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Aim: This study sought to determine factors associated with general practitioner (GP) recognition of emotional distress in Australian general practice. Methods: Twenty eight GPs completed a clinical audit in which they noted their identification of any emotional distress in their patients, while 868 of their patients completed the General Health Questionnaire (GHQ-28). The GHQ was scored with the conventional 4/5 cut-off. GP recognition was determined by a comparison of the GP record of emotional distress and the patient GHQ. Logistic regression was used to examine which patient and GP characteristics influenced correct recognition. Results: The GHQ identified 48% of all patients as probable cases. GPs identified 34% of their patients as having emotional distress, correctly recognizing 43% of GHQ cases. Overall, specificity was high (8 1%), though sensitivity was modest (43%). For individual GPs the rate of correct recognition varied considerably, from 4% to 100%. Correct recognition was associated with years experience as a GP, older age of patient and greater severity of distress. Conclusions: The data raise questions about the possible oversensitivity of the GHQ. The clinical skills associated with the recognition of mental illness and of emotional distress are obviously complex, and take time and experience to develop. Reassuringly, GPs are recognising most of the more severe depressions. [ABSTRACT FROM AUTHOR]

Objective: To study the relationship between aspects of insight and medication adherence and elements of psychopathology. Method: Clients completed insight and adherence measures in interview; doctors and case managers independently completed ratings of adherence and psychopathology. Other client information was obtained from the clinical file. Results: The subscale structure of the insight scale was well reproduced. Clients endorsed items relating to need for treatment more than items relating to relabelling of symptoms and awareness of illness. Selfreported insight was lower in those clients for whom either the treating doctor or the case manager or both thought the client was non-adherent. Insight was related positively to clinician ratings of depressed mood, and negatively to clinician ratings of personal functioning. Conclusion: Our data support the subscale structure of the insight questionnaire used, and previous suggestions that insight is positively related to depressive affect, and inversely related to impaired psychosocial functioning. [ABSTRACT FROM AUTHOR]

Ninety-four psychiatric in-patients, receiving regular antipsychotic medication, were videotaped using a standard procedure. The tapes were rated by blind observers using a simple scoring system for the duration of abnormal movements. Using this combined videotape and rating scale assessment technique the re-rating reliability, inter-rater reliability and test-retest reliability were high. In order to demonstrate the validity of the technique the rating scale scores in a sub-sample of 30 patients, were compared with the assessment of three experienced clinicians on the same patients, and AIMs scores. Central (lip, tongue, jaw and neck movements) scores showed close agreement with the clinicians' assessment, suggesting that clinical diagnosis is based principally on the presence and severity of oro-facial dyskinesia. Total rating scale scores were in close accord with total AIMs scores. When the two scales were carried out on the same patients on the same occasion a diagnostic criterion level of 2 or more on the central score produced a tardive dyskinesia prevalence rate identical to that produced by an AIMS criterion level of 2 or more on the global severity rating. The tardive dyskinesia prevalence rate based on the central score criterion level showed an increase with age. [ABSTRACT FROM AUTHOR]