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Professional stress in general practitioners and psychiatrists: The level of psycologic distress and burnout risk  [PDF]
Vi?enti? Sreten,Jovanovi? Aleksandar,Dunji? Bojana,Pavlovi? Zorana
Vojnosanitetski Pregled , 2010, DOI: 10.2298/vsp1009741v
Abstract: Background/Aim. So far, studies of stress have shown that physicians are at a high risk of sickness from psychic and somatic disorders related to professional stress, that can lead to important disturbance of personal, familiar and professional functionating. The aim of this study was to investigate the doctors exposition level to professional stress, to compare stress level in general practitioners (GP) group with that in the group of psychiatrists and risk level for the apperance of burnout syndrome. Methods. This cross-section study included subjects recruited by a random sample method. Thirty General Practice doctors and 30 psychiatrists (totally 60 doctors) filled the set of 3 questionnaires: Sociodemographics features, General Health Questionnaire (GHQ; Goldberg D, 1991), and Maslach Burnout Inventory (MBI; Maslach C, 1996). Appropriate statistical procedures (Pearson test, t-test, variance analysis) in interpretation of the results were used. Results. A total level of psychic distress measured with the GHQ test in both groups of physicians was very low implying their good mental health. A difference in Burnout risk based on MBI test between the groups was statistically significant (χ2 = 4,286; p < 0.05) only at subscale Personal Accomplishment (MBI-PA); it was a consequence of a higher number of GPs with medium burnout risk (13.3 : 0.0%). However, even 35 physicians from the sample were affected with a high burnout risk measured with subscales Emotional Ehausation (MBI-EE) and MBI-DP, showing that both groups of physicians had risk for the appearance of burnout syndrome. Conclusion. The obtained results showed a high burnout risk level in both, GPs and psychiatrists, groups. In both groups there was no presence of psychic disorders (anxiety, depression, insomnia), while there was a high level of emotional ehausation and overtension by job, and also a lower total personal accomplishment. Level of exposition to professional stress is higher in GPs than in psychiatrists, but the difference was not statistically significant.
Do general practitioners and psychiatrists agree about defining cure from depression? The DEsCRIBE? survey
Koen Demyttenaere, Marc Ansseau, Eric Constant, Adelin Albert, Geert Van Gassen, Kees van Heeringen
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-169
Abstract: A 51-item questionnaire based on six validated scales was used to rate the importance of several depression outcome dimensions. Physicians' attitudes about depression were also assessed using the Depression Attitude Scale. Overall, 369 Belgian physicians (264 general practitioners [GPs]; 105 psychiatrists) participated in the DEsCRIBE? survey.GPs and psychiatrists strongly agreed that functioning and depressive symptomatology were most important in defining cure; anxious and somatic symptomatology was least important. GPs and psychiatrists differed in their attitudes about depression (p < 0.001). Logistic regression revealed that the attitudes of GPs - but not psychiatrists - were significantly associated with their rates of antidepressant prescription (p < 0.001) and that certain attitudes predicted which outcome dimensions were seen as important in defining cure.Belgian GPs and psychiatrists strongly agreed on which criteria were important in defining cure from depression but differed in their attitudes about depression. The outcome dimensions that were considered important in defining cure were influenced by physicians' attitudes - this was more pronounced in GPs than in psychiatrists.In 2006, the US National Institute of Mental Health published an article regarding the possibility of finding a cure for mental disorders [1]. This paper was a call to health practitioners to set themselves more ambitious goals when treating patients with mental illness. Moreover, this initiative aimed to cause a paradigm shift in perceptions of depression and its cure. While such an effort is admirable the paper failed to take into account the complexity of mental disorders such as depression and the inadequacies in our current ability to monitor and define the disease. Depression is multifactorial, and its aetiology and presentation differ greatly from one patient to the next. Furthermore, decades of research have failed to find consistent biological markers for depression or for
Why Psychiatrists Are Not Interested and Why They Should Be Interested in Mental Health  [PDF]
Dusan Kecmanovic
Aktuelnosti iz Neurologije, Psihijatrije i Grani?nih Podru?ja , 2011,
Abstract: Mental pathology is the primary focus of psychiatrists’ attention. Yet it is difficult to get a better understanding of mental disorders without knowing what mental health is, what its manifestation are, how it can be defined and recognized. Hence, psychiatrists should be more interested in mental health. So long as they ignore the relevance of mental health to psychiatry, they cannot acquire knowledge about it, and consequently they cannot be competent to provide proper assistance to those in need.
