Psychiatric comorbidity in general practice.
BACKGROUND
Much of teaching and research has concentrated on single disease entities. In general practice, however, many patients suffer from a number of interacting illnesses at the same time. It is unlikely we will ever have randomised controlled trials to guide the management of such patients.


OBJECTIVE
This article aims to develop a framework that will assist general practitioners in day-to-day clinical work with patients presenting with concurrent multiple physical and mental health problems.


CONCLUSIONS
A positive, caring, patient centred approach is required and multiple diagnoses need to be managed within an integrated treatment plan. The quality of the therapeutic relationship is central to patient outcomes. Assessing and managing risk issues is a priority and coordinating care with other health professionals is essential. Set realistic goals, don't make changes too quickly or all at once, and don't assume that because a patient is taking a particular medication the associated diagnosis is correct.
Pierce
David
D
Department of General Practice, University of Melbourne, Victoria. d.pierce@unimelb.edu.au
Wilson
Ian
I
D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000628:therapy; D001416:Back Pain / Q000150:complications / Q000628:therapy; D002908:Chronic Disease; D005194:Family Practice / Q000379:methods*; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D010819:Physician's Role; D010817:Physician-Patient Relations; D011247:Pregnancy; D018570:Risk Assessment / Q000379:methods