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Kwitowski MA, Lebin LG, Kelleher J, Zsemlye M, Nagle-Yang S. Behavioral Health Integration on Inpatient Obstetric Units: Program Development, Strategies for Implementation, and Lessons Learned. Clin Obstet Gynecol 2024; 67:169-185. [PMID: 38281174 DOI: 10.1097/grf.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Perinatal mood and anxiety disorders and substance use disorders are the primary causes of maternal mortality in the postpartum period and represent major public health concerns. Despite this, these conditions remain undertreated. Behavioral health integration in outpatient obstetric settings is necessary but insufficient to meet the needs of all patients. Inpatient behavioral health integration represents a promising avenue for addressing gaps in care. Results from recent program development indicate that needs assessment, stakeholder backing, collaboration with existing programs, and adaptability are key factors in successful implementation.
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Affiliation(s)
| | | | | | - Meggan Zsemlye
- Department of Obstetrics,University of Colorado School of Medicine, Aurora, Colorado
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Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd010530.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patricia Casey
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Divina Pillay
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Lorna Wilson
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Andreas Maercker
- Department of Psychology; University of Zurich; Zurich Switzerland
| | - Angela Rice
- Library and Information Service; Mater Misericordiae University Hospital; Dublin Ireland
| | - Brendan Kelly
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
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Chaudhry SK, Gordon-Elliott JS, Brody BD. The Cornell Peripartum Psychosis Management Tool: A Case Series and Template. PSYCHOSOMATICS 2015; 57:319-24. [PMID: 26608749 DOI: 10.1016/j.psym.2015.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/04/2015] [Accepted: 09/08/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medical College, New York, NY.
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Coverdale J, Roberts LW, Balon R, Beresin EV. Pedagogical Implications of Partnerships Between Psychiatry and Obstetrics-Gynecology in Caring for Patients with Major Mental Disorders. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:430-436. [PMID: 26059737 DOI: 10.1007/s40596-015-0364-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Because there are no formal reviews, the authors set out to identify and describe programs that serve female patients with major mental disorders by integrating mental health care with services in obstetrics and gynecology and to describe the pedagogical implications of those programs. METHOD The authors searched PubMed for all articles describing a program in which psychiatry was formally integrated with obstetric or gynecological services, other than standard consultation-liaison programs, in the care of patients with major mental disorders. The search terms used included interdisciplinary, interprofessional, integrated, collaborative care, psychiatry, and obstetrics-gynecology or psychosomatic obstetrics-gynecology. RESULTS The authors found six distinct integrated programs. These included family planning clinics that were integrated into inpatient psychiatry services; inpatient and outpatient psychiatry services for pregnant mentally ill women in close collaboration with obstetric services; a day hospital for pregnant women with psychiatric disorders in an obstetric setting; an interdisciplinary training site providing care for predominantly depressed, low-income, and minority women; a primary care HIV service for women integrated with departments of obstetrics-gynecology and psychiatry; and an obstetrics-gynecology clinic-based collaborative depression care intervention for socially disadvantaged women. Residents' involvement was described in four of the programs. CONCLUSIONS These innovative and integrated programs potentially enhance the care of vulnerable and culturally diverse women with major mental disorders. The authors discuss how these programs may contribute to the education of residents in psychiatry and obstetrics-gynecology.
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Abstract
The immediate postpartum period is a time of acute vulnerability to mental illness, which presents unique challenges for the psychiatric consultant. Because the postpartum hospital stay is typically brief, the consultant must have a working knowledge of postpartum physiology and the myriad forms of mental illness that may emerge in this vulnerable time, in order to quickly make a diagnosis and formulate a treatment plan. This review aims to characterize the most common reasons for postpartum consultation, review postpartum physiology and psychiatric conditions, and propose an evidence-based, practical approach to treatment. A literature search using the terms "postpartum," "obstetric," "consultation," and "psychiatry" yielded six studies that identified reasons for psychiatric consultation to the obstetrics and gynecology services. These studies informed the structure of the article such that we review the most common reasons for consultation and how to approach each issue. The most common reason for consultation is past psychiatric history, often in the absence of current symptoms. For each clinical situation, including depression, adverse birth events, and psychosis, we present a differential diagnosis, as well as risk factors, clinical signs, and recommended treatment.
