Psychiatric services in primary care settings: a survey of general practitioners in Thailand

BACKGROUND: General Practitioners (GPs) in Thailand play an important role in treating psychiatric disorders since there is a shortage of psychiatrists in the country. Our aim was to examine GP's perception of psychiatric problems, drug treatment and service problems encountered in primary care settings. METHODS: We distributed 1,193 postal questionnaires inquiring about psychiatric practices and service problems to doctors in primary care settings throughout Thailand. RESULTS: Four hundred and thirty-four questionnaires (36.4%) were returned. Sixty-seven of the respondents (15.4%) who had taken further special training in various fields were excluded from the analysis, giving a total of 367 GPs in this study. Fifty-six per cent of respondents were males and they had worked for 4.6 years on average (median = 3 years). 65.6% (SD = 19.3) of the total patients examined had physical problems, 10.7% (SD = 7.9) had psychiatric problems and 23.9% (SD = 16.0) had both problems. The most common psychiatric diagnoses were anxiety disorders (37.5%), alcohol and drugs abuse (28.1%), and depressive disorders (29.2%). Commonly prescribed psychotropic drugs were anxiolytics and antidepressants. The psychotropic drugs most frequently prescribed were diazepam among anti-anxiety drugs, amitriptyline among antidepressant drugs, and haloperidol among antipsychotic drugs. CONCLUSION: Most drugs available through primary care were the same as what existed 3 decades ago. There should be adequate supply of new and appropriate psychotropic drugs in primary care. Case-finding instruments for common mental disorders might be helpful for GPs whose quality of practice was limited by large numbers of patients. However, the service delivery system should be modified in order to maintain successful care for a large number of psychiatric patients

Atlas Swam: Freedom, Capital, and Floating Sovereignties in the Seasteading Vision.

Political actors have long drawn on utopian imaginaries of colonizing marine and island spaces as models for idealized libertarian commonwealths. A recent inheritor of this tradition is the seasteading movement, which seeks to “further the establishment and growth of permanent, autonomous ocean communities [by] enabling innovations with new political and social systems” on semi-stationary, floating platforms. Fueled by a cocktail of ideologies (techno-optimism, libertarian secession theories, and strains of anarcho-capitalism), seasteading is touted as the newest “frontier” in creative, entrepreneurial, and social engineering. Inherent in the project, however, are buried ideals about the nature of ocean space, the limits of sovereignty, and the liberatory role of technology and capitalism in the drive for social change and individual freedom. We explore these notions through an examination of seasteading’s broader philosophical and economic underpinnings, and their deployment through multiple structural, legal, and social frameworks. Although seasteading is a highly speculative, and even fanciful project, it reflects attempts to resolve contradictions within capitalism: between, on the one hand, the need for order and planning, and, on the other hand, the desire to foster and lionize individual freedom. In the United States, this tension has most visibly entered mainstream discourse through the rise of the Tea Party movement, whose ideology combines adherence to classical liberal ideals about individual entrepreneurship with hostility toward government intervention. Although the seasteading movement, like its better known and more realizable libertarian contemporaries, proposes a solution that its leaders say will resolve this tension, our analysis reveals that it would merely rework it, and thus it unwittingly reinforces the structures it seeks to escape