Approach to risk identification in undifferentiated mental disorders.

OBJECTIVE: To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders. SOURCES OF INFORMATION: We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology. MAIN MESSAGE: Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders. CONCLUSION: A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients' immediate needs while continuing the search for diagnostic clarity and long-term treatment.

Évaluer les risques dans le cas de troubles mentaux indifférenciés.

OBJECTIF: Proposer aux médecins de soins primaires une approche novatrice pour la détermination des risques et la prise de décisions cliniques connexes dans la prise en charge de troubles mentaux indifférenciés. SOURCES DE L'INFORMATION: Nous avons procédé à une recherche documentaire dans PubMed, CINAHL, PsycINFO et Google Scholar à l'aide des expressions de recherche suivantes, en anglais : diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control et violence/psychology. MESSAGE PRINCIPAL: Les troubles mentaux constituent une grande part de la pratique en soins primaires; ils se présentent souvent de manière indifférenciée et ce, pendant de longues périodes. La difficile quête d'un diagnostic peut détourner l'attention de la détermination des risques, parce que nous présumons souvent qu'il faut un diagnostic avant d'amorcer un traitement. Cette situation peut avoir contribué par inadvertance à des événements indésirables. Il faudrait en priorité se concentrer sur les points saillants relatifs aux risques que présente le patient. Cet article propose une approche novatrice pour organiser les renseignements sur le patient afin d'aider à la détermination des risques et à la prise de décisions relativement à la prise en charge des patients souffrant de troubles mentaux indifférenciés. CONCLUSION: Une approche structurée peut aider les médecins à gérer l'incertitude clinique fréquente dans la détermination des risques chez des patients souffrant de troubles mentaux, et à composer avec l'anxiété et les biais cognitifs courants qui influencent la prise de décisions en matière de risques. En se concentrant sur les risques, les déficiences fonctionnelles et les symptômes connexes à l'aide d'un cadre novateur, les médecins peuvent répondre aux besoins immédiats de leurs patients tout en continuant à rechercher un diagnostic précis et à établir un traitement à long terme.

A novel network for mentoring family physicians on mental health issues using E-mail.

OBJECTIVE: Family practitioners are significant providers of mental health care and routinely report difficulty acquiring timely support in this area. The Collaborative Mental Health Care Network assembled groups of family practitioners and provided them with mental health practitioner mentors. This article addresses communication in the Network, its effect on family practitioners, and the role e-mail plays. METHODS: This descriptive study utilizes two sources of data: a quality assurance survey administered to family practitioners in the Network and a sampling of e-mail correspondence between family practitioners and mental health and addiction mentors, examined qualitatively. RESULTS: Family practitioners in the Network requested consultation on pharmacotherapy (53%), psychotherapy (34%), treatment review (27%), and diagnosis (24%). Satisfaction with the Network was high, with 88% of family practitioners reporting an improvement in ability to provide mental health care. E-mail analysis suggests that mentors convey information directly and indirectly and that a knowledge hierarchy, but not a power hierarchy, develops. The trusted relationship between the mentee and mentor is an important context for effective education. CONCLUSION: This model of mentoring is highly satisfactory to family practitioners and correlates with increased confidence in caring for patients with mental health issues. E-mail is a promising strategy for effective feedback and support between family practitioners and specialists.

Shared mental health care. Model for supporting and mentoring family physicians.

PROBLEM BEING ADDRESSED: Family physicians lack access to psychiatrists and mental health services for patients with serious and persistent mental illnesses. OBJECTIVE OF PROGRAM: To develop a mentoring program to provide FPs with education and e-mail, telephone, and face-to-face support for managing patients with mental illness. PROGRAM DESCRIPTION: The Ontario College of Family Physicians' Collaborative Mental Health Care Network developed a mentoring program. Family physicians are grouped according to clinical interest with psychiatrist and general practice psychotherapist mentors whom they can contact for help. Communication is established via e-mail, telephone, fax, or listserv, or even face to face. Monitoring and evaluation is carried out through surveys and chart audits to examine use of, satisfaction with, and effectiveness of the program. CONCLUSION: Mental health care can be enhanced through collaborative at-a-distance relationships between FPs and psychotherapists and psychiatrists. Family physicians can get timely consultation in the areas of psychotherapy and pharmacotherapy, and access to community resources.