiatric morbidity at baseline were associated with persistence 12 months later. Outcome did not differ between countries of different stages of economic development.Conclusions. The prognosis of fatigue syndromes in international primary care is relatively good. The study underlines the importance of psychological factors in influencing short-term prognosis.

Emotional Disturbance in Newly Registered General Practice Patients

1978 ◽  
Vol 132 (2) ◽  
pp. 172-176 ◽  
Author(s):  
Charles M. Corser ◽  
Alistair E. Philip
Keyword(s):  
General Practice ◽  
Emotional Disturbance ◽  
Emotional State ◽  
General Health Questionnaire ◽  
Psychiatric Morbidity ◽  
Health Questionnaire ◽  
New Town ◽  
Emotional Upset ◽  
One Year ◽  
To Receive

The General Health Questionnaire has had some popularity as an index of minor psychiatric morbidity and was used in the present study to ascertain the emotional state of newcomers to a practice in a new town. High scorers on the GHQ had more episodes of illness, had more severe ratings of psychological problems, and were more likely to receive a formal psychiatric diagnosis than were low scorers. A second survey one year later confirmed the variability of response to the GHQ, inherent in a ‘present state’ inventory. Doubts are expressed as to the psychiatric nature of the emotional upset measured by the GHQ.

Personality Disorder and Psychiatric Illness in General Practice

1990 ◽  
Vol 156 (2) ◽  
pp. 261-265 ◽  
Author(s):  
Patricia R. Casey ◽  
Peter Tyrer
Keyword(s):  
Personality Disorder ◽  
Psychiatric Illness ◽  
Psychiatric Morbidity ◽  
Structured Interview ◽  
The Other ◽  
High Rate ◽  
Interview Schedule ◽  
General Practices ◽  
One Year ◽  
Alcohol Abuse And Dependence

In a one-year prevalence study of conspicuous psychiatric morbidity in two group general practices, one urban and the other rural, personality disorder was diagnosed in 5.3% by the GP and in 5.6% by the psychiatrist, but this increased to 28% when personality disorder was assessed using a structured interview. The prevalence of personality disorder was higher in the urban practice than in the rural one but there was no consistent association between personality disorder and mental state disorder, with the exception of alcohol abuse and dependence. The high rate of personality disorder found using the interview schedule is likely to be a true finding, and failure to recognise this hidden morbidity is important in both general and psychiatric practice.

Follow-Up of Attempted Suicide in Christchurch

1983 ◽  
Vol 17 (1) ◽  
pp. 18-25 ◽  
Author(s):  
K. S. Adam ◽  
J. Valentine ◽  
G. Scarr ◽  
D. Streiner
Keyword(s):  
General Practice ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Interpersonal Relationships ◽  
Mental State ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Follow Up Study ◽  
Self Reports

Ninety-eight subjects who had attempted suicide and 102 general practice controls previously interviewed were followed-up at 18–24 months. The former continued to show greater social and psychiatric disability than controls and more than one-third made repeat suicide attempts. Nevertheless, as a group, the attempted suicides showed significant improvement in mental state, and familial and interpersonal relationships, whereas controls reported little change in most measures. Persistence of suicidal ideation and repeat attempts were correlated with the diagnosis of psychosis and personality disorder and predictions about the likelihood of further suicidal activity were accurate. Although 92% of patients were referred for further treatment, 38% of these were judged to have dropped out prematurely. Completion of treatment and being in ongoing treatment were positively correlated with patients' self reports of improvement. The findings are compared to experience elsewhere and to a previous Christchurch follow-up study.

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