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Affiliation(s)
- Eleanor A Anderson
- Patient and Family Services, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Boulevard, 1st Floor South Pavilion, Philadelphia, PA, 19104, USA,
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Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patricia Casey
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
| | - Divina Pillay
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
| | - Lorna Wilson
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
| | - Andreas Maercker
- University of Zurich; Department of Psychology; Binzmuhlestr. 14/17 Zurich Switzerland 8050
| | - Angela Rice
- Mater Misericordiae University Hospital; Library and Information Service; Dublin Ireland
| | - Brendan Kelly
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
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Goodman JH, Tyer-Viola L. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. J Womens Health (Larchmt) 2013; 19:477-90. [PMID: 20156110 DOI: 10.1089/jwh.2008.1352] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS This study aimed to assess the rates of detection, treatment, and referral of maternal depression and anxiety by obstetrical providers during pregnancy and at 6 weeks postpartum. METHODS A convenience sample of women receiving obstetrical care at a large urban teaching hospital (n = 491) was screened for depression and anxiety during the third trimester of pregnancy and again at 6 weeks postpartum using the Edinburgh Postnatal Depression Scale and the anxiety portions of the Patient Health Questionnaire. Participants were also asked if they thought they needed help for depression, anxiety, or stress at the two time points. Obstetrical providers were blind to screening results. Two months postdelivery, each woman's obstetrical electronic medical record (EMR) was reviewed for documentation of psychiatric symptoms, diagnoses, psychiatric treatment, and mental health referrals at the two time points. Data were analyzed using descriptive statistics. RESULTS Twenty-three percent of participants screened positive for an anxiety disorder or high levels of depressive symptoms or both prenatally, and 17% screened positive at 6 weeks postpartum. The majority of women who screened positive were not identified by their providers during pregnancy or postpartum. Only 15% of positively screened participants had evidence of any mental health treatment in their EMR during pregnancy, with equally low rates of referral to mental health or social services. In the postpartum period, only 25% of positively screened postpartum women received treatment, and an additional 2.5% were referred. A low proportion of women who reported they felt a need for help with depression, anxiety, or stress prenatally or postpartum received treatment or referral. CONCLUSIONS These findings indicate that detection, treatment, and referral of perinatal depression by obstetrical providers are seriously lacking and need to be addressed.
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Affiliation(s)
- Janice H Goodman
- MGH Institute of Health Professions and The Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Abstract
Adjustment disorders are common, yet under-researched mental disorders. The present classifications fail to provide specific diagnostic criteria and relegate them to sub-syndromal status. They also fail to provide guidance on distinguishing them from normal adaptive reactions to stress or from recognized mental disorders such as depressive episode or post-traumatic stress disorder. These gaps run the risk of pathologizing normal emotional reactions to stressful events on the one hand and on the other of overdiagnosing depressive disorder with the consequent unnecessary prescription of antidepressant treatments. Few of the structured interview schedules used in epidemiological studies incorporate adjustment disorders. They are generally regarded as mild, notwithstanding their prominence as a diagnosis in those dying by suicide and their poor prognosis when diagnosed in adolescents. There are very few intervention studies.
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Affiliation(s)
- PATRICIA CASEY
- Department of Psychiatry, Mater Misericordiae
University Hospital, Eccles St., Dublin 7, Ireland
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Judd F, Stafford L, Handrinos D, Laios L, Breadon C, Cornthwaite L, Gill A, Thomson-Salo F, Mercuri K, Nguyen T, Bryant C. Consultation-liaison psychiatry in a maternity hospital. Australas Psychiatry 2010; 18:120-4. [PMID: 20059308 DOI: 10.3109/10398560903314120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of the study was to describe referral patterns of maternity inpatients to the consultation-liaison psychiatry (CLP) service at a large women's hospital in metropolitan Melbourne, Australia. METHOD Clinicians recorded socio-demographic data, referring unit, consultee's reason for referral, psychiatric diagnosis made, and treatment provided for all maternity inpatients referred from 2004 to 2008. RESULTS Main reasons for referral were detection of depression, past psychiatric history, and concern regarding a woman's coping. Most common diagnoses were depression, substance use disorders and anxiety disorders. Many women referred for assessment while inpatients were initially seen in the antenatal period. CONCLUSIONS Pregnant women referred to a CLP service present with a range of mental health problems, most often depression, anxiety and substance use disorders. Many of these problems are evident in and require intervention during the antenatal period as well as at the time of confinement. CLP services to maternity hospitals should be provided in the antenatal as well as the inpatient setting.
