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The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
261 Results
121
Major depression in primary care: making the diagnosis
Type: Journal Article
Year: 2016
Publication Place: Singapore
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Major depression in primary care: making the diagnosis
122
Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review
Type: Journal Article
Year: 2019
Publication Place: England
Abstract: Background: Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. Objectives: The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. Methods: A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. Results: Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. Conclusions: Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review
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View the PubMed citation for Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review126
Medically unexplained physical symptoms in primary care: a controlled study on the effectiveness of cognitive-behavioral treatment by the family physician
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: BACKGROUND: Disabling medically unexplained physical symptoms occur in 16% of all patients in primary care. OBJECTIVE: The aim of this study was to assess the effectiveness of a cognitive-behavioral intervention by the family physician. METHOD: In a controlled design with detailed information on patient selection, 6,409 patients were screened on somatoform disorder, and 65 participants were allocated to care-as-usual or the experimental condition. RESULTS: After 6 and 12 months, the cognitive-behavioral intervention by trained family physicians was not more effective than care-as-usual. CONCLUSION: Possibly, the intensity of treatment was insufficient for the severe and persistent symptoms that were encountered in primary care.
Topic(s):
Medically Unexplained Symptoms
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127
Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care
Type: Journal Article
Year: 2004
Publication Place: England
Abstract: OBJECTIVE: The aim of this study was to estimate the number of patients with medically unexplained physical symptoms (MUPS) that could be eligible for group cognitive-behavioural treatment (CBT) and to assess the acceptability of this treatment. METHODS: For 3 months, all consultations of one general practitioner (GP) were screened for MUPS. Patients with MUPS who were considered eligible for group CBT were interviewed and offered treatment. RESULTS: From January to March 1999, 1084 consultations of 796 patients were screened. The GP classified the symptoms of 104 patients aged 25-79 as unexplained. Of these, 71 patients were not considered to be eligible for treatment, mainly due to a psychological attribution of the symptoms. The research interview was offered to 33 patients, 16 of them declined and 12 were interviewed. Seven out of the 12 eligible patients accepted treatment. CONCLUSION: In primary care, 18% of patients aged 25-79 years was estimated to have MUPS. For only a minority of these patients, group CBT was considered suitable and acceptable.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care
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View the PubMed citation for Medically unexplained physical symptoms: the feasibility of group cognitive-behavioural therapy in primary care130
Medically unexplained symptoms in family medicine: defining a research agenda. Proceedings from WONCA 2007
Type: Journal Article
Year: 2008
Publication Place: England
Abstract: BACKGROUND: Medically unexplained symptoms (MUSs) are frequently presented in primary care. Unfortunately, knowledge of these patients and/or symptoms in primary care is still limited. Available research comes mainly from Europe and North America, while the perspectives of cultures such as Africa, Asia and South America are relatively unknown. To bring cultural perspectives together, a symposium and workshop on MUS in primary care was held at the WONCA World Conference 2007 in Singapore. OBJECTIVE: Main goals of this symposium and workshop-apart from presenting ongoing research and bringing together experts in MUS-were to detect knowledge gaps in MUS and to establish priorities in MUS research. This publication focuses on the proposed research agenda. METHODS: Using a nominal group technique, we generated research topics and set priorities. Research topics were grouped into research themes. RESULTS: Participants' (66 researchers and GPs from 29 nationalities) most important research topics were 'formulating a broadly accepted definition of MUS', 'finding a strategy to recognize MUS better and at an earlier stage', 'studying the value of self-management and empowerment in patients with MUS' and 'finding predictors to decide which strategy will best help the individual patient with MUS'. Priorities in research themes of MUS are as follows: (i) therapeutic options for patients with MUS and (ii) problems in consultations with these patients. CONCLUSIONS: More research on MUS in primary care is needed to improve the consultations with and management of these patients. Internationally primary care conferences are excellent for exchanging ideas and formulating central issues of research.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Medically unexplained symptoms in family medicine: defining a research agenda. Proceedings from WONCA 2007
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View the PubMed citation for Medically unexplained symptoms in family medicine: defining a research agenda. Proceedings from WONCA 2007131
Medically unexplained symptoms: perceptions of physicians in primary health care
Type: Journal Article
Year: 2004
Publication Place: England
Abstract: BACKGROUND: Patients presenting with multiple symptoms represent a substantial part of a GP's total work load. At the same time, these patients account for the majority of the people on long-term sick-leave in Sweden today. OBJECTIVE: The aim of this study was to explore GPs' perceptions and ways of managing patients with medically unexplained symptoms (MUS). METHODS: Five focus group discussions were conducted with a total of 27 GPs. In the collection and analysis of data, a phenomenographic approach was used. RESULTS: The GPs described how they used four different approaches to manage patients with MUS: a biomedical, a psychological, an educational and a psychosocial approach. Different approaches were used, depending on the patient and the situation, and the GPs even switched approach when working with the same patient. CONCLUSIONS: In their work with patients with MUS, GPs need support and further training to improve the way the biomedical frame of reference is integrated with the humanistic perspective.
