Clinical vs. structured interview on anxiety and affective disorders by primary care physicians. Understanding diagnostic discordance

2007 ◽  
Vol 16 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Matteo Balestrieri ◽  
Sandra Baldacci ◽  
Antonello Bellomo ◽  
Cesario Bellantuono ◽  
Luciano Conti ◽  
...  
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Affective Disorder ◽  
Clinical Diagnosis ◽  
Organizational Support ◽  
Affective Disorders ◽  
Primary Care Physicians ◽  
Clinical Diagnoses ◽  
Group A

SUMMARYAims— To assess in a national sample the ability of GPs to detect psychiatric disorders using a clinical vs. a standardized interview and to characterize the patients that were falsely diagnosed with an anxiety or affective disorder.Methods— This is a national, cross—sectional, epidemiological survey, carried out by GPs on a random sample of their patients. The GPs were randomly divided into two groups. Apart from the routine clinical interview, the experimental group (group A) had to administer the Mini—International Neuropsychiatric Interview (MINI).Results— Data was collected by 143 GPs. 17.2% of all patients had a clinical diagnosis of an affective disorder, and 25.4% a clinical diagnosis of an anxiety disorder. In group A, the number of clinical diagnoses was about twice that of MINI diagnoses for affective disorders and one and a half times that for anxiety disorders. The majority of clinical diagnoses were represented by MINI subsyndromal cases (52.3%). Females showed a higher OR of being over—detected by GPs with anxiety disorders or of not being diagnosed with an affective disorder. Being divorced/separated/widowed increased the OR of over—detection of affective and anxiety disorders. The OR of over—detection of an affective or an anxiety disorder was higher for individuals with a moderate to poor quality of life.Conclusions— In the primary care a gap exists between clinical and standardized interviews in the detection of affective and anxiety disorders. Some experiential and social factors can increase this tendency. The use of a psycho.Declaration of Interest: GlaxoSmithKline provided unrestricted economic and organizational support to the study. No further declarations on other form of financing or any other involvement that might be considered a conflict of interest in connection with the submitted article.

Comparative Study Between Preferential Consultations And Most Common Diagnoses

2016 ◽  
Vol 33 (S1) ◽  
pp. S451-S451
Author(s):  
C. Manso Bazús ◽  
J. Valdes Valdazo ◽  
E. Garcia Fernandez ◽  
L.T. Velilla Diez ◽  
J. Min Kim ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Observational Study ◽  
Affective Disorders ◽  
Primary Care Physicians ◽  
The Other ◽  
Health Care Burden ◽  
Competing Interest ◽  
The One

IntroductionTo the specialized attention arrives as preferred patients with minor diagnosis.ObjectiveWe do a relation between the type (normal/preferential) derivation of the first consultations and their corresponding diagnosis.MethodologyRetrospective observational study with data gathered during 3 months, which handle 2 variables: on the one hand, type of derivation and on the other, effected diagnosis.ResultsThe most frequent diagnosis found are adaptative disorders and affective disorders, corresponding to 45.45% and 9.1%, respectively of preferred leads.ConclusionsAlmost half of preferential queries (consultations) could be treated in first instance by primary care physicians releasing mental health care burden.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Functioning and disability levels in primary care out-patients with one or more anxiety disorders

2010 ◽  
Vol 40 (12) ◽  
pp. 2059-2068 ◽  
Author(s):  
C. D. Sherbourne ◽  
G. Sullivan ◽  
M. G. Craske ◽  
P. Roy-Byrne ◽  
D. Golinelli ◽  
...  
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Well Being ◽  
Post Traumatic Stress ◽  
Co Morbidity ◽  
Post Traumatic ◽  
Relative Differences

BackgroundAnxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of combinations of anxiety disorders in primary care out-patients.MethodA total of 1004 patients with panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD) or post-traumatic stress disorder (PTSD) provided data on their mental and physical functioning, and disability. Multivariate regressions compared functional levels for patients with different numbers and combinations of disorders.ResultsOf the patients, 42% had one anxiety disorder only, 38% two, 16% three and 3% all four. There were few relative differences in functioning among patients with only one anxiety disorder, although those with SAD were most restricted in their work, social and home activities and those with GAD were the least impaired. Functioning levels tended to deteriorate as co-morbidity increased.ConclusionsOf the four anxiety disorders examined, GAD appears to be the least disabling, although they all have more in common than in distinction when it comes to functional impairment. A focus on unique effects of specific anxiety disorders is inadequate, as it fails to address the more pervasive impairment associated with multiple anxiety disorders, which is the modal presentation in primary care.

