fricchione psychosomatic medicine in mental health

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  • 1.Psychosomatic Medicine and its Relevance to Mental Health in Africa
    Gregory Fricchione, MD
    Associate Chief of Psychiatry
    Director, Division of Psychiatry and Medicine
    Director, Benson Henry Institute
    Senior Scientist, Pierce Division of Global Psychiatry
    Massachusetts General Hospital
    Professor of Psychiatry
    Harvard Medical School

2. Conflict of Interest
None to report
3. Objectives
To Review:
Scope of the global mental health crisis
The Importance of Psychosomatic Medicine in helping to address it
Implications for modern medicine and the quest to improve mental health in Africa.
4. International Psychiatry
1972-73British J Psychiatry : prevalence of mental illnesses ~ equal in developed and developing worlds; services very unequal
1993 HSPH, HDSM, World Bank, WHO:
--GBD=gap between current health status and ideal of life into old age free of disease/disability
--DALYs= sum of yrs of life lost due to premature death (YLL) + yrs lost due to disability (YLD) for incident cases of the health condition.
5. http://www.who.int/msa/mnh/ems/dalys/table.htm
6. Background
Murray CJL and Lopez AD, eds.1996; The GBD: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. HSPH on behalf of WHO and World Bank, Cambridge, MA.
WHO GBD: 2004 Update (WHO, 2008):
--Depression, schizophrenia, epilepsy, dementia, alcohol dependence and other neuropsychiatric and substance use disorders constitute 13% of GBD surpassing CV disease and cancer.
--Depression alone is the 3rd leading cause of GBD. By 2020, suicide is estimated to result in 1.5 million deaths a year and up to 30 million will attempt it.
7. Background
WHO Solutions: 1. Treat in Primary Care, 2. Make psychotropics available, 3. Community care, 4. Educate the public, 5. Involve communities, families and consumers, 6. National policies, programs and legislation, 7. Develop human resources, 8. Link with other sectors, 9. Monitor community health, 10. More research.
Recent Lancet Series: mental health is essential for general health; psychiatric disorders can predispose to physical illnesses and exacerbate them and vice versa. This is a Psychosomatic Medicine argument.
8. Chester M. Pierce Division of Global Psychiatry at MGH
2002 African Diaspora Meeting at MGH
2003 Global Division Established
2009 Named for Prof Pierce and David Henderson takes over from Greg Fricchione as Director.
Bauer AM, Fielke K, Brayley J, Araya M, Alem A, Frankel BL, Fricchione GL. Tackling the global mental health challenge: a psychosomatic medicine/consultation-liaison psychiatry perspective. Psychosomatics. 2010 May;51(3):185-93.
--depression in primary care
--neuropsychiatry
--consultant/supervisory model
9. 10. Prevalence of Depression
Med Illness %Prev Rate
Cardiac Disease 17-27
Cerebrovascular14-19
DAT30-50
PD4-75
Epilepsy (controlled)3-9
Epilepsy (intractable)20-55
DM 9(interview)-26 (self-report)
Cancer 22-29
Pain30-54
Obesity20-30
General Pop 10.3
[Evans et al, Biol Psychiatry 2005; 58: 175-189]
11. Depression
Primary prevention or early detection of depression should be a major focus of primary care practice
Only ~ half of those patients who present to their primary care physician with major depression are accurately diagnosed (Eisenberg, 1992.)
A diagnosis of major depression is often missed in patients who present with unexplained somatic symptoms or a symptomatic worsening of a chronic medical illness (Kirmayer, 1993).
12. Improving Outcomes in Primary Care Psychiatry
Randomized controlled trials
Consultation Liaison Primary Care Collaborative Model: patients with depression received two visits with a psychiatrist in the primary care clinic and two visits with the primary care physician within the first six weeks of treatment. (Katon, 1997).

  • Psychiatrist assistance

13. Educational materials 14. Half-day workshop for primary care physicians 15. Automated pharmacy data for primary care physicians to aid in monitoring patient compliance.