|
|
|
|
|
|
|
| Neuro-Psychiatry In Primary Care | ||||||
| Introduction | ||||||
| ������� There has recently been a lot of interest in improving the treatment of any population through educating and updating general physicians in neuropsychiatry . Since the publication of the work by (Shepherd et al. , 1966) much research has been devoted to this topic in various countries , research which has demonstrated that the majority of neuropsychiatric disorders are treated by non-specialists . 80 % of psychiatric cases and the majority of epilepsy , strokes and dementia are seen by primary care physicians (Okasha, 1995). Other research disclosed a serious discrepancy between this high prevalence of mental disorders and the low standards of their recognition and treatment in general practice (Shepherd etal., 1966 ;Regieretal. , 1978 ; Hoeperetal. , 1979 ) . In a WHO research project undertaken at primary health care clinics in four developing countries , two thirds of the psychiatric cases was found to have been missed by the health workers on the primary care level (Harding et al., 1980) | ||||||
| On the other hand it was estimated that 80% of psychiatric patients present with somatic symptoms to the extent that WHO project for PHC (Primary Health Care) has devoted a lot of psychiatric syndromes under the term unexplained somatic symptoms ,which primary care physicians should be able to differentiate and manage . The Egyptian component of the project (Okasha et al., 1994) identified a number of areas of lack of knowledge and training that need to be satisfied . | ||||||
| Chronic fatigue is another symptom that presents frequently to the general practitioner clinic . Psychiatric assessment of patients presenting as such revealed that operational criteria for psychiatric disorder , in most cases , major depression , are fulfilled in 50%-80% of cases (Kroenke et al., 1988 ; Gold et al., 1990 ; Kruesi et al., 1989 ; Wessely & Powell et al., 1989 ) . | ||||||
| Another aspect is that Neuropsychiatrists are rarely found in rural areas . The practicing general practitioner in these areas has the overwhelming tasks of diagnosis & treatment of many Neuropsychiatric emergencies as Cerebrovascularstroke , status epilepticus , suicidal attempts , acute excitement .This is usually done without the backup of any specialist or hospital setups (Eltribi, 1995) . | ||||||
| The role of the general practitioner is not only limited to the detection and identification of neuropsychiatric disorders .In several of those disorders , especially those which leave a permanent disability which requires long term mental , physical and social rehabilitation , patients and their families resort to the general practitioner or guidance and follow up . His or her awareness of the disorders , their course and the required resources or proper rehabilitation are an integral part of the role expected from the general practitioner . | ||||||
| Throughout this thesis we will try to cover all aspects of primary care in Neuropsychiatry .First , we will try to identify the problem of managing Neuropsychiatric defects , also we will try to focus a head light in some of the commonest neuropsychiatric Disorders seen in Primary Care level , Also we will try to set a general schema for a better care of the patient this will include major aspects as referral would be , lastly we hope that a set of recommendations to improve the quality of Primary care givers to the individual patient . | ||||||