scholarly journals Hypnotherapy: A Case of Anxiety Person Who Doesn’t Want to Use Medication

2019 ◽  
Vol 7 (16) ◽  
pp. 2698-2700
Author(s):  
Muhammad Hasbi ◽  
Elmeida Effendy
Keyword(s):  
United States ◽  
Primary Care ◽  
Case Report ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
The United States ◽  
Emotional Disorder ◽  
Critical Factors ◽  
Conscious Mind ◽  
One Year

BACKGROUND: Anxiety disorder is the most common emotional disorder in the United States. At least 0.9%-1.9% of adult individuals in the United States show one disorder of anxiety in one year. Anxiety disorder is often unknown and carried out therapy in primary care. Hypnotherapy is a penetration of the critical factors of the conscious mind, followed by the acceptance of a suggestion/idea or thought that causes changes in the behaviour of the mental-emotional order. CASE REPORT: We got a case of anxiety disorder that could be cured with hypnotherapy treatment. A 45-year-old male from Batak tribe with complaints of feeling anxious and not cured because the sufferer always thinks his disease, inflammation of the stomach. Often, the anxiety arose when the patient felt weak, and the heart palpitated as he in dying condition. CONCLUSION: From this case, it can be found that patients who experience anxiety disorders (anxiety disorder) can recover without medical drugs but by using hypnotherapy.

Psychotherapeutic interventions

2017 ◽  
Author(s):  
Fiammetta Cosci ◽  
Giovanni Andrea Fava
Keyword(s):  
Primary Care ◽  
Anxiety Disorders ◽  
Clinical Judgment ◽  
Primary Care Physicians ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Somatic Symptom ◽  
Treatment Plan ◽  
Unipolar Depression ◽  
Psychotherapeutic Interventions ◽  
Primary Care Settings

Primary care physicians may offer a comprehensive care of patients having psychiatric ailments. Psychological interventions are effective in treating major depressive disorder, anxiety disorders, somatic symptom disorders, and tobacco use disorders in primary care settings. Psychotherapeutic approaches are effective either as an alternative or as an adjunct to pharmacotherapy, with enduring benefits after discontinuation of drug treatment. Psychotherapy also represents a pilot area of intervention to treat withdrawal symptoms and disorders due to the tapering or discontinuation of psychotropic medications, in particular selective serotonin reuptake inhibitors (SSRIs). This chapter illustrates the basic steps to establish routine evidence-based psychotherapy for unipolar depression, anxiety disorders, somatic symptom disorder, and substance use disorders in primary care settings. Some factors should be considered to formulate a proper treatment plan for mental disorders in primary care, including primary care physicians’ clinical judgment, availability of treatment, and patient’s preference.

Improving the Recognition of Anxiety Disorders in Depressed Patients

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S1) ◽  
pp. 2-4
Author(s):  
Iwona Chelminski
Keyword(s):  
Primary Care ◽  
Anxiety Disorder ◽  
Panic Disorder ◽  
Anxiety Disorders ◽  
Panic Attacks ◽  
Depressed Patients ◽  
Increased Risk ◽  
History Of ◽  
Primary Care Patients

