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F J Huyse

Publications and source records attributed to F J Huyse.

At least 37 records · Page 2Linked to original sources
PubMed1997

Health services research on mental health in primary care.

OBJECTIVE: The article seeks to provide an international perspective on the facilitating role of health services research in the treatment of psychiatric disorders in primary care. It builds on Goldberg and Huxley's model describing pathways to mental care for the psychiatrically ill in the community. METHOD: Seventy studies were selected for review by Medline search, sixteen studies by contacting prominent researchers in the field. All studies are discussed more or less extensively. RESULTS: Case identification strategies including screening tools and diagnostic modules have been developed. Other strategies include educational training programs and psychiatric consultation services designed to facilitate psychopharmacological and other types of treatment of psychiatric disorders in primary care. Several models for the linkage of primary care and specialty mental health providers are discussed, and a primary care psychiatry programme is examined. CONCLUSION: Better psychiatric training of general practitioners (GPs), on-site consultation, and better communication between mental health professionals and GPs can improve the recognition, management, and referral of psychiatrically ill primary care patients. The further development of guidelines focusing on anxiety disorders, somatization, subthreshold disorders, and effectiveness in primary care is recommended.

Forecasting↗
PubMed1997

Psychiatric referrals associated with substance use disorders: prevalence and gender differences. European Consultation-Liaison Workgroup.

A psychoactive substance use disorder (ICD-10) was diagnosed in 28% of 1222 psychiatric referrals in six general hospitals in Finland. In the age group 35 o 50 years, 53% of men and 29% of women had a substance use disorder. In the age group 35 to 50 years, sociodemographic characteristics differentiated men diagnosed with substance use disorders from other male consultation patients, but women with substance use disorders were similar to other female consultation patients. Urgency (i.e., consultation required within the same day) was accentuated in referrals associated with substance use disorders. Of attempted suicides, 65% were related to substance use disorders. Use of sedatives or hypnotics had more frequently induced disorders in women with substance use diagnosis compared to men with diagnosis (30% vs. 13%; p < 0.01). Female consultation patients with substance use disorders more often than respective male patients were current mental health outpatients. In conclusion, the proportion of substance use disorders among psychiatric consultation patients was remarkably higher in the present study (28%) compared with the average provided by the earlier literature (12%), and therefore, at least in Finland, psychiatric assessment of general hospital patients should always include assessment for the presence of substance use disorders. If substance use is only looked for in patients who have social problems typical of advanced misuse, detecting female substance use might be impeded. Relation of attempted suicides to substance use disorders was confirmed. To prevent misuse of prescribed drugs detected particularly in female consultation patients, and to prevent attempted suicides, doctors' attention is called to prescriptions of sedatives and hypnotics.

Adolescent↗
PubMed1996

The ECLW Collaborative study II: patient registration form (PRF) instrument, training and reliability. European Consultation/Liaison Work group.

This paper describes the development and testing of the Patient Registration Form (PRF), a standardized instrument for the description of patients seen by consultation-liaison (C-L) psychiatrists and psychosomatists in general hospitals, the referral patterns, the C-L interventions and their outcomes. The PRF study is part of a large multi-centre. European investigation on the effectiveness of mental health service delivery, conducted by the European C-L Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW) and performed in the framework of the of the E.C. 4th Medical and Health Research Program. The final version of the PRF consists of 68 items. It was developed by the Program Management Group (PMG) and National Coordinators (NC) after long preparatory studies to assure both face and content validity and pilot testing. Two hundred and twenty consultants, who required 40 hours of training and came from 14 different European countries and 90 different sites, participated in the final reliability study. The PRF was tested in 13 written case histories. A "gold standard' for the correct answers in each item was decided by "consensus ratings' of the PMG and a subsequent 80% agreement by the NCs. A high standard (average kappa (k) > or = 0.70; at least 2/3 of the PRF items, kappa > or = 0.70) was required for the rater to be considered as "reliable' (RR). The consultants considered the PRF both "feasible' and 93.2% of them fulfilled the RR criteria. The calculated rater-"gold standard' reliability was satisfactory: only four PRF items were identified with low agreement coefficients and no biases were observed cross-nationally in the ratings. Given the implications of misclassification for evaluating C-L effectiveness and services, these results are important and the achievement unprecedented.

Europe↗
PubMed1996

The European Consultation-Liaison Workgroup (ECLW) Collaborative Study. I. General outline.