Topic(s):
Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Medically unexplained symptoms: perceptions of physicians in primary health care
132
Medically unexplained symptoms: the need for effective communication and an integrated care strategy
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: Much is already known about medically unexplained symptoms (MUS) in terms of incidence, presentation and current treatment. What needs to be urgently addressed is a strategy for dealing with patients and their conditions, particularly when they do not fall neatly into medical frameworks or pathologies where the syndrome can be easily explained. This article will consider the provision of health and social care support for patients with MUS within an interprofessional education context. The author will contend that a sensitive and valued service for this large client group is dependent upon services without professional boundaries and practitioners with a clinical interest that can work together and agree an appropriate way forward in terms of care, support and strategic service provision. The article will support the idea that clear guidelines through the National Institute for Health and Care Excellence can offer clear clinical direction for practitioners working in primary and secondary care settings to work together interprofessionally to ensure a seamless and sensitive service for people with this condition.
Topic(s):
Education & Workforce
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, Medically Unexplained Symptoms
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Reference Links: View the PubMed citation for Medically unexplained symptoms: the need for effective communication and an integrated care strategy
133
Mental disorders among frequent attenders in primary care: a comparison with routine attenders
Type: Journal Article
Year: 2011
Publication Place: United States
Abstract: Frequent attenders account for a large proportion of primary care (PC) contacts, referrals, and prescriptions. Psychosocial and emotional distress is related to the high use of health services. Few studies have focused on the association between mental disorders assessed using structured interviews and frequent use of PC services.The aim of this study was to determine the factors associated with frequent attendance at primary healthcare units, focusing specifically on mental disorders. A two-phase screening epidemiological study comparing frequent attenders and routine attenders in five primary health care units was designed. Three hundred eighteen frequent attenders and 203 patients who attended the same units on a routine basis were compared. Sociodemographic and clinical data were obtained from statistical records and medical charts. Patients with a total score equal or higher than 7 points on the General Health Questionnaire-28 (GHQ-28) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. All the scores obtained on the GHQ were statistically different in the two populations. Frequency of mental disorders also differed significantly between both groups, with somatoform and affective disorders being the most prevalent ICD-10 categories among frequent attenders. The presence of depressive disorders and somatoform disorders is the most powerful predictive factor for frequent attendance. High comorbidity was found among frequent attenders with somatoform disorder. Frequent attendance at primary healthcare units is associated with depressive and somatoform disorders. Psychiatric comorbidity could be a confounder, particularly because affective and somatoform disorders often overlap in PC patients.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Mental disorders among frequent attenders in primary care: a comparison with routine attenders
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View the PubMed citation for Mental disorders among frequent attenders in primary care: a comparison with routine attenders134
Mental disorders in primary care in Israel: prevalence and risk factors
Type: Journal Article
Year: 2013
Abstract: OBJECTIVE: Psychiatric morbidity is common among patients in primary care services and leads to disability and increased use of medical services. Comparison of primary care and community prevalence data is of interest in relation to the health services planning for mental disorders. The aim of the present study was to measure prevalence of mental disorders in six primary care clinics in Israel and to assess risk factors for these disorders. METHOD: Prevalence of mental disorders was measured in a sample of 2,948 primary care consecutive attendees, using two-stage stratified sampling with the General Health Questionnaire 12 (GHQ-12) and the Composite International Diagnostic Interview (CIDI). RESULTS: A high rate (46.3 %) of current mental disorders was found, with rates of current depressive episode, generalized anxiety disorder, somatization disorder, and neurasthenia being relatively high in comparison with rates in other countries. Low education was a risk factor for all categories of disorders, unemployment a risk factor for depressive disorders, and parenthood was protective for most categories of disorders. CONCLUSIONS: High rates of mental disorders were found in this Israeli primary care sample as compared to other countries, while in the community the rates were midrange as compared to other countries, pointing to a relatively higher use of primary care services by patients with mental disorders in Israel than in other countries.
