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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
182
PTSD in primary care-an update on evidence-based management
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: Posttraumatic stress disorder (PTSD) is common in primary care but it is frequently not detected or treated adequately. There is insufficient evidence to recommend universal screening for PTSD in primary care, but clinicians should remain alert to PTSD among patients exposed to trauma, and among those with other psychiatric disorders, irritable bowel syndrome, multiple somatic symptoms and chronic pain. A two-stage process of screening (involving the PC-PTSD), and, for those with a positive screen, a diagnostic evaluation (using the PTSD-Checklist), can detect most patients with PTSD with few false positives. Evidence-based recommendations are provided for treatment in primary care or referral to mental health.
Topic(s):
Education & Workforce
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, Healthcare Disparities
See topic collection
, Measures
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for PTSD in primary care-an update on evidence-based management
185
Randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of selective serotonin reuptake inhibitors plus supportive care, versus supportive care alone, for mild to moderate depression with somatic symptoms in primary care
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: OBJECTIVES: To determine (1) the effectiveness and cost-effectiveness of selective serotonin reuptake inhibitor (SSRI) treatment plus supportive care, versus supportive care alone, for mild to moderate depression in patients with somatic symptoms in primary care; and (2) the impact of the initial severity of depression on effectiveness and relative costs. To investigate the impact of demographic and social variables. DESIGN: The study was a parallel group, open-label, pragmatic randomised controlled trial. SETTING: The study took place in a UK primary care setting. Patients were referred by 177 GPs from 115 practices around three academic centres. PARTICIPANTS: Patients diagnosed with new episodes of depression and potentially in need of treatment. In total, 602 patients were referred to the study team, of whom 220 were randomised. INTERVENTIONS: GPs were asked to provide supportive care to all participants in follow-up consultations 2, 4, 8 and 12 weeks after the baseline assessment, to prescribe an SSRI of their choice to patients in the SSRI plus supportive care arm and to continue treatment for at least 4 months after recovery. They could switch antidepressants during treatment if necessary. They were asked to refrain from prescribing an antidepressant to those in the supportive care alone arm during the first 12 weeks but could prescribe to these patients if treatment became necessary. MAIN OUTCOME MEASURES: The primary outcome measure was Hamilton Depression Rating Scale (HDRS) score at 12-week follow-up. Secondary outcome measures were scores on HDRS at 26-week follow-up, Beck Depression Inventory, Medical Outcomes Study Short Form-36 (SF-36), Medical Interview Satisfaction Scale (MISS), modified Client Service Receipt Inventory and medical record data. RESULTS: SSRIs were received by 87% of patients in the SSRI plus supportive care arm and 20% in the supportive care alone arm. Longitudinal analyses demonstrated statistically significant differences in favour of the SSRI plus supportive care arm in terms of lower HDRS scores and higher scores on the SF-36 and MISS. Significant mean differences in HDRS score adjusted for baseline were found at both follow-up points when analysed separately but were relatively small. The numbers needed to treat for remission (to HDRS > 8) were 6 [95% confidence interval (CI) 4 to 26)] at 12 weeks and 6 (95% CI 3 to 31) at 26 weeks, and for significant improvement (HDRS reduction > or = 50%) were 7 (95% CI 4 to 83) and 5 (95% CI 3 to 13) respectively. Incremental cost-effectiveness ratios and cost-effectiveness planes suggested that adding an SSRI to supportive care was probably cost-effective. The cost-effectiveness acceptability curve for utility suggested that adding an SSRI to supportive care was cost-effective at the values of 20,000 pounds-30,000 pounds per quality-adjusted life-year. A poorer outcome on the HDRS was significantly related to greater severity at baseline, a higher physical symptom score and being unemployed. CONCLUSIONS: Treatment with an SSRI plus supportive care is more effective than supportive care alone for patients with mild to moderate depression, at least for those with symptoms persisting for 8 weeks and an HRDS score of > or = 12. The additional benefit is relatively small, and may be at least in part a placebo effect, but is probably cost-effective at the level used by the National Institute for Health and Clinical Excellence to make judgements about recommending treatments within the National Health Service. However, further research is required.
