P. Williamson

Bio: P. Williamson is an academic researcher. The author has contributed to research in topics: Psychosocial. The author has an hindex of 1, co-authored 1 publications receiving 24 citations.

A prospective study of 60 consecutive psychiatric consultations in a family medicine clinic.

Abstract: This paper describes a prospective study collating demographic, medical, psychiatric, and illness behavior characteristics of 60 consecutive patients referred for consultation to a psychiatric liaison physician attending in a family medical clinic. The data were accumulated to add to the developing body of information about the characteristic psychosocial problems family physicians treat. Results showed that the most frequent psychiatric diagnosis in these patients was primary affective disorder depression. The presence of somatic complaints often obscured the recognition and management of psychiatric syndromes such as depression, anxiety neurosis, personality disorder, family and marital discord, psychosis, and alcoholism. The importance of training in psychopharmacology and time limited psychotherapy was underscored by the frequent consultant recommendations for the use of these treatment modalities by the family physician. Patients averaged 2.4 illness problems (psychosocial problems and reactions that arise from a perceived illness), pointing to the need to systematically evaluate and treat them concomitantly with traditional disease problems.

Integration of Mental Health/Substance Abuse and Primary Care

Abstract: Objectives To describe models of integrated care used in the United States, assess how integration of mental health services into primary care settings or primary health care into specialty outpatient settings impacts patient outcomes and describe barriers to sustainable programs, use of health information technology (IT), and reimbursement structures of integrated care programs within the United States. Data sources MEDLINE, CINAHL, Cochrane databases, and PsychINFO databases, the internet, and expert consultants for relevant trials and other literature that does not traditionally appear in peer reviewed journals. Review methods Randomized controlled trials and high quality quasi-experimental design studies were reviewed for integrated care model design components. For trials of mental health services in primary care settings, levels of integration codes were constructed and assigned for provider integration, integrated processes of care, and their interaction. Forest plots of patient symptom severity, treatment response, and remission were constructed to examine associations between level of integration and outcomes. Results Integrated care programs have been tested for depression, anxiety, at-risk alcohol, and ADHD in primary care settings and for alcohol disorders and persons with severe mental illness in specialty care settings. Although most interventions in either setting are effective, there is no discernible effect of integration level, processes of care, or combination, on patient outcomes for mental health services in primary care settings. Organizational and financial barriers persist to successfully implement sustainable integrated care programs. Health IT remains a mostly undocumented but promising tool. No reimbursement system has been subjected to experiment; no evidence exists as to which reimbursement system may most effectively support integrated care. Case studies will add to our understanding of their implementation and sustainability. Conclusions In general, integrated care achieved positive outcomes. However, it is not possible to distinguish the effects of increased attention to mental health problems from the effects of specific strategies, evidenced by the lack of correlation between measures of integration or a systematic approach to care processes and the various outcomes. Efforts to implement integrated care will have to address financial barriers. There is a reasonably strong body of evidence to encourage integrated care, at least for depression. Encouragement can include removing obstacles, creating incentives, or mandating integrated care. Encouragement will likely differ between fee-for-service care and managed care. However, without evidence for a clearly superior model, there is legitimate reason to worry about premature orthodoxy.

How primary care physicians treat psychiatric disorders: a national survey of family practitioners.

Abstract: A survey of 350 family practice physicians nationwide showed that 22.6% of their patients had significant psychiatric disorders. Physicians reported treating most psychiatric problems themselves, usually through a combination of psychotropic drugs, advice, and reassurance. The results suggest that anxiolytics are more conservatively used and referrals for mental health care more often made than past studies indicate. Physicians cited patient resistance and time limitations as the most important barriers to primary care mental health treatment, followed by limited third-party payment for mental health services, poor coordination between the primary care and mental health care sectors, and insufficient training to treat psychiatric disorders.

Psychiatric illness and subsequent traumatic brain injury: a case control study.

Abstract: Objective: To determine whether psychiatric illness is a risk factor for subsequent traumatic brain injury (TBI). Methods: Case control study in a large staff model health maintenance organisation in western Washington State. Patients with TBI, determined by International classification of diseases, 9th revision, clinical modification (ICD-9-CM) diagnoses, were 1440 health plan members who had TBI diagnosed in 1993 and who had been enrolled in the previous year, during which no TBI was ascertained. Three health plan members were randomly selected as control subjects, matched by age, sex, and reference date. Psychiatric illness in the year before the TBI reference date was determined by using computerised records of ICD-9-CM diagnoses, psychiatric medication prescriptions, and utilisation of a psychiatric service. Results: For those with a psychiatric diagnosis in the year before the reference date, the adjusted relative risk for TBI was 1.7 (95% confidence interval (CI) 1.4 to 2.0) compared with those without a psychiatric diagnosis. Patients who had filled a psychiatric medication prescription had an adjusted relative risk for TBI of 1.6 (95% CI 1.2 to 2.1) compared with those who had not filled a psychiatric medication prescription. Patients who had utilised psychiatric services had an adjusted relative risk for TBI of 1.3 (95% CI 1.0 to 1.6) compared with those who had not utilised psychiatric services. The adjusted relative risk for TBI for patients with psychiatric illness determined by any of the three psychiatric indicators was 1.6 (95% CI 1.4 to 1.9) compared with those without any psychiatric indicator. Conclusion: Psychiatric illness appears to be associated with an increased risk for TBI.

Hypochondriacal patients, their physicians, and their medical care

Abstract: Objective:To examine the views hypochondriacal patients have of their physicians, and their physicians’ assessments of the hypochondriacal patients. Design:A sample of patients meeting DSM-III-R diagnostic criteria for hypochondriasis was obtained by screening consecutive medical outpatients. They underwent a battery of self-report questionnaires and structured interviews, their medical records were audited, and their physicians completed questionnaires about them. A random sample of nonhypochondriacal patients from the same clinic served as a comparison group. Setting:A large general medicine outpatient clinic of an academic teaching hospital. Patients:41 DSM-III-R hypochondriacs and 71 comparison patients. Measurements and main results:Hypochondriacal patients were more dissatisfied with their physicians than were comparison patients. Physicians rated the hypochondriacal patients as more frustrating to care for, more help-rejecting, and more demanding. Physician ratings of how hypochondriacal their patients were correlated significantly with their ratings of how frustrating they considered the patients (R2=0.36)and with objective measures of how hypochondriacal the patients were (incremental R 2=0.08).Physician estimates of anxiety and depression in the hypochondriacal patients were not statistically related to patient anxiety and depression. In contrast, physician estimates of patient anxiety and depression were significantly associated with the presence of anxiety and depression in comparison patients. Conclusions:The physician’s use of the term hypochondriasis is closely associated with his or her frustration with the patient and is associated with objective measures of the extent of hypochondriacal symptoms. In addition, the presence of DSM-III-R hypochondriasis impairs the physician’s accuracy in assessing the levels of the patient’s anxiety and depression.