The role of the general practitioner in management of psychiatric disorders

Aim. - Psychiatric disorders represent a huge burden of disease worldwide. Significant gaps in their diagnosis and treatment remain. In Morocco, an observed shortage of psychiatrists would logically call for their collaboration with family physicians. Our objectives were to analyse perceptions of general practitioners' capacity to manage psychiatric disorders, to study the difficulties encountered in their management of these pathologies, and to assess their degree of collaboration with existing mental health structures. Methods. - A cross-sectional nationwide survey of family physicians practicing in urban and rural areas in the private and public sectors in the Kingdom of Morocco was organised. Carried out over a period of 10 months (April 2016 to January 2017), the study was based on an anonymised self-administered questionnaire comprising 23 items. Were excluded from the sample: physicians who had tested the questionnaire prior to its distribution, medical students, family physicians employed in administrative services, resident doctors in university hospitals, and questionnaires with incomplete answers. Results. - All in all, five hundred and four questionnaires were distributed, with a participation rate of 79.8%, while 57.9% of the respondents were men. Their seniority as doctors ranged from 1 year to 60 years with average duration of 19.5 +/- 11 years. An overwhelming majority of the doctors had obtained their doctorates in Morocco, while 8.4% had been trained abroad. The majority of the doctors surveyed worked in private practice in urban areas (53.1%), and most of them (81.9%) agreed that the management of psychiatric disorders is a public health priority. The participating physicians stated that they received an average of five patients per day suffering from mental disorders, representing 17.3% of their medical consultations. According to their perceptions, the most frequent psychiatric pathologies were depression, somatoform disorders and sleep disturbances, which were cited by 92.9%, 78.8% and 78.5% of them respectively. Regarding the diagnosis of psychiatric pathologies, 60.2% of the doctors considered bipolar disorder as a difficult pathology to diagnose, followed by schizophrenia, autism and dementia, while the pathologies reported as the most difficult to treat were addictive behaviours, schizophrenia, bipolar disorder, autism and dementia. Physicians felt a need for training, primarily pertaining to anxiety disorders, schizophrenia and bipolar disorders (49.5%, 35% and 33.7%, respectively). Nearly a quarter of the respondents (22.4%) mentioned a need for training in management of all psychiatric illnesses. Regarding the reasons for their referral of patients to mental health care structures, 65.4% of the physicians justified their doing so by a need for hospitalisation, while in 43.7% of cases, the transfer was carried out at the request of the patient or his family. The difficulties mentioned by the respondents were firstly a lack of adapted means of care (77.5%), followed by their insufficient training in mental healthcare (52.4%) and absence of collaboration with mental health professionals (52.4%). Conclusion. - For the majority of the physicians surveyed, psychiatry represented a public health priority, and their prioritising provides a probable explanation for their positive perception of their role Historique in the management of mental disorders. However, we went on to observe that a number of difficulties constituted obstacles to their role in management of mental disorders and induced them to refer their patients to psychiatrists. Our analysis highlighted the impact of continuing education on physicians' attitudes and the interest of collaboration between practitioners. Efforts in university teaching and continuous education should be encouraged in view of enabling family physicians to more effectively cope with the demands of daily practice and meet the expectations of the overall population. (C) 2020 Elsevier Masson SAS. All rights reserved.