Mental Health Services in General Health Care A Conference Report, Volume I (1979) / Chapter Skim
Currently Skimming:
VII. Commissioned Papers
VII. Commissioned Papers
Pages 145-246
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 145... ...
for the chronically ill in the community, and prevention/educational outreach programs about mental health and mental illness. We have been impressed by the opportunities that such a setting provides for mental health professionals to collaborate with primary physicians in the latter's roles as case-finders and treaters of patients with defined mental disorder, patients with combined psychiatric and medical problems, and patients reacting to either external or illness-related stresses.
|
From page 146... ...
Primary physicians are major case-finders and treaters of patients with mental disorder. It is estimated that 60% of all patients with mental disorders seen in primary care is not referred to mental health specialists.
|
From page 147... ...
The NHC offers primary practice and mental health trainees opportunities for both front-line, acute ambulatory care and long-term care of chronic illness in the community Training in their patients' neighborhood can help both sets of providers consider the impact on clinical care of socio-environmental, ethnic and cultural, and public health aspects of care often ignored in institution-bound training. Importantly, the proximity to other trainees and availability of collaborating role models can help both primary practice and mental health professional trainees overcome prior negative inter-professional stereotypes to learn to use each otherts expertise to their patients' benefit.
|
From page 148... ...
7. Support is proposed for greater in-service and professional training of both primary physicians and mental health professionals in NHCs and other coordinated primary health and mental health care settings.
|
From page 149... ...
Shepherd 1/, for example, showed a nine-fold variation between family physicians in London, and surveys in the United States have shown even wider variations. The results of five recent surveys are summarized in Table 1, which shows the percentage of consecutive attenders thought "psychiatric" by the primary care The mean is the figure which is most usually quoted when and it is often conveniently .
|
From page 150... ...
150 When psychiatric screening tests are used simultaneously during such surveys, they typically show much less variation between the various practice populations than that suggested by the doctors' own assessments. Figure l shows 14 practices in Michael Shepherd's wellknown study , arranged in rank order, so that the prac Lice with the highest rate of ascertainment of psychiatric illness is on the extreme left while that with the lowest is on the extreme right.
|
From page 151... ...
Figure 2 has a familiar look about it. But we are now using the General Health Questionnaire instead of the Cornell Medical Inventory; we are studying 29 second and third year family practice residents rather than established physicians; the time is 1979, and the place is Charleston, South Carolina.
|
From page 152... ...
1/ 14 General Practitioners, London, England -0.31 (NS) Marks, Goldberg & Hillier 2/ 22 General Practitioners, Manchester, England Goldberg & Steele 6/ 29 Family Practice Residents, Charleston, S.C.
|
From page 153... ...
Mild _~ 1 "Non-Cases" 3 4 Moderate Severe "Cases" CLINICAL ASSESSMENT BY DOCTOR (% Cases= Conspicuous Psychiatric Morbidity, CPM)
|
From page 155... ...
Figure 5 SCORE ON PSYCHIATRIC SCREENING QUESTIONNAIRE , !
|
From page 156... ...
The more important he thinks they are, the higher will be his estimate of psychiatric morbidity. Our recent study in Manchester 2/ was able to include rich observational data made by a psychiatrist observing over two thousand interviews by 56 family doctors, and succeeded in accounting for 53% of the variance of the doctors' assessments.
|
From page 157... ...
~ 91- Family Doctors, Manchester, U.K. 45 Family Practice Residents; Chor/eston, U.S.A.
|
From page 158... ...
Patients in the control group gradually improved with time, but had to endure an average of 5.3 illnessmonths following initial consultation, in contrast to the 2.8 illness-months for the patients whose disorder had been discussed with their doctor. Before we consider the implications that such findings have for the future training of family physicians, let us turn briefly to consider the treatment that emotionally disturbed patients actually receive from family physicians.
|
From page 159... ...
Since the topic of this paper is training, it is also worth recalling that the older generation of the family doctors studied will have had an undergraduate training in psychiatry which was wholly inadequate by present day standards, and that very few of them will have had any training at all aimed at helping them to acquire psychotherapeutic skills. Hawton and Blackstock _ / have recently interviewed family doctors who had been looking after 122 patients who had deliberately poisoned themselves with psychotropic drugs.
|
From page 160... ...
