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改变基层医疗医生的精神科知识。简短干预对临床诊断和治疗的影响。

Changing the psychiatric knowledge of primary care physicians. The effects of a brief intervention on clinical diagnosis and treatment.

作者信息

Andersen S M, Harthorn B H

机构信息

Department of Psychology, New York University, New York 10003.

出版信息

Gen Hosp Psychiatry. 1990 May;12(3):177-90. doi: 10.1016/0163-8343(90)90077-p.

Abstract

This research examined the malleability of physicians' knowledge about psychiatric disorders (and their recommended treatments) based on a brief educational intervention. Primary care physicians were randomly assigned to a single-session intervention dealing with selected DSM-IIIR affective and anxiety disorders or to a wait-list control group. Posttest (vs. pretest) measures indicated that experimental physicians showed greater increases than controls in diagnostic accuracy on relevant disorders, specifically, major depression, dysthymic disorder, and agoraphobia with panic attacks. Treatment recommendations were also influenced, specifically, for major depression and panic disorder. Interestingly, treatment recommendations were also influenced for certain somatic disorders not addressed in the intervention, suggesting "halo" effects for these disorders. Overall, the intervention was effective in increasing diagnostic knowledge and altering treatment recommendations. Implications for research on psychiatric interventions among physicians are discussed.

摘要

本研究基于一次简短的教育干预,考察了医生关于精神障碍(及其推荐治疗方法)知识的可塑性。初级保健医生被随机分配到一个针对选定的《精神疾病诊断与统计手册》第三版(DSM-IIIR)中的情感和焦虑障碍的单节干预组,或一个等待名单对照组。后测(与前测相比)结果表明,实验组医生在相关疾病(具体为重度抑郁症、心境恶劣障碍和伴有惊恐发作的广场恐惧症)的诊断准确性上比对照组有更大提高。治疗建议也受到了影响,特别是在重度抑郁症和惊恐障碍方面。有趣的是,干预中未涉及的某些躯体疾病的治疗建议也受到了影响,这表明这些疾病存在“光环”效应。总体而言,该干预在增加诊断知识和改变治疗建议方面是有效的。文中还讨论了对医生精神科干预研究的启示。

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