الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Most people with psychiatric disorders are seen first by primary care
physicians, and for many, these remains their only opportunity to receive
diagnosis and treatment of their psychosocial problems or psychiatric
disorders (Schulberg and Burns, 1988).
Given the importance of the primary care system in mental health
care, it is discouraging to find that in most settings, physicians’ rates of
recognition of psychiatric disorders in their patients are very low (Wells
et al. 1989; Goldberg et al. 1992).
The record rates of under recognition of psychiatric disorders in
primary care range from 20% to 80% of true cases (Schulberg and Burns,
1988).
Even when psychological distress or social problems are recognized,
imprecise diagnosis contributes to what is generally inappropriate or
inadequate treatment (Schulberg and Burns, 1988).
Mental disorders commonly seen in primary care are not only
associated with more impairment in health related quality of life than
common medical disorders, but also have distinct patterns of impairment.
Primary care directed at improving health related quality of life needs to
focus on recognition and treatment of common mental disorders (Spitzer
et al.,1995).
Also, Results of the WHO study on Psychological problems in
general health care organized in 14 countries (26,000 patients briefly
described; 5438 interviewed) suggest that mixed anxiety and depressive
disorder (MADD) and subsyndromal depression (SubDE) are frequent in
primary care (current prevalence rates 1.3% and 1.4%, respectively).
MADD was associated with substantial disability, as reflected by the
proportion of patients moderately or severely disabled in this group
(41%), similar to that observed in depression (55%). The level of
disability observed in SubDE was lower (24%) but still higher than in
patients with no psychiatric symptom (8%) (Lecrubier and Weiller,
1997).
Patients with various psychiatric disorders may also manifest
abnormal illness behavior (Guo et al. 2000; and Pilowsky, 1993) for
example, some patients with psychiatric disorders tend to overuse
medical services, waste time in seeking unnecessary treatment or receive
inappropriate treatment at GP clinics rather than appropriate care in
psychiatric clinics.