The authors are not opposed to the use of psychotropic drugs by family physicians, but they observe that they should be prescribed only for clear indications: "Antidepressants in therapeutic doses where there is clear evidence of underlying depressive illness; tranquillizers for short periods to help patients through crises when levels of anxiety are such that their coping ability is grossly impaired; and nonbarbiturate hypnotics for short periods where insomnia, secondary to stress, is undermining an individual's resources, such as during a severe grief reaction... Automatic represcribing, found to be so common for psychotropic drugs by Freed, should be avoided if at all possible." 11/ To what extent do primary care physicians prescribe psychotropic drugs which are appropriate to the symptoms experienced by their patients?
|
From page 161... ...
2. Although many primary care physicians make accurate assessments about emotional disorder, many others are very poor at making such assessments.
|
From page 162... ...
This is far from true. In the future, psychologists, social workers, epidemiologists, nutritionists and others will have more important roles as teachers."
|
From page 163... ...
The syndromes which the trainee should be able to assess are those in which diagnosis implies special management procedures: for example, those depressive states which are especially responsive to drug therapy; the presentations of substance abuse in a primary care setting; and the assessment of confusional states in the elderly. Third, he should be largely responsible for teaching the proper use of psychotropic drugs, and helping his trainee to understand how
|
From page 164... ...
On the one hand, the family physician will often have a role to play in the management of long-term major disorders, and will therefore need the skills to make appropriate clinical assessments, when the occasion demands, of patients who are receiving depot injections of phenothiazines or who are on long-term lithium therapy. And on the other hand, neurotic and characterological problems often require specialized psychotherapeutic skills for their management which it would be unreasonable to expect every family physician to possess.
|
From page 165... ...
(1971) "The Prescribing of Psychotropic Drugs in General Practice." J
|
From page 166... ...
(1979) "Detection & Assessment of Emotional Disorders in a Primary Care Setting," Int.
|
From page 167... ...
Division of Primary Care and Family Medicine Harvard Medical School Boston, Massachusetts Kafka wrote in A Country Doctor that "to write prescriptions is easy, but to come to an understanding with people is hard." 1/ That truth undoubtedly explains in large part the prominence enjoyed by psychotropic drugs among the 1.4 billion prescriptions written last year for the seventy million Americans who regularly take drugs ordered by physicians. How did this gap emerge between the technical skills and knowledge exemplified by the use (and abuse)
|
From page 168... ...
: "Mental disorder was diagnosed in 78Z of visits to psychiatrists, 4% of visits to general practitioners, and 9% of visits to internists. Because of the larger number of visits to non-psychiatrists, 59% of all visits by patients with mental disorders were to these physicians." 12/ How did the physicians respond to these patients?
|
From page 169... ...
14/ Lazarson notes that "even more anxiety-provoking than the theoretical body of knowledge is work with the clinical source of all theory -- the patient."' 15/ The affect of patients with mental disorders re-evokes in the physician those "problems and conflicts whose existence and solution took place exclusively in his unconscious, and towards whose revival there are the strongest resistances." 16/ The consequences of this behavior for primary care physicians already burdened with anxiety about their patients' medical needs are that emotional problems often present as an enigma. Some physicians completely fail to recognize mental disorders or are uncomfortable with patients whom they label malingerers, hypochondriacs, crocks or "problem patients." Management of these patients often includes extensive diagnostic or treatment plans with the minority of patients receiving time for ventilation and therapeutic listening through repeated visits.
|
From page 170... ...
Certainly it would be easier to support the resident's enthusiastic and skillful pursuit of organic disease while makir~ other arrangements for dealing with those mental disorders which are less well-defined and frequently viewed as less legitimate aspects of patient care. 27/ But in moving beyond the biomedical model we acknowledge that the primary care physician is ideally placed for the prevention, diagnosis and treatment of mental disorders for the following reasons: "many mentally disturbed patients present with physical complaints; physical and mental illness frequently coexist; some stigma is still attached to seeing a mental health specialist; the important social and family context of the patient are already known; and the potential for long-term follow-up is present.'' _ / To take advantage of these opportunities the primary care physician needs to acquire specific mental health skills.
|
From page 171... ...
31/ These skills are broadly defined in three categories: sensitivity skills, therapeutic skills, and referral skills. First, the sensitivity skills; the overall objective in this category is to educate primary care physicians to be more sensitive to patients and their needs for treatment and understanding.
|
From page 172... ...
