Tertiary Mental Health Services: IL Subpopulations and Best Practices for Service Delivery

Cochrane, Jeanette; Goering, Paula; Durbin, Janet; Butterill, Dale; Dumas, John; Wasylenki, Donald

doi:10.1177/070674370004500210

Cited by 15 publications

(10 citation statements)

References 21 publications

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“…First, both patient samples were selected from tertiary care centers. It is likely that psychiatric patients referred to a tertiary mental health service may have more severe psychopathological disturbances than those generally seen in other mental health care settings [42]. Also, FGID patients referred to tertiary care clinics have been found to have more psychiatric disorders, abnormal illness behavior, and activity disruption, and less physiological correlates of their symptoms, than those referred to primary care settings [43, 44].…”

Section: Discussionmentioning

confidence: 99%

Alexithymia and Psychopathology in Patients with Psychiatric and Functional Gastrointestinal Disorders

Porcelli¹,

Affatati

Bellomo

et al. 2004

Psychother Psychosom

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Background: Alexithymia and psychopathology may influence the way individuals experience psychological distress and somatic symptoms. This study evaluated patients referred to psychiatric and gastroenterologic outpatient settings in order to investigate the levels of alexithymia and psychopathology, and the possible role of alexithymia in symptom perception and health care utilization. The association between psychiatric disorders and functional gastrointestinal disorders (FGIDs) was also assessed. Methods: Psychopathology (by the Revised 90-item Symptom Checklist), alexithymia (by the 20-item Toronto Alexithymia Scale), and gastrointestinal symptoms (by the Gastrointestinal Symptom Rating Scale) were evaluated in 52 psychiatric outpatients and 58 medical outpatients with FGIDs. Two comorbid subgroups of 25 psychiatric patients with FGIDs and 38 FGID patients with psychiatric disorders were formed and compared. Results: Forty-eight percent of the psychiatric patients had associated FGIDs, and 65.5% of the FGID patients had associated psychiatric disorders. The FGID patients had significantly less psychopathology, but significantly higher alexithymia and more severe gastrointestinal symptoms, than the psychiatric patients. In the comparison of the two subgroups with comorbidity, FGID patients with psychiatric disorders were still more alexithymic and had less psychopathology than psychiatric patients with FGIDs, but gastrointestinal symptoms were not significantly different. Conclusion: Patients with ‘functional’ gastrointestinal symptoms attending a medical care service are likely to be highly alexithymic, whereas those attending a psychiatric care service are likely to show severe psychopathology. Alexithymia seems to influence the presentation of ‘functional’ somatic symptoms and the type of health care utilization.

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Section: Discussionmentioning

confidence: 99%

Alexithymia and Psychopathology in Patients with Psychiatric and Functional Gastrointestinal Disorders

Porcelli¹,

Affatati

Bellomo

et al. 2004

Psychother Psychosom

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“…Secondary mental healthcare is delivered primarily through community mental health services and psychiatric services in general hospitals, and refers to the more specialized support provided to patients with mental health needs that cannot be supported by primary care services [ 24 ]. Highly specialized mental healthcare, also commonly referred to as tertiary mental healthcare, is defined as specialized intervention delivered by highly-trained staff with specific expertise in a given field to individuals with problems that cannot be treated with sufficient result by either primary or secondary mental health services [ 25 , 26 ]. Finally, the term indicators is used to refer to clinical characteristics and risk factors that may aid clinicians in the identification of the subgroup of patients with MDD likely in need of highly specialized care.…”

Section: Methodsmentioning

confidence: 99%

Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review

et al. 2017

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ObjectivesEarly identification of patients with major depressive disorder (MDD) that cannot be managed by secondary mental health services and who require highly specialized mental healthcare could enhance need-based patient stratification. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The development of a valid tool to identify patients with MDD in need of highly specialized care is hampered by the lack of a comprehensive understanding of indicators that distinguish patients with and without a need for highly specialized MDD care. The aim of this study, therefore, was to systematically review studies on indicators of patients with MDD likely in need of highly specialized care.MethodsA structured literature search was performed on the PubMed and PsycINFO databases following PRISMA guidelines. Two reviewers independently assessed study eligibility and determined the quality of the identified studies. Three reviewers independently executed data extraction by using a pre-piloted, standardized extraction form. The resulting indicators were grouped by topical similarity, creating a concise summary of the findings.ResultsThe systematic search of all databases yielded a total of 7,360 references, of which sixteen were eligible for inclusion. The sixteen papers yielded a total of 48 unique indicators. Overall, a more pronounced depression severity, a younger age of onset, a history of prior poor treatment response, psychiatric comorbidity, somatic comorbidity, childhood trauma, psychosocial impairment, older age, and a socioeconomically disadvantaged status were found to be associated with proxies of need for highly specialized MDD care.ConclusionsSeveral indicators are associated with the need for highly specialized MDD care. These indicators provide easily measurable factors that may serve as a starting point for the development of a valid tool to identify patients with MDD in need of highly specialized care.

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“…tertiary mental healthcare) is the care provided by highly trained professionals to individuals with mental health problems that are complex and refractory to interventions provided in specialised (for example secondary) mental healthcare settings such as community mental health centres and general hospitals. 22,23 Given the level of necessary staff expertise, assessment and resources, highly specialised mental healthcare is often, but not per definition, provided in mental healthcare centres affiliated with academic medical settings. 22 In order to enhance the early identification and adequate management of patients with mental health problems in need of highly specialised care, the following four diagnosis-specific decision support algorithms were developed: the Decision Tool Personality Disorders, 19 the Decision Tool Eating Disorders, 18 the Decision Tool Unipolar Depression 20 and the Decision Tool Anxiety Disorders.…”

Section: Definition Of Terms and Transdiagnostic Decision Tool Develomentioning

confidence: 99%

Development and psychometric evaluation of the Transdiagnostic Decision Tool: matched care for patients with a mental disorder in need of highly specialised care

et al. 2020

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Background Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors. Aims To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups. Method The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered. Results The six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value. Conclusions The Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.

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Tertiary Mental Health Services: IL Subpopulations and Best Practices for Service Delivery

Cited by 15 publications

References 21 publications

Alexithymia and Psychopathology in Patients with Psychiatric and Functional Gastrointestinal Disorders

Alexithymia and Psychopathology in Patients with Psychiatric and Functional Gastrointestinal Disorders

Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review

Development and psychometric evaluation of the Transdiagnostic Decision Tool: matched care for patients with a mental disorder in need of highly specialised care

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