Mental Health and Primary Care Management of Complex Psychiatric Conditions

Author(s):  
Jenny Drife
Author(s):  
Louise Robinson ◽  
Carolyn Chew-Graham

This chapter discusses the presentation and primary care management of the commonest mental health problems in older people; these include delirium, delusions, depression and anxiety, and dementia. Primary care is on the front line in dealing with older people who have mental health problems, supporting their families to care for them and managing people with complex co-morbidities in addition to mental health issues. Older people consult their GP almost twice as often as other age groups and up to 40% may have a mental health problem. Cases drawn from the authors’ real-life practice are presented firstly to represent clinical presentations and management within primary care and secondly to demonstrate how primary care links with secondary care and the wider services. The management of patients is discussed largely within reference to UK primary care systems and policy, but the international readership should find parallels within their own healthcare systems.


Author(s):  
Louise Robinson ◽  
Carolyn A Chew-Graham

This chapter discusses the presentation and primary care management of the commonest mental health problems in older people; delirium, delusions, depression and anxiety, and dementia. Primary care is on the front line in dealing with older people who have mental health problems, supporting their families to care for them, and managing people with complex comorbidities in addition to mental health issues. Older people consult their GP almost twice as often as other age groups and up to 40% of older people may have a mental health problem. The chapter presents cases drawn from the authors’ real-life practice, first, to represent clinical presentations and management within primary care; and second, to demonstrate how primary care links with secondary care and the wider services. It discusses the management of patients largely within reference to UK primary care systems and policy, but the international readership should find parallels within their own healthcare systems.


2005 ◽  
Vol 35 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Frances J. Wren ◽  
Sarah H. Scholle ◽  
Jungeun Heo ◽  
Diane M. Comer

Objective: To describe how primary care clinicians manage children in whom they diagnose mood or anxiety syndromes. Method: This study is a secondary analysis of data from the multi-site Child Behavior Study (CBS)—a cross-sectional survey of primary care management of psychosocial problems. The management of children in whom clinicians identified mood or anxiety syndromes is described and compared with the management of children in whom they identified other psychosocial problems. Recruitment for the CBS occurred in 206 primary care practices in the United States, Puerto Rico, and Canada from October 1994 through June 1997. Participants were 20,861 consecutively sampled primary care attendees aged 4–15 years and 395 clinicians. Primary outcome measures for this report are rates of referral to specialized mental health care and rates of active primary care management (i.e., scheduling a follow-up appointment and/or providing ongoing counseling and/or psychotropic prescription). Results: Identification of a mood or anxiety syndrome was associated with increased rates of referral to mental health compared with rates for children with other psychosocial problems. There was no effect on the proportion of children counseled during the visit. In fact, unless accompanied by a co-morbid behavioral syndrome, children receiving the diagnosis of a mood or anxiety syndrome were less likely to be offered a scheduled follow-up appointment. Rates of prescription of antidepressants or anti-anxiety agents were higher for mood/anxiety groups but this was still uncommon (6.7%). Conclusions: Active management of childhood mood and anxiety syndromes in primary care was uncommon in the United States, Puerto Rico, and Canada in the mid-1990s.


JAMA ◽  
2016 ◽  
Vol 315 (24) ◽  
pp. 2703 ◽  
Author(s):  
Konrad Schmidt ◽  
Susanne Worrack ◽  
Michael Von Korff ◽  
Dimitry Davydow ◽  
Frank Brunkhorst ◽  
...  

Author(s):  
Jean-Marie Degryse ◽  
Ruth Kalda ◽  
Roar Maagaard ◽  
Phil Phylaktou ◽  
Howard Tandeter ◽  
...  

2009 ◽  
Vol 36 (4) ◽  
pp. 457-462 ◽  
Author(s):  
Laurent Malet ◽  
Michel Reynaud ◽  
Pierre-Michel Llorca ◽  
Nadia Chakroun ◽  
Olivier Blanc ◽  
...  

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