Vijayalakshmy Patrick, Hebert Candice, Green Seth, Ingram Charlotte L
Department of Behavioral Medicine, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200, USA.
Mil Med. 2011 Sep;176(9):986-90. doi: 10.7205/milmed-d-11-00070.
OBJECTIVE: To evaluate critically whether treatment models existed in the literature to treat a soldier with multiple psychiatric and other comorbidities and propose a mental health model consisting of an integrated multidisciplinary treatment team for use in military outpatient settings. METHOD: A case example was described to demonstrate the complexity of presentation including depression, anxiety, insomnia, post-traumatic stress disorder, chronic pain, substance abuse, relationship problems, and suicide attempts. Literature search was conducted for the period 2004-2009. Articles that referred to collaborative/integrated care were examined in detail. RESULTS: Seven articles described collaborative care. Of these, five described collaboration with only primary care and 2 with other specialties including pain, substance abuse, and vocational rehabilitation services. Most articles gave a broader description of the collaborative model. Some postulated a theoretical framework. One described collaborative care in detail but was coordinated by only one professional. None described integration of providers involved in the patient's care. The process of implementation was not sufficiently described. CONCLUSION: Because of limitations in the published literature, a mental health model consisting of a multidisciplinary integrated treatment team is proposed to treat the soldiers in the military outpatient setting.
目的:严格评估文献中是否存在治疗患有多种精神疾病及其他合并症士兵的治疗模式,并提出一种由多学科综合治疗团队组成的心理健康模式,供军事门诊使用。 方法:描述一个病例以展示临床表现的复杂性,包括抑郁、焦虑、失眠、创伤后应激障碍、慢性疼痛、药物滥用、人际关系问题和自杀未遂。对2004年至2009年期间进行了文献检索。详细审查了提及协作/综合护理的文章。 结果:七篇文章描述了协作护理。其中,五篇描述了仅与初级护理的协作,两篇描述了与其他专科的协作,包括疼痛、药物滥用和职业康复服务。大多数文章对协作模式进行了更广泛的描述。一些文章提出了理论框架。一篇详细描述了协作护理,但仅由一名专业人员协调。没有一篇描述参与患者护理的提供者的整合。实施过程没有得到充分描述。 结论:由于已发表文献存在局限性,建议采用由多学科综合治疗团队组成的心理健康模式来治疗军事门诊中的士兵。
J Clin Psychol. 2008-8