Topic(s):
Medically Unexplained Symptoms
See topic collection
186
Recent developments in the understanding and management of functional somatic symptoms in primary care
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: PURPOSE OF REVIEW: Medically unexplained or functional somatic symptoms are prevalent in primary care, but general practitioners commonly find them difficult to treat. We focus on the conceptual issues and treatment from a primary care perspective, although the field is difficult to review because of the inconsistency and multiplicity of terminology used by different authors and specialties. RECENT FINDINGS: The training of general practitioners in management techniques has been hampered by an obsolete theoretical framework and outdated diagnostic systems. Epidemiological studies, however, indicate that valid, empirically based diagnostic criteria for functional disorders may be developed. Management studies in primary care have shown disappointing effects on patient outcome, but a lot may be gained by making the training programmes more sophisticated. Recently, stepped care approaches have been introduced but they need scientific evaluation. SUMMARY: There is an immediate need for a common language and a theoretical framework of understanding of functional symptoms and disorders across medical specialties, clinically and scientifically. Any names that presuppose a mind-body dualism (such as somatization, medically unexplained) ought to be abolished. The overall ambition for treatment is to offer patients with functional somatic symptoms the same quality of professional healthcare as we offer any other patient.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Recent developments in the understanding and management of functional somatic symptoms in primary care
View DOI Record
View the PubMed citation for Recent developments in the understanding and management of functional somatic symptoms in primary care188
Religion and beliefs about treating medically unexplained symptoms: a survey of primary care physicians and psychiatrists
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: OBJECTIVE: Historical evidence and prior research suggest that psychiatry is biased against religion, and religious physicians are biased against the mental health professions. Here we examine whether religious and non-religious physicians differ in their treatment recommendations for a patient with medically unexplained symptoms. METHOD: We conducted a national survey of primary care physicians and psychiatrists. We presented a vignette of a patient with medically unexplained symptoms, and experimentally varied whether the patient was religiously observant. We asked whether physicians would recommend six interventions: antidepressant medication, in-office counseling, referral to a psychiatrist, referral to a psychologist or licensed counselor, participation in meaningful relationships and activities, and involvement in religious community. Predictors included the physician's specialty and the physician's attendance at religious services. RESULTS: The response rate was 63% (896 of 1427) primary care physicians and 64% (312 of 487) psychiatrists. We did not find evidence that religious physicians were less likely to recommend mental health resources, nor did we find evidence that psychiatrists were less likely to recommend religious involvement. Primary care physicians (but not psychiatrists) were more likely to recommend that the patient get more involved in their religious community when the patient was more religiously observant, and when the physician more frequently attended services. CONCLUSIONS: We did not find evidence that mental health professionals are biased against religion, nor that religious physicians are biased against mental health professionals. Historical tensions are potentially being replaced by collaboration.
Topic(s):
Medically Unexplained Symptoms
See topic collection
189
Rethinking the place of the psyche in health: toward the integration of health care systems
Type: Journal Article
Year: 2005
Publication Place: Australia
Abstract: OBJECTIVE: To review the value provided when health care systems independently manage medical and psychiatric care. METHOD: The authors draw on data from the world literature, their own experiences and reflections (one author as an international consultant in the coordination of physical and behavioural health care), and input from colleagues throughout the world who face similar challenges to improve outcomes for complex, high cost patients in their own health care systems. RESULTS: Most health care systems in the world approach the administration and delivery of mental health care separately from that of general medical care. This practice is no longer supported as effective, efficient or inexpensive. Rather accumulating data indicates that concurrent and coordinated medical and psychiatric care, which can only be accomplished by integrating physical and behavioural health through infrastructure change, should replace the present system of independently provided sequential care; that is, one which provides first medical and then psychiatric treatment, or vice versa, with little communication between clinicians in the two sectors. CONCLUSIONS: By making mental health treatment an integral part of general medical care through reorganization of the funding system, a higher percentage of those now untreated for their psychiatric disorders, both within and outside of the medical setting, can have their mental health needs addressed in coordination with their physical disorders. At the same time, the number of patients that can be treated within the same budget will be expanded.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Rethinking the place of the psyche in health: toward the integration of health care systems
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View the PubMed citation for Rethinking the place of the psyche in health: toward the integration of health care systems190
Role of mental health professionals in the management of functional somatic symptoms in primary care
Type: Journal Article
Year: 2012
Publication Place: England
Abstract: Functional somatic symptoms associated with persistent frequent attendance is emotionally demanding, costly and intractable to treat. Such patients are hard to engage in practice and research by mental health professionals, whose main role may be indirect training, supporting and advising primary care professionals rather than direct patient care.
