Gonzales J J, Magruder K M, Keith S J
Department of Psychiatry, Georgetown University Medical Center, Washington, DC 20007.
Public Health Rep. 1994 Mar-Apr;109(2):251-8.
Frank mental disorders, such as depression and panic disorder, are prevalent in primary care; they cause people substantial suffering and interfere with daily functioning. Even subthreshold or "subsyndromal" conditions, with fewer symptoms than necessary for making a diagnosis, cause substantial morbidity. Recent literature on mental disorders in primary care, where many, if not most, people with mental health problems are seen, is reviewed with focus on recognition and diagnosis issues, management of these problems in primary care, obstacles to accurate diagnosis and appropriate treatment, and prevention issues. In addition to a review of recent research, there is an effort to place these topics in the context of various directives, including research and Federal documents, that have direct implications for better treatment in primary care of people with mental disorders (for example, practice guidelines). Mental health problems and disorders seen in primary care are a public health problem meriting immediate attention and substantial work at many levels--clinical, educational, organizational, and budgetary.
诸如抑郁症和惊恐障碍等明显的精神障碍在初级保健中很常见；它们给人们带来巨大痛苦，并干扰日常功能。即使是症状比确诊所需症状少的阈下或“亚综合征”情况，也会导致相当高的发病率。本文回顾了初级保健中精神障碍的近期文献，许多（即便不是大多数）有心理健康问题的人在此接受诊治，重点关注识别与诊断问题、初级保健中这些问题的管理、准确诊断和适当治疗的障碍以及预防问题。除了对近期研究进行综述外，还努力将这些主题置于各种指令的背景下，包括对精神障碍患者在初级保健中进行更好治疗有直接影响的研究和联邦文件（例如实践指南）。在初级保健中看到的心理健康问题和障碍是一个公共卫生问题，值得在临床、教育、组织和预算等多个层面立即予以关注并开展大量工作。
