Detection and management of mental distress and psychiatric disorders in primary care settings.
OBJECTIVE
Epidemiological and clinical studies indicate that 10-50% of primary care patients suffering from clinically relevant psychiatric distress are not diagnosed by their physician and only a minority of them receive an appropriate treatment. The improvement of physicians' ability to detect mental distress and psychiatric disorder, in their routine clinical activity, represents a crucial point to reduce the social impact of mental illnesses, prevent their worsening and chronicity and, eventually, relieve mental health services of an excessive burden of care and costs. The aim of this article is to examine a number of factors which intervene in the process of detection of mental distress by the physician. Then, we will examine factors related to the management of psychiatric disorders most commonly co-occurring with physical illness in general health care sector.


METHODS
The method used for this review was essentially a recension of the literature concerning detection and treatment of psychiatric disorders in primary care settings, having in view to see the factors connected with these processes.


RESULTS
Among factors intervening in the process of identification of mental distress in primary care settings, both the characteristics of the physician and the characteristics of the patient should be taken into account. Primary care physicians and psychiatrists are being asked to work together more frequently in this era of community care. The principal aim of such invoked collaboration is the amelioration of quality of care and reduction of costs for mentally ill patients. An important issue within this collaboration is the referral by primary care physicians to specialist services.
Pini
S
S
Clinica Psichiatrica, Università di Pisa. spini@psico.med.unipi.it
Tansella
M
M
D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D011320:Primary Health Care; D013315:Stress, Psychological / Q000175:diagnosis* / Q000628:therapy*