Identification of psychiatric disorders in primary care

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The first stage of providing services for psychiatric disorders in primary care is to detect them. This is not a simple matter because, as explained above, some people with a psychiatric disorder do not present with psychiatric symptoms but complain instead of physical symptoms. The latter may be those of a coincidental physical illness or part of the symptoms of the psychiatric disorder, for example, palpitations in an anxiety disorder or tiredness in a depressive disorder. Some patients are aware that they have an emotional problem but describe physical symptoms instead of psychiatric symptoms because they fear that the doctor will not respond sympathetically to psychiatric illness. Other patients are unaware that their physical symptoms have a psychological origin. Goldberg and Huxley (1992) have introduced two useful terms: conspic uous morbidity refers to the cases that are detected, hidden morbidity refers to the rest. Hidden cases are generally less severe than conspicuous ones.

How accurately the general practitioners identify undeclared psychiatric disorder depends on:

• Ability to gain the patients' confidence and so enable them to disclose psychiatric problems of which they are aware;
• Skill in assessing whether physical symptoms are caused by physical or psychiatric illness.

This requires a good knowledge of physical medicine as well as psychiatry.

General practitioners can be trained to increase their ability to identify psychiatric disorder among their patients.