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Affiliation(s)
- Fiona Judd
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
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Abstract
Adjustment disorder was introduced into the psychiatric classification systems almost 30 years ago, although the concept was recognized for many years before that. In DSM-IV, six subtypes are described based on the predominant symptoms, but no further diagnostic criteria are offered to assist the clinician. These are common conditions, especially in primary care and in consultation liaison psychiatry, where the prevalence ranges from 11% to 18% and from 10% to 35%, respectively. Yet they are under-researched, possibly due to the failure of some of the common diagnostic tools to allow for the diagnosis of adjustment disorder. Among the tools that incorporate adjustment disorder, the concordance between the clinical and interview diagnosis is very poor, with the diagnosis being made more commonly in clinical practice than the diagnostic tools allow for. Adjustment disorder is found in all cultures and in all age groups. The presence of a causal stressor is essential before a diagnosis of adjustment disorder can be made, while the symptoms vary and include those that are found in other common psychiatric disorders. It is also important to distinguish adjustment disorder from normal reactions to stressful events. Adjustment disorders are difficult to distinguish from normal responses to life's stressors, while the distinction from major depression also poses a classificatory conundrum since both are conceptually different. Adjustment disorder is a diagnosis based on the longitudinal course of symptoms in the context of a stressor, while a diagnosis of major depression is a cross-sectional one based on symptom numbers. Treatments consist mainly of brief interventions, while pharmacotherapy is limited to the symptomatic management of anxiety or insomnia. There are no robust studies demonstrating benefits from antidepressants. However, the number of studies of either type of intervention is very limited.
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Affiliation(s)
- Patricia Casey
- University Department of Psychiatry, Mater Misericordiae University Hospital, Dublin 7, Ireland.
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Sloan EP, Kirsh S. Characteristics of obstetrical inpatients referred to a consultation-liaison psychiatry service in a tertiary-level university hospital. Arch Womens Ment Health 2008; 11:327-33. [PMID: 19015935 DOI: 10.1007/s00737-008-0034-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 10/07/2008] [Indexed: 11/28/2022]
Abstract
A review of psychiatric consult notes of 96 obstetric inpatients referred to a Consultation-Liaison (C-L) psychiatry service in a tertiary-level university general hospital was carried out in order to compare the characteristics of such a service in a North American setting with similar services in other parts of the world. Data extracted from consult notes included: reason for referral, current diagnosis (DSM-IV-R), psychiatric history, obstetrical history, recommended treatment approaches, current psychotropic medications, current gestational age or number of days postpartum, patient age, and partnership status. In addition, obstetrical referrals were calculated as a percentage of hospital-wide referrals to C-L psychiatry. The most prominent findings include: (1) a high C-L psychiatry referral rate from obstetrics as a percentage of total C-L referrals within the study hospital; (2) past psychiatric history alone as a prevalent reason for referral; (3) adverse reproductive event (past and/or current) as a common reason for referral. These findings differ markedly in certain ways from comparable studies and may reflect both the hospital's large high-risk pregnancy service that represents an at-risk group for mental health issues, and the focus on educational collaboration with obstetrical staff regarding risk factors for, and consequences of, perinatal mental illness. Inpatient perinatal C-L psychiatric services require creative approaches to the accurate identification and treatment of women at risk for antenatal and postpartum mental illness due to psychiatric history and/or reproductive crises.
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Affiliation(s)
- Eileen P Sloan
- Department of Psychiatry, Perinatal Mental Health Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Weidner K, Siedentopf F, Zimmermann K, Bittner A, Richter J, Joraschky P, Distler W, Stobel-Richter Y. Which gynecological and obstetric patients want to attend psychosomatic services? J Psychosom Obstet Gynaecol 2008; 29:280-9. [PMID: 19065397 DOI: 10.1080/01674820802292015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The aim of this study is to explore the wish of gynecological and obstetric inpatients to attend psychosomatic services. Predictors influencing this wish are evaluated. METHOD Three groups of patients participated in the study. The groups consisted of patients diagnosed with malignant gynecological diseases (n = 175), benign gynecological diseases (n = 302), and obstetric diseases (n = 238). The following domains were assessed in a cross-sectional design: symptoms of anxiety and depression (HADS), physical complaints (GBB-24), health-related quality of life (SF-12), and the wish to attend psychosomatic services. RESULTS 34% of the participants indicated that they wanted to attend psychosomatic services during their stay in the hospital. The group of patients diagnosed with malignant gynecological diseases had the highest proportion of women who stated that wish (43%). Multiple logistic regression models showed that former psychotherapeutic experiences as well as low psychological quality of life predicted the wish to attend psychosomatic services in patients diagnosed with malignant gynecological or obstetric diseases. CONCLUSION It was shown that a considerable proportion of patients wanted to attend psychosomatic care during their hospitalization. Contrary to physical and sociodemographic variables, psychological factors were significant predictors of the inpatient's wish to attend psychosomatic services. This suggests that the subjective estimation of impairments is a major predictor of the wish to attend psychosomatic care.
