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. 2016 Aug-Sep;48(7):449-57.
doi: 10.1016/j.aprim.2015.09.009. Epub 2016 Jan 14.

[Ability to detect psychiatric disorders by the family physician]

[Article in Spanish]
Sofía Garrido-Elustondo  1 , Blanca Reneses  2 , Aida Navalón  3 , Olga Martín  3 , Isabel Ramos  3 , Manuel Fuentes  4
Affiliations

[Ability to detect psychiatric disorders by the family physician]

[Article in Spanish]
Sofía Garrido-Elustondo et al. Aten Primaria. 2016 Aug-Sep.

Abstract
in English, Spanish

Objective: To determine the ability of family physicians to detect psychiatric disorders, comparing the presence of psychiatric disorders detected using validated tests and referrals by family physicians.

Design: Cross-sectional, two-phase study.

Location: Primary healthcare centres in an urban area of Madrid.

Participants: Patients between 18 and 65years attending primary healthcare centres for non-administrative purposes.

Main measurements: To detect psychiatric disorders in the waiting room, an interview was performed using GHQ-28 and MULTICAGE CAD-4 in the screening phase (considered positive: score of 6 or higher on the GHQ-28 or a score 2 or higher on MULTICAGE CAD-4). Patients with a positive score and 20% with negative were recruited for the second phase (case identification) using MINI interview. During family physician consultation, the patient gave his doctor a card with an identification number to record the presence of psychiatric illness in his/her opinion and whether there was treatment with psychotropic drugs.

Results: A total of 628 subjects participated. The prevalence of psychiatric disorders corrected by two phase methodology was 31.7% (95%CI: 27.9 to 35.5). Of the 185 patients with a psychiatric disorder detected, 44.2% (95%CI: 36.7 to 51.7) were identified as patients with psychiatric disorders by their family physician. Disorders best detected were: hypomania, dysthymic disorder, depressive episode with melancholic symptoms, and panic disorder.

Conclusions: A significant percentage of patients with possible psychiatric disorders detected with validated test have not been identified by their family physician.

Objetivo: Conocer la capacidad de detección de patología psiquiátrica por el médico de familia, comparando la presencia de patología psiquiátrica detectada mediante test validados y la referida por su médico de familia.

Diseño: Estudio transversal de doble fase.

Emplazamiento: Centros de Salud de un área urbana de Madrid.

Participantes: Pacientes entre 18 y 65 años que acuden a consulta por motivos no administrativos.

Mediciones principales: Para la detección de posible patología psiquiátrica, en la sala de espera se utilizaron instrumentos de cribado, el GHQ-28 (punto de corte 6 o superior) y el MULTICAGE CAD-4 (punto de corte 2 o superior). Como instrumento de identificación de «caso» en la segunda fase se utilizó la entrevista MINI en los pacientes con puntuación positiva en uno de los instrumentos de cribado y un 20% de los negativos. Por otro lado, cuando los pacientes entraban en la consulta entregaban a su médico una tarjeta con un número de identificación para que, de manera ciega, registrase: presencia de patología psiquiátrica actual según su criterio y existencia, o no, de tratamiento actual con psicofármacos.

Resultados: Participaron 628 sujetos. La prevalencia de patología psiquiátrica corregida por metodología de doble fase fue del 31,7% (IC 95%: 27,9-35,5). De 185 pacientes con patología psiquiátrica detectada, el 44,2% (IC 95%: 36,7-51,7) fueron identificados como pacientes con patología psiquiátrica por su médico de familia. Las patologías mejor identificadas fueron: hipomanía, trastorno distímico, episodio depresivo con síntomas melancólicos y trastorno por angustia.

Conclusiones: Un porcentaje importante de pacientes con patología psiquiátrica detectada con test validados no han sido identificados por su médico de familia.

Keywords: Atención primaria; Habilidad diagnóstica; Patología psiquiátrica; Primary care; Psychiatric disorder; Recognition.

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Figures

Figura 1
Figura 1
Distribución de frecuencias de la patología detectada en los pacientes mediante la entrevista MINI (n = 628).
See this image and copyright information in PMC

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