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M R Block

Publications and source records attributed to M R Block.

59 records · Page 4Linked to original sources
PubMedDate not supplied

Major depression in primary care practice. Clinical characteristics and treatment implications.

Major depression is thought to be underdiagnosed and undertreated in primary medical care facilities. The authors conducted a clinical trial that included a three-phase assessment so only ambulatory medical patients judged eligible for treatment of this disorder in medical settings were recruited. In addition to administering the Center for Epidemiologic Studies-Depression scale and the Diagnostic Interview Schedule's (DIS) Depression section, the psychiatrists evaluated the DIS-positive patients. This third assessment determined that clinical characteristics of DIS-positive patients were such that 70% of the patients could be treated for major depression in a primary care setting, 13% should probably be referred to a mental health facility, and 17% were experiencing conditions other than major depression.

Adolescent↗
PubMedDate not supplied

A taxonomy of difficult physician-patient interactions.

A taxonomy of troublesome physician-patient interactions helps learners classify what goes wrong during an interview and then remedy the problem in order to obtain reliable symptom data. This framework permits an orderly approach to interactions that often become laden with emotion and also emphasizes the use of specific skills to acquire accurate and precise medical information. Like most systems of classification in medicine, this one is a mixed bag of nosology; although based on the needs of learners, it is arbitrary and imperfect and will change as new knowledge is integrated.

Classification↗
PubMedDate not supplied

Psychiatric disorders in primary care: physician judgements of prevalence and management.

Primary care physicians underdiagnose depression, anxiety, and other psychiatric disorders. Decision analysis suggests that subjective estimates of the probability of a condition and the utility (severity and treatability) of identifying that condition play a role in diagnosis. We asked 108 internists (IM) and family practitioners (FP) to rank 25 conditions on ten-point scales for probability, severity, and treatability. FPs ranked depression significantly higher than IMs did on all three scales, anxiety reactions higher in probability and severity, and both alcoholism and drug dependency higher on the severity scale. Ranks for schizophrenia and personality disorder did not differ between specialties. Thirty-eight physicians completed the scales a second time after six to eight weeks. Test-retest agreement ranged from 47% to 100% for different conditions on different scales. Some common psychiatric disorders tended to have low test-retest agreement in probability and severity. With further refinement, this instrument may contribute to the investigation of psychiatric decision making in primary care.

Family Practice↗