![]() | Only 14 pages are availabe for public view |
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. |