Mental health in family medicine最新文献

{"title":"The Geriatric Giant: Mental Health and Well- being in Elderly","authors":"I. Grammatikopoulos","doi":"10.25149/1756-8358.1201007","DOIUrl":"https://doi.org/10.25149/1756-8358.1201007","url":null,"abstract":"The burden of mental, neurological, and substance use (MNS) disorders increased by 41% between 1990 and 2010 and now accounts for one in every 10 lost years of health globally [1]. Mental and brain disorders represent the greatest health burden to Europe-not only for directly affected individuals, but also for their caregivers and the wider society. They incur substantial economic costs through direct (and indirect) healthcare and welfare spending, and via productivity losses, all of which substantially affect European development [2].","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"52 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88301458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Patients Train Doctors: Feasibility and Acceptability of Patient Partnership to Improve Primary Care Providers' Awareness of Communication Barriers in Family Medicine for Persons with Serious Mental Illness","authors":"J. Pelletier, A. Lesage, J. Bonin, Julie Bordeleau, Nathalie Rochon, Sylvain Baril, Karen Medina, S. Kisely","doi":"10.25149/1756-8358.1201009","DOIUrl":"https://doi.org/10.25149/1756-8358.1201009","url":null,"abstract":"Introduction: Excess mortality from physical chronic disease in patients with serious mental illness (SMI) is such that their life expectancy could be lessened by up to 20 years. This paper reports the results of a pilot study aimed at raising awareness among Primary Care Providers (PCPs) about communication barriers that stand in the way of the better integration of mental and physical health promotion and integration in Primary Care. Methods: We developed a small group learning script of medical training to be delivered by a health promotion nurse and a patient to address the diagnostic overshadowing phenomenon and positively change PCPs’ health promotion knowledge and attitudes. PCPs were asked to fill a series of questionnaires before and after the training. Results: 21 PCPs participated in the 60 minutes patient-centered training. Data shows a statistically significant change (p?.05) between baseline and follow up for 4 out of the 7 dimensions covered by the questionnaires: Health promotion capacity – Resources (p=.001), Psychological Medicine Inventory (p=.002), Efficacy of lifestyle counselling (p=.006), and Perception of skills at lifestyle counselling (p=.000). Discussion: Results suggest that it is possible to raise awareness about the diagnostic overshadowing phenomenon and change PCPs’ knowledge and attitudes by directly exposing them to the personal history of a person with SMI who acts as an auxiliary of medical education. Conclusions: Our script of medical training proved to be more effective than traditional simulation-based training, especially in terms of enhanced inter-professional collaboration. Primary Care Providers also learned that they can be supported by other professionals to whom they can refer their patients for health promotion counselling, and they learned how to better communicate from the patient who acted as an auxiliary of medical training.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"37 1","pages":"112-118"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74556477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life Course Challenges Faced by Siblings of Individuals with Schizophrenia May Increase Risk for Depressive Symptoms.","authors":"Matthew J Smith, Jan S Greenberg, Sarah A Sciortino, Gisela M Sandoval, Ellen P Lukens","doi":"10.25149/1756-8358.1201003","DOIUrl":"10.25149/1756-8358.1201003","url":null,"abstract":"<p><strong>Background: </strong>Research suggests siblings of individuals with schizophrenia are at a heightened risk for depressive symptomatology. Research has not yet examined whether the strains of growing up with a brother or sister with schizophrenia contribute to this risk. This study examined whether early life course burdens associated with an emerging mental illness, and current objective and subjective caregiver burden predicted depressive symptoms in siblings of individuals with schizophrenia.</p><p><strong>Method: </strong>Forty-one siblings of individuals with schizophrenia were recruited from a large study of schizophrenia neurobiology to complete a self-administered questionnaire and a neuropsychological test battery.</p><p><strong>Results: </strong>Early life course burdens and current objective and subjective burdens explained incremental variance in depressive symptoms of siblings of individuals with schizophrenia after accounting for gender and global neurocognitive function. Higher levels of depressive symptoms among siblings were associated with perceptions of being stigmatized by the community (β=.37, <i>p</i><.01), and perceiving that the brother or sister's emerging illness negatively impacted the sibling's social life during childhood and adolescence (β=.39, <i>p</i><.01). Taking on adult responsibilities while the sibling was growing up was found to be protective against depressive symptoms in adulthood (β= -.36, <i>p</i><.01).</p><p><strong>Conclusions: </strong>Early life course burdens associated with having a sibling with schizophrenia and current subjective burden provide insight into psychosocial factors that may contribute to the risk for depression in this sibling group. Mental health service providers and psychoeducation programs would benefit by considering these factors when developing family-based interventions.</p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"12 1","pages":"147-151"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862204/pdf/nihms780143.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34480262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How and Why is Autism Spectrum Disorder Misdiagnosed in Adult Patients? : From Diagnostic Problem to Management for Adjustment","authors":"Kiyoharu Takara, T. Kondo, Teizo Kuba, 高良 聖治, 近藤 毅, 久場 禎三","doi":"10.25149/1756-8358.1102011","DOIUrl":"https://doi.org/10.25149/1756-8358.1102011","url":null,"abstract":"Autism spectrum disorder (ASD) is often overlooked or misdiagnosed in adult patients especially in those with other psychiatric comorbidities. Several reasons possibly account for this fact, for example, difficulty in obtaining accurate developmental history from a patient, insufficient experience among psychiatrists detecting ASD in adult patients, and mild/atypical autistic traits in contrast to prominent symptoms of psychiatric comorbidities. We conducted a search of databases (PubMed, PsycINFO, and ERIC) for relevant articles published from January 2000 to May 2015 and summarized unrecognized or misdiagnosed cases as well as major psychiatric comorbidities among adults with ASD from previous reports. Five disorders, (i.e., schizophrenia, psychotic disorder, bipolar disorder, major depressive disorder, and personality disorder) were specifically highlighted as misdiagnosed psychiatric diseases or comorbidities responsible for unrecognized ASD. This review also proposes plausible pathways for patterns of maladjustment and processes leading to misdiagnosis among adults with ASD, together with necessary approaches to support their goals of a requisite social life. In conclusion, clinicians should be more concerned with correct diagnosis of ASD as well as treatments of psychiatric comorbidities and need perspective of management for better mental health and social adjustment in ASD patients.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"16 1","pages":"73-88"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86242984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treating Anxiety with either Beta Blockers or Antiemetic Antimuscarinic Drugs: A Review","authors":"T. P. Dooley","doi":"10.25149/1756-8358.1102013","DOIUrl":"https://doi.org/10.25149/1756-8358.1102013","url":null,"abstract":"Beta adrenergic receptor antagonists and antiemetic muscarinic receptor antagonists are useful for mental health in primary care and family medicine settings, as they provide favorable risk/benefit profiles, and especially so relative to benzodiazepines. Beta blockers (e.g., propranolol) prescribed off-label have been known for decades to provide some, albeit limited, anxiolytic benefit for patients affected by social anxiety disorder (social phobia), including performance anxiety. Blockage of adrenaline’s binding to cardiovascular beta adrenergic receptors inhibits tachycardia, reduces blood pressure, and thus diminishes palpitations in acute anxiety and panic. However, beta blockers are not effective against the psychic (CNS) symptoms, such as anxiousness, fear, and avoidance. Another approach involves antiemetic muscarinic receptor antagonists that are available by prescription (e.g., scopolamine) or over-the-counter (e.g., meclizine) for the treatment of non-cardiovascular symptoms that manifest in anxiety disorders. Antiemetic agents inhibit nausea, vomiting, sweating, and in some instances other psychic (CNS) symptoms. The symptoms affected by antimuscarinic agents represent the “inverse” of the symptoms of acute anxiety affected by beta blockers. Thus, anxiety disoders can be treated by alternative biochemical pathways, as well as by affecting alternative symptoms thereof. The results of human clinical studies are summarized for both classes of anxiolytic agents that display complementary pharmacologic approaches to a diverse array of symptoms.