The category of referral skills includes learning to recognize serious psychiatric disorders and developing skills of the referral process, utilizing appropriate resources. To make appropriate referrals for specialized mental health services the primary care physician must: develop diagnostic skill for the major psychiatric disorders; be able to elicit data relevant to suicidal or homicidal potential; - know how to arrange for psychiatric hospitalization when needed; be able to provide initial management of psychiatric emergencies until the services of a psychiatrist can be arranged if necessary; know how to work with psychiatrists in providing proper treatment; and
|
From page 173... ...
As Dr. Regier and his colleagues noted, much of the ability of primary care physicians "to deal with more explicitly defined organic illness may well depend on the ease and compe fence wi th which they respond to the pre sentat ion o f mental disorder and broader emotional concerns .
|
From page 174... ...
14. Training the Psychiatrist to Meet Changing Needs: Report of the 1962 Conference of Graduate Psychiatric Education, American Psychiatric Association, 1963.
|
From page 175... ...
Fisher, J.V., Family physicians want more postgraduate psychiatric training. Patient Care 7:54-57, 1973.
|
From page 176... ...
39. Schniewind, H.E., A psychiatrist's experience in a primary health care setting, Inter J Psychiatry in Med 7~3~:229-240, 1976-77.
|
From page 177... ...
45/ The 1964 Report of the Royal Commission on Health Services laid the framework for national health insurance. 8/ Recommendation Number 29 stated that: "Henceforth all discrimination and distinction between physical and mental illness in the organization and provision of service, the treatment, and the attitudes on which these discriminations are based, be disallowed for all time as unworthy and unscientific." The authors acknowledge the unpublished tabulations from Health Information Division, Information Systems Directorate, Policy, Planning and Information Branch, Department of National Health and Welfare, Canada; Program Development Division, Nova Scotia Department of Health; Maritime Medical Care Inc., and Carl d'Arcy, Ph.D., University of Saskatchewan; the help of Mrs.
|
From page 178... ...
24/ The patient has choice of physician; the physician submits a claim for an individual patient. The method by which the provincial costs are financed varies from Province to Province; in Ontario there is an annual premium, Nova Scotia has a sales tax.
|
From page 179... ...
113,914 2,741,233 851,717 3,7C6,864 Payments ($) 2,525,174 58,493,260 19,603,574 809712,008 Services per 1000 Insured Persons(No, )
|
From page 180... ...
The figures are based upon fee-for-ser~nce payments made by the medical care insurance plans of nine provinces to physicians residing in the province making the payments. Out-of-province payments are excluded.
|
From page 182... ...
The Canadian universal prepaid hospital insurance plan does not discriminate against mental disorders. The provincial data bases of individual hospitalizations and medical services enable detailed studies of the use by the general population of specialized psychiatric services, mental health services from private practitioners, general
|
From page 183... ...
50 -18% Mean 9, 735 11, 579 +19% Payments Coefficient of variation .43 .45 + 5% Psychiatric Visits and Consultations Mean .93% 3.24% +248% Visits as Percentage Coefficient of of All Visits and variation 6.86 3.4 -50% Consultations Mean 1.477 4~27% +190% Payments as Coefficient of Percentage of Pay- variation 4.98 2.73 -45% meets for All Visits and Con sultations From Mathematica Policy Research, 1978 hospital care for mental disorders, and in some provinces with pharmacare the use of prescribed psychopharmaceutical agents. 26/ These data, by and large, have not been extensively used for health services research.
|
From page 184... ...
Functional psychoses made up 30 percent of the psychiatric inpatient service patients, 9 percent of admissions to the mental health clinic, 7 percent of the mental disorders in general hospital wards, and 4 percent of the mental disorders recorded by physicians in private practice. The picture for psychoneuroses and psychosomatic disorders
|
From page 186... ...
186 UP Cut Cat A ~ .
|
From page 187... ...
Figure VI shows the distribution of 540,886 medical services among the 112,000 patients seen by fee-for-service practitioners during the two-year period. The lefthand side of Figure VI shows the distribution of 112,000 patients; the righthand side the distribution of 540,886 services for mental disorders; the middle set of figures shows the number of medical services per patient during the two year period.
|
From page 188... ...
2% TABLE 3. MEDICAL SERVICES FOR MENTAL DISORDERS, SASKATCHEWAN, 1971-1972 Services Total General Hospital Days (Care by psychiatrist or general practitioner)
|
From page 190... ...