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Affiliation(s)
- K Weidner
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl-Gustav-Carus, Dresden, Germany.
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Coleman VH, Carter MM, Morgan MA, Schulkin J. United States obstetrician-gynecologists' accuracy in the simulation of diagnosing anxiety disorders and depression during pregnancy. J Psychosom Obstet Gynaecol 2008; 29:173-84. [PMID: 18608826 DOI: 10.1080/01674820701833265] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The objective of this study was to examine obstetrician-gynecologists' diagnostic accuracy for mental health issues during pregnancy through utilization of clinical vignettes describing depressive and anxiety symptoms, as well as to explore factors associated with increased diagnostic accuracy and related practice patterns. Questionnaires were mailed to 1193 American College of Obstetricians and Gynecologists Fellows and Junior Fellows. The response rate was 44% after three mailings. Depression was correctly identified by over 90% of respondents, whereas significantly fewer correctly diagnosed panic disorder (55%) and generalized anxiety disorder (32%). Confidence ratings significantly predicted diagnostic accuracy in some cases. Approximately half of respondents reported referring anxiety disordered patients to a mental health professional. There may be an education gap in ob-gyns' diagnostic knowledge of anxiety disorders, which may addressed by increasing physician confidence in diagnosis through increased training.
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Affiliation(s)
- Victoria H Coleman
- The American College of Obstetricians and Gynecologists, Washington, DC, USA.
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Coleman VH, Carter MM, Morgan MA, Schulkin J. Obstetrician-gynecologists' screening patterns for anxiety during pregnancy. Depress Anxiety 2008; 25:114-23. [PMID: 17326098 DOI: 10.1002/da.20278] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
As obstetrician-gynecologists (ob-gyns) take on a greater role in women's healthcare, it is important that they are aware of the high prevalence of anxiety disorders in their patient population. Anxiety disorders present during pregnancy can have detrimental effects on both mother and child. In this study, we queried 1,193 ob-gyns on their screening rates, practice patterns, training, and knowledge as they relate to anxiety disorders during pregnancy. We achieved a 44% response rate (n=397) after three mailings. Physicians reported a moderate interest in screening for and diagnosing anxiety, but less interest in treatment. Only 20% of respondents (n=79) screen for anxiety during pregnancy, and they typically refer anxiety-disordered patients to mental health professionals. Ob-gyns with comprehensive or adequate training were significantly more likely to screen than those who stated that their training was inadequate. Having a friend who has been diagnosed with an anxiety disorder also significantly increased both the likelihood that these physicians would screen and the reported level of interest in screening of anxiety disorders during pregnancy. At present, the majority of ob-gyns feel that their training in this area was barely adequate to inadequate. Specifically, generalized anxiety disorder may be the least understood. Increased training in this area would allow ob-gyns to overcome what they list as the primary barrier to anxiety screening during pregnancy--that is, inadequate training about anxiety disorders.
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Leithner K, Assem-Hilger E, Fischer-Kern M, Löffler-Stastka H, Thien R, Ponocny-Seliger E. Prenatal care: the patient's perspective. A qualitative study. Prenat Diagn 2006; 26:931-7. [PMID: 16845682 DOI: 10.1002/pd.1529] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To investigate the subjective experiences and perceptions of the prenatal care system for women following a prenatal diagnosis and to assess the factors related to dissatisfaction with medical treatment. METHODS Data derived from a follow-up investigation in fifty women following a prenatal diagnosis is presented. Women were asked to give written comments concerning their feelings and experiences during their time at the prenatal care unit. A qualitative content analysis was performed in order to examine the patients' perceptions and expectations of the prenatal care management and to seek potential associations of certain attitudes with socio-demographic, clinical, or psychological characteristics. Womens' comments were coded within established categories including 'satisfaction', 'dissatisfaction' and 'communicated emotionality'. RESULTS A high proportion of women were found to be dissatisfied with the physicians' attitudes (42%), the amount of information provided (46%), and medical staffs' attitudes (30%). One criticism, in particular, concerned a lack of communication skills in doctors and medical staff members. Forty-eight percent of our study population mentioned that they had benefited from psychological support. 'Nullipara' was the only variable associated with dissatisfaction with the received prenatal care. CONCLUSIONS The results of the study suggest that the high degree of discontent found in prenatal care patients could at least in some part be alleviated by implementation of communication training and supervision services for prenatal care workers. Moreover, nullipara may constitute a particular vulnerable subgroup that may need special attention and support. However, given the qualitative nature of our study, our results warrant replication in further empirically based research.
