[Psychological diagnosis in general practice].
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Someone who experiences an important psychological trauma will undergo typical sequences of mental disorder with a time-dependent clinical course. The classification of psychiatric disorders (DSM-IV) focuses on two stages: acute and chronic. Clinical intervention with these traumatized patients must consider this evolution and must adjust the intensity and kind of treatment response as well as the therapist's profile. The involvement during the acute stage, often called "debriefing", is the fundamental start point of a quality care, eventually leading toward a long lasting therapy, but is currently controversial needing some development. The aim of this article is the clarification of the debate related to the clinician's care of the psychological trauma.
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In a study of children 7-12 yr of age referred to general paediatric clinics, paediatricians reported psychological factors associated to somatic presentations in 47% of the children. These cases presented with a variety of somatic symptoms, but abdominal/chest/joint pains and soiling were particularly common. From research interviews with the parents we found increased rates of psychiatric disorder (abnormalities of emotions, behaviour or relationships) amongst them. The most common psychiatric symptoms were depressive mood changes and relationship problems. We also identified an excess of certain personality features in the children and of family health problems in this group. Paediatricians commonly identify psychosomatic issues in children attending general paediatric clinics and independent evidence supports the validity of their assessments.
Rats were trained to press two keys consecutively for reinforcement. During stimulus one (slow clicker) a 6-sec time delay was required between the two responses. During stimulus eight (fast clicker) no time delay was required between the two responses. When tested with intermediate stimuli (intermediate click rates) the median time delays emitted by the animals were intermediate between their performances on the original training stimuli, resulting in typical generalization gradients. Closer examination of the data revealed that the median values were not representative of the behavior of the animals.
Determinants of emergency room visits for psychological reasons were studied prospectively for a four month period in an Indian General Hospital. Psychiatric emergencies constituted only 2% of all emergency visits. Most of the patients were new except for 7.4% who were already registered with the outpatient services of the psychiatry department. Males outnumbered females in a ratio of 2:1. Self-referrals constituted 77% of the samples; 21% of patients were brought by police. Two-thirds of the patients were brought owing to the severity of their clinical condition and the rest, one-third, for medico-legal and social reasons. Approximately 80% of the patients sought consultation within one month of the onset of illness episode. First episode of mental illness was within last one year of the emergency room visit in 60% patients. Past history of hospitalization for mental illness was obtained only in 10% of cases. The pattern suggested that there was no misuse of emergency services by psychiatric patients although 20% of the patients presented with social problems only which required social rather than psychiatric intervention.
OBJECTIVE: General practitioners (GPs) provide the majority of care for people's mental health problems. The recently introduced Better Outcomes in Mental Health Care initiative aims to improve the quality of mental health care in general practice. This study examines current GP management of psychological problems and any changes in their management in the decade leading up to this initiative. METHOD: Current practice was examined through a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) (2000-02) data. We compared BEACH data with the Australian Morbidity and Treatment Survey (1990-1991) to investigate management changes over the past decade. RESULTS: Between April 2000 and March 2002, psychological problems were managed at a rate of 11.5/100 encounters. Problems most commonly managed were mood disorders, stress-related disorders, behavioural syndromes and disorders due to psychoactive substances. Prescriptions occurred at a rate of 69.5/100 contacts and clinical treatments at a rate of 50.0/100 contacts with psychological problems from 1990 to 1991. The management rate of psychological problems increased from 9683/100,000 encounters (95% CI=9129- 10,237) in 1990-1991 to 11 557 (11,136-11 977) in 2000-2002. Prescription rates (from 63.3, 95% CI=60.5-66.1 to 69.1, 95% CI=67.1-71.1) and clinical treatments (from 36.0, 95% CI =33.4-38.7 to 53.1, 95% CI =51.3-54.9) increased. CONCLUSIONS: This study shows that prior to the introduction of the Better Outcomes in Mental Health initiative changes had already occurred in rates and management of psychological problems in general practice. It also provides a baseline from which future research can measure the impact of the recent reforms on mental health care.
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We assessed psychological and somatoform dissociation and their relationships in the general population. The study questionnaires included the Dissociative Experiences Scale, the Somatoform Dissociation Questionnaire, the Beck Depression Inventory, and background characteristics. Four study groups were formed: subjects with low dissociation scores (N = 1334), with high psychological dissociation (N = 93), with high somatoform dissociation (N = 93), and with high psychological and somatoform dissociation (N = 65). Those with high psychological and somatoform dissociation differed clearly from the other groups. They had depressive symptoms, suicidal ideation, a reduced working ability, a poor financial situation, poor general health, and inadequate social support more frequently than subjects in the other groups. Thus, a considerable amount of ill health was recorded in this group.
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In Experiment 1, three pigeons were given variable interval training to peck at a light of 550 mmu and then were tested for stimulus generalization in extinction to several different wavelengths. A gradient was obtained for latency of the first response in each test period, for the number of test periods in which responding occurred, and for the measure of response rate. When the response rate gradient was corrected for differences in initial latency and in number of responded trials, the change was minimal, indicating that the major component of response rate as usually measured is rate of responding having once responded. In Experiment 2, three other pigeons were trained to respond to 550 mmu (for variable interval reinforcement) and not to 570 mmu (extinguished). Analysis of generalization gradients dictated the same conclusion as that reported for generalization following single stimulus training.
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It is argued that a general practitioner's ability to make accurate ratings of psychological distress is partly determined by the rate at which patients emit cues that are indicative of such distress. This study addresses the behaviours of doctors which influence the rates at which patients emit such cues. Consultations were videotaped involving six General Practice Vocational Trainees, three of them poor, and three of them able identifiers of emotional illness. Consultations were selected so that each trainee was rated interviewing 4 patients with low GHQ scores, and 4 patients with high scores. Behaviours are described which lead to increased cue emission and which are also practised more frequently by able identifiers, while other behaviours reduce cue emission and are practised less frequently by them. Another set of behaviours is no more frequent among the able identifiers, but when practised by able identifiers is associated with increased cue emission by the patients, and when practised by poor identifiers with unaltered or decreased cue emission. Interviews that are 'patient-led' are associated with increased rates of cue emission, while those that are 'doctor-led' are associated with lower rates. The implications of these findings for training doctors working in general medical settings are discussed.