Chen H, Parker G, Kua J, Jorm A, Loh J
Department of Adult Psychiatry, Woodbridge Hospital/Institute of Mental Health, Singapore. Helen_CHEN/MOH/SINGOV
Ann Acad Med Singap. 2000 Jul;29(4):467-73.
To assess the beliefs amongst health professionals in Singapore about management of 3 major mental disorders, comparing psychiatrists and a sample of primary care physicians, and so identify target areas for the education of primary health professionals.
A questionnaire earlier distributed to psychiatrists at Woodbridge Hospital was posted to both Singapore general practitioners and polyclinic doctors. The questionnaire assessed the capacity of respondents to identify vignettes of depression, schizophrenia or mania, and then assessed respondents' views about the likely helpfulness of a number of interventions.
The psychiatrists and primary health professionals differed little in terms of diagnostic accuracy for depression and schizophrenia; however, only half the general practitioners and three-quarters of the polyclinic doctors correctly diagnosed mania, which was consistently diagnosed by the psychiatrists. A number of distinct differences were identified between the groups concerning the likely helpfulness and disorder specificity of various psychotropic drugs. The primary health physicians were more likely to favour non-specific management approaches, whilst the psychiatrists generally supported a focused biological approach to treatment, especially for the psychotic disorders. Some of the differences in beliefs about mental health management may well be contributed by the different patients treated by each group of clinicians.
The findings have important clinical implications in terms of diagnosing common psychiatric conditions accurately and giving us professionals' views about a range of interventions for such conditions, while also assisting review of educational programmes for identifying and managing major mental disorders.
评估新加坡卫生专业人员对三种主要精神障碍管理的看法,比较精神科医生和初级保健医生样本,从而确定初级卫生专业人员教育的目标领域。
一份早些时候分发给伍德布里奇医院精神科医生的问卷被寄给了新加坡的全科医生和专科门诊医生。该问卷评估了受访者识别抑郁症、精神分裂症或躁狂症病例的能力,然后评估了受访者对一系列干预措施可能有效性的看法。
精神科医生和初级卫生专业人员在抑郁症和精神分裂症的诊断准确性方面差异不大;然而,只有一半的全科医生和四分之三的专科门诊医生正确诊断出躁狂症,而精神科医生能始终如一地做出诊断。两组在各种精神药物的可能有效性和疾病特异性方面存在一些明显差异。初级卫生医生更倾向于采用非特异性管理方法,而精神科医生通常支持针对治疗的重点生物方法,尤其是针对精神障碍。每组临床医生治疗的不同患者可能是造成心理健康管理观念差异的部分原因。
这些发现对于准确诊断常见精神疾病以及了解专业人员对一系列此类疾病干预措施的看法具有重要的临床意义,同时也有助于审查识别和管理主要精神障碍的教育计划。