A Study of the Use of Antidepressant Medication in General Practice

1974 ◽  
Vol 125 (585) ◽  
pp. 186-192 ◽  
Author(s):  
D. A. W. Johnson
Keyword(s):  
General Practice ◽  
Psychiatric Disorders ◽  
General Practitioners ◽  
Present Author ◽  
Antidepressant Medication ◽  
Undergraduate Teaching ◽  
Specific Information ◽  
Clinical Expertise ◽  
Prescribing Habits ◽  
Treatment Of Depression

Several surveys (Carstairs and Bruhn, 1962; Shepherd et al., 1966; and Johnson, 1973a) have demonstrated that the treatment of psychiatric disorders in general practice consists principally of prescribing drugs, with relatively little use of social agencies and psychotherapy. Although Shepherd et al. (1966) comment that the treatment is often haphazard and inadequate, the published surveys of general practice give little specific information about the prescribing habits of doctors. The present author surveyed the prescribing habits of general practitioners in the treatment of depression in the belief that it is necessary to have this information in order to evaluate the need for education in this clinical expertise, and also to act as a comparison for other surveys which will undoubtedly be carried out in the future to test the effectiveness of the current expansion of undergraduate teaching in psychiatry.

Child and Adolescent Psychiatry in General Practice

2001 ◽  
Vol 35 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Elena Garralda
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
General Practice ◽  
Psychiatric Disorders ◽  
General Practitioners ◽  
Mental Health Problems ◽  
Child And Adolescent ◽  
Health Problems ◽  
Undergraduate Teaching ◽  
Further Development

Objective: This review discusses the role of general practitioners and primary care health staff in the assessment, treatment and prevention of child and adolescent psychiatric disorders and to consider implications for service delivery. Method: Literature review. Papers were selected as having an empirical evidence base or as describing and documenting new initiatives in general practice. Results: A small proportion of about 3% of children present to general practice with behavioural or emotional problems, but psychiatric disorders in the context of somatic presentations are considerably more common. They are probably higher than in the general population reflecting an increased tendency by children with disorders to consult. Recognition by general practitioners is limited and few children with disorders are referred to specialist clinics. However, referrals are mostly appropriate: the more severely affected children in difficult psychosocial circumstances. A number of pilot studies have shown the feasibility and potential usefulness of setting up shifted specialist clinics in primary care and of training primary care doctors and other staff in the recognition or management of child mental heath problems. Conclusion: Primary care is an appropriate resource to help increase attention to child and adolescent mental health problems. Its potential requires further development and rigorous evaluation. Areas lending themselves to development include: improved medical undergraduate teaching and postgraduate training; suitable information and advice-giving on child mental health problems by the primary care team; the development of specific child and adolescent psychiatric interventions for use in the primary care setting; careful and discriminating development of shifted outpatient clinics for selected child psychiatric disorders; the development of focused protocols for referral to specialist services; further development of mental health promotion clinics in primary care.

scholarly journals Vocational thresholds: developing expertise without certainty in general practice medicine

2016 ◽  
Vol 8 (2) ◽  
pp. 99 ◽  
Author(s):  
Karen Vaughan
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Learning Experience ◽  
Learning Experiences ◽  
Structured Learning ◽  
Clinical Expertise ◽  
Threshold Concepts ◽  
Powerful Learning ◽  
Hidden Knowledge ◽  
Identity Learning

Abstract INTRODUCTION This paper argues that particular experiences in the workplace are more important than others and can lead to transformational learning. This may enable practitioners to cross ‘vocational thresholds’ to new ways of being. AIM A notion of ‘vocational thresholds’ is developed, aiming to help build an understanding of the most powerful learning experiences of general practitioners (GPs). Vocational thresholds takes its cue from the idea of ‘threshold concepts’ - concepts that transform perspectives and integrate previously disconnected or hidden knowledge, sometimes in ways that are ‘troublesome’ to previously held beliefs. METHODS The paper is based on a thematic analysis of 57 GPs’ brief written accounts of a particularly powerful learning experience during their development. Accounts were provided in a conference session about an ongoing study of workplace-based structured learning arrangements in the fields of general practice medicine, engineering, and building. FINDINGS Most GPs’ accounts focused on development of dispositional attributes that moved them to a new understanding of themselves in relation to their work and patients. Just under two-thirds picked out informal and formal collegial relationships within purposeful learning arrangements as pivotal. A third picked out direct experiences with patients as shifting their perspective. CONCLUSION The emergent idea of vocational thresholds is offered as a way to frame the most important learning experiences identified by GPs. It supports a focus in early and ongoing development beyond accumulating clinical expertise and skills (knowing and doing), to dispositional capability (being) - vital for practitioners negotiating inherent and daily uncertainty. KEYWORDS General practitioners; Medical education; Vocational education; Identity; Learning experiences; Threshold concepts

