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Psychiatric Disorders in Primary Care: Results of a Follow-up Study

Psychiatric Disorders in Primary Care: Results of a Follow-up Study Abstract • Despite extensive documentation of high rates of psychiatric morbidity among primary care patients, there have been, to our knowledge, no US studies following up these patients over time. We analyzed data based on two administrations of the Schedule for Affective Disorders and Schizophrenia-Lifetime version (SADS-L) six months apart to 166 attenders at a primary care clinic in Marshfield, Wis. In the short span between interviews, 35% of the study group exhibited at least one Research Diagnostic Criteria disorder, and almost two thirds of these individuals had significant changes in diagnostic status based on SADS-L data. Diagnosis of these transient and episodic cases by the primary care physicians was under 10%, demonstrating the need for careful evaluation of the psychiatric status of primary care patients. References 1. Goldberg D: Detection and assessment of emotional disorders in a primary care setting . Int J Ment Health 1979;8:30-48. 2. Hoeper EW, Nycz GR, Cleary PD, Regier DA, Goldberg ID: Estimated prevalence of RDC mental disorder in primary medical care . Int J Ment Health 1979;8:6-15. 3. Shepherd M, Cooper A, Brown AC, Kalton G: Psychiatric Illness in General Practice . London, Oxford University Press, 1966. 4. Stumbo D, Good MD, Good BJ: Diagnostic profile of a family practice clinic: Patients with psychosocial diagnosis . J Fam Pract 1982;14:281-285. 5. The President's Commission on Mental Health: Report to the President From the President's Commission on Mental Health . Washington, DC, 1978, vol 1, stock No. 040-000-00390-8. 6. National Institute of Mental Health: Mental Health Services in Primary Care Settings: Report of a Conference, April 2-3, 1979, Dept of Health and Human Services publication ADM 83-995, series DN No. 2. Rockville, Md, National Institute of Mental Health, 1983. 7. Fry J: What happens to our neurotic patients? Practitioner 1960;185:85-89. 8. Cooper B, Fry J, Kalton G: A longitudinal study of psychiatric morbidity in a general practice population . Br J Prevent Soc Med 1969;23:210-217. 9. Harvey-Smith E, Cooper B: Patterns of neurotic illness in the community . J R Coll Gen Pract 1970;19:132-139. 10. Marks J, Goldberg D, Hillier V: Determinants of the ability of general practitioners to detect psychiatric illness: II. Influence of variables related to the doctors . Psychol Med 1979;9:337-354.Crossref 11. Goldberg DP, Steele JJ, Johnson A, Smith C: Ability of primary care physicians to make accurate ratings of psychiatric symptoms . Arch Gen Psychiatry 1982;39:829-833.Crossref 12. Regier DA, Kessler LG, Burns BJ, Goldberg ID: The need for a psychosocial classification in primary care practice . Int J Ment Health 1979;8:16-28. 13. Goldberg DP, Rickels K, Downing R, Hesbacher P: A comparison of two psychiatric screening tests . Br J Psychiatry 1976;129:61-67.Crossref 14. Kedwood HB, Sylph J: The social correlates of chronic neurotic disorders . Soc Psychiatry 1974;9:91-98.Crossref 15. Mann AH, Jenkins R, Belsey E: The 12-month outcome of patients with neurotic illness in general practice . Psychol Med 1981;11:535-550.Crossref 16. Goldberg D: The concept of a psychiatric 'case' in general practice . Soc Psychiatry 1982;17:61-65.Crossref 17. Hankin JR, Oktay JS: Mental Disorder and Primary Medical Care: An Analytical Review of the Literature , US Dept of Health, Education, and Welfare publication (ADM) 78-661, series D, No.5. National Institute of Mental Health, 1979. 18. Hoeper EW, Nycz GR, Cleary PD: The Quality of Mental Health Services in an Organized Primary Health Care Setting: Final Report to National Institute of Mental Health Under Contract 278-77-0071(DB) . Marshfield, Wis, Marshfield Medical Foundation and Clinic, 1979. 19. Goldberg D: The Manual of the General Health Questionnaire . London, NFER, 1978. 20. Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia: Life-Time Version (SADS-L) , ed 3. New York, New York State Psychiatric Institute, 1977. 21. Weissman MM, Myers JK: Psychiatric disorders in a US community: The application of Research Diagnostic Criteria to a resurveyed community sample . Acta Psychiatr Scand 1980;62:99-111.Crossref 22. Andreasen NC, Grove WM, Shapiro RA, Keller MB, Hirschfeld RMA, McDonald-Scott P: Reliability of lifetime diagnosis: A multicenter collaborative perspective . Arch Gen Psychiatry 1981;38:400-405.Crossref 23. Keller MB, Lavori PW, McDonald-Scott P, Scheftner WA, Andreasen NC, Shapiro RA, Crougham J: Reliability of lifetime diagnoses and symptoms in patients with a current psychiatric disorder . J Psychiatr Res 1981;16:229-240.Crossref 24. Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM: Best estimate of lifetime psychiatric diagnosis . Arch Gen Psychiatry 1982;39:879-883.Crossref 25. Mazure C, Gershon ES: Blindness and reliability in lifetime psychiatric diagnosis . Arch Gen Psychiatry 1979;36:521-525.Crossref 26. Kessler LG, Tessler RC, Nycz GR: Co-occurrence of psychiatric and medical morbidity in primary care . J Fam Pract 1983;16:319-324. 27. Endicott J, Spitzer RL, Fleiss JL, Cohen JC: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;33:766-771.Crossref 28. Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD Jr, Kramer M, Stoltzman R: Six-month prevalence of psychiatric disorders in three communities: 1980-1982 . Arch Gen Psychiatry 1984;41:959-967.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Psychiatric Disorders in Primary Care: Results of a Follow-up Study

