Mental health in family medicine最新文献

{"title":"Exploring core competencies for mental health and addictions work within a Family Health Team setting.","authors":"Brian Rush, Catherine McPherson-Doe, Reneé C Behrooz, Alan Cudmore","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Approximately 200 Family Health Teams (FHTs) have been implemented in Ontario to improve access to primary healthcare, including mental health and addiction. The objectives of this project were to examine, through a focus group and qualitative methodology with three FHTs, the profile of patients' mental health and addiction-related needs and to identify the implications for the development of core competencies in these innovative organisations. A spectrum of needs and service trajectories was identified, as well as the importance of a wide range of clinical skills and knowledge. The results indicate that 'core' competencies for mental health work in the context of an FHT go well beyond those required for an embedded mental health 'programme' or specialised mental health counsellors, but rather they relate to the core and discipline-specific competencies of members of the entire team. In addition to specific knowledge and skills, competencies include common attitudes and values relating to teamwork, good communication and collaboration. Challenges were noted with regard to working with some community service providers, especially addiction services. Implications for core competencies at the individual and organisational level were identified. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 2","pages":"89-100"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822640/pdf/MHFM-10-089.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32031047","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":"Somatoform disorders among patients attending walk-in clinics in Trinidad: prevalence and association with depression and anxiety.","authors":"Rg Maharaj,&nbsp;C Alexander,&nbsp;C H Bridglal,&nbsp;A Edwards,&nbsp;H Mohammed,&nbsp;Ta Rampaul,&nbsp;S Sanchez,&nbsp;Gp Tanwing,&nbsp;K Thomas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Objectives Somatoform disorders are common in international primary care settings, but have been little studied in the developing world. The objective of this study was to determine the prevalence of severe undifferentiated somatoform disorder, and its relationship to depression and anxiety, among patients attending walk-in clinics in Trinidad. Methods The study participants, who were all aged 18 years or older and attending walk-in clinics at 16 randomly selected health centres, were surveyed between May and August 2007 using the PRIME-MD questionnaire. Results There were 594 participants (the response rate was 92%), of whom 72.7% were female. Their ages ranged from 18 to 93 years, and 54.5% were over 50 years of age. In total, 37.2% were married and 25.9% were single. Indo-Trinidadians represented 43.1% and Afro-Trinidadians represented 36% of the study sample; 56.5% of the participants reported that their income was less than US$ 400 per month, and 65.7% were unemployed. At walk-in clinics in Trinidad, the estimated prevalence of severe undifferentiated somatoform disorder was 10.3% (95% CI: 7.86-12.74), that of hypochondriasis was 28.5% (95% CI: 24.9-32.1), and that of body dysmorphic disorder was 15.8% (95% CI: 11.9-18.7). Severe undifferentiated somatoform disorder was statistically significantly associated with gender and ethnicity but not with age, level of education, employment status or income. Chi-square testing found significant associations between the presence of severe undifferentiated somatoform disorder and both depression and anxiety (P < 0.05), between hypochondriasis and both anxiety and depression (P < 0.05), and between body dysmorphic disorder and depression (P < 0.05) but not anxiety. Regression analysis suggested that the demographic features that predicted severe undifferentiated somatoform disorder were being female or Indo-Trinidadian. Conclusions Walk-in clinics in Trinidad that serve older patients on a lower income have a high proportion of patients with somatoform disorders as measured by the PRIME-MD scale. These patients exhibit many features of anxiety and depression. These findings have implications for medical training and service delivery. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 2","pages":"81-8"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822639/pdf/MHFM-10-081.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32031046","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":"Making sense of medically unexplained symptoms in general practice: a grounded theory study.","authors":"Louise Stone","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background General practitioners often encounter patients with medically unexplained symptoms. These patients share many common features, but there is little agreement about the best diagnostic framework for describing them. Aims This study aimed to explore how GPs make sense of medically unexplained symptoms. Design Semi-structured interviews were conducted with 24 GPs. Each participant was asked to describe a patient with medically unexplained symptoms and discuss their assessment and management. Setting The study was conducted among GPs from teaching practices across Australia. Methods Participants were selected by purposive sampling and all interviews were transcribed. Iterative analysis was undertaken using constructivist grounded theory methodology. Results GPs used a variety of frameworks to understand and manage patients with medically unexplained symptoms. They used different frameworks to reason, to help patients make sense of their suffering, and to communicate with other health professionals. GPs tried to avoid using stigmatising labels such as 'borderline personality disorder', which were seen to apply a 'layer of dismissal' to patients. They worried about missing serious physical disease, but managed the risk by deliberately attending to physical cues during some consultations, and focusing on coping with medically unexplained symptoms in others. They also used referrals to exclude serious disease, but were wary of triggering a harmful cycle of uncoordinated care. Conclusion GPs were aware of the ethical relevance of psychiatric diagnoses, and attempted to protect their patients from stigma. They crafted helpful explanatory narratives for patients that shaped their experience of suffering. Disease surveillance remained an important role for GPs who were managing medically unexplained symptoms. