Long term GP opinions and involvement after a consultation-liaison intervention for mental health problems

<p>Abstract</p> <p>Background</p> <p>Shared Mental Health care between Psychiatry and Primary care has been developed to improve the care of common mental health problems but has not hitherto been adequately evaluated. The present study evaluated a consultation-liaison intervention with two objectives: to explore long-term GP opinions (relating to impact on their management and on patient medical outcome) and to determine the secondary referral rate, after a sufficient time lapse following the intervention to reflect a "real-world" primary care setting.</p> <p>Methods</p> <p>All the 139 collaborating GPs (response rate: 84.9%) were invited two years after the intervention to complete a retrospective telephone survey for each patient (181 patients; response rate: 69.6%).</p> <p>Results</p> <p>91.2% of GPs evaluated effects as positive for primary care management (mainly as support) and 58.9% noted positive effects for patient medical outcome. Two years post-intervention, management was shared care for 79.7% of patients (the GP as the psychiatric care provider) and care by a psychiatrist for 20.3% patients. Secondary referral occurred finally in 44.2% of cases.</p> <p>Conclusion</p> <p>The intervention supported GP partners in their management of patients with common mental health problems. Further studies are required on the appropriateness of the care provider.</p

General Practitioners' opinions on their practice in mental health and their collaboration with mental health professionals

BACKGROUND: Common mental health problems are mainly treated in primary care settings and collaboration with mental health services is needed. Prior to re-organisation of the mental health care offer in a geographical area, a study was organized: 1) to evaluate GPs' opinions on their day-to-day practice with Patients with Mental Health Problems (PMHP) and on relationships with Mental Health Professionals (MHPro); 2) to identify factors associated with perceived need for collaboration with MHPro and with actual collaboration. METHODS: All GPs in the South Yvelines area in France (n = 492) were informed of the implementation of a local mental health program. GPs interested in taking part (n = 180) were invited to complete a satisfaction questionnaire on their practice in the field of Mental Health and to include prospectively all PMHP consultants over an 8-day period (n = 1519). For each PMHP, data was collected on demographic and clinical profile, and on needs (met v. unmet) for collaboration with MHPro. RESULTS: A majority of GPs rated PMHP as requiring more care (83.4%), more time (92.3%), more frequent consultations (64.0%) and as being more difficult to refer (87.7%) than other patients. A minority of GPs had a satisfactory relationship with private psychiatrists (49.5%), public psychiatrists (35%) and social workers (27.8%). 53.9% had a less satisfactory relationship with MHPro than with other physicians. Needs for collaboration with a MHPro were more often felt in caring for PMHP who were young, not in employment, with mental health problems lasting for more than one year, with a history of psychiatric hospitalization, and showing reluctance to talk of psychological problems and to consult a MHPro. Needs for collaboration were more often met among PMHP with past psychiatric consultation or hospitalization and when the patient was not reluctant to consult a MHPro. Where needs were not met, GP would opt for the classic procedure of mental health referral for only 31.3% of their PMHP. CONCLUSION: GPs need targeted collaboration with MHPro to support their management of PMHP, whom they are willing to care for without systematic referral to specialists as the major therapeutic option

What makes people decide who to turn to when faced with a mental health problem? Results from a French survey

<p>Abstract</p> <p>Background</p> <p>The unequal use of mental health care is a great issue, even in countries with universal health coverage. Better knowledge of the factors that have an impact on the pathway to mental health care may be a great help for designing education campaigns and for best organizing health care delivery. The objective of this study is to explore the determinants of help-seeking intentions for mental health problems and which factors influence treatment opinions and the reliance on and compliance with health professionals' advice.</p> <p>Methods</p> <p>441 adults aged 18 to 70 were randomly selected from the general population of two suburban districts near Paris and agreed to participate in the study (response rate = 60.4%). The 412 respondents with no mental health problems based on the CIDI-SF and the CAGE, who had not consulted for a mental health problem in the previous year, were asked in detail about their intentions to seek help in case of a psychological disorder and about their opinion of mental health treatments. The links between the respondents' characteristics and intentions and opinions were explored.</p> <p>Results</p> <p>More than half of the sample (57.8%) would see their general practitioner (GP) first and 46.6% would continue with their GP for follow-up. Mental health professionals were mentioned far less than GPs. People who would choose their GP first were older and less educated, whereas those who would favor mental health specialists had lower social support. For psychotherapy, respondents were split equally between seeing a GP, a psychiatrist or a psychologist. People were reluctant to take psychotropic drugs, but looked favorably on psychotherapy.</p> <p>Conclusion</p> <p>GPs are often the point of entry into the mental health care system and need to be supported. Public information campaigns about mental health care options and treatments are needed to educate the public, eliminate the stigma of mental illness and eliminate prejudices.</p

Déficit d'attribution d'intentions à autrui et schizophrénie (apport de l'imagerie cérébrale fonctionnelle )

PARIS-BIUSJ-Thèses (751052125) / SudocPARIS-BIUSJ-Physique recherche (751052113) / SudocSudocFranceF

Vulnérabilité et schizophrénie (revue de la littérature des 5 dernières années)