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1985 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1985.01790290065007
Publisher site
See Article on Publisher Site

Abstract

Abstract • Despite extensive documentation of high rates of psychiatric morbidity among primary care patients, there have been, to our knowledge, no US studies following up these patients over time. We analyzed data based on two administrations of the Schedule for Affective Disorders and Schizophrenia-Lifetime version (SADS-L) six months apart to 166 attenders at a primary care clinic in Marshfield, Wis. In the short span between interviews, 35% of the study group exhibited at least one Research Diagnostic Criteria disorder, and almost two thirds of these individuals had significant changes in diagnostic status based on SADS-L data. Diagnosis of these transient and episodic cases by the primary care physicians was under 10%, demonstrating the need for careful evaluation of the psychiatric status of primary care patients. References 1. Goldberg D: Detection and assessment of emotional disorders in a primary care setting . Int J Ment Health 1979;8:30-48. 2. Hoeper EW, Nycz GR, Cleary PD, Regier DA, Goldberg ID: Estimated prevalence of RDC mental disorder in primary medical care . Int J Ment Health 1979;8:6-15. 3. Shepherd M, Cooper A, Brown AC, Kalton G: Psychiatric Illness in General Practice . London, Oxford University Press, 1966. 4. Stumbo D, Good MD, Good BJ: Diagnostic profile of a family practice clinic: Patients with psychosocial diagnosis . J Fam Pract 1982;14:281-285. 5. The President's Commission on Mental Health: Report to the President From the President's Commission on Mental Health . Washington, DC, 1978, vol 1, stock No. 040-000-00390-8. 6. National Institute of Mental Health: Mental Health Services in Primary Care Settings: Report of a Conference, April 2-3, 1979, Dept of Health and Human Services publication ADM 83-995, series DN No. 2. Rockville, Md, National Institute of Mental Health, 1983. 7. Fry J: What happens to our neurotic patients? Practitioner 1960;185:85-89. 8. Cooper B, Fry J, Kalton G: A longitudinal study of psychiatric morbidity in a general practice population . Br J Prevent Soc Med 1969;23:210-217. 9. Harvey-Smith E, Cooper B: Patterns of neurotic illness in the community . J R Coll Gen Pract 1970;19:132-139. 10. Marks J, Goldberg D, Hillier V: Determinants of the ability of general practitioners to detect psychiatric illness: II. Influence of variables related to the doctors . Psychol Med 1979;9:337-354.Crossref 11. Goldberg DP, Steele JJ, Johnson A, Smith C: Ability of primary care physicians to make accurate ratings of psychiatric symptoms . Arch Gen Psychiatry 1982;39:829-833.Crossref 12. Regier DA, Kessler LG, Burns BJ, Goldberg ID: The need for a psychosocial classification in primary care practice . Int J Ment Health 1979;8:16-28. 