Roles and practices of general practitioners and psychiatrists in management of depression in the community
Sophie Tardieu, Alain Bottero, Patrick Blin, Michael Bohbot, Sylvia Goni, Alain Gerard, Isabelle Gasquet
BMC Family Practice , 2006, DOI: 10.1186/1471-2296-7-5
Abstract: The study design is an observational cross-sectional study on a random sample of GPs and psychiatrists working in France. Consecutive inclusion of patients seen in consultation considered as depressed by the physician. GPs enrolled 6,104 and psychiatrists 1,433 patients. Data collected: sociodemographics, psychiatric profile, environmental risk factors of depression and treatment. All clinical data were collected by participating physicians; there was no direct independent clinical assessment of patients to check the diagnosis of depressive disorder.Compared to patients identified as depressed by GPs, those identified by psychiatrists were younger, more often urban (10.5% v 5.4% – OR = 2.4), educated (42.4% v 25.4% – OR = 3.9), met DSM-IV criteria for depression (94.6% v 85.6% – OR = 2.9), had been hospitalized for depression (26.1% v 15.6% – OR = 2.0) and were younger at onset of depressive problems (all adjusted p < .001). No difference was found for psychiatric and somatic comorbidity, suicide attempt and severity of current depression.Compared to GPs, psychiatrists more often prescribed tricyclics and very novel antidepressants (7.8% v 2.3% OR = 5.0 and 6.8% v 3.0% OR = 3.8) with longer duration of antidepressant treatment. GPs' patients received more "non-conventional" treatment (8.8% v 2.4% OR = 0.3) and less psychotherapy (72.2% v 89.1% OR = 3.1) (all adjusted p < .001).Differences between patients mainly concerned educational level and area of residence with few differences regarding clinical profile. Differences between practices of GPs and psychiatrists appear to reflect more the organization of the French care system than the competence of providers.Depression is a highly prevalent disorder associated with enormous personal and societal cost [1] The global burden of mental illness is expected to rise sharply over the coming decades. The WHO Global Burden of Disease Study estimates that by 2020, major depression will rank as the second cause of disability[
General Practitioners' opinions on their practice in mental health and their collaboration with mental health professionals
Nadia Younes, Isabelle Gasquet, Pierre Gaudebout, Marie-Pierre Chaillet, Viviane Kovess, Bruno Falissard, Marie-Christine Hardy Bayle
BMC Family Practice , 2005, DOI: 10.1186/1471-2296-6-18
Abstract: All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro.A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians.Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro.Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP.GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option.In developed countries, mental health problems, especially anxious and depressive disorders, are frequent and a leading cause of disability [1-4]. Since they are potentially remediable when adequately treated, they represent a major public health challenge [5,6]. A major obstacle to the instatement of adequate care is that when people do se
General practitioners are bearing an increasing burden of the care of common mental disorders in France
Norton,Joanna; David,Michel; Boulenger,Jean-Philippe;
The European Journal of Psychiatry , 2007, DOI: 10.4321/S0213-61632007000100008
Abstract: introduction: in france, general practice is playing an increasing role in the management of common mental disorders. this is due to a variety of factors, among which the way general practice and specialised mental health services have evolved over time. methods: a description of the status quo in france, with a comparison between france, the uk and the netherlands. a review of reasons for the present position. results: the general practitioner (gp) is often the only medical carer to be contacted in cases of psychological distress and over 80% of psychotropic medications are prescribed in this setting. although most common forms of mental disorder can be managed at the primary care level, gps need to be able to refer patients rapidly to specialised mental health services. yet there are delays for consultations with both private and public psychiatrists along with difficulties in finding beds for full-time hospitalisation. the situation is predicted to get worse with the reduction in the number of psychiatrists and gps forecasted for the coming years. 'psychiatric sectorisation' has led to a substantial development of community mental health care services, yet this has not compensated fully for the reduction in full-time hospital beds. furthermore, community mental health care services remain relatively isolated from other community health services with very limited exchanges with general practice. conclusion: gps report an urgent need for training in mental health. along with improving their ability to accurately detect and treat mental disorders, it is crucial also to improve communication between gps and psychiatrists and increase shared case-management. structural changes are also necessary to ensure a quicker and easier access to specialised mental health care services.