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89113918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the Potential for Family Physicians to Coach Patients? Self-care of Depression: An Exploratory Study","authors":"M. Yaffe, M. Cole, J. McCusker, T. Sussman, M. Sewitch, D. Şahin, Manon de Raad, É. Belzile","doi":"10.25149/1756-8358.1102014","DOIUrl":"https://doi.org/10.25149/1756-8358.1102014","url":null,"abstract":"BACKGROUND: The potential for family physicians (FPs) to be self-care coaches for patients with depression was explored within a feasibility study examining lay coach support for self-care of depressive symptoms in adults with chronic physical illness. METHODS: FPs were approached from a list of 400 randomly generated urban FPs to assist recruitment of adults with chronic illness and depressive symptoms. Patients received, independent of usual FP care, six months of lay coaching for self-care of depression. Nested within this intervention FPs completed questionnaires at study entry and termination exploring how they normally used self-care, the degree to which they promoted it, and their hypothetical interest in coaching self-care. Two-sided paired T-tests and McNemar's tests were performed respectively for continuous and binary outcomes to assess significance of change from study onset to completion. RESULTS: 110 / 400 FPs were contactable and eligible. 63 consented to participate, and 4 withdrew at onset. Of the 59 FP participants 86% (51/59) completed entry questionnaires and 63% (37/59) terminal ones. For physical illness versus depression significantly more FPs were familiar with self-care (p=0.002) and felt it more effective (p=0.013). Of 7 targeted illnesses for which self-care might be recommended depression was ranked 5th by them. Attitudes and practice did not change as a result of study participation. CONCLUSIONS: At present it is unlikely that FPs will act as depression self-care coaches, except perhaps on an individual basis. Changes in FP training, practice styles, practice support, and remuneration may be required to improve this. Language: en","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"14 1","pages":"53-58"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82036892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can behavioural activation be used as an alternative treatment for subthreshold depression in type 2 diabetes","authors":"S. Hardy, B. A. Shamari, M. Al-Mutawa, Jesveena Mathias, D. Ekers, J. Gellatly, Natalie Figgins, R. Gray","doi":"10.25149/1756-8358.1102008","DOIUrl":"https://doi.org/10.25149/1756-8358.1102008","url":null,"abstract":"Subthreshold depression is common in people with type 2 diabetes and is an important risk factor for poor health. Collaborative care is the suggested approach for people with long term conditions and persistent subthreshold depression, with a high-intensity psychological intervention being the recommended treatment. However, there is little evidence that a high-intensity psychological intervention improves subthreshold depression in people with type 2 diabetes. Additionally, its use as a treatment in day to day practice can be difficult and expensive to organise even when a collaborative care approach is utilised. Behavioural activation delivered by the patients? usual diabetes care giver as a treatment for subthreshold depression could be an effective alternative.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77708299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' perspectives on improvement of medically unexplained physical symptoms: a qualitative analysis","authors":"N. V. Dessel, F. R. Velzeboer, J. C. Wouden, C. Boer, J. Dekker, H. Horst","doi":"10.25149/1756-8358.1102007","DOIUrl":"https://doi.org/10.25149/1756-8358.1102007","url":null,"abstract":"Title: Patients’ perspectives on improvement of Medically Unexplained Physical Symptoms: a qualitative analysis. \u0000Background: Medically unexplained physical symptoms (MUPS) are common. Knowledge of Knowledge on factors contributing to improvement of MUPS may be useful for the development of more effective treatments. This study aims to assess the factors contributing to improvement of symptoms, according to recently improved MUPS patients. \u0000Methods: This qualitative study is part of a prospective cohort study on the course of MUPS. We selected patients with at least moderate MUPS at baseline and with a substantial decrease of symptoms after 6 or 12 months. We performed semi-structured interviews. Recordings were transcribed verbatim and analysed in ATLAS.ti. \u0000Findings: Although saturation of data was reached after 6 interviews, 9 patients were interviewed. Their symptoms had developed gradually and worsened until a certain point of crisis. Before this crisis patients were focused on finding symptom causes and on becoming one’s old self again. The experience of a crisis made them accept their situation. This resulted in a search for improvement instead of recovery. Participants started taking control of their own well-being by coping differently (e.g. by pacing activities and relaxing effectively), mostly supported by a therapist. This led to symptom improvement. Participants deemed it important that General Practitioners and therapists were coaching and took their problem seriously. Received therapies varied from regular therapies to complementary therapies. The latter were experienced as effective, as they combined psychological and physical components. Some participants missed this multidimensional approach in regular treatments. \u0000Conclusions: Acceptance of symptoms and their consequences seems to be the most important condition for improvement of MUPS. As a moment of personal crisis forms the most important motivation for acceptance, it may be something that cannot be forced by therapists. Nevertheless, General Practitioners and therapists can support patients on their way to acceptance. A wish for multidimensional treatments in regular health care was identified.