190 FIGURE VIII PSYCH IATR IC SERVICES 105- B Y P SYC H I ATR I ST S AND GENERAL PRACTITIONERS N O VA SC O T I A, 1971 - 78 1 / u, o 75 ~ 60an O 45 o - Hi ~ - 304 r~~ All ~ ~ / Lo An TOTAL / / __ 15 v- , _ 1971 1972 1973 1974 1975 GE N E RA L PRACTITION / / / f / / ,, ———~ P S YC H I A TR I S T S Fiscal Years Ending March 31 l 1976 1977 1978
|
From page 191... ...
Accordingly, a psychotherapeutic procedure may be charged for if onehalf hour, or major part thereof, has been spent in such treatment of the patient." The total number of insured medical services increased 185% from 39 per 1,000 in 1971 to 111 per 1,000 in 1978. In relation to the total expenditures for medical services, the costs for psychotherapy increased from 1 percent to 3.5 percent.
|
From page 192... ...
There has been relatively little progress in defining "stage" because of our limited understanding of the natural history of the various mental disorders. "Severity" is highly subjective as yet; 65% of patients seen by private psychiatrists were judged as "serious" in comparison to 19% of patients seen by all specialists.
|
From page 193... ...
_ / Finally, we can begin to establish "Diagnosis Related Groups," to bring together patients with diverse diagnoses who require common treatment services and should have similar outcomes. 49/ Concerns for Quality Assurance and Cost Containment The applications of Quality Assurance and Cost Containment methods to psychiatry do not yet compare with their applications to other medical specialities.
|
From page 194... ...
32/ We must be able to identify whether problems for which care is sought by the patient are congruent with those being approached by the practitioners 48/ Continuation of therapy must be based on whether predetermined clinical goals have been attained. We do not yet have reliable methods for assessing progress in attaining treatment goals.
|
From page 195... ...
A cost-containment system for ambulatory care must allow for: a) conceptual clarification between claims review and other types of review; b)
|
From page 196... ...
18/, 36/ It is not appropriate to have a few procedure codes and reimbursement rates to cover the wide range of psychotherapies and all providers of psychotherapy. Some mental disorders can be cared for by non-psychiatrists or nonphysicians.
|
From page 197... ...
during the six month period ranged from 4.0% to 5.3% in the various income groups, with socially assisted enrollees having a rate similar to that for non-subsidized ("independent") enrollees.
|
From page 198... ...
Percent 28% 46% 26% Distribution Persons with diagnosis of mental disorder Number (thousands) 17 22 16 Percentage of subscribers 5.3% 4.0% 5.1% Single Service Claims For Mental Disorders Distribution of patients among general practitioners 34% 42% 24% psychiatrists 19% 31% 50% Average number of services by: - general practitioners 3 4 4.5 - psychiatrists 5.5 6.5 8 Multi Service Claims for Mental Disorders (single claims~for number of services for a patient during a single month)
|
From page 199... ...
The universal insurance program~started with a rate of utilization of psychiatric services less than the privately insured nonpoor were getting four years earlier. Did the poor continue to receive smaller numbers of services, and did the privately insured persons get a larger number of services?
|
From page 200... ...
Quality assurance and cost containment methods for mental health services in primary practice; and (c) Health systems research on mental health services in primary practice.
|
From page 201... ...
The report urged that immediate priority be given to studies on the utilization and cost of services under current health insurance and projected National Health Insurance plans. Although there is much overlap in content and approach between epidemiology, quality assurance and cost containment, and health systems research, by and large, there has been sparse collaboration by the few researchers in each of these fields.
|
From page 202... ...
G.W. Albee, Does Including Psychotherapy in Health Insurance Represent a Subsidy to the Rich from the Poor?
|
From page 203... ...
H Hatcher, Canadian Approaches to Health Policy Decisions National Health Insurance, American Journal of Public Health, 68: 881-889, 1978.
|
From page 204... ...
A Richman, Psychiatric Care and Prepaid Medical Insurance Plans, Chapters 16-19, in Psychiatric Care in Canada: Extent and Results, Royal Commission on Health Services, Queens Printer, 1966.
|
From page 205... ...
52. World Health Organization, WHO Collaborative Project on Det'~rminants of Outcome of Severe Mental Disorders, 1977-1979, MHNJ 78, 14, Rev.
|
From page 207... ...
Regier and how it has already begun to come to grips with many of the issues raised by our own work on the extramural dimensions of mental disorder. From the beginning this was based on the primary care physicians or general practitioners who occupy a central position in the health service structure which differs radically from that prevailing in the two other models encountered in developed countries.
|
From page 208... ...
