Psychiatry and general health care.

Abstract

There has been much discussion about the high prevalence of psychiatric problems among patients of primary care physicians. The questions of particular interest are: to what extent do emotional problems appear as presenting complaints, and are they problems with which a primary care clinician might be expected to deal? A number of studies have reported a fairly consistent level of presenting emotional difficulties: about 14 per cent in general practices in England,' Australia,2 and Austria.3 In one study, it was reported that "a large proportion of psychiatric morbidity encountered in general practice is made up of chronic disorders, and in a seven-year follow-up study more than half the cohort showed a very poor outcome in terms of recurrence or chronicity."4 It was also found that emotional disorders were "associated with high demand for medical care," and that they showed "higher rates of general morbidity and more categories of illness per head than the remainder of the patients consulting their doctors."5In this paper, we shall address the question of psychiatric morbidity in a general health care program on the basis of a five-year experience

Treating Mental Illness: Generalist Versus Specialist

“…This goal could be facilitated through attaching mental health specialty services to group practices and using liaison arrangements to assist primary care physicians in managing those patients for whom they take responsibility. 27 Whatever the case, the definition of which services are covered and the intensity of services are likely to be central issues. In the future, it is clear that such arrangements are unlikely to be financially viable outside of a system of controlled referral and careful monitoring of the intensity of services used.…”

The Prevalence of Psychoactive Drug Intake in a Metropolitan Population

“…statistics, only offer infonnation about the quantities of the drugs in circulation: they do not, however, go into the drug habits of individuals or groups of persons in specific geographie areas. Many ofthe epidemiologie surveys ofthe use of psychotropic drugs are restricted in order to find the answer to the question ofhow orten such drugs are prescribed (Coleman. 1977) or to investigate the frequency of prescription and consumption of drugs (Guse.…”

Are frequent attenders of primary health care distressed?

“…Thus, these patients tend to be less educated (5-7), to be unemployed (8), to belong to low social groups (5,7), to receive low incomes, retirement pensions or family benefits (1), to have undergone marital breakdown (9), or to be single (l), to feel lonely (8), to be mothers of infants (l), and to have multiple physical illnesses (7.9). Psychological distress leads to increased use of medical services (10)(11)(12) and patients with emotional probScand J Prim Health Care 1995; 13 lems tend to be frequent attenders at all primary care facilities (13).…”