Treatment Changes in General Practice Patients With Chronic Mental Disorders Following a Psychiatric–Psychosomatic Consultation

Abstract

Objective:To determine whether a psychiatric–psychosomatic consultation can identify unmet treatment needs and improve treatment of patients with mental disorders in general practice.Methods:In 40 primary care practices, 307 consecutive primary patients who met criteria for chronic mental disorders were assessed by a psychiatric–psychosomatic consultant. After random assignment, general practitioners (GPs) were informed for half of the patients about the results of the assessment and received recommendations on how to improve treatment. Changes in treatment and patient status were reevaluated after 6 months.Results:Patients were mostly having depression, adjustment, or anxiety disorders, with 28.8% on sick leave. Contact with their respective GPs was longer than a year in 77.2% of cases. Patients had already received pharmacotherapy (60.9%), psychotherapeutic counseling by GPs themselves (27.7%), psychotherapy by specialists (73.9%), psychiatric outpatient care (57%), inpatient psychiatric treatment (12.1%), inpatient psychosomatic rehabilitation (ie, specialized behavioral medicine facilities for patients with work problems; 41.4%), and a broad spectrum of other diagnostic and therapeutic measures. Newly recommended interventions included leisure activities (42%), a new specialist psychotherapy (37.5%), or inpatient psychosomatic treatment (15.3%). Most recommendations were agreed upon by the GP. Nevertheless, there was only a limited increase in therapeutic actions 6 months later, and no statistically significant improvement in the status of patients.Conclusion:General practitioners undertake a broad spectrum of therapeutic interventions in patients with chronic mental disorders. According to our results, additional psychiatric–psychosomatic consultations can intensify treatment but does not significantly change the general course of chronic mental disorders.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

“…Further research could generalize the conclusions among other populations to explore the internal mechanisms of the mental and physical changes and lay a theoretical foundation for further intervention research, such as interventions for occupational health [ 92 ]. Fifth, this study assessed the patient’s status at 7, 12, and 15 months after leaving the hospital without structured maintenance treatment, and most patients only receive long-term treatment by a primary care therapist and physician [ 93 ]. Thus, considering the concrete treatment patients receive and its effect on long-term development of patients’ mental and physical health as well as their actual ability to work and return to work would be needed.…”

Psychological capacity limitations according to Mini-ICF-APP are differently related with sick leave in patients from different professional fields

“…In 40 general practice offices, a random sample of patients in the waiting room were contacted by study psychologists and asked to fill in a screening questionnaire on their socio-demographic and medical status, whether they suffered from mental disorders as well as their present mental health overall status (WHO-5 [24]; IMET [25]). The screening included questions concerning the chronicity of the mental health problem (whether the person was suffering from the symptoms for at least 6 months or longer), as well as standardized self-rating questionnaires (see [26] for the full description of this assessment).…”

Indikation zur stationären medizinischen Rehabilitation bei Hausarztpatienten mit chronischen psychischen Erkrankungen und Teilhabebeeinträchtigungen

“…Die Behandlungsvorgeschichte wurde mit der "Reha-Checkliste" erfasst (TOPP Checklist [25]), die 76 Items umfasste und alle diagnostischen und therapeutischen Aktivitäten enthielt, die im Sinne einer rehabilitationsmedizinischen Behandlung ambulant oder stationär zur Anwendung kommen. Bei der Zusammenstellung der Rehamaßnahmen für die Checkliste war zurückgegriffen worden auf Erfahrungen aus vorangegangen versorgungsepidemiologischen Projekten und Therapie-Studien in Kooperation mit niedergelassenen Ärzten [1,8], sowie einem Projekt zum betrieblichen Eingliederungsmanagement [11].…”

“…Bei der Zusammenstellung der Rehamaßnahmen für die Checkliste war zurückgegriffen worden auf Erfahrungen aus vorangegangen versorgungsepidemiologischen Projekten und Therapie-Studien in Kooperation mit niedergelassenen Ärzten [1,8], sowie einem Projekt zum betrieblichen Eingliederungsmanagement [11]. Der Checklistenerstellung [25] lag zudem eine Literatursichtung zugrunde, um Hinweise auf rehabilitationsrelevante Tätigkeiten niedergelassener Ärzte zu finden. Es war außerdem recherchiert worden, welche Rehabilitationsmaßnahmen im Rahmen eines stationären Rehaaufenthalts zur Anwendung kommen und geprüft, was davon ggfls.…”