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DSM & PUBLIC HEALTH Professor I. PELC U.L.B. June 2, 2006 Alcoholis m Psychosis Depressi on Anxiet y Etc… Schizo phreni a

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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 Presentation

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Page 1: DSM & PUBLIC HEALTH

DSM & PUBLIC HEALTH

Professor I. PELC

U.L.B.

June 2, 2006

Alcoholism

Psychosis

Depression

Anxiety

Etc…

Schizophrenia

Page 2: DSM & PUBLIC HEALTH

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.

Page 3: DSM & PUBLIC 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

Page 4: DSM & PUBLIC HEALTH

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

Page 5: DSM & PUBLIC HEALTH

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

Page 6: DSM & PUBLIC HEALTH

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:

Page 7: DSM & PUBLIC HEALTH

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)

Page 8: DSM & PUBLIC HEALTH

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)

Page 9: DSM & PUBLIC HEALTH

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)

Page 10: DSM & PUBLIC HEALTH

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.

Page 11: DSM & PUBLIC HEALTH

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.

Page 12: DSM & PUBLIC HEALTH

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.

Page 13: DSM & PUBLIC HEALTH

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

Page 14: DSM & PUBLIC HEALTH

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