Le modèle de vulnérabilité suggère que la schizophrénie résulte de l'interaction entre une susceptibilité génétique et des facteurs de risque environnementaux. L'augmentation du risque d'être schizophrène chez les parents de sujets atteints montre l'origine génétique de la maladie. Plusieurs loci chromosomiques sont mis en cause, ainsi que les récepteurs de la dopamine. Des anomalies neurologiques macroscopiques, tissulaires et des circuits neurobiologiques sont aussi constatées. Plusieurs théories expliquent le rôle de ces anomalies dans la pathogenèse de la maladie. Pour évaluer cette vulnérabilité endogène différents tests cognitivo-comportementaux, neurologiques ou neurosensoriels sont utilisés. Les facteurs d'environnement suspectés d'interagir avec la susceptibilité endogène sont le stress, des facteurs périnataux, les drogues, l'immigration, les traumatismes cérébraux.Une discussion sur l'état actuel de ces connaissances, leur apport pratique et les contraintes que cela implique pour la recherche dans l'avenir permet de conclure ce travail.The vulnerability model suggests that schizophrenia results from an interaction between a genetic susceptibility and environmental risk factors. The increased risk fir a subject to be affected when he has schizophrenic silblings shows the genetic origin of this disease. Several chromosomal sites are implicated as well as are dopamine receptors. Macroscopic and tissular neurological anomalies and neurobiological pathways anomalies are also observed. Several theories explain the role of these anomalies in the pathogenesis of the disease. In order to evaluate this endogenous vulnerability several cognitive and comportemental or neurological tests are used. The environmental factors which are suspected to interact with the endogenous vulnerability are the stress, perinatal factors, drugs, immigration, and brain traumatisms. A discussion about the current state of this knowledge, its practical contribution and the impact on future research enables us to conclude this work.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LIENS ENTRE LA PERSONNALITE ET LE TROUBLE BIPOLAIRE

PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

La place de l'hospitalisation en psychiatrie

La prévalence des troubles psychiques touche 1 personne sur 3 sur la vie entière.Mais, malgré une augmentation de la file active, les capacités d'accueil en terme d'hospitalisation à temps complet se sont réduites ces 30 dernières anneés et nous avons assisté à un développement des prises en charge sur les secteurs (avec notamment la politique de sectorisation). L'hospitalisation qui a toujours plus ou moins tenu un rôle central, a connu un essor avec les thérapies institutionnelles, mais depuis quelques anneés, son rôle thérapeutique est décrié (avec description par exemple de " l'institutionnalisme ").Une réflexion s'organise autour de la place que tient encore l'hospitalisation dans l'offre de soins.Nous discuterons des alternatives et du travail de prévention, permettant de limiter les hospitalisations, mais aussi de la déshospitalisation et ses conséquences. En tous cas, même si le débat sur l'hospitalisation en psychiatrie paraît de plus en plus actuel (compte tenu notamment d'impératifs économiques), l'institution semble garder une place incontournable dans l'offre de soins.Ce serait surtout sur sa place dans la trajectoire de soins des patients qu'il faudrait s'interroger.Prevalence of mental disorders affects one person out of three in a lifetime. In spite of the increase of psychiatric consultations, the number of whole time hospitalization beds have decreased these last thirty years, and we have witnessed a flight in the number of patients cared for in community centers. Hospitalization which has always held more or less a central part, has accomplished great strides on milieu therapy, but since several years, its therapeutic importance is being disparaged. A reflexion os engaged over the position that hospitalization still holds in the offer of medical care. We shall discuss the alternatives and preventive actions, allowing the limitation of hospitalizations, as well as of desinstitutionnalization and its consequences. At any rate, even if the debate over psychiatric hospitalization appears more and more current (considering among other things, economic imperatives), this institution seems to occupy an unavoidable part in the care service offer. Above all, it is its position in the treatment trajectory of patients that should be examined.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Bases neuronales du traitement du contexte sémantique et intentionnel chez le sujet sain et le patient schizophrène (étude en magnéto-encéphalographie)

Notre travail a consisté à approfondir l étude du modèle explicatif des troubles de la communication schizophréniques proposé par Hardy-Baylé et collaborateurs, en introduisant la magnéto-encéphalographie afin d apporter des mesures neurofonctionnelles de l existence d une anomalie cognitive de l intégration d une information à son contexte dans le domaine langagier et de la théorie de l esprit. Dans une tâche d amorçage sémantique, la modulation anormale d un réseau fronto-temporal gauche a été observée chez les patients. Nous avons ensuite montré, chez les sujet sains, que les régions temporo-pariétales droites recrutées lors d une tâche d attribution d intention, sous-tendaient une étape d intégration contextuelle. Des anomalies fonctionnelles au sein de ces régions ont été constatées chez les patients. Nos résultats sont en faveur de l existence d un déficit de l intégration contextuelle touchant les domaines du langage et de la théorie de l esprit chez les patients schizophrènes.Our work consisted in deepening the study of the schizophrenic communication disorders explanatory model proposed by Hardy-Baylé and collaborators, by introducing magneto-encephalography to bring neurofunctional measures of the existence of a cognitive abnormality concerning the integration of an information into its context in both linguistic and theory of mind domains. In a semantic priming task, abnormal modulation of a left fronto-temporal network has been observed in patients. Then we showed, in healthy subjects, that right temporo-parietal regions recruited during an attribution of intention task, underlied a cognitive contextual integration stage. Functional abnormalities in these regions have been noticed in patients. Our results are in favor of the existence of a contextual integration deficit affecting schizophrenic patients in the linguistic and theory of mind domains.VERSAILLES-BU Sciences et IUT (786462101) / SudocSudocFranceF