~ ~ irst-co'~tact care Specialist care for the ambulatory Hospital in-patient care P()
|
From page 209... ...
209 FIGURE 2 BREAKDOWN OF PSYCHIATRIC ILLNESS IN AUTHOR'S PRACTICE FOR PATIENTS CONSULTING IN A COMPLETE YEAR Atcoh31~r addiction Psychopathy Compensation neurosisSchizophrenia- Amentia - . 1 IATRIC ~~N Chronic Anxiety and · ~ | I | I | Acu~ Hystero:~: il il tEDndo~=~1~'~ he Anxiety States Am;< `~/4TR~C \~0~/
|
From page 210... ...
Blacker, who used the findings to put forward quantitative proposals for the reorganization of the whole of the national mental health services, including a detailed model plan for a population of a million persons. 4/ Much of the report is eminently sensible and anticipates later provisions of the National Health Service.
|
From page 211... ...
211 FIGURE 3 O 12 per 1000 Suicides 0 1 3 per 1000~ ~ Compulsory admissions 077perlOOO ~ 1101011111 - - 1144~111I' 1-90 perlOOO Level of recognition _ Informal admissions ,_ Patients seen by psych istrist Patients seen by ~ ?
|
From page 212... ...
He then went on to say: ''There will also be about 24 family doctors in the area. These doctors, however, cannot give psychiatrists much help for in our Health Service family doctors are already seeing the bulk of the patients with socioeconomic problems." _/ A similar perspective has been adopted all too often by clinical psychiatrists, though they peep at the matter through the practitioner's key-hole rather than the planners'.
|
From page 213... ...
Accordingly, we were compelled to construct a more relevant system of our own, designed to meet the needs of the 8p's by distinguishing between 'formal' psychiatric illness and what we called 'psychiatric-associated' disorders, thereby anticipating the multiaxial systems which have since been widely compassed to do justice to the health-menta1 health interface (Figure 4~. Using this schema, with all its manifest imperfections, we found that about one-third of recorded psychiatric morbidity had to be classified in this way (Figure 5~.
|
From page 214... ...
Personality disorder Formal psychiatric illness(~)
|
From page 216... ...
The subjects with psychiatric disorders were compared with a control group from the same population, matched for age, sex, marital status and social class. The results showed strong presumptive evidence of an association between physical and mental illness in this population, the links being most marked with subjects suffering from cardiovascular and respiratory disease.
|
From page 217... ...
12/ The ratings were made by a medical member of the research-team and demonstrate that the health of the population was generally poor; only seven percent of referrals were without a somatic or a psychiatric diagnosis and more than a quarter were sufferings from both mental and physical ill-health. A majority of cases with major psychiatric illness were in the senium, but the bulk of minor mental disorders were presented by married women with family problems and associated mood-disorders.
|
From page 218... ...
octal Work Today, 9. example, information has been obtained about all individuals referred over a 3-month period to social workers in two settings -- a large health center run by a group of general practitioners and a local authority area team which is administered by the non-medical social services department.
|
From page 219... ...
At follow-up, 38.0% of the experimental group had been taken off psychotropic drugs, compared with 24.7% of the controls. Continuing medical care and supervision were deemed necessary for 59.8% of the experimental patients, compared with 77.3% of the controls.
|
From page 220... ...
16/ The "casework" concept has tended to dominate the theory and practice of social work in the United States, especially with the large corps of social workers in private practice. It has also been influential in Britain despite the many differences in organizational structure.
|
From page 221... ...
[he presence of a social worker as part of a primary care team may be expected to catalyze all these activities and so diffuse his or her influence at various points of professional contact. Finally, I should like to pull my argument together and devote a few words to its implications.
|
From page 222... ...
Furthermore, as a participant on these terms the mental health professional may become a beneficiary as well as a donor, for the task would surely help restore the holistic concept of the discipline which, though it has receded in recent years, underlay Adolf Meyer's notions of psychobiology which itself reached back to the earlier concept of psychological medicine and, still earlier, to the views of Andrew Wynter on psychiatry in relation to family medicine, expressed more than 100 years ago: "...we are convinced," he wrote in 1875, "that for the good of general medicine,
|
From page 223... ...
223 this particular study of psychological medicine, dealing as it does with so many complex problems should be merged in the general routine of medical practiced 27/ Such a process of integration, or rather of re-integration, would {6 for the good of not only general medicine but also general psychiatry.
|
From page 224... ...
