Type, severity and course of chronic mental disorders in general health care

Abstract

Introduction: The majority of patients with mental disorders is treated by general practitioners. Objectives: Goal of the present study is to investigate the proportion, type, course, and impairment of general practice patients who are suffering from chronic mental disorders. Methods: 1451 general practice patients, aged 18 to 60, were screened. 307 patients, who had indicated that they were suffering from chronic and disabling mental problems underwent a medical assessment with the standardized International Neuropsychiatric Interview, the Burvill Rating for somatic disorders, the SCL-90, Mini-ICF-APP for capacity limitations and the IMEP for participation restrictions. Results: 29.7% of all general practice patients reported to suffer from mental problems with relevant impairment in their daily living. From the 307 patients 55.4% had additionally seen a psychiatrist or psychotherapist during the last year. 28.8% were at present on sick leave. Frequent limitations in capacity are seen for flexibility (57% all, or 5.2% very severe), decision making (57.9%, or 2.9%), endurance (55.3%, or 7.8%), assertiveness (53.4%, or 2.9%), contact to others (50.1%, or 1.6%), intimate relationships (52.8%, or 3.9%), and spontaneous activities (73.3%, or 3.9%). Conclusions: Chronic and disabling mental disorders are frequent in primary health care. Cross-sectionally they look not very impressive, but in respect to negative illness consequences and restrictions in participation they are disabling. The data show that general practitioners are, to a large degree, therapists for mental disorders. As most cases are chronic and disabling general practitioners must work not so much in a curative but rather rehabilitation perspective.

Patients Characteristics and Psychosocial Treatment in Psychodynamic and Cognitive Behavior Therapy

“…Apart from school-specific and symptom oriented treatment goals and techniques, there is school-overlapping a second level of targets and interventions, regarding capacity limitations and participation restrictions in life, as defined by the International Classification of Functioning Disability and Health (19). Many patients have to struggle with problems at home, at work, and in leisure time, and show high rates of work incapacity and early retirement (20)(21)(22)(23)(24)(25)(26)(27)(28). This must therapeutically be addressed.…”