Biomaterial Database

Psychiatric disorders in primary care: physician judgements of prevalence and management. 1987

J L Coulehan, and M R Block, and H C Schulberg, and V C Arena

Department of Community Medicine, University of Pittsburg School of Medicine, PA 15261.

Primary care physicians underdiagnose depression, anxiety, and other psychiatric disorders. Decision analysis suggests that subjective estimates of the probability of a condition and the utility (severity and treatability) of identifying that condition play a role in diagnosis. We asked 108 internists (IM) and family practitioners (FP) to rank 25 conditions on ten-point scales for probability, severity, and treatability. FPs ranked depression significantly higher than IMs did on all three scales, anxiety reactions higher in probability and severity, and both alcoholism and drug dependency higher on the severity scale. Ranks for schizophrenia and personality disorder did not differ between specialties. Thirty-eight physicians completed the scales a second time after six to eight weeks. Test-retest agreement ranged from 47% to 100% for different conditions on different scales. Some common psychiatric disorders tended to have low test-retest agreement in probability and severity. With further refinement, this instrument may contribute to the investigation of psychiatric decision making in primary care.

UI	MeSH Term	Description	Entries
D007388	Internal Medicine	A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults.	General Internal Medicine,Medicine, Internal,Internal Medicine, General,Medicine, General Internal
D010817	Physician-Patient Relations	The interactions between physician and patient.	Doctor-Patient Relations,Doctor Patient Relations,Physician Patient Relations,Physician Patient Relationship,Doctor Patient Relation,Doctor-Patient Relation,Physician Patient Relation,Physician Patient Relationships,Physician-Patient Relation,Relation, Doctor Patient,Relation, Doctor-Patient,Relation, Physician Patient,Relation, Physician-Patient,Relations, Doctor Patient,Relations, Doctor-Patient,Relations, Physician Patient,Relations, Physician-Patient,Relationship, Physician Patient,Relationships, Physician Patient
D012017	Referral and Consultation	The practice of sending a patient to another program or practitioner for services or advice which the referring source is not prepared to provide.	Consultation,Gatekeepers, Health Service,Hospital Referral,Second Opinion,Consultation and Referral,Health Service Gatekeepers,Hospital Referrals,Referral,Referral, Hospital,Referrals, Hospital,Consultations,Gatekeeper, Health Service,Health Service Gatekeeper,Opinion, Second,Opinions, Second,Referrals,Second Opinions
D005194	Family Practice	A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family.	Family Practices,Practice, Family,Practices, Family
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001523	Mental Disorders	Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function.	Mental Illness,Psychiatric Diseases,Psychiatric Disorders,Psychiatric Illness,Behavior Disorders,Diagnosis, Psychiatric,Mental Disorders, Severe,Psychiatric Diagnosis,Illness, Mental,Mental Disorder,Mental Disorder, Severe,Mental Illnesses,Psychiatric Disease,Psychiatric Disorder,Psychiatric Illnesses,Severe Mental Disorder,Severe Mental Disorders