Australian Family Physician April 2007 - Mental health
Vol 36, (4) 193-288
The theme for the April issue of AFP
is mental health. This month's articles include managing mental health
issues in general practice, adjusting to illness and other major life
events, managing anxious patients, depression and anxiety, using problem
solving therapy in general practice, somatising disorders, bipolar
disorder, refugee health, benzodiazepine prescribing, and a GP work plan
for pandemic flu.
Crises and meaning
Simon Cowap
However much we stress prevention and health
promotion, all general practitioners occasionally diagnose unexpected cases of life threatening illness. We also bear witness to many health and personal
crises in the lives of our patients and their families.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Mental health in general practice
Janice Charles, Helena Britt, Salma Fahridin, Graeme Miller
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of
consultations involving the management of psychological problems. In a separate analysis we also examine the
prescribing/provision of antidepressants. This synopsis provides a backdrop against which articles in this issue of Australian Family Physician can be further considered.
Managing mental health issues in general practice
Caroline Johnson
The Australian Federal Government has invested in initiatives aimed at enhancing the general practitioner's role in mental health care. Potential benefits for general practice include better remuneration for longer consultations and improved access to support from other mental health care professionals.
Adjusting to illness and other major life events - How can GPs help?
David M Clarke, Louise Stone
General practitioners often see patients who are struggling with a change in their life circumstances. When this change
involves illness, the GP is well placed to provide support and practical assistance. However, research in this area has tended to concentrate on the patient who is overwhelmed and unable to cope, focusing on the negative consequences of anxiety and depression.
Managing anxious patients - Cognitive behaviour therapy in general practice
Sarah Edelman, Grant Blashki
It is well established that some individuals have an inherent disposition toward experiencing anxiety more readily than others. These individuals are prone to high levels of autonomic arousal, exaggerated threat perception and dysfunctional coping strategies. In general practice these patients present frequently with a broad range of physical and psychological concerns that are often time consuming and challenging for general practitioners to assess and manage.
Depression and anxiety - Pharmacological treatment in general practice
Steven Ellen, Rob Selzer, Trevor Norman, Grant Blashki
Depression and anxiety are common presentations in general practice and medications are one of the key treatment strategies.
Using problem solving therapy in general practice
David Pierce, Jane Gunn
In Australia, mild and moderate depression is predominantly treated by general practitioners. Many of these patients
prefer a nondrug therapeutic approach. Problem solving therapy (PST) is an evidence based psychological treatment
that can be provided to such patients by GPs.
Somatising disorders - Untangling the pathology
Louise Stone, David M Clarke
Somatising disorders are a common, complex and disabling cluster of disorders. Research suggests that general practitioners find this group of patients challenging. The disorders are complicated by the fact that doctors play a role in both their aetiology and maintenance. The interaction between the illness worry of the patient and the disease worry of the doctor can lead to escalating disability and the risk of iatrogenic disease.
Bipolar disorder - Assessment and management
Gordon Parker
General practitioners are increasingly aware of the bipolar disorders and of being required to adopt a management role.
Benzodiazepine prescribing - Lessons from interprofessional dialogue
Caroline Johnson, Bev Baxter, Rodger Brough, John Buchanan
The prescribing of benzodiazepines in the general practice setting raises many issues for general practitioners. In the latter part of 2005, GP members of The Royal Australian College of General Practitioners Victoria Faculty Drug and Alcohol Sub-Committee and GP-Psychiatry Liaison Sub-Committee met with representatives of the Royal Australian
and New Zealand College of psychiatrists and the Pharmacy Guild to discuss these challenges from their different perspectives.
Complementary therapies in mental health care
Michelle Woolhouse
Mental illness is a common and often complicated condition that general practitioners deal with on a daily basis. Despite its complex nature, treating mental illness can be very rewarding. The mainstay of conventional treatment is pharmaceutical medications and psychotherapy; however, some people suffer with recalcitrant disease or significant side effects from pharmacotherapy.
