Changing the psychiatric knowledge of primary care physicians

Andersen, Susan M.; Harthorn, Barbara Herr

doi:10.1016/0163-8343(90)90077-p

Cited by 46 publications

(8 citation statements)

References 43 publications

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“…Training/educational models involve directly training PCPs and other staff members to provide mental health care (Bower & Gilbody, 2005; Gilbody et al, 2003). Such training can take place by using videotapes, written materials, small group teaching sessions (Thompson et al, 2000), intensive practice based seminars (Bower et al, 2006), or educational meetings to disseminate information and practice guidelines (Bower et al, 2006; Andersen & Hawthorne, 1990). The goals of educational models are to improve prescribing of antidepressants or to teach skills in psychotherapy (Bower et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Interpersonal Counseling (IPC) for Depression in Primary Care

Weissman

Hankerson

Scorza

et al. 2014

APT

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Interpersonal Counseling (IPC) comes directly from interpersonal psychotherapy (IPT), an evidenced-based psychotherapy developed by Klerman and Weissman. It [IPC?] is a briefer, more structured version for use primarily in non-mental health settings, such as primary care clinics when treating patients with symptoms of depression. National health-care reform, which will bring previously uninsured persons into care and provide mechanisms to support mental health training of primary care providers, will increase interest in briefer psychotherapy. This paper describes the rationale, development, evidence for efficacy, and basic structure of IPC and also presents an illustrated clinical vignette. The evidence suggests that IPC is efficacious in reducing symptoms of depression; that it can be used by mental health personnel of different levels of training, and that the number of sessions is flexible depending on the context and resources. More clinical trials are needed, especially ones comparing IPC to other types of care used in the delivery of mental health services in primary care.

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Section: Introductionmentioning

confidence: 99%

Interpersonal Counseling (IPC) for Depression in Primary Care

Weissman

Hankerson

Scorza

et al. 2014

APT

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“…Although studies have shown effects of educational interventions on short‐term diagnostic or treatment knowledge, 6 few studies have evaluated prolonged knowledge effects. Only one study demonstrated improved clinician knowledge of psychiatric diagnoses over nearly a year 7 . The purpose of this study was to assess the effects of a combined educational and clinical care system quality improvement (QI) intervention on primary care clinician knowledge 18 months after the initiation of the intervention and 6 months after its completion.…”

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confidence: 99%

Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians

et al. 2000

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“…Several previous studies suggest that misdiagnosis of depression in primary care outpatients occurs fairly often, and even in educational general hospitals non-psychiatric house staff frequently misdiagnose psychiatric disorders [ 18 ]. This can be improved by psychiatric training/education [ 19 , 20 ] and using the screening instruments mentioned previously in I. Diagnostic system improvement.…”

Section: Discussionmentioning

confidence: 99%

Avoiding diagnostic errors in psychosomatic medicine: a case series study

Koyama

Ohtake

Yasuda

et al. 2018

BioPsychoSocial Med

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BackgroundNon-organic lesions or diseases of unknown origin are sometimes misdiagnosed as “psychogenic” disorders or “psychosomatic” diseases. For the quality of life and safety of patients, recent attention has focused on diagnostic error. The aim of this study was to clarify the factors that affected misdiagnoses in psychosomatic medicine by examining typical cases and to explore strategies that reduce diagnostic errors.Case presentationThe study period was from January 2001 to August 2017. The data of patients who had visited the Department of Psychosomatic Medicine, Kindai University Hospital and its branches, Sakai Hospital and Nihonbashi Clinic, were collected. All patients were aged 16 years or over. Multiple factors, such as age, sex, presenting symptoms, initial diagnosis, final diagnosis, sources of re-diagnosis and types of diagnostic errors were retrospectively analyzed from the medical charts of 20 patients. Among them, four typical cases can be described as follows. Case 1; a 79-year-old woman, initially diagnosed with psychogenic vomiting due to depression that was changed to gastric torsion as the final diagnosis. Case 2; a 24-year-old man, diagnosed with an eating disorder that was later changed to esophageal achalasia. Case 10; a 60-year-old woman’s diagnosis changed from conversion disorder to localized muscle atrophy. Case 19; a 68-year-old man, appetite loss from depression due to cancer changed to secondary adrenal insufficiency, isolated ACTH deficiency (IAD).ConclusionThis study showed that multiple factors related to misdiagnoses were combined and had a mutual influence. However, they can be summarized into two important clinical observations, diagnostic system-related problems and provider issues. Provider issues contain mainly cognitive biases such as Anchoring, Availability, Confirmation bias, Delayed diagnosis, and Representativeness. In order to avoid diagnostic errors, both a diagnostic system approach and the reduction of cognitive biases are needed. Psychosomatic medicine doctors should pay more attention to physical symptoms and systemic examination and can play an important role in accepting a perception of patients based on a good, non prejudicial patient/physician relationship.

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Changing the psychiatric knowledge of primary care physicians

Cited by 46 publications

References 43 publications

Interpersonal Counseling (IPC) for Depression in Primary Care

Interpersonal Counseling (IPC) for Depression in Primary Care

Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians

Avoiding diagnostic errors in psychosomatic medicine: a case series study

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