There is considerable symptom overlap and high levels of comorbidity between anxiety disorders and depression. The recognition of this comorbidity has both academic interest and clinical significance. Epidemiological studies have demonstrated that depressed individuals with a history of anxiety disorders are at increased risk for hospitalization, suicide attempt, and greater impairment from the depression. These individuals also tend to have a more chronic course of depression, as observed in psychiatric patients, primary care patients, and epidemiological samples. Van Valkenberg and colleagues reported that depressed patients with anxiety had poorer outcome and greater psychosocial impairment than those without an anxiety disorder. In the National Institute of Mental Health Collaborative Depression Study, the presence of panic attacks predicted a lower rate of recovery during the first 2 years of the follow-up interval. Similarly, Grunhaus found poorer outcome in depressed patients with comorbid panic disorder than in depressed patients without panic. In an 8-month follow-up study, depressed primary care patients with a history of generalized anxiety disorder (GAD) or panic disorder were less likely to have recovered from their depressive episode.Gaynes and colleagues prospectively followed primary care patients with major depressive disorder (MDD) every 3 months for 1 year after their initial diagnostic evaluation. At baseline, half of the original 85 patients had a coexisting anxiety disorder, the most frequent being social phobia (n=38). Twelve months after intake, 68 of the patients were available for the final interview. Those with a comorbid anxiety disorder were significantly more likely to still be in an episode of depression (82% vs 57%; risk ratio=1.44; 95% CI 1.02-2.04), and they experienced more disability days during the course of the 12 months than the depressed patients without an anxiety disorder (67.1 days vs 27.5 days).

scholarly journals Twenty-five practical recommendations in primary care dermoscopy

2020 ◽  
Vol 12 (1) ◽  
pp. 10
Author(s):  
Antonio Chuh ◽  
Vijay Zawar ◽  
Regina Fölster-Holst ◽  
Gabriel Sciallis ◽  
Thomas Rosemann
Keyword(s):  
Primary Care ◽  
Local Anaesthesia ◽  
Primary Care Physicians ◽  
Clinical Settings ◽  
Special Interests ◽  
Wide Range ◽  
Clinical Diagnoses ◽  
The Face ◽  
Primary Care Clinicians ◽  
Practical Recommendations

ABSTRACT Dermoscopy in primary care enhances clinical diagnoses and allows for risk stratifications. We have compiled 25 recommendations from our experience of dermoscopy in a wide range of clinical settings. The aim of this study is to enhance the application of dermoscopy by primary care clinicians. For primary care physicians commencing dermoscopy, we recommend understanding the aims of dermoscopy, having adequate training, purchasing dermoscopes with polarised and unpolarised views, performing regular maintenance on the equipment, seeking consent, applying contact and close non-contact dermoscopy, maintaining sterility, knowing one algorithm well and learning the rules for special regions such as the face, acral regions and nails. For clinicians already applying dermoscopy, we recommend establishing a platform for storing and retrieving clinical and dermoscopic images; shooting as uncompressed files; applying high magnifications and in-camera improvisations; explaining dermoscopic images to patients and their families; applying toggling; applying scopes with small probes for obscured lesions and lesions in body creases; applying far, non-contact dermoscopy; performing skin manipulations before and during dermoscopy; practising selective dermoscopy if experienced enough; and being aware of compound lesions. For clinicians in academic practice for whom dermatology and dermoscopy are special interests, we recommend acquiring the best hardware available with separate setups for clinical photography and dermoscopy; obtaining oral or written consent from patients for taking and publishing recognisable images; applying extremely high magnifications in search of novel dermoscopic features that are clinically important; applying dermoscopy immediately after local anaesthesia; and further augmenting images to incorporate messages beyond words to readers.

Effects of a transdiagnostic unguided Internet intervention (‘velibra’) for anxiety disorders in primary care: results of a randomized controlled trial

2016 ◽  
Vol 47 (1) ◽  
pp. 67-80 ◽  
Author(s):  
T. Berger ◽  
A. Urech ◽  
T. Krieger ◽  
T. Stolz ◽  
A. Schulz ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trial ◽  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Controlled Trial ◽  
Post Treatment ◽  
Depression Symptom ◽  
Behavioural Treatment ◽  
Randomized Controlled

