Treatment Options for Patients with Chronic Mental Disorders in Primary Care

DOI: 10.3238/zfa.2016.0121-0127

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Jochen Gensichen, Ulrich Schwantes, Michael Linden, Beate Muschalla, Ulrich Keßler

Keywords: Primary Care Family Medicine Quality Assurance Chronic Mental Disorders Rehabilitation

Background: Longterm medical care for mental disorders needs the participation of primary care physicians. This study investigates how such patients are treated in primary care and what can be improved.

Methods: In the waiting rooms of 40 family physicians patients with chronic mental disorders and restrictions in participation were identified. Out of these, 307 patients, aged 18 to 60 years, were intensively investigated by a research physician.

Results: 29:7 % of patients were suffering from longterm and disabling mental disorders (47% depression, 32 % adjustment disorders, 25 % agoraphobia, 19 % panic disorder, 8% substance abuse). 77.2 % were longer than a year in contact with their family physician, 28.8 % were on sick leave. Family physicians applied a variety of diagnostic and therapeutic measures like exclusion of somatic illnesses, pharmacotherapy or psychotherapeutic counseling. In cooperation with others they have initiated specialist psychotherapy (73.9 %), psychiatric care (57 %), or inpatient rehabilitation treatment (41.4 %). They also give social support to their patients. The research physician recommended only limited additional measures like leisure activities (42.0 %), or renewed specialist psychotherapy (37.5 %), or rehabilitation treatment (15.3 %).

Conclusions: Chronic mental disorders with restrictions in participation are frequent in primary care and in need of a comprehensive bio-psycho-social treatment or rehabilitation treatment. Family practitioners do what can be done.

(State: 16.03.2016)

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