Assessing the competence of general practitioners in diagnosing generalized anxiety disorder using standardized patients

Simulation and mental health outcomes: a scoping review

BACKGROUND

A scoping review was conducted in order to map and determine the gaps in literature on the impact of simulation as an educational approach to improve mental health care outcomes. As it became apparent that no literature existed on this topic, the study aimed to examine the educational impact of simulation on mental health education.

METHODS

An established five-stage scoping methodology was used: (1) identification of the research question, (2) identification of relevant studies, (3) study selection, (4) charting the data and (5) collation, summarising and reporting of results. CINAHL, ProQuest, PubMed, MEDLINE, EMBASE and PsychINFO databases were searched. These databases were deemed to represent a majority of the literature while accommodating for the particular search strategy used for this review. Websites that provide grey literature were also searched for articles of relevance.

RESULTS

A total of 48 articles were included in this review, with a considerable portion of studies conducted in the USA and UK. Others were conducted in an array of locations including Australia, Canada, Iran and Taiwan. Of the included articles, seven groups of simulation methods (including standardised patients, virtual reality and manikins as patients) were evident, with standardised patients being most prominent.

CONCLUSIONS

Literature is lacking to evidence the benefit of simulation on mental health patient outcomes. However, the available literature suggests a variety of simulation-based education, and training methods are currently being used within mental healthcare education. The findings do suggest some methods of simulation, such as the use of standardised patients, are more commonly used in education and have been deemed as effective to assist in mental health education. As no article specifically examining the mental health outcomes of patients treated by health professionals taught by simulation was identified, the educational outcomes outlined in this paper may be used to inform further research, incorporating mental health patient outcomes.

A systematic review of anxiety prevalence in adults within primary care and community settings in Malaysia

BACKGROUND

Anxiety disorders are common mental health disorders with significant impact on the individual as well as burden on the country as a whole.

METHODS

A systematic review of databases, reference lists, internet sources, and input from content experts revealed 42 studies that documented the prevalence of anxiety symptoms or disorders. 12 of these studies specifically evaluated anxiety disorders.

RESULTS

4 studies looked at the prevalence of anxiety disorders in the general population, whilst the remainder focused on selected population groups: university students (4 studies); substance abuse (3 studies); and victims of abuse (1 study). Studies in the general population showed that the prevalence of generalised anxiety disorder was 0.4-5.6%, mixed anxiety and depression were 3-5%, panic without agoraphobia 0.4%, phobia unspecified 0.5-%, and anxiety not-otherwise-specified 0.3-6.5%. We found significant variability in anxiety disorders in the studies in selected population groups. The variability could also have been affected by methodological factors within each study.

CONCLUSION

This study provides a broad overview of the prevalence of anxiety disorders in Malaysia. More research is required to develop diagnostic instruments that are validated for local use and comparable with international standards. Reliable prevalence estimates are lacking within certain groups, e.g. those in rural, indigenous, migrant population groups and those exposed to natural disasters.

Primary care physicians' evaluation and treatment of depression: Results of an experimental study using video vignettes

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics.

Empirical limits for the forensic assessment of PTSD litigants

This paper discusses the limits of expert opinion on posttraumatic stress disorder (PTSD) in personal injury claims. The construct of PTSD is hampered by several empirical limitations. Multiple reliable measures of PTSD exist, but have not been evaluated sufficiently within litigating samples and are infrequently used by forensic assessors. Common methods for trauma screening appear insensitive. Opinions about causation of PTSD and disability are complicated by retrospective memory biases, as well as the failure of most anxiety disorders to be detected within primary medical care. PTSD appears to have a steep spontaneous remission curve during the first year, but at least 10% of trauma-exposed people suffer chronic distress. Little is known about the course beyond 1 year. Efficacious psychological treatments have been developed for PTSD, but are not in common use limiting claimants' access to rehabilitative treatments. Research on functional disability associated with PTSD is in its infancy, but it seems likely that PTSD will account for only a part of the variance in work disability. We provide suggestions for improving forensic practice, advising the courts about the limitations of forensic opinions, and necessary research.

Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey

The aim of this study was to examine the attitudes of hospital staff toward major mental diseases: schizophrenia and depression. Negative attitudes were common among all of the hospital staff, and were more common among academicians, resident physicians and nurses. Causes of attitude variations were discussed.

BACKGROUND

Attitudes of hospital staff are important for admission, early diagnosis and treatment, and the rehabilitation process of mentally ill patients.

AIMS

The main objective of this study was to investigate and compare hospital workers' attitudes toward and knowledge of schizophrenia and depression.

METHODS

In 2001, a total of 160 hospital staff (40 academicians, 40 resident physicians, 40 nurses and 40 hospital employees) in a teaching hospital were interviewed with a questionnaire. The questionnaire included items about background information, a one-paragraph vignette, questions on social distance and expected burden, recognition of mental illness, hospitalization, prognostic outcome, and to whom and where the patient should be admitted.

RESULTS

Although academicians, resident physicians, and nurses have sufficient knowledge about schizophrenia and depression, the frequency of their negative attitudes towards mentally ill subjects was more than that for uneducated hospital employees.

CONCLUSIONS

It was commented that this difference might be as a result of negative effects of the medical education system.

An observational study comparing quality of care in walk-in centres with general practice and NHS Direct using standardised patients

OBJECTIVES

To compare the quality of clinical care in walk-in centres with that provided in general practice and by NHS Direct.

DESIGN

Observational study involving assessment of clinicians by standardised patients.

SETTING

20 walk-in centres, 20 general practices, and 11 NHS Direct sites.

PARTICIPANTS

297 consultations with standardised patients, 99 in each setting, carried out by professional role players trained to play five clinical scenarios (postcoital contraception, chest pain, sinusitis, headache, and asthma).

MAIN OUTCOME MEASURES

Primary outcomes were mean scores on consensus derived checklists of essential items for the management of the clinical scenarios. Data were also collected on access to and referral by walk-in centres, general practices, and NHS Direct.

RESULTS

Walk-in centres achieved a significantly greater mean score for all scenarios combined than general practices (difference between groups 8.2, 95% confidence interval 1.7 to 14.6) and NHS Direct (10.8, 5.5 to 16.1). There was considerable between scenario variation, with walk-in centres performing particularly well on postcoital contraception and asthma scenarios. In contrast to general practices, walk-in centres and NHS Direct referred a higher proportion of patients (26% and 82%, respectively).

CONCLUSION

Walk-in centres perform adequately and safely compared with general practices and NHS Direct for the range of conditions under study, but the impact of referrals on workload of other healthcare providers requires further research.