scholarly journals Somatoform disorders in general practice

2004 ◽  
Vol 184 (6) ◽  
pp. 470-476 ◽  
Author(s):  
Margot W M. De Waal ◽  
Ingrid A. Arnold ◽  
Just A. H. Eekhof ◽  
Albert M. Van Hemert
Keyword(s):  
General Practice ◽  
Psychiatric Disorders ◽  
General Practitioners ◽  
Depressive Disorders ◽  
Somatoform Disorders ◽  
Functional Limitations ◽  
Physical Symptoms ◽  
Diagnostic Interview ◽  
Choice Of Treatment ◽  
Mild Impairment

BackgroundGeneral practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment.AimsTo quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders.MethodTwo-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25–80 years), followed by a standardised diagnostic interview (SCAN 2.1).ResultsThe prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive.ConclusionsOur findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.

A Double-Blind Controlled Trial of ‘Vivalan’ (Viloxazine Hydrochloride) and Imipramine Hydrochloride in the Treatment of Depression in General Practice

1974 ◽  
Vol 2 (4) ◽  
pp. 260-264 ◽  
Author(s):  
P F C Bayliss ◽  
A R Dewsbury ◽  
J F Donald ◽  
J W Harcup ◽  
M Mayer ◽  
...  
Keyword(s):  
General Practice ◽  
Side Effects ◽  
General Practitioners ◽  
Side Effect ◽  
Controlled Trial ◽  
Depressive Illness ◽  
Double Blind ◽  
Patient Study ◽  
Treatment Of Depression ◽  
Imipramine Hydrochloride

One hundred and twenty-three patients with mild to moderate depressive illness were entered into a double-blind between-patient study of viloxazine hydrochloride (150 mg/day, expressed as base) and imipramine hydrochloride (75 mg/day, expressed as salt) by nine general practitioners. Sixty-two took viloxazine and sixty-one took imipramine. Both drugs produced a statistically highly significant improvement in both the depressive and anxiety symptoms over the period of the study, an effect being seen as early as the seventh day of treatment. Viloxazine produced fewer side-effects than imipramine, in particular significantly less drowsiness and dry mouth. The only side-effect seen with viloxazine was an upper gastro-intestinal disturbance with nausea and occasional vomiting, but this was transient. It is concluded that viloxazine hydrochloride is an effective anti-depressant in mild to moderate cases of depression in general practice and has the advantage of fewer side-effects than imipramine. The absence of sedation with viloxazine is of particular value in the treatment of ambulant patients.

scholarly journals An evaluation of general practitioners' knowledge and satisfaction of a local child and family psychiatric service

1990 ◽  
Vol 14 (6) ◽  
pp. 328-329 ◽  
Author(s):  
Aristos Markantonakis ◽  
John Mathai
Keyword(s):  
General Practice ◽  
Psychiatric Disorders ◽  
General Practitioners ◽  
Psychiatric Service ◽  
Psychiatric Services ◽  
Written Communication ◽  
Professional Help ◽  
Child Psychiatric ◽  
Childhood Psychiatric Disorders ◽  
Gain Access

Although childhood psychiatric disorders are commonly seen in general practice, only a few children in the community eventually gain access to professional help (Rutter, Cox, Tupling et al, 1975; Bailey, Graham & Boniface, 1978). Whether a child is referred or not depends on various factors connected with the child and family (Garralda & Bailey, 1988) and others such as what the GP expects from the referral. Whether GPs know of what the child psychiatric services in the area have to offer might also be expected to effect referral. We know that there is a general dissatisfaction with written communication between general practitioners and specialists in terms of the quality on the communication and usefulness to both groups (Pullen & Yellowlees, 1985; Kentish, Jenkins & Lask, 1987).

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

scholarly journals How to set up a postmortem facility in a farm animal practice

Livestock ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 196-201
Author(s):  
John F Mee ◽  
Rhona Ley
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Diagnostic Tool ◽  
Small Ruminants ◽  
Farm Animal ◽  
Small Animals ◽  
Animal Medicine ◽  
Set Up ◽  
Postmortem Examinations

Postmortem examinations can be a useful diagnostic tool in farm animal medicine; however, they are often avoided in general practice because of a lack of appropriate facilities and expertise/familiarity with techniques. This article describes the setting up of a basic facility to allow general practitioners to perform postmortem examinations of calves, small ruminants and other small animals, e.g. poultry.

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