Asymptomatic schistosomiasis in a young Sudanese refugee
Jill Benson
In 2004-2005, approximately 13 000 refugees settled in Australia, 70% of them from Africa. Schistosomiasis is one of the many illnesses endemic in Africa and approximately 40% of refugees have been found to be infected by this parasite. It has the potential to cause serious morbidity and mortality in those who are infected and after malaria is the second most prevalent tropical disease worldwide.
Nutrition and growth in kidney disease - CARI guidelines
David Voss, Elisabeth Hodson, Charles Crompton
The Caring for Australasians with Renal Impairment (CARI) guidelines initiative is an Australia/New Zealand evidence based project that aims to provide high quality, evidence based clinical practice guidelines for the management of all stages of kidney disease. This article summarises CARI guidelines on Nutrition and growth in kidney disease and forms part of a series of articles on aspects of management of patients with chronic kidney disease.
Arc welding and the risk of cancer
Anthony Dixon
Mrs LF, 71 years of age, presents with numerous squamous cell carcinomas (SCCs) on her hands. She comments that she had 'perfect' hands until recent years and had never been an 'outdoors person'. On questioning her about trauma or exposure to her hands she commented that she had frequently experienced 'sunburn' on her hands after assisting her son with his welding business.
A GP work plan for pandemic flu
Jonathan Anderson
The possibility of an influenza pandemic is real - and while it is impossible to predict when such a pandemic might occur, general practitioners must be prepared.
Clinical challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online.
Book review
The book reviewed this month is General Practice Psychiatry, edited by Grant Blashki, Fiona Judd and Leon Piterman.
An incorrect diagnosis of psychosis?
Sara Bird
This article examines a recent claim in which a patient alleged his general practitioner had incorrectly diagnosed him as suffering from psychosis. The GP had prescribed Melleril, which was complicated by the development of pancytopaenia.
GPs' attitudes toward complementary medicine
Vicki Kotsirilos
The National Center for Complementary and
Alternative Medicine (NCCAM) define complementary and alternative medicine as a group of 'diverse medical and health care systems, practices, and
products that are not presently considered to be part of conventional medicine', as defined by our medical peers.
Systems and complexity thinking in general practice - Part 2 - application in primary care research
Joachim P Sturmberg
Systems organise themselves upward toward larger wholes, and downward toward ever smaller parts. The upward view describes holism or emergence (complexity science view), the downward view reductionism or analysis (Newtonian science view).
Stress management groups in general practice - A pilot randomised trial
Helen Malcolm
Stress management delivered to groups of psychologically stressed patients effectively decreases their distress. This study investigated the effects of stress management delivered by Australian general practitioners.
Multidisciplinary care plans for diabetic patients - What do they contain?
Sanjyot Vagholkar, Oshana Hermiz, Nicholas A Zwar, Timothy Shortus, Elizabeth J Comino, Mark Harris
The Enhanced Primary Care package, introduced in 1999, included an item number for multidisciplinary care plans. There has been little research into what is contained in care plans. This study investigated what general practitioners documented in care plans for their diabetic patients.
Breastfeeding and the responsibilities of GPs - A qualitative study of general practice registrars
Wendy Brodribb, Claire Jackson, Anthony B Fallon, Desley Hegney
The most recent National Health Survey reports that more than 80% of women initiate breastfeeding, while recent studies describe initiation rates of more than 90%. Yet fewer than 50% of women continue to breastfeed for 6 months or longer. This is at odds with National Health and Medical Research Council recommendations that 80% of infants be exclusively breastfed for the first 6 months of life.
Organisational capacity and chronic disease care - An Australian general practice perspective
Judith Proudfoot, Fernando Infante, Christine Holton, Gawaine Powell-Davies, Tanya Bubner, Justin Beilby, Mark Harris
Although we are rapidly improving our understanding of how to manage patients with chronic illness in Australian general practice, many patients are still receiving suboptimal care.