Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2008 Nov 18;38(10):563–569. [Article in Spanish] doi: 10.1157/13095928

La derivación a salud mental de pacientes sin un trastorno psíquico diagnosticable

Mental health referrals of patients without diagnosable psychiatric pathology

Alberto Ortiz Lobo a,⁎, Rocío González González b, Francisco Rodríguez Salvanés b
PMCID: PMC7669137  PMID: 17198609

Abstract

Objective

To analyze the characteristics of referral from primary health care to mental health of patients with no diagnosable mental disorder.

Methods

Consecutively and without exemptions, all persons attending for firsttime consultation a mental health centre in the course of a year were clinically examined.We measured the incidence of conditions not attributable to a mental disorder using ICD-10 (Z codes). Information was collected on whose idea it was that they attended, and who, how and with what treatment they were referred. In addition, data about their social,demographic and clinical characteristics were collected.

Results

Of the 1004 persons examined, 244 (24.4%) (95% CI, 21.6-27) did not meet the ICD-10 diagnosis criteria for mental disorders. They themselves or their family tended to request the Z codes (54.5%) (95%CI, 48.3-60.8]. Mental health referral was almost always through the PC doctor (95.5%)(95% CI, 92.1-97.7). Half the patients were already receiving drug therapy under their general practitioner before their visit and 20.9% (95% CI, 15.8-26) were referred as priority patients.

Conclusions

Our study found that a large number of patients with no diagnosable mental disorder at the mental health centre,many of them with drug treatment prescribed,were referred. This places a question-mark over the function of primary care as a filter for these patients. The populatiońs indiscriminate health care demand and the steady increase in treating mental health with drugs partially explain this phenomenon.

Key words: Mental health, Referral, Z code, Subumbral disorder

Bibliografía

  • 1.American Psychiatric Association Manual diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson; 1995
  • 2.Organización Mundial de la Salud Clasificación de la CIE-10 de los trastornos mentales y del comportamiento: descripciones clínicas y pautas para el diagnóstico. Madrid: Meditor; 1992.
  • 3.Magruder K.M., Calderone G.E. Public health consequences of different thresholds for the diagnosis of mental disorders. Comprehensive Psychiatr. 2000;41:14–18. doi: 10.1016/s0010-440x(00)80003-6. [DOI] [PubMed] [Google Scholar]
  • 4.Lewinson P.M., Shankman S.A., Gau J.M., Klein D.N. The prevalence and comorbidity of subthreshold psychiatric conditions. Psychological Med. 2004;34:613–622. doi: 10.1017/S0033291703001466. [DOI] [PubMed] [Google Scholar]
  • 5.Helmchen H., Linden M. Subthreshold disorders in psychiatry:clinical reality, methodological artifact and the double-threshold problem. Comprehensive Psychiatr. 2000;41:1–7. doi: 10.1016/s0010-440x(00)80001-2. [DOI] [PubMed] [Google Scholar]
  • 6.Charlton B.G., McKenzie K. Treating unhappiness: society needs palliative psychopharmacology. Br J Psychiatry. 2004;185:194–195. doi: 10.1192/bjp.185.3.194. [DOI] [PubMed] [Google Scholar]
  • 7.Illich I. Barral; Barcelona: 1975. Némesis médica: la expropiación de la salud. [Google Scholar]
  • 8.Hart J.T. The inverse care law. Lancet. 1971;1:405–412. doi: 10.1016/s0140-6736(71)92410-x. [DOI] [PubMed] [Google Scholar]
  • 9.Sennet R. Ediciones Península; Barcelona: 1978. El declive del hombre público. [Google Scholar]
  • 10.Lasch C. Editorial Andrés Bello; Barcelona: 1999. La cultura del narcisismo. [Google Scholar]
  • 11.Giddens A. Península; Barcelona: 1995. Modernidad e identidad del yo. [Google Scholar]
  • 12.Castel R. Anagrama; Barcelona: 1984. La gestión de los riesgos. [Google Scholar]
  • 13.Beck U., Beck-Gernsheim E. Paidos; Barcelona: 2002. La individualización. [Google Scholar]
  • 14.Windle C., Thompson J.W., Goldman H.H. Treatment of patients with no diagnosable mental disorders in CHMCs. Hosp Comm Psychiatr. 1988;39:753–758. doi: 10.1176/ps.39.7.753. [DOI] [PubMed] [Google Scholar]
  • 15.De Figueiredo J.M., Boerstler H., O’Conell L. Conditions not attributable to a mental disorder: an epidemiologic study of family problems. Am J Psychiatr. 1991;148:780–783. doi: 10.1176/ajp.148.6.780. [DOI] [PubMed] [Google Scholar]
  • 16.Siddique C.M., Aubry T.D., Mulhall D. The burden of conditions not attributable to mental disorders. Am J Psychiatr. 1996;153:1489–1491. doi: 10.1176/ajp.153.11.1489. [DOI] [PubMed] [Google Scholar]
  • 17.Siddique C.M., Aubry T.D. Use of mental health resources in the treatment of adult out-patients with no diagnosable mental disorders. Acta Psychiatr Scand. 1997;95:19–25. doi: 10.1111/j.1600-0447.1997.tb00368.x. [DOI] [PubMed] [Google Scholar]
  • 18.Spinhoven P. Van Der Does JW Conditions not attributable to a mental disorder in Dutch psychiatric outpatients. Psychological Med. 1999;29:213–220. doi: 10.1017/s0033291798007909. [DOI] [PubMed] [Google Scholar]
  • 19.Ortiz-Lobo A., García-Moratalla B., Mata-Ruiz I., Rodríguez-Salvanés F. Las consultas en un centro de salud mental sin trastorno mental diagnosticable. Archivos Psiquiatría. 2005;68:151–168. [Google Scholar]
  • 20.Homer D., Lemeshow S. John Wiley & Sons Inc; New York: 1989. Applied logistic regression. [Google Scholar]
  • 21.Hemels M.E.H., Koren G., Einarson T.R. Increased use of antidepressants in Canada: 1981-2000. Ann Pharmacotherapy. 2002;36:1375–1379. doi: 10.1345/aph.1A331. [DOI] [PubMed] [Google Scholar]
  • 22.Alonso M.P., De Abajo F.J., Martínez J.J. Evolución del consume de antidepresivos en España. Impacto de los inhibidores selectivos de la recaptación de serotonina. Med Clin (Barc) 1997;108:161–166. [PubMed] [Google Scholar]
  • 23.Ortiz Lobo A., Lozano Serrano C. El incremento en la prescripción de antidepresivos. Aten Primaria. 2005;35:152–155. doi: 10.1157/13071941. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES