dsm & public health
DESCRIPTION
DSM & PUBLIC HEALTH. Alcoholism. Psychosis. Depression. June 2, 2006. Anxiety. Schizo phrenia. Professor I. PELC U.L.B. Etc…. DSM & PUBLIC HEALTH. Mental Public Health today : The WHO European Ministerial Conference on Mental Health, Helsinki, January 2005. - PowerPoint PPT PresentationTRANSCRIPT
DSM & PUBLIC HEALTH
Professor I. PELC
U.L.B.
June 2, 2006
Alcoholism
Psychosis
Depression
Anxiety
Etc…
Schizophrenia
DSM & PUBLIC HEALTH
• Mental Public Health today : The WHO European Ministerial Conference on Mental Health, Helsinki, January 2005.
• Aims of Classification in Mental Health.
• Data record inventory : the Minimal Psychiatric Summary (M.P.S.), a data base for mental inpatients.
• Need for more informations than the diagnosis to treat a patient.
• E.B.M. and Mental Health.
WHO European Ministerial Conference on Mental Health
1. Promote mental well-being for all2. Demonstrate the centrality of mental health3. Tackle stigma and discrimination4. Promote activities sensitive to vulnerable life stages5. Prevent mental health problems and suicide6. Ensure access to good primary care for mental health problems7. Offer effective care in community-based services for people
with severe mental health problems8. Establish partnerships across sectors9. Create a sufficient and competent workforce10. Establish good mental health information11. Provide fair and adequate funding12. Evaluate effectiveness and generate new evidence
Helsinki, January 2005
Mental Health : Facing the Challenges, building solutions
Action Plan
I. Pelc – BCNBP 2005
Is not sufficient for an adequate treatment
M.C.S.M.P.S.
What for whom ?
Whohas what ?
Largely orients the treatment
Can be validated by a series of objectivizations
Other aspects should be considered (motivation for changes ; psychosocial situation …)
Minimal Psychiatric Summary (M.P.S..)Minimal Clinical Summary and Minimal Psychiatric Summary
DIAGNOSIS
Medical care provided by a multidisciplinary team in function of the particular characteristics of the person
M.C.S. M.P.S.
Codified procedures in acts in function of the disease
TREATMENT
Minimal Psychiatric Summary (M.P.S..)Minimal Clinical Summary and Minimal Psychiatric Summary
RPM: les blocs d’informations
1.1a
- Milieu de vie avant l’admission - Type et niveau du dernier enseignement suivi - Statut professionnel au moment de l’admission - Profession principale
b2
- Diagnostic DSM-IV provisoire à l’admission médicale
b3
- Signes et symptômes psychiques - Problème relationnels - Performances sociale - Développement - Fonctions physiques - Objectifs thérapeutiques
b4
- Type d’admission - Mode d’admission - Intervenants
b1
- Diagnostic définitif DSM-IV (fin de traite- ment / période statistiq.)
b7
- Soins dispensés - Surveillances exercées
b5
- Evaluations effectuées - Traitements psychotropes - Traitements relationnels
b6
Sortie intermédiaire: - Nombre de jours prévus - Destination - Raison
b9
- Mode de sortie - Destination - Postcure et suivi proposé - Objectifs thérapeutique du suivi proposé - Signes et symptômes psychiques résiduels - Problèmes relationnels - Performance sociale - Développement - Fonctions physiques
b10
- Items personnalisa- bles par l’institution pour usage local
b8
- Profil - Soins - Equipe de soins
b11 b12
LF Lab. PsyMed/ULB
Admission médicale
Début de traitement
Fin du traitement
Sortie intermédiaire
Sortie médicale
Données d’échantillon:
The Minimal Psychiatric Summary (M.P.S.) and the current organization in mental health care.
I. Pelc, J. Joosten, L. From, I. Bergeret, Y. Ledoux and J. Tecco.
In : Manage or Perish ? The Challenges of Managed Mental Health Care in Europe – Edited by J. Guimon and N. Sartorius Kluwer Academic – Plenum Publishers, New York, 1999.
Factors of Length of STAY : Patients with Alcohol related Problems. Intensity of the Correlation. (Bravais-Pearson r at P < 0.001)
In : Manage or Perish ? The Challenges of Managed Mental Health Care in Europe – Edited by J. Guimon and N. Sartorius
Kluwer Academic – Plenum Publishers, New York, 1999.
The Minimal Psychiatric Summary (M.P.S.) and the current organization in mental health care.
I. Pelc, J. Joosten, L. From, I. Bergeret, Y. Ledoux and J. Tecco.
Types of therapeutic interventions as factors of the Reduction in number of mental symptoms. Correlation Intensity. (Bravais-Pearson r at P < 0.001)
In : Manage or Perish ? The Challenges of Managed Mental Health Care in Europe – Edited by J. Guimon and N. Sartorius
Kluwer Academic – Plenum Publishers, New York, 1999.
Psychological problems at admission according to final diagnosis (axe 1 DSM IV)
Evidence Based MedecineWhat is EBM ?
Sackett (2000) : The conscientious explicite and judicious use of the current based-evidence in making decisions about the care of individual patients
I. Pelc – BCNBP 2005
Adapted from G. Pieters Higher Council of Health Belgium.
Evidence Based Practice (1)
Elements for clinical decision
Clinical Experience
Research data
Patient’s(and therapist’s ?) preference
I. Pelc – BCNBP 2005
Adapted from G. Pieters Higher Council of Health Belgium.
Evidence Based Practice (2)
Clinical Problem
Formulation of a specific question
Looking for evidences
Critical evaluation of the evidences
« Adapted Evidence »
Relevant for a specific patient
Patient’s choice
« Values »
Evaluation of the results
I. Pelc – BCNBP 2005
Adapted from G. Pieters Higher Council of Health Belgium.
Value Based Medecine (Fulford)
• Evidence Based Medicine : to consider the complexity of relevant research data
• Value Based Medecine : to consider the complexity of relevant values and/or individual choices
Adapted from G. Pieters Higher Council of Health Belgium.
I. Pelc – BCNBP 2005
Management of depressive patients in primary care
Patient with depressive mood
Depression ?
Patient with somatic complaints
Somatic pathologies to be excluded Para clinic investigations
Etiological treatmentMajor depression (DSM-IV)
Minor depressive
Some worrying signsTreatment by general practitioner
Bio-Psycho-Social supportPsychotherapy no medications
No Improvement
Refer topsychiatristYes
No
No
Urgent No urgent
Psychiatric emergency unit Psychiatric outpatient clinic
No Yes
Refer to mental health network
Bio-Psycho-Socialapproach
Psychiatrist Psychologist orGeneral practitioner
for medication
Yes
Eole, 2005