Verhaak Peter F M, Schellevis Francois G, Nuijen Jasper, Volkers Anita C
Netherlands Institute for Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
Gen Hosp Psychiatry. 2006 Mar-Apr;28(2):125-32. doi: 10.1016/j.genhosppsych.2005.11.001.
Although psychiatric disorders are highly prevalent in the community, many patients with a psychiatric morbidity remain unidentified as such in primary care.
The aim of this study was to analyze which clinical and sociodemographic characteristics of patients with psychiatric morbidity are related to general practitioners' (GPs) diagnosis of mental illness.
A 1-year naturalistic survey of primary care contacts of patients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis of affective disorder, anxiety disorder or alcohol abuse was carried out.
Of the patients with a DSM-IV diagnosis, 10% did not visit their GP at all during 1 year, 40% visited their GP but were only diagnosed as having somatic diagnoses and 50% were given a psychological or social diagnosis at least once during 1 year. Affective disorders are more frequently diagnosed than anxiety disorders or alcohol abuse. The chances of psychological GP diagnosis increase with the number of GP contacts.
GPs appear to have few indications to help them distinguish patients with a psychiatric morbidity from others, as long as the patients themselves do not express more explicit clues to their condition. Public mental health education and a better public relations policy are badly needed.
尽管精神障碍在社区中高度流行，但许多患有精神疾病的患者在初级保健中仍未被识别出来。
本研究旨在分析患有精神疾病的患者的哪些临床和社会人口学特征与全科医生（GP）对精神疾病的诊断有关。
对《精神疾病诊断与统计手册》第四版（DSM-IV）诊断为情感障碍、焦虑障碍或酒精滥用的患者的初级保健接触情况进行了为期1年的自然主义调查。
在患有DSM-IV诊断的患者中，10%在1年内根本没有去看全科医生，40%去看了全科医生，但仅被诊断为患有躯体疾病，50%在1年内至少有一次被给予心理或社会诊断。情感障碍比焦虑障碍或酒精滥用更常被诊断出来。全科医生进行心理诊断的可能性随着与全科医生接触次数的增加而增加。
全科医生似乎几乎没有迹象帮助他们将患有精神疾病的患者与其他患者区分开来，只要患者自己没有对其病情表达更明确的线索。急需开展公共心理健康教育和制定更好的公共关系政策。
