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SynopsisThis article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and he association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS).Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 ‘new’ patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrolment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders.Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

follow-up study Course of auditory vocal hallucinations in childhood: 5-year permissions Reprints/ permissions@rcpsych.ac.uk write to To obtain reprints or permission to reproduce material from this paper, please to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/199/4/296 from Downloaded The Royal College of Psychiatrists Published by on December 13, 2011 http://bjp.rcpsych.org/ http://bjp.rcpsych.org/site/subscriptions/ go to: The British Journal of Psychiatry To subscribe to Subclinical psychotic experiences in the general population are prevalent in both children and adults, and not generally associated with persistence over time or onset of psychiatric disorder. Nevertheless, literature reviews suggest that a small number will make the transition to a clinical psychotic disorder. 1,2 In a previous study on a representative sample of 7-and 8-year-old children in The Netherlands, the prevalence of auditory vocal hallucinations was 9%. 3 Although auditory vocal hallucinations in these children were mostly of limited functional impact, a subgroup with serious suffering was considered at risk for more severe psychotic outcomes. The current study presents a 5-year follow-up of this sample (now 12 and 13 years of age) and examines the persistence and new incidence of auditory vocal hallucinations, as well as their clinical relevance in terms of problem behaviour, severity and associations with aetiological variables. In view of the baseline results and previous work in this area, it was hypothesised that: (1) severity of auditory vocal hallucinations at baseline would predict persistence; 4-6 (2) auditory vocal hallucinations would show associations with behavioural problems 7-9 and other psychotic symptoms; 10 (3) incidence and severity of auditory vocal hallucinations would be associated with environmental factors such as cannabis use 11-13 and urbanicity; 14-16 (4) baseline characteristics of auditory vocal hallucinations suggesting external attribution and higher level of intrusion would be predictive of persistence; 4-6 (5) auditory vocal hallucinations would be associated negatively with cognitive ability. 17-20 Method Procedure From the case-control sample of the first wave (n = 694, of which 347 children with auditory vocal hallucinations), parents of 605 children (87%, of which 50% with auditory vocal hallucinations) gave informed consent for follow-up. These parents were sent a notification letter by mail. Non-responders were sent a reminder followed by a second letter, if necessary. In case of persisting non-response, parents were contacted by telephone if their numbers could be traced. Seven female interviewers (six students (bachelor degree) from the Department of Orthopedagogy and one psychology graduate, all from the University of Groningen) received extensive training by A.A.B.-V., G.v.d.W. and J.A.J. in conducting the interviews. First, they were introduced to the topic of auditory hallucinations, and then, with consent, observed several therapeutic sessions of patients r...

Auditory vocal hallucinations in 7- and 8-year-olds are prevalent but mostly of limited functional impact. Nevertheless, there may be continuity with more severe psychotic outcomes given the serious suffering in a subgroup of children and there is evidence for a poorer prognosis in an urban environment.