PubMed · 10187651
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A Melville, A House. 1998-12-03. Deliberate self-harm.. https://pubmed.ncbi.nlm.nih.gov/10187651/
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Roughly every fifth patient attending the doctor's office complains of insomnia. The first thing that needs to be done is to determine whether a particular patient has primary insomnia of pathological significance, or a temporary disturbance of his/her sense of well-being, or whether the sleep disorder is a secondary consequence of some other somatic or psychiatric condition. For the treatment of insomnia in the doctor's office, a number of basic rules derived from behavioral medicine can be recommended, for example systematic self-observation and record-keeping in a sleep diary, reassurance as to the harmlessness of a temporary sleep problem, practicing relaxation to reduce the general level of activity, reduction of the time spent in bed, and sleep-deprivation treatment. For all of these forms of treatment, a good doctor-patient relationship is mandatory, in particular when--as is to be expected--setbacks occur, which should not be dramatized. A diagnosis-treatment diagram is presented, in which proposals for medication should also be integrated.
Helping patients change behavior is an important role for family physicians. Change interventions are especially useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions. The concepts of "patient noncompliance" and motivation often focus on patient failure. Understanding patient readiness to make change, appreciating barriers to change and helping patients anticipate relapse can improve patient satisfaction and lower physician frustration during the change process. In this article, we review the Transtheoretical Model of Change, also known as the Stages of Change model, and discuss its application to the family practice setting. The Readiness to Change Ruler and the Agenda-Setting Chart are two simple tools that can be used in the office to promote discussion.
Long-term institutionalization is no longer the preferred treatment for the severely mentally ill. Several models for outpatient treatment of the severely mentally ill have been developed, among them Assertive Community Treatment (ACT). The literature on this model is reviewed in a Cochrane review and in randomized trials comparing ACT with hospital admission. ACT is a clinically effective approach to managing the care of severely ill people in the community. ACT, if correctly targeted on high users of in-patient-care, can substantially reduce costs of hospital care whilst improving outcome and patient and relatives satisfaction. Setting up ACT teams should be supported by politicians, professionals and consumers.