Topic(s):
Education & Workforce
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Role of mental health professionals in the management of functional somatic symptoms in primary care
View DOI Record
View the PubMed citation for Role of mental health professionals in the management of functional somatic symptoms in primary care191
Sick leave and work disability in primary care patients with recent-onset multiple medically unexplained symptoms and persistent somatoform disorders: A 10-year follow-up of the FIP study
Type: Journal Article
Year: 2015
Publication Place: United States
Topic(s):
Medically Unexplained Symptoms
See topic collection
192
Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample
Type: Journal Article
Year: 2017
Publication Place: Switzerland
Topic(s):
Medically Unexplained Symptoms
See topic collection
, Opioids & Substance Use
See topic collection
193
Social work in primary care: A demonstration student unit utilizing practice research
Type: Journal Article
Year: 2000
Publication Place: UNITED STATES
Abstract: A neighborhood primary health care program serving a socially and economically oppressed community, and a graduate school of social work have collaborated to create a social work student field work unit in a primary health care setting, to demonstrate emerging and innovative social work roles in an ever-increasing managed care environment. Patients with high levels of psychosocial stress make large demands on the primary care system and consume considerable laboratory and diagnostic treatment resources. Development of social services in primary care settings is a relatively new concept, however it has been clearly demonstrated that primary care physicians need the skills of social workers to handle the psychosocial and environmental aspects of illness. The principal goal was to demonstrate social work practice in a primary care health setting, utilizing practice research approaches. Validation of effectiveness was noted, as depression, anxiety, adjustment reactions (to name a few) were decreased, resulting in fewer physician visits, less somatization and improved compliance with medical and diet/nutrition regimens. The case examples and single subject data presented provide qualitative evidence, in the context of a natural experiment, for the profession to pursue this model further in both program development and research.
Topic(s):
Education & Workforce
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Social work in primary care: A demonstration student unit utilizing practice research
View DOI Record
View the PubMed citation for Social work in primary care: A demonstration student unit utilizing practice research194
Somatic complaints in primary care: further examining the validity of the Patient Health Questionnaire (PHQ-15)
Type: Journal Article
Year: 2006
Publication Place: United States
Abstract: The authors examined the reliability and validity of the PHQ-15, a measure of current somatic complaints. An index of medically unexplained symptoms was used as a key criterion. Data were utilized from medical outpatients enrolled in a treatment study for moderate-to-severe somatization (N=172). Approximately 68% of the sample was Hispanic. Results showed that the PHQ-15 was moderately related to a history of medically unexplained symptoms among non-Hispanic participants. Results indicated ethnic differences on the validity profile of the PHQ-15 showing that the criterion variables were less predictive of the PHQ-15 among Hispanics than among non-Hispanics. Also, among the Hispanic group, the PHQ-15 was less related to medically unexplained symptoms and more to psychiatric distress. General support was provided for using the PHQ-15 with clinical samples composed of non-Hispanics. Also, the PHQ-15 appears to measure medically unexplained symptoms, psychiatric distress, and physical functioning. Further study is recommended to better evaluate ethnic variations and other types of validity for the PHQ-15.