Previous C-L psychiatric service research is seriously limited by its parochial nature; very few results can be generalized outside of the hospital in which the original study was performed because of differences in the nature of the hospital and the type of C-L service. This article presents the general outline and methodology of a European multicentered C-L service delivery study effected by the European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW). The study is unique in its kind as it allows the comparison of very different C-L services; for example, some services are run by C-L psychiatrists, others are run by C-L psychosomaticists and the study encompasses a large variety of different settings. As a result, both common factors in C-L service delivery and specific local patterns can be explored. The overall hypothesis tested in this study was that the most developed services would see (as well as more patients) a wider variety of clinical problems than small services. The implication is that the absence of well-developed C-L services in a general hospital may mean that there are patients with unmet mental health needs. In separate articles the training and reliability testing of the new Patient Registration Form (PRF) and the Institutional and Provider characteristics will be described. The former includes the use of ICD-10 in the general hospital setting. This study is a collaborative effort made by 226 consultants from 56 psychiatric C-L services in 11 countries. Each consultant recorded details of 1 year's caseload leading to a thorough description of 14,717 patients collected between 1991 and 1993. The advanced methodology included a multicentered international approach, rigid training for all participating consultants, and the development and testing of new instruments. This will allow us to assess the impact of important structural and process variables on the outcome of C-L service delivery in several European countries. These results will be reported in papers both in the international and national literature of the participating countries.

Adolescent↗
PubMed1996

Effects of psychiatric consultation on medical consumption in medical outpatients with low back pain.

A randomized, controlled, clinical trial (N = 104) was conducted to test the hypothesis that a protocol of collaboration and communication between neurologist and general practitioner, sustained with psychiatric consultation, would reduce medical consumption (especially of diagnostic procedures and medication) in medical outpatients with low back pain. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. A reduction in medical consumption could not be demonstrated. As there was a great variation in adherence to the protocol in the experimental group, this might explain the lack of hypothesized effects. Full implementation of the protocol seemed to imply a lower number of major surgery operations, but this effect disappeared after excluding cases with a diagnosed hernia. The possibilities for consumption reduction for three post hoc-defined patient categories (cases with hernia and chronic and nonchronic cases) and the consequences for patient selection and treatment intensity are discussed. It is concluded that the target groups should be more narrowly defined, and that a more intensive intervention might prove to be more effective.

Ambulatory Care↗
PubMed1996

The ECLW Collaborative Study: III. Training and reliability of ICD-10 psychiatric diagnoses in the general hospital setting--an investigation of 220 consultants from 14 European countries. European Consultation Liaison Workgroup.

A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.

Diagnosis, Differential↗
PubMed1996

Supervised integrated screening of low-back pain patients by a neurologist. A randomized clinical trial.

In a randomized, controlled design, the effect of psychiatric consultation intervention in medical outpatients with low-back pain (N = 104) was assessed for the patients' subjective well-being and satisfaction of general practitioners (GPs) in their cooperation with the neurologists. The goal of the intervention was an integrated approach towards the patients' symptoms and the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 104 patients were subdivided into an intervention group (N = 50) and a control group (N = 54). The major outcome measures were the psychological status of the patient and degree of the GPs' satisfaction concerning the cooperation with the medical specialists. After 6 months follow-up, there was a greater overall decline of symptoms in the patient intervention group compared with the control group. However, it was not possible to specify this effect. Contrary to the hypotheses, GPs in the control group were as satisfied about the cooperation with the neurologist as their colleagues in the intervention group. Yet, the information in the specialists' letters of the intervention group was more often in agreement with the integrated model carried out. It is concluded that great diversity of the target group of patients and the focus on the neurologists' behavior may explain the lack of hypothesized effects. It is recommended that the target group be more specifically defined, and that a more intensive intervention might prove to be more effective.

Adolescent↗
PubMed1996

Psychiatric consultation for somatizing patients in the family practice setting: a feasibility study.

OBJECTIVE: The purpose of the study was to assess the feasibility of a psychiatric consultation intervention for somatizing patients in the family practice setting in terms of 1) patient compliance, 2) patient satisfaction, and 3) compliance and satisfaction of general practitioners (GPs). METHOD: In a period of nine months, forty-six patients were selected for psychiatric consultation in six solo family practices in a semi-urban area in the Netherlands. The consultation included an interview with the consulting psychiatrist, the patient, and the GP. A written summary of the consultation was provided to the GP and the patient. A booster session with a GP and psychiatrist was included to evaluate and reinforce the recommendations. RESULTS: The majority of the selected patients agreed to participate after informed consent. An intervention was implemented containing interpersonal techniques, reattribution, clarification, and structuring. GP compliance with recommendations was 100 percent, patient compliance 75 percent. CONCLUSION: A standardized psychiatric consultation for somatizing patients in a family practice setting can be implemented. Several levels of implementation can be distinguished.

