Evaluation of knowledge and attitudes among primary care physicians in Cavan-Monaghan as 'gatekeepers-in-waiting' for the introduction of Carepath for Overcoming Psychosis Early (COPE).

AIM: To investigate general practitioners' current knowledge of and attitudes towards psychosis and its management by Cavan-Monaghan Mental Health Service, Ireland, prior to their involvement in the introduction of an early intervention service. METHODS: As part of a continuing medical education programme for psychosis, delivered to all 32 general practitioners practising in this region, participants were asked to complete a 29-item questionnaire designed to assess their baseline knowledge and attitudes. RESULTS: All 32 general practitioners participated in the study. Although 17% had received no previous psychiatric training, 93% described their knowledge of psychiatric disorders as average or above average. However, only 53% could correctly identify all of a set of psychiatric symptoms related to psychosis. Only 50% felt comfortable initiating treatment for psychotic symptoms. Whereas only 40% had heard of the early intervention model, 89% believed it to be advantageous. Easy accessibility to services and rapid assessment of patients referred were most commonly reported as helpful. However, concerns were expressed about the potential for associated increases in workload. CONCLUSIONS: As 'gatekeepers-in-waiting', these general practitioners will have a vital role in effective implementation of the early intervention service for psychosis. However, their knowledge needs improvement, through regular educational sessions, and this service must be responsive to their needs. In addition, general practitioners' concerns regarding the potential for increased workload must be adequately addressed in order to maintain enthusiasm and collaboration at the interface between primary care and mental health services, particularly in the context of early intervention.

The prevalence and manifestations of hereditary hemorrhagic telangiectasia in the Afro-Caribbean population of the Netherlands Antilles: a family screening.

Hereditary hemorrhagic telangiectasia (HHT) has been reported rarely in people of African descent. The prevalence in the Afro-Caribbean population of the Netherlands Antilles is suspected to be high. A family screening in this population was done to arrive at a point prevalence and to identify patients with pulmonary involvement. By clinical history and physical examination, 219 persons over age twelve with a first-degree relative with HHT were screened. The diagnosis was based on the new diagnostic criteria [Shovlin et al., 2000]. Chest-roentgenogram and pulse-oximetry or measurement of arterial oxygen pressure were used to detect pulmonary involvement. HHT was diagnosed in 112 individuals (51%), with at least a point prevalence of 1 in 1,331 inhabitants of Curaçao and Bonaire older than twelve years. The diagnosis was uncertain in 27; this was partly due to the new stringent criteria. Epistaxis was present in 98% and telangiectases in 99%. Facial telangiectases were relatively rare due to pigmented skin. Pulmonary involvement was found in 28% with serious-mainly neurological-complications in 48%. The point-prevalence of HHT in the Afro-Caribbean population of the Netherlands Antilles is the highest known in the world. Pulmonary involvement in this population is not rare and causes serious complications.