13. Goldberg DP, Rickels K, Downing R, Hesbacher P: A comparison of two psychiatric screening tests . Br J Psychiatry 1976;129:61-67.Crossref 14. Kedwood HB, Sylph J: The social correlates of chronic neurotic disorders . Soc Psychiatry 1974;9:91-98.Crossref 15. Mann AH, Jenkins R, Belsey E: The 12-month outcome of patients with neurotic illness in general practice . Psychol Med 1981;11:535-550.Crossref 16. Goldberg D: The concept of a psychiatric 'case' in general practice . Soc Psychiatry 1982;17:61-65.Crossref 17. Hankin JR, Oktay JS: Mental Disorder and Primary Medical Care: An Analytical Review of the Literature , US Dept of Health, Education, and Welfare publication (ADM) 78-661, series D, No.5. National Institute of Mental Health, 1979. 18. Hoeper EW, Nycz GR, Cleary PD: The Quality of Mental Health Services in an Organized Primary Health Care Setting: Final Report to National Institute of Mental Health Under Contract 278-77-0071(DB) . Marshfield, Wis, Marshfield Medical Foundation and Clinic, 1979. 19. Goldberg D: The Manual of the General Health Questionnaire . London, NFER, 1978. 20. Spitzer RL, Endicott J: Schedule for Affective Disorders and Schizophrenia: Life-Time Version (SADS-L) , ed 3. New York, New York State Psychiatric Institute, 1977. 21. Weissman MM, Myers JK: Psychiatric disorders in a US community: The application of Research Diagnostic Criteria to a resurveyed community sample . Acta Psychiatr Scand 1980;62:99-111.Crossref 22. Andreasen NC, Grove WM, Shapiro RA, Keller MB, Hirschfeld RMA, McDonald-Scott P: Reliability of lifetime diagnosis: A multicenter collaborative perspective . Arch Gen Psychiatry 1981;38:400-405.Crossref 23. Keller MB, Lavori PW, McDonald-Scott P, Scheftner WA, Andreasen NC, Shapiro RA, Crougham J: Reliability of lifetime diagnoses and symptoms in patients with a current psychiatric disorder . J Psychiatr Res 1981;16:229-240.Crossref 24. Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM: Best estimate of lifetime psychiatric diagnosis . Arch Gen Psychiatry 1982;39:879-883.Crossref 25. Mazure C, Gershon ES: Blindness and reliability in lifetime psychiatric diagnosis . Arch Gen Psychiatry 1979;36:521-525.Crossref 26. Kessler LG, Tessler RC, Nycz GR: Co-occurrence of psychiatric and medical morbidity in primary care . J Fam Pract 1983;16:319-324. 27. Endicott J, Spitzer RL, Fleiss JL, Cohen JC: The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance . Arch Gen Psychiatry 1976;33:766-771.Crossref 28. Myers JK, Weissman MM, Tischler GL, Holzer CE, Leaf PJ, Orvaschel H, Anthony JC, Boyd JH, Burke JD Jr, Kramer M, Stoltzman R: Six-month prevalence of psychiatric disorders in three communities: 1980-1982 . Arch Gen Psychiatry 1984;41:959-967.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jun 1, 1985

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