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"14 1","pages":"42-48"},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75118043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression Risk and Cancer in Ecuador: The Protective Role of Social Support","authors":"Paula N Goldman, E. Prochaska, Ignacio Stacey, Aimee D. Miller, S. Merajver, J. Mosquera, Zongshan Lai, M. Grunauer, M. McInnis","doi":"10.25149/1756-8358.1102010","DOIUrl":"https://doi.org/10.25149/1756-8358.1102010","url":null,"abstract":"Introduction: Depression is a determinant of quality of life for cancer patients and predicts cancer progression and mortality. Our study assessed depression and distress among cancer patients receiving care at the hospital Sociedad de Lucha Contra el Cancer (SOLCA) in Quito, Ecuador and evaluated the role of interpersonal support in protecting against depression. Awareness of the specific benefit of interpersonal support for cancer patients at risk for depression is critical for the ongoing care provided by PCPs to the patient and family in community. \u0000Methods: Computer tablets were used to collect demographic information and to administer three questionnaires: the Patient Health Questionnaire (PHQ-9) to assess severity of depression symptoms, the Distress Thermometer to characterize level and nature of distress, and the Experiences in Close Relationships assessment (ECR) to measure social support from one’s partner. \u0000Results: A high level of depression was reported by 29.1% of patients (N=300). Those with high levels of depression reported significantly more distress. Those demonstrating high levels of depression also reported significantly less support from their partners. The demographic factors found to be related to increased risk of depression were unemployment and lack of higher education; young age was related to increased distress. \u0000Conclusions: Depression is common in the cancer patient population and strong support from one’s partner is a protective factor. The importance of strengthening support from a patient’s partner is emphasized at all levels of care, especially the community based PCP engaged with the patient and family longterm.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83776816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health of Pregnant Women with Substance- related Disorder, A Neglected Global Health Issue Requiring Combined Maternity Care Units","authors":"N. Nikoo, A. Frank, M. Nikoo, K. Jang, R. Abrahams, M. Krausz","doi":"10.25149/1756-8358.1102006","DOIUrl":"https://doi.org/10.25149/1756-8358.1102006","url":null,"abstract":"Background: Pregnant women using substances (PWUS) are defined as women in the pregnancy and postpartum period (pregnancy to 8 weeks after the delivery) that use illicit drugs. Health of PWUS is a hidden global epidemic, becoming visible in part due to increasing numbers of street children. Lack of awareness and stigma contributes to the scarcity of research for PWUS. Combined maternity care units (CMCU) have been proposed as standard of care for PWUS and their newborns. \u0000Objective: This review aims to evaluate global awareness of PWUS’s health and proposes CMCU as an effective integrated part of the continuum of care through a health systems approach. \u0000Methods: The authors completed a critical narrative review of the available evidence about the health of PWUS and based on that, provided recommendations for health care delivery using a systems thinking approach. \u0000Findings: Determinants of health for PWUS's and their children include: economic disadvantage, poverty, homelessness, stigma, violence, sexual and emotional abuse, mental co- morbidities, history of childhood abuse and disrupted family structure, and trans-generational trauma. Although there is a scarcity of data on trends of substance use among PWUS in many regions of world, there is sufficient evidence to demonstrate the need for a standard of care. \u0000Conclusions: Increasing awareness of and providing new care options for mothers suffering from substance-related disorder- including by opening more CMCU- can help families, lower maternal and child morbidities and mortalities, and achieve Millennium Development Goals.","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75165124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}