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DSM & PUBLIC HEALTH

DSM & PUBLIC HEALTH. Alcoholism. Psychosis. Depression. June 2, 2006. Anxiety. Schizo phrenia. Professor I. PELC U.L.B. Etc…. DSM & PUBLIC HEALTH. Mental Public Health today : The WHO European Ministerial Conference on Mental Health, Helsinki, January 2005.

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DSM & PUBLIC HEALTH

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  1. DSM & PUBLIC HEALTH Alcoholism Psychosis Depression June 2, 2006 Anxiety Schizophrenia Professor I. PELC U.L.B. Etc…

  2. DSM & PUBLIC HEALTH • Mental Public Health today : The WHO European Ministerial Conference on Mental Health, Helsinki, January 2005. • Aims of Classification in Mental Health. • Data record inventory : the Minimal Psychiatric Summary (M.P.S.), a data base for mental inpatients. • Need for more informations than the diagnosis to treat a patient. • E.B.M. and Mental Health.

  3. WHO European Ministerial Conference on Mental Health Helsinki, January 2005 Mental Health : Facing the Challenges, building solutionsAction Plan • Promote mental well-being for all • Demonstrate the centrality of mental health • Tackle stigma and discrimination • Promote activities sensitive to vulnerable life stages • Prevent mental health problems and suicide • Ensure access to good primary care for mental health problems • Offer effective care in community-based services for people with severe mental health problems • Establish partnerships across sectors • Create a sufficient and competent workforce • Establish good mental health information • Provide fair and adequate funding • Evaluate effectiveness and generate new evidence I. Pelc – BCNBP 2005

  4. Minimal Psychiatric Summary (M.P.S..) Minimal Clinical Summary and Minimal Psychiatric Summary DIAGNOSIS M.C.S. M.P.S. What for whom ? Whohas what ? Is not sufficient for an adequate treatment Largely orients the treatment Can be validated by a series of objectivizations Other aspects should be considered (motivation for changes ; psychosocial situation …)

  5. Minimal Psychiatric Summary (M.P.S..) Minimal Clinical Summary and Minimal Psychiatric Summary TREATMENT M.C.S. M.P.S. Codified procedures in acts in function of the disease Medical care provided by a multidisciplinary team in function of the particular characteristics of the person

  6. The Minimal Psychiatric Summary (M.P.S.) and the current organization in mental health care.I. Pelc, J. Joosten, L. From, I. Bergeret, Y. Ledoux and J. Tecco. Factors of Length of STAY : Patients with Alcohol related Problems. Intensity of the Correlation.(Bravais-Pearson r at P < 0.001) In : Manage or Perish ? The Challenges of Managed Mental Health Care in Europe – Edited by J. Guimon and N. Sartorius Kluwer Academic – Plenum Publishers, New York, 1999.

  7. The Minimal Psychiatric Summary (M.P.S.) and the current organization in mental health care.I. Pelc, J. Joosten, L. From, I. Bergeret, Y. Ledoux and J. Tecco. Types of therapeutic interventions as factors of the Reduction in number of mental symptoms. Correlation Intensity. (Bravais-Pearson r at P < 0.001) In : Manage or Perish ? The Challenges of Managed Mental Health Care in Europe – Edited by J. Guimon and N. Sartorius Kluwer Academic – Plenum Publishers, New York, 1999.

  8. Psychological problems at admission according to final diagnosis(axe 1 DSM IV) In : Manage or Perish ? The Challenges of Managed Mental Health Care in Europe – Edited by J. Guimon and N. Sartorius Kluwer Academic – Plenum Publishers, New York, 1999.

  9. Evidence Based MedecineWhat is EBM ? Sackett (2000) : The conscientious explicite and judicious use of the current based-evidence in making decisions about the care of individual patients Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  10. Evidence Based Practice (1) Elements for clinical decision Clinical Experience Patient’s(and therapist’s ?) preference Research data Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  11. Evidence Based Practice (2) Clinical Problem Evaluation of the results Formulation of a specific question « Adapted Evidence » Relevant for a specific patient Patient’s choice « Values » Looking for evidences Critical evaluation of the evidences Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  12. Value Based Medecine (Fulford) • Evidence Based Medicine : to consider the complexity of relevant research data • Value Based Medecine : to consider the complexity of relevant values and/or individual choices Adapted from G. Pieters Higher Council of Health Belgium. I. Pelc – BCNBP 2005

  13. Management of depressive patients in primary care Patient with depressive mood Patient with somatic complaints Depression ? Somatic pathologies to be excluded Para clinic investigations No Improvement Refer to psychiatrist No Minor depressive Major depression (DSM-IV) Etiological treatment Yes Bio-Psycho-Social support Psychotherapy no medications No Some worrying signs Treatment by general practitioner Yes No Yes Urgent No urgent Refer to mental health network Bio-Psycho-Social approach Psychiatric emergency unit Psychiatric outpatient clinic Psychiatrist Psychologist or General practitioner for medication Eole, 2005

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