early detection of psychosis in general practice/family medicine j. de lepeleire, md, phd, g....

Early Detection of psychosis in General Practice/Family Medicine

J. De Lepeleire, MD, PhD, G. Pieters, MD, PhD, P. De Cort, MD, PhD

IntroductionGeneral practitioners have an important role in the early detection and management of psychosis. However little is known about the way GPs handle this problem, what they experience caring for psychotic patients and what problems they are facing.

MethodsA focus group research was performed in two cities of Flanders to get insight in the management of psychosis. Transcripts were coded by two independent researchers. Consensus was reached after discussion, using the grounded theory. Analysis was performed using Weft QDA..

ResultsFour focus groups were performed until saturation. 23 GPs with an average professional experience of 19 years and a male/female ratio of 0.76 participated.

Nine clusters of experiences were identified:1. The professionalism of the GPCaring for psychotic patients is time consuming. GPs use their therapeutic relation. They need important communication skills.2. The diagnostic processGPs use classical diagnostic strategies, hampered by lacking core symptoms, clear definitions and snoozing clinical presentations3. The cooperation with the specialized mental health sector is difficult. There is lack of good communication and a varying commitment of psychiatrists. GPs need support, quick interventions and if needed a team meeting4. Patient behavior and properties: The lack of insight hinders adequate interventions, both diagnostic and therapeutic.5. The subclinical course of the disease is variable6. The relation with the family: GPs, as family doctors, are favored being able to use the relationships with carers and families.7. The organization of care.GPs have high expectations of new models of care delivery in ambulatory care. 8. Hospital admissionGPs have an ambivalent attitude towards hospital admission and civil commitment of psychotic patients.9. Substance abuseGPs have little experience with substance abuse and psychosis.

ConclusionGPs are engaged and in favor of the care for psychotic patients but experience important thresholds in the organization of care and the cooperation with the mental health care sector. Getting support is more important than educational tools. Diagnosis and treatment are difficult because of the variable clinical presentation and patient characteristics. The results support and confirm existing data (1-3).

References (1) Oud MJ, Schuling J, Slooff CJ, Groenier KH, Dekker JH, Meyboom-de JB. Care for patients with severe mental illness: the general practitioner's role perspective. BMC Fam Pract 2009;10:29.(2) Oud MJ, Schuling J, Slooff CJ, Meyboom-de JB. How do General Practitioners experience providing care for their psychotic patients? BMC Fam Pract 2007;8:37.(3) Simon AE, Lester H, Tait L, Stip E, Roy P, Conrad G, et al. The International Study on General Practitioners and Early Psychosis (IGPS). Schizophr Res 2008 Dec 15.

Contactaddress Project financed by

Prof Dr J De Lepeleire, MD, PhD Department Psychiatry, Campus Kortenberg, Prof Dr J PeuskensAcademisch Centrum Huisartsgeneeskunde KULeuven ACHG, KULeuven, Prof Dr J De LepeleireKapucijnenvoer 33 blok j bus 7001B-3000 LeuvenBelgiumJan.DeLepeleire@med.kuleuven.be