The ability to detect mental disorders varies greatly among general practitioners in primary health care. The aim of this study was to determine the factors underlying the differences between general practitioners in the ability to recognize mental disorders in Finnish patient populations. The group studied consisted of 1000 randomly selected adult patients of primary care facilities in the city of Turku. The Symptom Checklist (SCL-25) was used as the reference method in the identification of psychiatric cases. According to the SCL-25, one fourth of the sample had mental disorders. A good recognition ability was associated with postgraduate psychiatric training and qualification as a specialist in general practice. Surprisingly, Balint group training, which is a method intended to improve the ability of general practitioners to manage their patients' mental health problems, was associated rather with poor than good detection ability.
To report the early experience of a multiagency child psychiatric consultation service.
The program is described, and the demographic characteristics of clients referred to the consultation program over the first 25 months of operation are presented. Referrals were examined for demographics and the questions consultees wanted to have answered.
In 59 of 100 consultations, physical and/or sexual abuse was proved or highly suspected. In 82 of the 100 cases, consultees had questions pertaining to management issues. Questions related to diagnostic issues numbered 62, and there were 45 questions about safety issues.
Effective psychiatric consultations services to rural areas can be established. Once established, the questions of consultees can provide an effective training ground for future community-oriented child psychiatrists.
To present experiences with teams in a university hospital and various community settings that promote the learning of collaboration among different professionals.
Research in developmental psychopathology has increasingly linked childhood vulnerabilities and risk factors to adolescent and adult disorders. In this context the multidisciplinary teams can be seen as the expression of the expanding knowledge and expertise of the medical and allied health professionals, which can be directed toward promotion of health as well as prevention and cure of illness.
Collaboration reflects the application of biopsychosocial principles to consultation and research both in the community and in hospital, and the general trend in medicine to move from solo to team practice.
Psychiatrists have the obligation to promote, develop and maintain the psychosocial and personal dimension in the teaching and practice of medicine.
This paper describes a program in Hamilton-Wentworth, Ontario, Canada, that brings mental health counselors and psychiatrists into the offices of 87 local family physicians, working in 35 practices serving 170,000 people. It outlines the organization of the mental health teams in the family physician's office and the way in which these teams are coordinated and discusses how this "shared care" approach can overcome many of the problems that traditionally bedevil the relationship between psychiatric services and family practices. It summarizes the benefits of this approach for patients providers and the health care system and looks at its implications for learners and for new approaches to continuing education. This model can be adapted to most communities.
An outpatient psychiatric department of a medical center was organized as a community psychiatry team to provide direct services, consultation and education, and preventive programs for high-risk groups. By successfully handling requests for service from a home for the aged, the team established a consultative relationship and then a six-month teaching program centered on problems presented by the home's staff in group sessions. Results included a drop in requests for direct service, the establishment of group programs for residents, and an increase in the home's willingness to accept and deal with disturbed behavior without resort to hospitalization.
Overcoming problems in communication between psychiatry and primary care requires new models of collaboration. Their success will depend upon the ability of participants to work productively with each other, which will require psychiatry residency programs to offer appropriate preparation for future graduates in working with primary care physicians. This article, based on the training at McMaster University in Hamilton, Ontario, describes a brief curriculum for training psychiatry residents to work effectively with primary care physicians that can be easily integrated with current training rotations and looks at adjustments academic departments need to make to support such programs.
Little has been written about teaching consultation-liaison inpatient psychotherapy to residents or other trainees.
Resident interviews at completion of consultation-liaison training identified learning needs. In response, the authors created a seminar series and modified it reiteratively eight times.
In this approach, the primary task of consultation-liaison psychotherapy assessment is to determine the success of a patient's adaptation to hospitalization, and to identify obstacles to adaptation. Selected determinants of adaptation are reviewed and organized as individual factors and intrahospital and extrahospital environmental factors. This provides a viable means of organizing and integrating disparate bodies of knowledge for the student.
The teaching model awaits empirical validation as a tool that enhances teaching and patient care outcomes.