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 2","pages":"101-11"},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822641/pdf/MHFM-10-101.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32031049","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":"Polypharmacy in the management of patients with schizophrenia on risperidone in a tertiary-care hospital in Malaysia.","authors":"Sa Jacob, Mi Mohamed Ibrahim, F Mohammed","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The present study was conducted primarily to determine the occurrence of polypharmacy in patients with schizophrenia on risperidone. The secondary aim was to ascertain the incidence of inappropriate prescribing with anticholinergics. A retrospective review of the medical records of all patients who were being followed up at the out-patient clinic of a tertiary-care hospital in Malaysia was conducted. Only patients who were being prescribed risperidone between 1 June 2008 and 31 December 2008 were included in the study. Demographic data such as patient's age, gender and race were obtained from the patient's medical records. In total, 113 patients met the selection criteria. Polypharmacy was found to occur in 34 patients (30.09%), with the majority (76.47%) being on two antipsychotics. In total, 27 patients (34.18%) on monotherapy with risperidone were prescribed an anticholinergic on scheduled dosing, while 19 patients (24.05%) were prescribed it on an as-needed basis. Of the patients on polypharmacy, 26 (76.47%) were on scheduled dosing of anticholinergics, while three (8.82%) were taking the medication on an as-needed basis. Polypharmacy should be avoided, and the use of anticholinergics should be closely reviewed. By adopting more efficient prescribing practices, costs can be reduced and financial resources can instead be channelled towards more beneficial areas for the patients. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"37-43"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822671/pdf/MHFM-10-037.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993155","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":"Use of standardised patients in the evaluation of a residency mood disorders curriculum: a brief report.","authors":"A M Kobus,&nbsp;J Heintzman,&nbsp;R D Garvin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background and objectives The purpose of this paper is to describe the use of resident performance on an observed structured clinical examination (OSCE) as a tool to refine a mood disorders curriculum, and to disseminate a mood disorders OSCE for use in other residency settings. Methods A depression-focused OSCE and a direct observation evaluation tool were developed and implemented. A total of 24 first-year family medicine residents (PGY1) participated in the OSCE, and their performance was used to direct changes in a mood disorders curriculum. Results Residents performed well on general interview behaviours, and 67% were able to uncover depression in a patient presenting with headaches. Less than 50% of the residents asked about suicidal ideation and recreational drug use. Curriculum was added that addressed the latter deficiencies. Conclusions Tracking of resident performance on specific behaviours during OSCE sessions can be used for curriculum evaluation purposes. The mood disorders curriculum in additional family medicine residency programmes can now be evaluated using our depression-focused OSCE and Clinical Performance Checklist. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"45-51"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822672/pdf/MHFM-10-045.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993156","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":"Barriers and errors in the implementation of community psychiatry in Slovenia.","authors":"Vesna Svab,&nbsp;Igor Svab","doi":"10.25149/1756-8358.1001001","DOIUrl":"https://doi.org/10.25149/1756-8358.1001001","url":null,"abstract":"<p><p>Background Slovenian psychiatry is predominantly hospital based. A programme for the development of general community psychiatric services was proposed to improve access to and quality and comprehensiveness of psychiatric care according to the modern standards of delivery of psychiatric services. Aim The aim of the paper is to present the programme for developing community services that was proposed to the Slovenian government, and to describe the barriers to its implementation that were encountered, as well as the errors made by the programme authors, that contributed to the rejection of the programme last year. Conclusions There are historical, political, professional and service organisation characteristics that impede the development of community psychiatry in Slovenia. These are to be addressed through coordinated action involving primary care professionals, non-government organisations with service users and carers, the Health Insurance Agency and politicians involved in the planning of health services. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"23-8"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822669/pdf/MHFM-10-023.