4 results
Lo studio internazionale multicentrico dell'Organizzazione Mondiale della Sanità sui disturbi psichici nella medicina generale: risultati relativi all'area di Verona1
- Marco Piccinelli, Stefano Pini, Cesario Bellantuono, Paola Bonizzato, Elisabetta Paltrinieri, T. Bedirhan Üstün, Norman Sartorius, Michele Tansella
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 4 / Issue 1 / Gennaio-Aprile 1995
- Published online by Cambridge University Press:
- 07 August 2014, pp. 27-50
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Objectives - To present the results obtained from a cross-sectional evaluation of a sample of primary care attenders selected in Verona in the framework of the World Health Organization International Multicentre Study on Psychological Problems in Primary Care Settings. Methods - Among consecutive attenders at 16 primary care clinics in Verona during the period April 1991/February 1992, a random sample, stratified on the basis of GHQ-12 scores, was selected for a thorough evaluation of psychological status, physical status and disability in occupational and other daily activities. All patients with psychopathological symptoms at baseline assessment and a 20% random sample of those without psychopathological symptoms were interviewed again after 3 and 12 months (data not presented here). Results - Overall, 1,656 subjects were approached at the primary care clinics and 1,625 met inclusion criteria. The screening procedure was completed by 1,558 subjects and the second-stage evaluation by 250. Psychiatric disorders according to ICD-10 criteria were diagnosed in 12.4% of consecutive primary care attenders; of these, about one-third (4.5% of consecutive primary care attenders) satisfied ICD-10 diagnostic criteria for two or more disorders. Current Depressive Episode (4.7%) and Generalized Anxiety Disorder (3.7%) were the most common diagnoses. In addition, 11.2% of consecutive primary care attenders had ‘sub-threshold’ psychiatric disorders (i.e., they suffered from symptoms in at least two different areas among those listed in ICD-10, but they did not satisfy diagnostic criteria for well-defined disorders). Psychiatric disorders were more common among females and those aged 24-44 years. Only 20.6% of the subjects with psychiatric disorders contacted the general practitioner for their psychological symptoms, 5.7% complained of symptoms which might have had a psychological origin, whereas in about 70% of the cases the psychiatric disorder was concealed behind the presentation of somatic symptoms, pains in various parts of the body or chronic physical illness. Sixty-two percent of the subjects with psychiatric disorders rated their health status as fair or poor, as compared to 52.0% of those with chronic physical illness and 31.3% of those without such disorders. According to the general practitioner, 40.1% of the subjects with psychiatric disorders and 45.3% of those with chronic physical illness had a fair or poor health status, compared to 14.4% of those without such disorders. Disability in occupational and other daily activities was reported by 52.5% of the subjects with psychiatric disorders (in 40.1% of the cases disability was moderate or severe), 44.4% of those with chronic physical illness (in 26.8% of the cases disability was moderate or severe), and 15.0% of the subjects without such disorders (in 9.1% of the cases disability was moderate or severe). According to the interviewer, disability was identified in 48.4% of the subjects with psychiatric disorders, 39.0% of those with chronic physical illness, and 27.6% of the subjects without such disorders. Sixty per cent of the subjects with psychiatric disorders suffered from concurrent chronic physical illness; these subjects had a poorer health status and higher disability levels than those with psychiatric disorders only. Conclusions - Psychiatric disorders among primary care attenders are frequent and represents a major public health problem, since they entail severe functional limitations for the patients and high costs for the society. Thus, appropriate programs for their recognition and treatment are needed.
