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

DSM & PUBLIC HEALTH Mental Public Health today : The WHO European Ministerial Conference on Mental Health, Helsinki, January 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.

WHO European Ministerial Conference on Mental Health 1.Promote mental well-being for all 2.Demonstrate the centrality of mental health 3.Tackle stigma and discrimination 4.Promote activities sensitive to vulnerable life stages 5.Prevent mental health problems and suicide 6.Ensure access to good primary care for mental health problems 7.Offer effective care in community-based services for people with severe mental health problems 8.Establish partnerships across sectors 9.Create a sufficient and competent workforce 10.Establish good mental health information 11.Provide fair and adequate funding 12.Evaluate effectiveness and generate new evidence Helsinki, January 2005 Mental Health : Facing the Challenges, building solutions Action Plan I. Pelc – BCNBP 2005

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

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

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. 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, 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, 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, Psychological problems at admission according to final diagnosis (axe 1 DSM IV)

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

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

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

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

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