The concept of a psychiatric “case” in general practice

Summary

The paper describes a classification of psychological disorders occurring in primary care settings which is attuned to the needs of the doctor and his patient, and takes into account the non-specific nature of many of the disorders, the effects of diagnostic “labelling” and the need for intervention. Three groups of disorders are described. These are (i) major psychiatric illness, which broadly correspond to psychotic illnesses for which physical treatments have been shown to be of value. “Labelling” is seen to be necessary for correct treatment, and often helpful for the patient. (ii) Psychological distress syndromes not requiring intervention, which include subclinical illnesses, transient illnesses, distress unrelated to the presenting symptoms and some patients with unmodifiable dysphoric symptoms. Such patients may benefit from ventilation of problems at the time of consultation but an illness label should be avoided. (iii) Psychological distress syndromes which require intervention; they form a large group which may benefit from a variety of psychological, social and drug treatments. It may be important to help the patients to see themselves as emotionally ill, but specific labels are only justified by particular interventions. The need for future research is discussed in relation to triaxial classification and intervention studies.