ABSTRACT
Serious problems persist in the recognition and treatment of psychiatric problems in primary care despite multiple interventions directed at correcting these problems. Improved outcomes depend on improved recognition, and screening instruments need to be streamlined tremendously to be accepted by primary care providers. Publication of guidelines and physician education, although essential for improved care, are probably insufficient to implement guidelines-based care. Improvements in psychiatric outcome appear to depend on the level of intensity of the intervention employed. Continued research is needed to determine the most effective type of educational intervention and more widely applicable quality improvement processes. Broad-based changes in health service delivery focusing on the true integration of mental health services with general medical care are required to bring about meaningful, effective change. Ongoing changes in physician training programs (combined primary care/psychiatry programs) may facilitate implementation of guideline-based psychiatric care in medical settings, but the full impact of these changes is not likely to be felt for several years.
Subject(s)
Delivery of Health Care, Integrated/organization & administration , Internal Medicine/standards , Mental Health Services/organization & administration , Primary Health Care/standards , Psychiatry/organization & administration , Ambulatory Care/organization & administration , Community-Institutional Relations , Cooperative Behavior , Evidence-Based Medicine , Humans , Mass Screening/methods , Mental Health Services/standards , Models, Organizational , Needs Assessment , Organizational Innovation , Practice Guidelines as Topic , Psychiatric Status Rating Scales , Total Quality Management/organization & administration , United StatesABSTRACT
The advances made in the 1980s and 1990s have yielded many advances in the diagnosis and treatment of depression and dysthymia. Skill of the clinician is important in sorting out the diagnosis, taking care to consider the various medical conditions that can cause depression or disguise themselves as depression. Depressive disorders are highly treatable conditions. Clinicians must overcome the stigma associated with these disorders to alleviate the pain and suffering of those afflicted. The advances in treatment have been enormous and continue to grow. The keys to these treatments lie in continuing to acquire the knowledge to unlock all of the causes of depression. An appendix follows listing medications commonly used in the treatment of depression or for other conditions in patients under treatment for depression.
Subject(s)
Depressive Disorder/diagnosis , Depressive Disorder/therapy , Dysthymic Disorder/diagnosis , Dysthymic Disorder/therapy , Primary Health Care/methods , Adult , Aged , Antidepressive Agents/classification , Antidepressive Agents/therapeutic use , Brain Chemistry , Child , Combined Modality Therapy , Comorbidity , Depressive Disorder/complications , Depressive Disorder/epidemiology , Diagnosis, Differential , Dysthymic Disorder/complications , Dysthymic Disorder/epidemiology , Electroconvulsive Therapy , Female , Humans , Male , Neurobiology , Pregnancy , Psychotherapy , Referral and Consultation , Research , Risk Factors , Suicide/statistics & numerical dataSubject(s)
Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Psychomotor Agitation/drug therapy , Acute Disease , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Benzodiazepines/administration & dosage , Benzodiazepines/adverse effects , Drug Combinations , Humans , Psychomotor Agitation/complicationsABSTRACT
This paper presents the results of a retrospective study that examines the association of cancer with a history of asthma, hay fever, hives, and other allergy-related diseases. This study is based on interview data collected from 13,665 cancer cases and 4,079 nonneoplastic controls who were admitted to Roswell Park Memorial Institute from 1957 to 1965. Although there is a general tendency for the age- and cigarette smoking-adjusted odds ratios associated with a history of asthma and hay fever to be less than 1, for both males and females, there is stronger evidence for a decreased risk of cancer associated with a history of hives and other allergy-related diseases. Decreased risks associated with a history of hives and other allergies are seen in males for oral cancer, cancers of the lung, larynx, digestive system, urinary system, and cancers of all sites combined and in females for cancers of the digestive system, reproductive system, in particular, cancer of the cervix, and cancers of all sites combined. None of the few odds ratios over 1 associated with a history of any allergy-related condition are statistically significant (alpha = 0.05). These findings suggest that individuals with allergy-related disorders may be at decreased risk of cancer, although reasons for cautious interpretation of the findings are emphasized. Prospective studies of carefully defined allergic disease cohorts are needed.
