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Detection and management of mental distress and psychiatric disorders in primary care settings1

Published online by Cambridge University Press:  11 October 2011

Stefano Pini  and
Michele Tansella
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Summary

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.

Riassunto

Scopo – Numerosi studi epidemiologici e clinici indicano che il 10-50% dei pazienti che si rivolgono al medico di medicina generale presentano disturbi psichiatrici. Tuttavia, solo un'esigua percentuale di questi disturbi viene adeguatamente identificata e curata. La possibilità di migliore le capacità del medico di medicina generale di identificare questa quota di patologia psichiatrica è quindi cruciale sia per ridurne l'impatto sociale sia per prevenire il peggioramento e la cronicizzazione di forme psicopatologiche attenuate. In ultima analisi, questo processo dovrebbe riflettersi in un minor carico assistenziale ed in costi phi bassi per le strutture psichiatriche. Metodo – Il metodo usato in questo articolo si basa sulla revisione della letteratura relativa al problema dell'identificazione e gestione dei disturbi mentali nei setting di medicina generale. Risultati – Tra i fattori implicati nel processo di identificazione della patologia mentale nella medicina generale vi sono numerose caratteristiche sia del medico che del paziente. Psichiatri e medici generali devono operare in stretta collaborazione in questo particolare settore della psichiatria. Infatti, solo un'efficace interscambio tra specialista e medico generale può portare ad una migliore qualità dell'assistenza e ad una riduzione significativa dei costi connessi con la cura delle malattie mentali. Un elemento essenziale, all'interno di tale collaborazione, è rappresentato dall'invio allo psichiatra del paziente con sintomi psichici da parte del medico generale.

Keywords

Primary carepsychiatric disordercomorbitydetectionmanagementMedicina generaledisturbi psichiatricicomorbilitaidentificazionetrattamento.
Type
Invited Papers
Information
Epidemiology and Psychiatric Sciences , Volume 8 , Issue 2 , June 1999 , pp. 92 - 104
Copyright
Copyright © Cambridge University Press 1999

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Footnotes

1

The Spanish version of this paper was published in Psiquiatria en Atencion Primaria (ed J.L. Vazquez-Barquero), pp. 73-87, Aula Medica: Madrid, 1998.

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