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Primary care mental health

Mette Trollund Rask, Eva Ørnbøl, Marianne Rosendal, Per Fink
OBJECTIVE: The upcoming International Classification of Diseases, 11th Revision for primary care use suggests inclusion of a new diagnostic construct, bodily (di)stress syndrome (BDS), for individuals with medically unexplained symptoms. We aimed to explore the long-term outcome of BDS in health care costs, work disability, and self-rated health. METHODS: Consecutive patients consulting their family physician for a new health problem were screened for physical and mental symptoms by questionnaires (n = 1785)...
October 20, 2016: Psychosomatic Medicine
Gregory Plotnikoff, Melissa Barber
INTRODUCTION: Single-disorder or single-organ-system clinical practice guidelines are often of limited usefulness in guiding effective management of patients with chronic multidimensional signs and symptoms. The presence of multiple long-standing medical problems in a given patient despite intensive medical effort suggests that addressing systemic core imbalances could complement more narrowly focused approaches. CASE PRESENTATION: A 72-year-old man experiencing longstanding depression, fatigue, irritable bowel syndrome, and chronic pain in the context of additional refractory illnesses was assessed and treated, guided by a system-oriented approach to underlying core imbalances termed functional medicine...
October 14, 2016: Permanente Journal
Marisa Elena Domino, Mona Kilany, Rebecca Wells, Joseph P Morrissey
OBJECTIVE: To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. DATA SOURCES/STUDY SETTING: Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. STUDY DESIGN: We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses...
October 21, 2016: Health Services Research
Darrell L Hudson, Kimberly A Kaphingst, Merriah A Croston, Melvin S Blanchard, Melody S Goodman
We examined the prevalence of mental disorders in a primary care setting affiliated with a large academic medical center. We also examined whether there were racial differences in mental health disorders. Patients were seeking medical care in an outpatient medical clinic; mental health data were available for them via medical records (n=767). Overall, 45% of patients had a diagnosed mental health problem; the most commonly reported form of mental disorder was depression. African Americans (OR= 1.88; CI: 1.21-2...
2016: Journal of Health Care for the Poor and Underserved
Faraz Kureshi, Kevin F Kennedy, Philip G Jones, Randal J Thomas, Suzanne V Arnold, Praneet Sharma, Timothy Fendler, Donna M Buchanan, Mohammed Qintar, P Michael Ho, Brahmajee K Nallamothu, Neil B Oldridge, John A Spertus
Importance: Cardiac rehabilitation (CR) improves survival after acute myocardial infarction (AMI), and referral to CR has been introduced as a performance measure of high-quality care. The association of participation in CR with patients' health status (eg, quality of life, symptoms, and functional status) is poorly defined. Objective: To examine the association of participation in CR with health status outcomes after AMI. Design, Setting, and Participants: A retrospective cohort study was conducted of patients enrolled in 2 AMI registries: PREMIER, from January 1, 2003, to June 28, 2004, and TRIUMPH, from April 11, 2005, to December 31, 2008...
October 19, 2016: JAMA Cardiology
Cheng-I Yang, Min-Yun Hsieh, Li-Hung Lee, Shu-Ling Chen
Adult clients with schizophrenia are primarily cared for by their ageing parents. When the parents become ill or die, siblings are considered to be responsible for taking over the caregiving role. However, little is known about caregiving for a sibling with schizophrenia, and no studies have explored this phenomenon in an Asian context. The aim of the present descriptive, qualitative study was to understand the experiences of being the primary caregiver of a sibling with schizophrenia. Data were collected from 10 siblings of currently-hospitalized patients diagnosed with schizophrenia using semistructured, in-depth interviews...