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993153","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":"Evaluation of a primary care adult mental health service: Year 2.","authors":"Patrick McHugh, John Brennan, Niall Galligan, Claire McGonagle, Michael Byrne","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Aims This study aimed to examine the effectiveness of a primary care adult mental health service operating within a stepped care model of service delivery. Methods Supervised by a principal psychologist manager, psychology graduate practitioners provided one-to-one brief cognitive behavioural therapy (CBT) to service users. The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) was used to assess service user treatment outcomes. Satisfaction questionnaires were administered to service users and referring general practitioners (GPs). Results A total of 43 individuals attended for an initial appointment, of whom 19 (44.2%) completed brief CBT treatment. Of the 13 service users who were in the clinical range pre-treatment, 11 (84.6%) achieved clinical and reliably significant improvement. Of the six service users who were in the non-clinical range pre-treatment, three (50%) achieved reliably significant improvement. Both service users and GPs indicated high levels of satisfaction with the service, although service accessibility was highlighted as needing improvement. Conclusion The service was effective in treating mild to moderate mental health problems in primary care. Stricter adherence to a stepped care model through the provision of low-intensity, high-throughput interventions would be desirable for future service provision. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"53-9"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822673/pdf/MHFM-10-053.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31994202","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":"Sense of coherence in people with and without type 2 diabetes mellitus: an observational study from Greece.","authors":"K Merakou,&nbsp;A Koutsouri,&nbsp;E Antoniadou,&nbsp;A Barbouni,&nbsp;A Bertsias,&nbsp;G Karageorgos,&nbsp;C Lionis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Background Antonovsky's concept of sense of coherence (SOC) has been suggested to relate to health, especially mental health and preventive health behaviours. Psychological distress has been identified as a risk factor for pre-diabetes and type 2 diabetes mellitus. The study of SOC and diabetes has not received much attention in Greece. This study aims to explore the extent to which type 2 diabetes mellitus can affect the SOC score. Methods An observational design was used to test the study hypothesis that individuals with type 2 diabetes mellitus would have a lower SOC than those without diabetes mellitus. A total of 202 individuals were studied, consisting of 100 people with diabetes mellitus (the study group) and 102 people with non-chronic orthopaedic conditions (the control group). All of the participants were patients of the Diabetic Clinic or the Orthopaedic Clinic of Livadia Hospital in Central Greece. SOC was assessed using a 29-item SOC questionnaire that had been translated into Greek and validated. Results Patients without type 2 diabetes mellitus had 2.4 times higher odds of having a high SOC score than patients with type 2 diabetes mellitus (P = 0.036; odds ratio [OR] = 2.35, 95% confidence interval [CI] = 1.06-5.23). Male patients had 3.9 times higher odds of having a high SOC score (P < 0.001; OR = 3.85, 95% CI = 1.71-8.67) than female patients. With regard to education, patients with a lower level of education had almost three times higher odds of having a high SOC score than patients with a higher level of education (P = 0.024; OR = 2.97, 95% CI = 1.15-7.67). Conclusions This study adds to the existing literature and indicates that SOC is a health asset. A study with an experimental design would clarify the interesting hypothesis of this study. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"3-13"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822667/pdf/MHFM-10-003.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993151","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":"Loneliness and the elderly: opportunities for health promotion.","authors":"Gabriel Ivbijaro","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822666/pdf/MHFM-10-001.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993149","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":"Patient's weight 6 months after depression treatment is not affected by either clinical remission or enrolment in collaborative care management.","authors":"Kurt B Angstman,&nbsp;Todd W Wade,&nbsp;Ramona S Dejesus,&nbsp;Kathy L Maclaughlin,&nbsp;Gregory L Angstman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Objective The primary aim of this study was to determine whether enrolment in collaborative care management (CCM) for treatment of major depression would have a significant impact on 6-month changes in weight compared with patients treated by their primary care provider with usual care. The secondary aim was to determine whether clinical remission would also affect 6-month weight changes. Design A retrospective chart review study included 1550 patients who had been diagnosed with major depression or dysthymia and who had a Patient Health Questionnaire (PHQ-9) score of ≥ 10 with follow-up data (PHQ-9 score and weight) at 6 months. Subjects The study sample consisted of adult patients (aged ≥ 18 years) from primary care practices, representing all body mass index (BMI) categories. The exclusion criteria were a diagnosis of bipolar disorder, recent obstetric delivery or recent gastric bypass procedure. Measurements Weight was measured at index and 6 months, with BMI calculated from electronic medical record data. Patient assessment data (including PHQ-9 score and clinical diagnosis) and demographic variables (age, gender, marital status and clinical location) were also collected. Results With regression modelling, neither enrolment in CCM (P = 0.306) nor clinical remission (P = 0.828) was associated with a significant weight gain. Conclusion After 6 months, enrolment in CCM had no significant impact on weight gain or weight loss among patients treated for depression, nor was improvement to clinical remission a factor in the patient's weight after 6 months. Incorporating a weight loss management intervention within the model may be warranted if concomitant weight reduction is desired. </p>","PeriodicalId":89603,"journal":{"name":"Mental health in family medicine","volume":"10 1","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3822668/pdf/MHFM-10-015.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31993152","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}