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.
In medicine, the concept "psychosomatic" indicates both dualism and polarisation. "Could it mean something psychic or is it something somatic?" This artificial dichotomy and body/mind split is not as apparent in general practice as it is in other medical disciplines. In general practice, the prerequisites for a division are overlooked. Following the work of Piaget, the article outlines manifestations of a body/mind unity as exposed in the language. Words and expressions describing the way we move, stand and walk therefore indicate our attitude and state of mind. Our body language conveys a message. The importance of breathing and its relation to our emotions is highlighted. The function of breathing is said to represent a bridge between the conscious and the unconscious--breathing can be controlled by our will, but generally we breathe reflexively. Restricted breathing is not just a mechanical process; it is shown that there is a connection between breathing and our emotions. Finally, a model of the "human organism" is presented linking four concepts, "human activity", "organ functions", "physical body" and "neurophysiological functions". Activities within the different systems are linked and relate to each other. The model supports the necessity to overcome the body/mind split, which is one of the obstacles to the fulfillment of good quality general practice.
Overall 90 patients aged 35 to 55 years with somatic pathology treated at the clinic for borderline conditions were examined. Astheno-hypochondriac disorders appeared dominant in 41 patients while in 22 patients the disorders were of more partial character, the hypochondriac symptoms, even pronounced to the degree of hyperquantivalent ideas, were relatively unstable, bearing the traces of exaggeration, "defensiveness", affective disorders were labile. Nineteen patients showed subdepressive disorders with a tinge of "endogenicity", masked by astheno-hypochondriac and somatic complaints. In the first group, the psychotherapeutic policy was based on the unraveling and destruction of the "conventionally profitable" mechanisms of neurotic responding and on the formation of the emotionally saturated dominant in the solution of real life problems. Cognitive psychotherapy was predominant in the second group receiving small doses of psychotropic agents (antidepressants and tranquilizers). Psychotherapy made it possible not only to reduce the main astheno-hypochondriac disorders but also to attain steady compensation for somatic disorders.