BackgroundInternet-based cognitive–behavioural treatment (ICBT) for anxiety disorders has shown some promise, but no study has yet examined unguided ICBT in primary care. This randomized controlled trial (RCT) investigated whether a transdiagnostic, unguided ICBT programme for anxiety disorders is effective in primary care settings, after a face-to-face consultation with a physician (MD). We hypothesized that care as usual (CAU) plus unguided ICBT would be superior to CAU in reducing anxiety and related symptoms among patients with social anxiety disorder (SAD), panic disorder with or without agoraphobia (PDA) and/or generalized anxiety disorder (GAD).MethodAdults (n = 139) with at least one of these anxiety disorders, as reported by their MD and confirmed by a structured diagnostic interview, were randomized. Unguided ICBT was provided by a novel transdiagnostic ICBT programme (‘velibra’). Primary outcomes were generic measures, such as anxiety and depression symptom severity, and diagnostic status at post-treatment (9 weeks). Secondary outcomes included anxiety disorder-specific measures, quality of life, treatment adherence, satisfaction, and general psychiatric symptomatology at follow-up (6 months after randomization).ResultsCAU plus unguided ICBT was more effective than CAU at post-treatment, with small to medium between-group effect sizes on primary (Cohen's d = 0.41–0.47) and secondary (Cohen's d = 0.16–0.61) outcomes. Treatment gains were maintained at follow-up. In the treatment group, 28.2% of those with a SAD diagnosis, 38.3% with a PDA diagnosis, and 44.8% with a GAD diagnosis at pretreatment no longer fulfilled diagnostic criteria at post-treatment.ConclusionsThe unguided ICBT intervention examined is effective for anxiety disorders when delivered in primary care.

Primary Care Management of Patients with Co-occurring Disorders

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S6) ◽  
pp. 13-15 ◽  
Author(s):  
Larry Culpepper
Keyword(s):  
Primary Care ◽  
Substance Use ◽  
Anxiety Disorder ◽  
Mood Disorder ◽  
Substance Use Disorder ◽  
Primary Care Physicians ◽  
Alcohol Use Disorder ◽  
First Line ◽  
Vast Number ◽  
Primary Care Management

Primary care physicians (PCPs) often provide the first line of care for the vast number of United States adults—∼30% at any given time—with either a psychiatric or a substance use disorder, or both. The widespread prevalence of this comorbidity bears reiterating: During the same 12-month period, 20% of national survey respondents with a substance use disorder (SUD) had at least one mood disorder, and 17% had at least one anxiety disorder. Conversely, at least one SUD was found among 20% of respondents with a mood disorder and 15% of those with an anxiety disorder. However, because PCPs are often not aware of or alerted to these problems, it would seem advisable that patients presenting with either a psychiatric or an alcohol use disorder should be evaluated for both conditions. Establishing the presence of co-occurring disorders may be difficult, but it is necessary for appropriate and realistic treatment planning.

Epidemiology of Anxiety Disorders in the Australian General Population: Findings of the 2007 Australian National Survey of Mental Health and Wellbeing

2011 ◽  
Vol 45 (11) ◽  
pp. 957-967 ◽  
Author(s):  
Peter M. McEvoy ◽  
Rachel Grove ◽  
Tim Slade
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Anxiety Disorder ◽  
General Population ◽  
Anxiety Disorders ◽  
Substance Use Disorders ◽  
National Survey ◽  
Affective Disorders ◽  
Lifetime Prevalence ◽  
Health And Wellbeing

Objective: The aims of this study were to report 12-month and lifetime prevalence for anxiety disorders in the Australian general population, identify sociodemographic and clinical correlates of anxiety disorders, and report the rates of comorbidity among anxiety, affective, and substance use disorders across the lifespan. Method: The 2007 National Survey of Mental Health and Wellbeing was a nationally representative, face-to-face household survey of 8841 (60% response rate) community residents aged between 16 and 85 years. Diagnoses for anxiety, affective and substance use disorders were made according to the DSM-IV using the World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Results: 12-month and lifetime prevalence of anxiety disorders were 11.8% and 20.0%, respectively. Anxiety disorders had a similar median age of onset (19 years) compared to substance use disorders (20 years), but earlier than affective disorders (34 years). Social phobia was the earliest onset anxiety disorder (median 13 years), with generalized anxiety disorder the latest (median 33 years). Significant correlates of the presence of anxiety disorders included being female, single, not in the labour force, in the middle age groups, not having post-graduate qualifications, having a comorbid physical condition, and having a family history of mental disorders. Being in the oldest age ranges and being born in another non-English speaking country were associated with lower odds of having an anxiety disorder. Body mass index was not associated with the presence of an anxiety disorder. Anxiety disorders were highly comorbid, particularly with major depression, dysthymia, and alcohol dependence. Comorbidity with substance use disorders reduced with age. Comorbidity with affective disorders was high across the lifespan. Conclusions: Anxiety disorders are common, can have an early onset, and are highly comorbid. Prevention, early detection, and treatment of anxiety disorders should be a priority.

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