October 19, 2016: International Journal of Mental Health Nursing
Kylee Trevillion, Jill Domoney, Andrew Pickles, Debra Bick, Sarah Byford, Margaret Heslin, Jeannette Milgrom, Rachel Mycroft, Carmine Pariante, Elizabeth Ryan, Myra Hunter, Louise Michele Howard
BACKGROUND: Depression is a common antenatal mental disorder and is associated with an increased risk of adverse effects on the fetus and significant morbidity for the mother; if untreated it can also continue into the post-natal period and affect mother-infant interactions. There has been little research evaluating the effectiveness or cost-effectiveness of antenatal psychological interventions for antenatal depression, particularly for mild to moderate disorders. International guidelines recommend a stepped care approach starting with Guided Self Help, and the aim of this exploratory trial is to investigate Guided Self Help modified for pregnancy...
October 18, 2016: Trials
Marie-Josée Fleury, Guy Grenier, Catherine Vallée, Denise Aubé, Lambert Farand, Jean-Marie Bamvita, Geneviève Cyr
BACKGROUND: This study evaluates implementation of the Quebec Mental Health (MH) Reform (2005-2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined...
October 18, 2016: BMC Health Services Research
Jennifer M Hensel, Jay Shaw, Lianne Jeffs, Noah M Ivers, Laura Desveaux, Ashley Cohen, Payal Agarwal, Walter P Wodchis, Joshua Tepper, Darren Larsen, Anita McGahan, Peter Cram, Geetha Mukerji, Muhammad Mamdani, Rebecca Yang, Ivy Wong, Nike Onabajo, Trevor Jamieson, R Sacha Bhatia
BACKGROUND: Mental illness is a substantial and rising contributor to the global burden of disease. Access to and utilization of mental health care, however, is limited by structural barriers such as specialist availability, time, out-of-pocket costs, and attitudinal barriers including stigma. Innovative solutions like virtual care are rapidly entering the health care domain. The advancement and adoption of virtual care for mental health, however, often occurs in the absence of rigorous evaluation and adequate planning for sustainability and spread...
October 18, 2016: BMC Psychiatry
Karen E van den Hondel, Anne Linde Saaltink, Peter Paul M Bender
BACKGROUND: Forensic physicians are responsible for first-line medical care of detainees (individuals held in custody) in the police station. The Dutch police law contains a 'duty of care', which gives the police responsibility for the apparent mentally ill and/or confused people they encounter during their work. The police can ask a forensic physician to do a primary psychiatric assessment of any apparent mentally ill detainee. The forensic physician determines if the apparent mentally ill behavior of the detainee is due to a somatic illness, or has a psychiatric cause for which the detainee needs admission to a psychiatric hospital...
October 11, 2016: Journal of Forensic and Legal Medicine
Guillermina Natera Rey, Perla Sonia Medina Aguilar, Fransilvania Callejas Pérez, Jim Orford, Guillermo Salinas Escudero, Marcela Tiburcio Sainz
Objective Estimate the cost-effectiveness ratio of a five-step brief intervention aimed at reducing the stress and symptoms of depression caused by living with an alcohol abuser. Methods The cost-effectiveness analysis was carried out with a decision tree, based on symptoms of depression measured on the CES-D scale. The effectiveness of the brief intervention was evaluated by comparing a group of indigenous women who received the intervention (n = 43) with a similar group who did not (n = 30). The groups were evaluated before, immediately after, and 12 months after the intervention, in the state of Hidalgo (Mexico)...
February 2016: Revista Panamericana de Salud Pública, Pan American Journal of Public Health
J Norton, M David, C Gandubert, C Bouvier, L-A Gutierrez, A Frangeuil, A Macgregor, A Oude Engberink, A Mann, D Capdevielle
OBJECTIVES: The general practitioner (GP) is the most frequently consulted health professional by patients with common mental disorders (CMD). Yet approximately half of cases are not detected by the GP. Many factors linked to the patient, the doctor and the health care system influence detection. For example, detection rates are higher when patients are better known to their GP. On the other hand, patients visiting a different GP for reasons of dissatisfaction with previous care are more likely to be detected on the survey-day...