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Affiliation(s)
- Katharina Leithner
- Department of Psychotherapy and Psychoanalysis, Vienna University Hospital, Austria.
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Coleman VH, Morgan MA, Zinberg S, Schulkin J. Clinical Approach to Mental Health Issues Among Obstetrician???Gynecologists: A Review. Obstet Gynecol Surv 2006; 61:51-8. [PMID: 16359569 DOI: 10.1097/01.ogx.0000193877.72966.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED In recent years, obstetrician-gynecologists have taken on a greater role in the provision of primary care. Mental health has been a topic worthy of further exploration as a result of the high prevalence rates of women presenting in gynecologic settings with depressive, anxiety, or eating-disordered symptoms. The detrimental effects of psychopathology have been well documented in the literature, especially if present during pregnancy. This article provides a review of the literature in the area of clinical practice related to mental health among obstetrician-gynecologists based on searches of the Psyc Info and MEDLINE databases. Lack of recognition and underdiagnosis are common problems that need to be addressed by focused educational initiatives. TARGET AUDIENCE Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES After completion of this article, the reader should be able to recall the importance of screening for various types of mental disease during an ob/gyn visit; describe the detrimental effects of psychopathology, especially during pregnancy; and explain the importance of educational initiatives in detecting and treating mental disorders.
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Affiliation(s)
- Victoria H Coleman
- Doctoral Candidate, Department of Psychology, American University, Washington DC 20024, USA.
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Galeazzi GM, Ferrari S, Mackinnon A, Rigatelli M. Interrater Reliability, Prevalence, and Relation to ICD-10 Diagnoses of the Diagnostic Criteria for Psychosomatic Research in Consultation-Liaison Psychiatry Patients. PSYCHOSOMATICS 2004; 45:386-93. [PMID: 15345783 DOI: 10.1176/appi.psy.45.5.386] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Diagnostic Criteria for Psychosomatic Research (DCPR) have been proposed by an international group of psychosomatic investigators as an operationalized tool for the assessment of psychological distress in medical patients. The aims of the present study were to evaluate interrater reliability, the distribution of DCPR syndromes, and their relationship with ICD-10 diagnostic categories. One hundred consecutive patients who were referred for psychiatric consultation in a university general hospital consented to assessment for DCPR syndromes as elicited in a joint interview conducted by two researchers. The results showed excellent interrater agreement, with kappa values for the 11 DCPR syndromes ranging from 0.69 to 0.97. More patients met criteria for one or more of the DCPR (87%) than for an ICD-10 diagnosis (75%). Four DCPR syndromes were particularly prevalent: demoralization, alexithymia, illness denial, and type A behavior. DCPR criteria appear to be a useful, reliable, and promising approach in the assessment and description of psychological distress in medical patients. They may serve as a focus of intervention studies in this population.
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Affiliation(s)
- Gian Maria Galeazzi
- Consultation/Liaison Psychiatry Service, Department of Neuroscience TCR, Section of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
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Abstract
The Reform Law 180, approved in Italy in 1978, had – and still has – great national and international significance for its dramatic consequences on both clinical and health organisational aspects of psychiatry: the law, in short, had the great effect of bringing psychiatry back to medicine, to the community and to the general hospital. This was the starting point of other relevant events, one of which was the establishment of the specialty of consultation-liaison psychiatry in Italy (Cazzulloet al, 1984). Since then, consultation-liaison psychiatry has gradually developed worldwide and in Italy as a super-specialised branch of psychiatry, able to put into practice – to operationalise – the great psychosomatic tradition in its three interrelated strands of clinical, teaching and research activities. The report that follows is strongly influenced by this historical background.
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Affiliation(s)
- M Rigatelli
- Modena Consultation-Liaison Psychiatry Service, Psychiatry Department, Modena University Hospital, Modena, Italy.
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