WHO study of psychological problems in general health care. Baseline findings and implications for primary care1
- Richard Gater
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 5 / Issue 3 / December 1996
- Published online by Cambridge University Press:
- 11 October 2011, pp. 172-177
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Objective - To investigate the form, frequency, management and outcome of common psychological disorders in primary care patients. Design - Two-stage sampling of primary care attenders followed by 3 and 12 month longitudinal assessment of mental state disability and treatment carried out using the same methods in 15 centres around the world, and coordinated by the World Health Organization. Main measures - The General Health Questionnaire, the primary care version of the Composite International Diagnostic Interview used to derive ICD-10 diagnosis, the Groningen Social Disability Schedule, and the primary care physician's assessment of the patient's current physical and psychological status along with a summary of their management of the case. Results - 25,916 patients were screened and 5,438 patients were interviewed in detail. Mental disorders among general health care attenders were common (average 24% of consecutive attenders, range 7.3%-52.5%). Disability was increased in patients with psychological illness: the more severe the psychological illness, the more severe was the disability The main presenting problem of such patients was often somatic, and only a minority presented a clearly psychological symptom. Detection varied greatly between centres, and across all centres half of the ICD-10 cases were not detected by the attending physician. Doctors in Verona displayed a particular bias towards psychological disorder. Treatment was offered to almost all patients identified as having psychological disorder by the primary care physician, though treatments showed a similar distribution regardless of diagnosis. Conclusions - The frequency and disability associated with the psychiatric disorder in general health care emphasise their importance to primary care and public health. These are patients who present to primary care, and most continue to be managed in primary care without recourse to specialist mental health services. It is important that training about the detection, diagnosis and management of common mental disorders are strengthened at medical school and in the vocational training of general practitioners.
Psychiatric disorders in primary care: why so many differences?
- Marco Piccinelli
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 3 / Issue 3 / December 1994
- Published online by Cambridge University Press:
- 11 October 2011, pp. 195-208
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Objectives - (I) To review the studies which investigated the frequency of psychiatric disorders among primary care attenders, using a standardized psychiatric interview as the case finding instrument; (II) to discuss the factors possibly explaining the different results found; (III) to highlight the central role of international multicenter collaborative studies, carried out in primary care settings. Method - the studies were reviewed, which were published in international journals between 1970 and 1993. The studies were located through a computerized search of the databases MEDLINE and Psychological Abstracts; in addition, the reference lists of the studies located in this way were examined and international journals were manually scanned in order to avoid possible omissions. Finally, the annotated bibliography, edited by Wilkinson (1985), was examined, since it included the studies having psychiatric focus, carried out in primary care and published between 1977 and 1985. Results - Thirty papers were traced, but 9 were excluded since they duplicated results or because of methodological limitations. So far, the overall frequency of psychiatric disorders among primary care attenders has been investigated using standardized procedures in 13 countries only. The frequency of psychiatric disorders ranged between approximately 10% and 50%. The possible reasons accounting for the differe- nces between the studies were discussed in the light of three factors: I) the research design and study characteristics; II) the reliability and comparability of different diagnostic categories and classificatory systems; and III) the different organization of health services across countries. Conclusions - In the light of the difficulties faced when the findings of independent studies, carried out in different countries or even in the same country, are compared, the central role of in- ternational multicenter collaborative studies conducted in this field is suggested.
Detection and management of mental distress and psychiatric disorders in primary care settings1
- Stefano Pini, Michele Tansella
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- Journal:
- Epidemiologia e Psichiatria Sociale / Volume 8 / Issue 2 / June 1999
- Published online by Cambridge University Press:
- 11 October 2011, pp. 92-104
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Objective – Epidemiological and clinical studies indicate that 10–50% of primary care patients suffering from clinically relevant psychiatric distress are not diagnosed by their physician and only a minority of them receive an appropriate treatment. The improvement of physicians' ability to detect mental distress and psychiatric disorder, in their routine clinical activity, represents a crucial point to reduce the social impact of mental illnesses, prevent their worsening and chronicity and, eventually, relieve mental health services of an excessive burden of care and costs. The aim of this article is to examine a number of factors which intervene in the process of detection of mental distress by the physician. Then, we will examine factors related to the management of psychiatric disorders most commonly co-occurring with physical illness in general health care sector. Method – The method used for this review was essentially a recension of the literature concerning detection and treatment of psychiatric disorders in primary care settings, having in view to see the factors connected with these processes. Results – Among factors intervening in the process of identification of mental distress in primary care settings, both the characteristics of the physician and the characteristics of the patient should be taken into account. Primary care physicians and psychiatrists are being asked to work together more frequently in this era of community care. The principal aim of such invoked collaboration is the amelioration of quality of care and reduction of costs for mentally ill patients. An important issue within this collaboration is the referral by primary care physicians to specialist services.
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