Psychiatric Diagnosis and Classification - ResearchGate

PSYCHIATRIC DIAGNOSIS AND CLASSIFICATION IN PRIMARY CARE 241
number of anxiety and depressive disorders go unrecognized in the typical
primary care visit. Recognition is strongly related to presenting complaint,
so the most straightforward approach to improving recognition is to encourage
the presentation of psychological complaints [5, 6]. Presentation of
psychological complaints is associated with specific physician behaviors,
and those behaviors are modifiable through training [8]. In some cases, a
focus on physician awareness and interviewing style may be sufficient.
Even the most skillful physician, however, will fail to recognize some
cases of significant psychological disorder.
Any systematic program to increase recognition should be inexpensive,
convenient, and acceptable to patients. Ideally, this initial stage of diagnosis
should require little or no time from physicians and minimal time from other
clinical staff. The least expensive and intensive approach is a passive screening
program allowing patients to self-screen and self-identify. Examples include
pamphlets or posters in the waiting room or consulting room. These approaches
are probably the least expensive and least intrusive, but evidence
of effectiveness is lacking. A range of options is available for active screening.
While visit-based screening is the most common approach, mail screening
allows a clinic or practice to target specific high-risk groups or screen those
who make infrequent visits. Various modes of administration are available:
paper and pencil, computer screen, telephone, or face-to-face live interview.
The choice of methods should depend on local availability and acceptability
to patients. Finally, a large number of measures have been proved sufficiently
sensitive and specific for primary care screening. The PRIME-MD
[9] and SDDS-PC [51] described above are examples of multipurpose measures
intended to screen for a number of specific mental and substance
use disorders. The General Health Questionnaire GHQ) [52] and the Mental
Health Inventory MHI-5) [53] are examples of a ``broad spectrum''
screener for common anxiety and depressive disorders. The Center for Epidemiologic
Studies Depression Scale CES-D) [54] and the Alcohol Use Disorders
Identification Test AUDIT) [55] are examples of disorder-specific
screeners.
A substantial literature suggests that screening alone or simple recognition
of psychological distress) is probably not sufficient to improve outcomes
[56±59]. Screening must be followed by specific diagnosis and effective treatment
[12, 60, 61]. Several studies have examined the diagnostic performance
of trained primary care providers [8, 9]. Specific diagnostic tools algorithms,
criteria, semi-structured interviews) are acceptable to primary care providers
and feasible for use in busy primary care practices. Diagnoses made by
trained primary care staff agree well with those made by mental health
specialists [9, 35]. Research supports the accuracy of diagnoses by trained
physicians and nurses, with no data necessarily favoring one type of provider
over the other. Two recent studies with the PRIME-MD system [29, 34]