Topic(s):
Healthcare Disparities
See topic collection
, Medically Unexplained Symptoms
See topic collection
View the PubMed citation for Mental disorders in primary care in Israel: prevalence and risk factors
Reference Links:
View the DOI record for Mental disorders in primary care in Israel: prevalence and risk factors
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View the PubMed citation for Mental disorders in primary care in Israel: prevalence and risk factors135
Mental illness and health care use: a study among new neurological patients
Type: Journal Article
Year: 2005
Publication Place: Netherlands: Elsevier Science
Topic(s):
Financing & Sustainability
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, Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Mental illness and health care use: a study among new neurological patients
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View the PubMed citation for Mental illness and health care use: a study among new neurological patients136
Mestizo spirituality: toward an integrated approach to psychotherapy for Latina/OS
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
Healthcare Disparities
See topic collection
, Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Mestizo spirituality: toward an integrated approach to psychotherapy for Latina/OS
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View the PubMed citation for Mestizo spirituality: toward an integrated approach to psychotherapy for Latina/OS138
Models of care for co-occurring mental and medical disorders
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: In this article we review practice models for treating common mental disorders in primary care. Novel treatment approaches by primary care providers and specialty providers, including collaborative care and telepsychiatric models, show considerable promise. An understanding of remaining barriers to improved care suggests several possible solutions and future directions for outpatient psychosomatic medicine.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Models of care for co-occurring mental and medical disorders
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View the PubMed citation for Models of care for co-occurring mental and medical disorders139
Moving towards a population health approach to the primary prevention of common mental disorders
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: There is a need for the development of effective universal preventive approaches to the common mental disorders, depression and anxiety, at a population level. Poor diet, physical inactivity and smoking have long been recognized as key contributors to the high prevalence noncommunicable diseases. However, there are now an increasing number of studies suggesting that the same modifiable lifestyle behaviors are also risk factors for common mental disorders. In this paper we point to the emerging data regarding lifestyle risk factors for common mental disorders, with a particular focus on and critique of the newest evidence regarding diet quality. On the basis of this most recent evidence, we consequently argue for the inclusion of depression and anxiety in the ranks of the high prevalence noncommunicable diseases influenced by habitual lifestyle practices. We believe that it is both feasible and timely to begin to develop effective, sustainable, population-level prevention initiatives for the common mental illnesses that build on the established and developing approaches to the noncommunicable somatic diseases.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Moving towards a population health approach to the primary prevention of common mental disorders
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View the PubMed citation for Moving towards a population health approach to the primary prevention of common mental disorders140
Multiple medically unexplained physical symptoms and health care utilization: outcome of psychological intervention and patient-related predictors of change
Type: Journal Article
Year: 2004
Publication Place: England
Abstract: OBJECTIVES: To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. METHODS: In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. RESULTS: ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. CONCLUSION: Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.
Topic(s):
Healthcare Disparities
See topic collection
, Medically Unexplained Symptoms
See topic collection