General practitioners are bearing an increasing burden of the care of common mental disorders in France  [cached]
Joanna Norton,Michel David,Jean-Philippe Boulenger
The European Journal of Psychiatry , 2007,
Abstract: Introduction: In France, general practice is playing an increasing role in the management of common mental disorders. This is due to a variety of factors, among which the way general practice and specialised mental health services have evolved over time. Methods: A description of the status quo in France, with a comparison between France, the UK and the Netherlands. A review of reasons for the present position. Results: The general practitioner (GP) is often the only medical carer to be contacted in cases of psychological distress and over 80% of psychotropic medications are prescribed in this setting. Although most common forms of mental disorder can be managed at the primary care level, GPs need to be able to refer patients rapidly to specialised mental health services. Yet there are delays for consultations with both private and public psychiatrists along with difficulties in finding beds for full-time hospitalisation. The situation is predicted to get worse with the reduction in the number of psychiatrists and GPs forecasted for the coming years. 'Psychiatric sectorisation' has led to a substantial development of community mental health care services, yet this has not compensated fully for the reduction in full-time hospital beds. Furthermore, community mental health care services remain relatively isolated from other community health services with very limited exchanges with general practice. Conclusion: GPs report an urgent need for training in mental health. Along with improving their ability to accurately detect and treat mental disorders, it is crucial also to improve communication between GPs and psychiatrists and increase shared case-management. Structural changes are also necessary to ensure a quicker and easier access to specialised mental health care services.
Characteristics of practitioners in a private managed behavioral health plan  [cached]
Reif Sharon,Torres Maria E,Horgan Constance M,Merrick Elizabeth L
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-283
Abstract: Background Little is known about the practitioners in managed behavioral healthcare organization (MBHO) networks who are treating mental and substance use disorders among privately insured patients in the United States. It is likely that the role of the private sector in treating behavioral health will increase due to the recent implementation of federal parity legislation and the inclusion of behavioral health as a required service in the insurance exchange plans created under healthcare reform. Further, the healthcare reform legislation has highlighted the need to ensure a qualified workforce in order to improve access to quality healthcare, and provides an additional focus on the behavioral health workforce. To expand understanding of treatment of mental and substance use disorders among privately insured patients, this study examines practitioner types, experience, specialized expertise, and demographics of in-network practitioners providing outpatient care in one large national MBHO. Methods Descriptive analyses used 2004 practitioner credentialing and other administrative data for one MBHO. The sample included 28,897 practitioners who submitted at least one outpatient claim in 2004. Chi-square and t-tests were used to compare findings across types of practitioners. Results About half of practitioners were female, 12% were bilingual, and mean age was 53, with significant variation by practitioner type. On average, practitioners report 15.3 years of experience (SD = 9.4), also with significant variation by practitioner type. Many practitioners reported specialized expertise, with about 40% reporting expertise for treating children and about 60% for treating adolescents. Conclusions Overall, these results based on self-report indicate that the practitioner network in this large MBHO is experienced and has specialized training, but echo concerns about the aging of this workforce. These data should provide us with a baseline of practitioner characteristics as we enter an era that anticipates great change in the behavioral health workforce.
Quality assessment of private practitioners in rural Wardha, Maharashtra  [cached]
Ganguly Enakshi,Deshmukh P,Garg B
Indian Journal of Community Medicine , 2008,
Abstract: Objective: To assess the quality of care provided by private practitioners in rural areas of Wardha district. Methodology: The study was carried out in three primary health centres of Wardha district. 20% of the 44 registered private practitioners were selected randomly for the study. The data was collected using checklist through direct observation for the infrastructure. Assessment of quality of services delivered, 10 consecutive patients were observed and also the medical practitioner was interviewed. Supplies and logistics were assessed through observation. Results: All the facilities were sheltered from weather conditions and 90% had adequate waiting space. But, drinking water and adequate IEC material was available in only 20% facilities. Complete history taking and relevant physical examination was done in only 20% cases. Only 20% practitioners recorded blood pressure and 30% recorded temperature in cases with fever. Provisional diagnosis was not written in any of the case and only 20% explained prescription to the patients. Conclusion: There is considerable scope to improve the quality of services of private practitioners. To achieve this quality assurance programs may be initiated along with the training of private medical practitioners.
Chronic fatigue syndrome: An update for psychiatrists  [PDF]
Camila Prochalska, Florence Gressier, Emmanuelle Corruble
Open Journal of Psychiatry (OJPsych) , 2012, DOI: 10.4236/ojpsych.2012.21007
Abstract: Chronic fatigue syndrome (CFS) is a poorly understood condition primarily characterized by debilitateing, persistent or recurrent fatigue, increased physical and mental fatigability, cognitive impairment and widespread musculoskeletal pain. During the past two decades, there have been heated debates about CFS among researchers, practitioners and patients. The existence of the disorder has been questioned, its underlying pathophysiology debated and an effective treatment opposed (such as antidepressants, stimulants or antibiotics). A lot of multidisciplinary literature is found about CFS, but to date, many psychiatrists seem to unknown the existence of this illness or think that it is a purely psychological disorder. However, CFS is sitting on the border between medicine and psychiatry. The aim of this review is to make psychiatrists aware of the existence of CFS and that they will, one day, be confronted with the management of this illness. Thus, this update allows understanding what is CFS, the diversity of physiopathology underlined and its management.
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