Clinical Schedules for Primary Care Psychiatry (CSP Ver 2.2)

Clinical Schedules for Primary Care Psychiatry (CSP Ver 2.2)

Primary care doctors (PCDs) are often the first contact for patients with common psychiatric disorders, but the majority of them are ill equipped to handle the same leading to symptomatic treatment. Hence, an innovative digitally driven and modular-based Clinical Schedules for Primary Care Psychiatry (CSP Ver 2.2) was designed and implemented exclusively for practicing Primary care doctors of India

Common mental disorders (CMDs) form the significant bulk with a prevalence of around 10%, whereas severe mental disorders have a prevalence of 0.8%.] The treatment gap for most of the psychiatric disorders is around 80%. The total number of psychiatrists registered as members of the Indian Psychiatric Society (IPS) is approximately 9000. Going by this data, we have 0.75 psychiatrists per 100,000 populations, whereas the estimated desirable is more than 3 per lakh. Taking these data into consideration, India requires 36,000 psychiatrists. Hence, we have a deficit of around 27,000 psychiatrists

The second area to be taken into consideration is the distribution of the Indian population. Around 70% of the Indian population reside in rural areas, whereas the distribution of doctors/mental health professionals follows an opposite trend, with a concentration of specialists in urban areas.] This hampers the delivery of services to the majority of the Indian population. Primary care doctors (PCDs) are most often the first contact for these patients. Several studies have been conducted to study the prevalence of CMDs in patient population consulting PCDs and have shown that 17%–46% of this population need psychiatric care. However, majority of PCDs are ill equipped to handle the psychiatric disorders and provide symptomatic treatment which further lead to chronicity of illnesses in the population.

Integrating psychiatric care into primary health care appears to be a viable option to manage the above-mentioned roadblocks. Dysfunctional work patterns of PCDs are the reason for “functional treatment gap” at primary care to provide psychiatric treatment but provide symptomatic treatment to them. Traditional classroom training (CRT) programs involving didactic lectures, video demonstrations, and PowerPoint presentations in group format are often conducted for these PCDs serving in government sector.

CSP is an all-in-one integrated, adopted, validated tool for PCDs to provide the first-line, safe, and effective pharmacotherapy for highly prevalent six psychiatric disorders at primary care which include tobacco addiction, alcohol (harmful and addiction), psychotic, depressive, anxiety (panic and generalized anxiety disorders), and somatization disorders (TAPPSAD).

It consists of the screener, classification of psychiatric disorders adapted for use in primary care settings, diagnostic criteria, referral points, and management guidelines for these six highly prevalent psychiatric disorders.

The CSP screener consists of a questionnaire containing 21 culturally appropriate questions to screen patients for TAPDAS. CSP uses a cluster-based transdiagnostic classification of psychiatric disorders adopted for the use of PCDs.

Clusters are CMDs cluster subdivided as (

(1) predominantly depressive, anxiety, somatization, or mixed symptoms;
(2) psychotic disorder cluster subdivided as acute (cover acute psychosis and mania), chronic (schizophrenia and schizoaffective disorders), or episodic (focus on bipolar disorder); and

(3) alcohol disorders simplified as harmful (frequent and infrequent type) and addiction with simplified diagnostic criteria for primary care use.

CSP version 2.2 designed by primary care psychiatry team at NIMHANS Bengaluru is available on request .

CSP version 2.2 is available for downloadable at http://nimhansdigitalacademy.in/wp-co....

Management guidelines in CSP include pharmacotherapy, brief counseling, and follow-up guideline along with strategies for referral guidelines. CSP screener has inbuilt pragmatism of real-world scenarios. It is adopted and validated with higher sensitivity and specificity at primary care