October 14, 2016: L'Encéphale
Soteri Polydorou, Stephen Ross, Peter Coleman, Laura Duncan, Nichole Roxas, Anil Thomas, Sonia Mendoza, Helena Hansen
OBJECTIVES: This report identifies the institutional barriers to, and benefits of, buprenorphine maintenance treatment (BMT) integration in an established hospital-based opioid treatment program (OTP). METHODS: This case study presents the authors' experiences at the clinic, hospital, and corporation levels during efforts to integrate BMT into a hospital-based OTP in New York City and a descriptive quantitative analysis of the characteristics of hospital outpatients treated with buprenorphine from 2006 to 2013 (N=735)...
October 17, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Hani Raoul Khouzam
Trazodone is an antidepressant that is FDA-approved for the treatment of depression. It has been used by mental health and primary care providers for the treatment of multiple psychiatric and medical conditions .This review describes trazodone mechanism of action, formulation, dosage and adverse effects and then summarizes the beneficial effects of trazodone in the treatment of various psychiatric and medical conditions such as major depression, as well non-approved FDA indications such as insomnia,anxiety disorders, posttraumatic stress disorder, obsessive compulsive disorder, feeding and eating disorders, substance use disorders, behavioral disturbances associated with cognitive dysfunction, sexual dysfunction, certain pain conditions, and rehabilitation after acute ischemic stroke...
October 17, 2016: Postgraduate Medicine
Zarnie Khadjesari, Sarah L Hardoon, Irene Petersen, Fiona L Hamilton, Irwin Nazareth
AIMS: Lack of financial incentive is a frequently cited barrier to alcohol screening in primary care. The Quality and Outcomes Framework (QOF) pay for performance scheme has reimbursed UK primary care practices for alcohol screening in people with schizophrenia since April 2011. This study aimed to determine the impact of financial incentives on alcohol screening by comparing rates of alcohol recording in people with versus those without schizophrenia between 2000 and 2013. METHODS: Cross-sectional and retrospective cohort study...
October 13, 2016: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
Rodger S Kessler, Andrea Auxier, Juvena R Hitt, C R Macchi, Daniel Mullin, Constance van Eeghen, Benjamin Littenberg
Introduction: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. Method: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC...
October 13, 2016: Families, Systems & Health: the Journal of Collaborative Family Healthcare
Kimberly Giraud, Megan Pontin, Linda D Sharples, Paul Fletcher, Tim Dalgleish, Allaina Eden, David P Jenkins, Alain Vuylsteke
Introduction: Post-operative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains). We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving post-operative outcomes such as factual memory encoding of the Intensive Care Unit (ICU) environment in older cardiac surgical patients...
2016: Frontiers in Aging Neuroscience
Pallab K Maulik, Abha Tewari, Siddhardha Devarapalli, Sudha Kallakuri, Anushka Patel
INTRODUCTION: Common mental disorders (CMD) such as depression, suicidal risk and emotional/medically unexplained complaints affect a large number of people in India, but few receive appropriate care. Key reasons for this include few trained mental health professionals and stigma associated with mental health. A potential approach to address poor access to care is by training village healthcare workers in providing basic mental health care, and harnessing India's vast mobile network to support such workers using mobile-based applications...
2016: PloS One
Ken Nash, Frank Ghinassi, Jaspreet S Brar, Abdulkader Alam, Mary Catherine Bohan, Kalyani Gopalan, Amie Carter, K N Roy Chengappa
OBJECTIVES: 1. A quality performance improvement (QI) project to implement an electronic screening and monitoring tool to record components of the metabolic syndrome (e-MSD) during clinic visits by persons with serious mental illness (SMI). 2. To encourage psychiatrists to use this tool in their documentation. METHODS: Working with the information technology staff, five psychiatrists developed, tested, revised and embedded the e-MSD tool into the medication management document within the electronic health record...
2016: Clinical Schizophrenia & related Psychoses
Preety Das, Chris Naylor, Azeem Majeed
No abstract text is available yet for this article.
October 2016: Journal of the Royal Society of Medicine
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