(1979~: The extent of mental and physical ill-health of clients referred to social workers in a local authority department and a general attachment scheme. Psychol.
|
From page 225... ...
: Social Work Support for Health Service. Department of Health and Social Security and the Welsh Office.
|
From page 227... ...
Published studies suggest that the prescription of psychotropic drugs is the modal management technique in the primary care setting. Nonpsychiatric physicians use drug threapy in 67 percent of-visits by patients with a diagnosis of mental disorder; psychotherapy is used in 22 percent of those visits.
|
From page 228... ...
Careful monitoring of patients using psychotherapeutics has been urged, given the problems of patient noncompliance and the risk of overdosing or adverse drug reactions. _/,8/ The studies reviewed point to the need for additional research in the area of the management of emotionally ill patients by primary care physicians prescribing psychotropic drugs.
|
From page 229... ...
1/ Few data are available concerning the intensity and nature of these psychotherapy sessions. Two studies revealed that more than half of the patients receiving psychotherapy by primary care physicians are seen from one to four times for such therapy.
|
From page 230... ...
In conclusion, the literature reviewed indicates that the primary care providers do manage emotionally disturbed patients with psychotropic drugs and psychotherapy. However, systematic data on the utilization of these techniques are lacking.
|
From page 231... ...
A., and Baiter, M B., Key interactions among psychiatric disorders, primary care, and the use of psychotropic drugs in Brown, B
|
From page 232... ...
18. Zabarenko, R.N., Merenstein, J., and Zabarenko, L., Teaching psychological medicine in the family practice office.
|
From page 233... ...
The literature search was restricted to articles relating to North American primary care practices. The articles address the problems of psychotherapy and drug prescribing by primary care providers, as well as psychiatric referral.
|
From page 235... ...
Behavioral medicine in family practice: A unifying approach for the assessment and treatment of psychosocial problems. The Journal of Family Practice, 6:545-552, 1978.
|
From page 236... ...
The authors call for research to determine which psychiatric disorders are best treated by psychotropic drugs, which disorders require psychotherapy, and when a mixed mode of treatment is needed. Additional research is needed to determine how to divide the responsibility between the primary care physician and the psychiatrist; what is the relative effectiveness of treatment by each type of provider, and the cost effectiveness of the treatment.
|
From page 237... ...
The primary care physicians usually handled medication maintenance, although at times referral to mental health clinicians was necessary to assist the primary care physician to establish the medication regimen. The authors conclude that this team approach has the major advantage of making the mental health clinician readily available to the primary care provider which can relieve him or her "of the undue, sometimes inordinate pressure of certain persistently demanding patients, usually patients with chronic characterological depressions and borderline states." Dressier, D.M.
|
From page 238... ...
The authors interviewed physicians at the Jamaica Medical Group of the Health Insurance Plan of Greater New York about 422 patients over 15 years old who were diagnosed as having a mental, psychoneurotic, or personality disorder. Twenty-six patients were referred for a psychiatric consultation.
|
From page 239... ...
The authors surveyed 860 family physicians who were members of the Michigan Chapter of the American Academy of General Practice regarding detection and management of emotional illness. Physicians graduating from medical school after 1950 had a tendency to use psychoactive drugs with a lower percentage of their emotionally ill patients than physicians graduating prior to 1950.
|
From page 240... ...
Among patients with emotional disorder, 50.4 percent had received a psychotropic drug prescription within the past two years. Twenty-nine percent of the emotionally ill patients were taking psychotropic drugs at the time of the survey.
|
From page 241... ...
Before the physicians heard a lecture on psychotropic drugs, they completed a multiple choice examination on the prescribing of psychotropic drugs. The answers of the physicians were compared with those of seventeen psychiatrists.
|
From page 242... ...
American Psychiatric Association: Psychiatric Research Report, 22:235-248, 1967. Seventy-nine general practitioners out of 107 in Prince Georges County, Maryland, kept records on patients seen in one week during February-July, 1964.
|
From page 243... ...
Even when the family physician does make a psychiatric referral, the patient may be reluctant to cooperate. Many patients fear emotional illness or want to avoid exploring deep feelings.
|
From page 244... ...
The author presents techniques to overcome a patient's resistance to psychiatric referral. The primary care physician can provide treatment for depressed patients in a majority of cases.
|
From page 245... ...
Office psychotherapy in family medicine. American Family Physician, 2:80-84, 1970.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.