Family Practice↗
PubMed1994

The applicability of antidepressants in the depressed medically ill: an open clinical trial with fluoxetine.

In the literature the side-effects and medical complications of tricyclic antidepressants (TCAs), in the medically ill have been extensively reviewed. This study uses a prospective design to examine these issues' questions in an almost solely in-patient C-L population (N = 37) treated with a serotinergic antidepressant (fluoxetine). A first remarkable finding is the fact that 83% of the patients have complaints comparable with the side-effects of the drug, prior to its administration. Second, although the drop-out rates (DO) are comparable with those in earlier studies, in this study DO do not seem to be related to the seriousness of the side-effects of the drug. The more serious side-effects were hyponatremia (N = 1) and gastrointestinal symptoms (N = 3). In contrast to TCAs no psychiatric side-effects have to be reported. Therefore this study suggests that with good medical supervision fluoxetine can be used in the treatment of seriously medically ill patients with depressive co-morbidity.

Adult↗
PubMed1994

Psychiatric consultations in medical outpatients with abdominal pain: patient and physician effects.

OBJECTIVE: The purpose of the study was to assess the effect of a psychiatric consultation intervention in terms of changes in 1) the patients' psychological symptoms, and 2) satisfaction of general practitioners (GPs) concerning their cooperation with the internists. METHOD: In a randomized controlled design, the effect of a psychiatric consultation intervention in medical outpatients with abdominal pain (n = 106) has been assessed. The goal of the intervention was 1) a holistic approach toward the patients' symptoms, and 2) the improvement of the cooperation between primary and secondary medical health services. The intervention was designed at the health care provider level; the psychiatrist did not see or examine the patient. The 106 patients were subdivided in an index group (N = 49) and a control group (N = 57). The major outcome measures were the psychological status of the patient and degree of satisfaction of the GPs about the cooperation with the medical specialists. RESULTS: At six months follow-up, there was a significantly greater decline in depressive symptoms assessed by SCL-90 in the patient index group compared with the control group. The GPs of the index group were significantly more satisfied with the cooperation and communication with the internists compared with the control group. CONCLUSIONS: An experimental psychiatric consultation intervention did effect the patients' well-being to a certain degree, and especially the GPs were affected in terms of satisfaction. The relevance of improving the communication between health care providers in the management of somatizing patients is discussed.

Abdominal Pain↗
PubMed1993

Euthanasia policy in The Netherlands: the role of consultation-liaison psychiatrists.

The authors describe national guidelines introduced in the Netherlands in late 1990 for carrying out euthanasia requests by medically ill patients. In about 49,000 of the 130,000 annual deaths in that country, doctors make a decision that may influence the duration of life. In 2,300 cases doctors perform euthanasia. Thus euthanasia accounts for 1.8 percent of all deaths and 5 percent of the cases in which doctors' decisions play a role. The authors point out cultural differences between the U.S. and the Netherlands, such as in access to health care and in social tolerance and pragmatism, that should be considered by American policymakers who address the issue of euthanasia. The role of Dutch consultation-liaison psychiatrists in euthanasia was assessed by a survey of members of the Netherlands Consortium of Consultation/Liaison Psychiatry. Most felt that involvement of psychiatrists in such cases should not be mandatory and that their most important role was to assess patients' decision-making capacity. Half of the psychiatrists felt that their role was to support the decision-making process of the ward staff.

Aged↗
PubMed1992

Evaluating psychiatric consultations in the general hospital. Multivariate prediction of concordance.

A study of 316 consultation cases was undertaken to examine the concordance between the psychiatric consultants' recommendations and the consultees' follow-through. Using a model of case concordance (defined as the proportion of all recommendations followed on each case), it was demonstrated that process variables, including who (the referring doctor p < or = 0.07) recommended what (psychosocial ward management p < 0.01, psychosocial diagnostic action p < 0.01, biological diagnostic action p < 0.01, aftercare p < or = 0.02, and number of recommendations p < or = 0.03), and when (timing of consultation p < or = 0.02), were the significant predictors of case concordance rather than clinical or demographic variables.

Comorbidity↗
PubMed1991

Consultation-liaison psychiatry. Does it help to get organized? The European Consultation-Liaison Workgroup.

Since 1987 consultation-liaison (C-L) psychiatrists in Europe have decided to develop a closer collaboration to stimulate the development of the C-L field. A first result of this collaboration is a companion paper on the history and current state of C-L psychiatry in Europe. This paper describes the arguments for the development of the European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW), and the results of the first 3 years of collaboration.

Europe↗