Addressing Issues in Social Change

Addressing Issues

Although the primary care setting has many potential advantages in providing psychiatric care, treatment outcomes have been, and continue to be, unimpressive. Despite the prevalence of psychiatric illness in primary care settings, depression is often underdiagnosed, therefore undertreated, and misdiagnosed, therefore mistreated (Finley, Rens & Pont, 2003). The problems in primary care treatment of psychiatric illnesses must be understood in order to be adequately corrected.

Many research studies have found that about half of those who could benefit from treatment don’t seek care (Olfson & Marcus, 2009). Furthermore, many people who may benefit from treatment don’t receive it and people who cannot benefit from treatment do receive it (Olfson & Marcus, 2009). This indicates several problems: physicians are not properly screening, diagnosing, and treating patients with mental illnesses.

Incorrect Diagnosing

In a study conducted by the World Health Organization (WHO), researchers found 32.5% of patients met the diagnosis of psychiatric illness but primary care physicians only found diagnosis in 24.2%. Of those diagnoses, 87.3% of the diagnoses were not congruent between the researcher’s diagnosis and the PCP diagnosis (World Health Organization, 2008). This suggests there are a under recognized percentage of patients presenting with depressive symptoms are in fact incorrectly diagnosed at presentation and therefore provide insufficient or misguided treatment regimen (Clark, 2011). This may also indicate that the outcome of the lack of education, training and understanding in which primary care physicians have regarding mental health care illness is that there are improperly screening, diagnosing, and treating psychiatric illnesses.

Major Depressive Disorder vs Bipolar Depression

Studies find that primary care physicians are increasing their use of anti-depressants, however, the majority of primary care physicians are using inappropriate pharmacologic treatment (Clarke, 2011). Traditional antidepressants are being over utilized in terms of monotherapy for a great many patients for whom this approach is not only inadequate, but also potentially harmful (Geddes, Gijsman, Goodwin, Nolen, & Rendell, 2004). For example, bipolar depression can be mistaken for major depressive disorder. The psychopharmacologic treatment for major depressive disorder can be much different than with bipolar depression, in that prescribing an antidepressant alone can result in worsening depression and additional harmful side effects (Geddes et al., 2004). An issue with primary care clinicians is that they are often not well enough equipped to differentiate the two and rather than treating the illness, they tend to treat the symptoms (Coyne, Thompson, Klinkman & Nease, 2002).

Psychotherapy

Although the American Psychiatric Association (2000) recommends both psychotropic medication and psychotherapy for the treatment of depressive disorders, there has been a significant increase of antidepressant use and significant decrease of psychotherapy use (Olfson & Marcus, 2009). Studies have found that psychotropic treatment is more favorable than psychotherapeutic treatment among certain populations, such as ethnic minorities and those with anxiety disorders, although research has found psychotherapy to be more effective than psychotropic treatment long term (Wagner, Bystritsky, Russo, Craske, Sherbourne, Stein, & Roy-Byrne, 2005).