Topic(s):
Medically Unexplained Symptoms
See topic collection
, Measures
See topic collection
Reference Links:
View the DOI record for Somatic complaints in primary care: further examining the validity of the Patient Health Questionnaire (PHQ-15)
View DOI Record
View the PubMed citation for Somatic complaints in primary care: further examining the validity of the Patient Health Questionnaire (PHQ-15)195
Somatic symptoms in primary care and psychological comorbidities in Qatar: neglected burden of disease
Type: Journal Article
Year: 2013
Publication Place: England
Abstract: Although somatic complains are the predominant reasons for seeking general medical care, there has been limited research on the clinical presentation of somatic symptoms in primary care settings in developing countries. The frequency of somatic symptoms in primary care in Qatar and its relationship to comorbidities of mental disorders is presented here. A total of 2,320 Arab patients were approached, of whom 76% agreed to participate for the survey conducted among primary healthcare (PHC) centre patients. The study was conducted with the help of general practitioners (GPs), using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ)-8 for depression, the Generalized Anxiety Disorder Scale (GAD)-7 for anxiety, PHQ-15 for somatic symptoms and the Psychological Stress Measure (PSM)-9 for stress. Of the subjects with somatic symptoms (229 cases), most were Qataris (57.2%). Poor hearing (52.1%), palpitation (47.1%) and stomach pain (43.8%) were the most common in men, whereas constipation (54.6%), feeling depressed (50.9%), and poor hearing (50.6%) were the most common in women; 48.5% had more than four somatic symptoms. Somatic symptoms were severe in 31.9%. Somatic symptoms were associated with depression (15.3%), anxiety (8.7%) and stress disorders (19.2%). The study findings revealed that somatic symptoms were significantly associated with socio-economic status. Somatic symptoms were significantly associated with depression, anxiety and stress disorders.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Somatic symptoms in primary care and psychological comorbidities in Qatar: neglected burden of disease
View DOI Record
View the PubMed citation for Somatic symptoms in primary care and psychological comorbidities in Qatar: neglected burden of disease196
Somatic symptoms in primary care: etiology and outcome
Type: Journal Article
Year: 2003
Publication Place: United States
Abstract: Although somatic complaints are the predominant reason for seeking general medical care, their etiology and prognosis remain poorly understood. In a random sample of the records of all patients visiting an urban primary care clinic during four 1-month periods, 289 patients had one or more somatic symptoms, a total of 433 symptoms. Using explicit criteria, physician raters classified nearly half (48%) of the symptoms as either psychiatric or idiopathic in etiology. Reviewing follow-up notes for 12 months after the index visit, raters found that at least one-fourth of the symptoms persisted. Independent predictors of symptom persistence were prior visits for the same symptom, symptom type (i.e., headache or back pain), male gender, and greater medical comorbidity (i.e., seven or more medical diagnoses). Developing better management strategies for prevalent, medically unexplained, persistent somatic symptoms is a health care priority.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Somatic symptoms in primary care: etiology and outcome
199
Somatization among older primary care attenders
Type: Journal Article
Year: 2003
Publication Place: England
Abstract: BACKGROUND: The importance of somatization among older primary care attenders is unclear. We aimed to establish the prevalence, persistence and associations of somatization among older primary care attenders, and the associations of frequent attendance. METHOD: One hundred and forty primary care attenders over 65 years were rated twice, 10 months apart, on measures of somatization, psychiatric status, physical health and attendance. RESULTS: The syndrome of GMS hypochondriacal neurosis had a prevalence of 5% but was transient. Somatized symptoms and attributions were persistent and associated with depression, physical illness and perceived poor social support. Frequent attenders (top third) had higher rates of depression, physical illness and somatic symptoms, and lower perceived support. CONCLUSION: Somatization is common among older primary care attenders and has similar correlates to younger primary care somatizers. Psychological distress among older primary care attenders is associated with frequent attendance. Improved recognition should result in benefits to patients and services.
Topic(s):
Healthcare Disparities
See topic collection
, Medically Unexplained Symptoms
See topic collection