Psychiatric diagnosis and treatment by general practitioners

In psychiatry in particular, the diagnosis is based on a careful review of the symptoms and recognition of the main characteristics of the current episode and characterisation of the intercritical periods, when possible, of recurrent disorders.¹ Given the known difficulties in relation to the validity and reliability of the diagnostic process of mental disorders, the assessment was implemented by structured clinical interviews, particularly in situations of clinical and epidemiological research.²

Nevertheless, structured clinical interviews are used in exceptional cases in routine clinical assessments, both in developed and developing countries, such as Colombia and others in Latin America.³ The scarce use of these strategies may be explained by the lack of knowledge of the instruments, the limited training or the little time available for the evaluation of symptoms related to mental disorders during outpatient consultations or at the emergency departments of specialist and non-specialist centres.⁴ This is not striking as, in routine psychiatric assessments, the comprehensive review of the compliance of all formal diagnostic criteria is often omitted, which may partly explain the big differences observed in the prevalence of mental disorders between the different countries in the world.^3,5

The use of structured interviews in the assessment of patients who may meet the criteria of a mental disorder is highly useful for a more accurate diagnosis in the hands of professionals with basic training in mental health from small towns and rural areas with little access to Psychiatry professionals. In these areas, general practitioners are responsible for resolving all existing health problems, including acute treatment and follow-up of mental disorders.⁶

Due to barriers to accessing mental health care in Colombia and the current situation of the country in the period after the peace agreement, the implementation of the structured clinical assessment by general practitioners is a necessary strategy for most municipalities of the country which does not have Psychiatry professionals.³ These types of instruments enable a valid and reliable evaluation of serious mental disorders, as they make a detailed review possible, with no omissions, of all the symptoms required for the diagnosis and its duration and specificities.⁷ Furthermore, the help of the structured interview for non-psychiatric doctors promotes their self-efficacy in the assessment of the health problems of patients who meet mental disorder criteria.⁸ Likewise, this technique improves the satisfaction of patients and their family members, as there is more extensive communication with a medical professional in these cases.⁹

It is necessary to bear in mind that mental health problems, whether or not they are associated with socio-political violence, affect a growing number of Colombians and, consequently, it is a priority issue for public mental health which needs timely attention.^10,11 Undoubtedly, structured interviews, such as SCID-I and others available free of cost, allow for the initial approach and clinical assessments by non-psychiatric physicians. Basic training in Psychiatry and minimum training in the use of these instruments is all that is needed.¹²

A psychiatric diagnosis with a structured interview by general practitioners would be a significant contribution in many municipalities of the country to reduce the burden of disease and the stigma-discrimination complex associated with mental disorders.^13,14 Likewise, the general practitioner should start treatment with identified cases and, for that, follow the growing number of treatment guidelines which are created and reviewed in the country.

Without a doubt, this type of assessment and treatment strategy for mental disorders by general practitioners may be the only option that enables access to mental health services for disadvantaged populations in the different Colombian regions.¹⁵

Funding

The Universidad del Magdalena, Santa Marta, Colombia, funded the participation of Adalberto Campo-Arias.

Conflicts of interest

None.