Conditions not attributable to a mental disorder: an epidemiological study of family problems

Analysis of Consultation Demand in a Mental Health Centre during the Recent Economic Recession

The economic recession that recently affected most European countries has led to a worsening of the mental health situation in the general population and an associated rise in outpatient psychiatric care. The aim of this study was to analyse the socio-demographic, clinical and assistential features of the demand for specialist mental health attention. A descriptive and analytical study was conducted in the period 2011-2015 (N = 1252). The principal relations among variables were analysed by an χ² test, followed by a Z test with Bonferroni's correction. For a global perspective a Multiple Correspondence Analysis was performed. 2 The most frequent disorders were adjustment, anxiety and mood disorders, and in addition there were a large number of patients without diagnosis. The percentage of unemployed or inactive patients was high, as it was for those with a low academic level. The younger patients were more prone to have adjustment disorders, especially among the unemployed ones, while anxiety disorders were more frequent in the patients with jobs. A close association seems to exist between unemployment, low academic level and mental health problems. The high demand for mental health attention reveals a clear need to optimize the utilization of specialized care in mental health.

Conditions that do not reach the threshold for mental disorder in Spanish psychiatric outpatients: prevalence, treatment and management

BACKGROUND

In recent years there has been controversy around the treatment demands of people who, without meeting diagnostic criteria for a mental disorder, have certain symptoms and are referred to mental health professionals.

AIMS

To determine the prevalence of individuals assessed by mental health service, referred from primary care, who do not meet the diagnosis criteria of mental disorders according to ICD-10. To analyze the medical treatment given to these individuals, measured by the indication for discharge or follow-up and by the pharmacological intervention decided in the first interview, as well as the associated variables.

DESIGN

descriptive study.

SCOPE

urban area.

POPULATION

all patients referred to the Salamanca mental health service during a year, without any exclusion (n = 1,187).

VARIABLES

sociodemographics; clinical and health service utilization gathered through clinical interview, GHQ-28, SCL-90-R and an expectations scale.

RESULTS

Of the 1,004 patients who attended interview, 24.4% (CI 95%: 21.6-27.0) did not present any diagnosable mental disorder (Z codes); they constitute the body of this study. 50.8% of these were referred from primary care with a psychotropic drug treatment already prescribed. Any drug intervention (addition, suspension or modification) was performed in 37.2% of the cases by the mental health service. Regardless of the treatment indicated, 52% were discharged after the first interview.

CONCLUSIONS

The prevalence of patients who failed to reach diagnostic criteria for a mental disorder in this health service is similar to other studies, in spite of the filter provided by primary care. Many individuals without a diagnosable mental disorder received treatment both in primary care and in the mental health service.

The making of a multicultural psychiatrist

The author grew up in Goa, a unique bicultural setting on the western coast of India. Goa came under Portuguese rule in 1510 AD and remained under the Portuguese until 1961 when it became part of India. The Indian and Portuguese cultures interacted in Goa and led the Goans to create an interesting blend in which elements of both cultures were made to reconcile. The author reviews his experiences in this setting and describes how his family background, his search for roots, and his exposure to two religions, two languages, and two cultures fostered his decision to study medicine, his passion for transcultural psychiatry, and eventual pursuit of an academic career in this field in the United States. Research and reflections are presented on the impact of colonization, migration, and acculturation, and the importance of the construct of demoralization.

[Mental health referrals of patients without diagnosable psychiatric pathology]

OBJECTIVE

To analyze the characteristics of referral from primary health care to mental health of patients with no diagnosable mental disorder.

METHODS

Consecutively and without exemptions, all persons attending for first-time consultation a mental health centre in the course of a year were clinically examined. We measured the incidence of conditions not attributable to a mental disorder using ICD-10 (Z codes). Information was collected on whose idea it was that they attended, and who, how and with what treatment they were referred. In addition, data about their social, demographic and clinical characteristics were collected.

RESULTS

Of the 1004 persons examined, 244 (24.4%) (95% CI, 21.6-27) did not meet the ICD-10 diagnosis criteria for mental disorders. They themselves or their family tended to request the Z codes (54.5%) (95% CI, 48.3-60.8]. Mental health referral was almost always through the PC doctor (95.5%) (95% CI, 92.1-97.7). Half the patients were already receiving drug therapy under their general practitioner before their visit and 20.9% (95% CI, 15.8-26) were referred as priority patients.

CONCLUSIONS

Our study found that a large number of patients with no diagnosable mental disorder at the mental health centre, many of them with drug treatment prescribed, were referred. This places a question-mark over the function of primary care as a filter for these patients. The population s indiscriminate health care demand and the steady increase in treating mental health with drugs partially explain this phenomenon.

Use of mental health resources in the treatment of adult out-patients with no diagnosable mental disorders

Comparisons of adult out-patients diagnosed with V-code conditions and those with mental disorders were conducted in a number of areas related to patient and treatment characteristics. Data were collected from three community mental health centres over a 6-year period (n = 7,220) in a semi-rural region of Nova Scotia, Canada. V-code patients represented approximately one-third of the psychiatric out-patient admission in these centres. Comparisons of the two patient groups indicated that V-code patients were of a higher socio-economic status than patients diagnosed with mental disorders. The difficulties of patients with V-code conditions appeared to be less severe than those of patients with mental disorders. However, patients with V-code conditions consumed comparable treatment resources to patients with mental disorders. Both groups of patients were evaluated by their therapists as experiencing similar levels of improvement during the course of treatment. The implications of these findings for more efficient use of resources in community mental health centres are discussed.