Person-centred medicine and mental health

L Salvador-Carulla1 and J E Mezzich2

1 Faculty of Health Sciences University of Sydney Australia2 Mount Sinai School of Medicine New York University New York USA

This paper discusses an integrated approach to person-centred medicine and its role in the future of mental health careThe origins and current status of this emerging field are revised with special attention to the contributions made frompsychiatry and to the implications for psychiatric diagnosis and evaluation of the three pillars of the Person-centredIntegrative Diagnosis (PID) model its conceptual domains (health status experiences and contributors to ill and goodhealth) the related evaluative procedures the partnerships needed and the existing links and differences with people-centred care and personalised medicine In spite of their striking complementarities person-centred medicine and per-sonalised medicine do not yet have substantial bridges built between them Knowledge transfer and coordination shouldbe established between these two models which will cast medical evaluation and care in the upcoming future

Key words People-centred care Personalised medicine Person-centred integrative Diagnosis Person-centred medicine

Background

During the second half of the 20th Century medicaldiagnosis was progressively simplified by identifi-cation of a reduced set of symptoms and signs forevery disease which was consequently incorporatedto operational diagnostic systems and clinical guide-lines These systems increasingly relied on laboratorytesting biomarkers imaging techniques and supportdecision systems However this approach is alsorelated to extreme specialisation and uncontrolledcommoditisation of the health care field resulting inneglect of patientsrsquo personal needs and concerns andweakening of the doctorndashpatient relationship (Heath2005) Person-centred medicine proposes the wholeperson and hisher context as the centre and goal ofclinical care and public health (Salloum amp Mezzich2011) taking into account the patientsrsquo values andhealth experiences as well as to their resilienceenvironmental and personal resources quality of lifeand other aspects of positive health (Mezzich et al2010a)

In a landmark report the Institute of Medicine con-cluded that the US health system was seriouslyflawed and requires a new framework with a newset of aims and rules a key principle being person-centredness (Institute of Medicine 2001) Along thesame lines the US Presidential Commission onMental Health (2003) found the national mental healthcare system is in a state of disarray and proposed a

thorough transformation of the system to be drivenby the patient and the community The World HealthOrganization European Office (2005) proposed anAction Plan to reorganise mental health care aroundthe needs of patients and carers A similar approachhas been adopted in the UK (Department of Health2009)

A short history of person-centred medicine

The personalised approach is a distinctive pattern ofmany ancient medical systems for example Chineseand Ayurvedic where practitioners follow the bodilystate and the experience of the patient from visit tovisit and adjust treatment accordingly (Kirmayer2004) Ancient Greek philosophers and physiciansalso advocated for a holistic approach and suchencompassing Eastern and Western views are consist-ent with the World Health Organizationrsquos broaddefinition of health as a complete state of physicalemotional and social well-being and not merely theabsence of disease (Mezzich et al 2010a)

The development of the person-centred approach isclosely linked to a restricted number of medical disci-plines as family medicine psychiatry paediatrics ger-iatrics and general internal medicine Paul Tourniera Swiss general practitioner made a seminal contri-bution to the renaissance of person-centred medicinein the 1940s (Pfeifer 2010) A patient-centred lsquomedicalhomersquo model which aims to provide comprehensiveprimary care and facilitate partnerships between indi-vidual patients and their physicians and when appro-priate the patientrsquos family was developed in 1967 by

Address for correspondence Luis Salvador-Carulla MD PhDFaculty of Health Sciences 75 East St Lidcombe NSW 2141 Australia

(Email Luissalvadortelefonicanet)

Epidemiology and Psychiatric Sciences (2012) 21 131ndash137 copy Cambridge University Press 2012 EDITORIALdoi101017S204579601200008X

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at

the American Academy of Paediatrics and endorsedlater by the American Academy of Family Physiciansand a growing number of national health professionalassociations (Rosenthal 2008) Family physicians haveadopted a holistic and contextualised patient-centredapproach (McWhinney 1989) The American physicianEric Cassell highlighted the importance of suffering asan experience of the whole person and introduced theconcept of personhood in general medicine (Cassell1982 Cassell 2010)

Mental health has also played a decisive role inshaping the person-centred model In the 1940s CarlR Rogers in the US argued for a Client-CenteredTherapy and for the value of open communicationand empowering individuals to achieve their fullpotential (Rogers 1951 1961) The beginnings of theWorld Psychiatric Association (WPA) in 1950 alreadyrevealed interest on the concept of the person as cen-tral to the field (Garrabe 2008) WA Anthony incor-porated the concept of personhood and recovery tothe psycho-social rehabilitation field (Anthony 19932004) This approach goes beyond the focus on symp-tom management and functional improvement topromote wellness and quality of life in a processthat involves shared decision-making and where theneeds of the patients always come first

The Finnish psychiatrists YO Alanen developed theNeed-adaptive Assessment and Treatment approachwhich encourages attention to the meaning of patientsrsquoexperiences and to the nature of their needs (Alanen1997) The interest on person-centredness has keptpace with a renaissance of philosophical analysis inpsychiatry aimed at addressing the complexity of ill-ness experience and engaging the patient as a personValues-based practice (Fulford et al 2002) and the multi-level explanatory schemas (Schaffner 2009) are keycontributions to this movement

Psychiatry has also played major role in developinga common framework by encouraging networking andbridging in this area During the past decade theSection on Classification Diagnostic Assessment andNomenclature of the WPA promoted and extendedthe person-centred approach to diagnosis and inter-vention based on the person-centred model (Mezzichamp Ustun 2002 Banzato et al 2005 Salloum ampMezzich 2009) This group developed theInternational Guidelines for Diagnostic Assessment(IGDA) a comprehensive diagnostic schema that inte-grates a standardised multiaxial formulation employ-ing scales and official typologies yielding informationcomparable across the world on illnesses disabilitiescontextual factors and quality of life and an idio-graphic personalised statement allowing clinicianspatients and families to indicate what is unique andmost meaningful in the contextualised clinical

situation including positive factors as well as jointplans for restoration and promotion of health

Members of the Classification Section and severalother WPA scientific sections actively cooperatedin the organisation of the Geneva conferences onperson-centred medicine (Mezzich 2011b) fromwhich aroused the International Network forPerson-centred Medicine (INPCM) (Mezzich 2011a)now the International College of Person-centredMedicine (ICPCM) and the International Journal ofPerson-Centred Medicine (Miles amp Mezzich 2011)These initiatives have been landmarks in a process ofbuilding a movement of medicine for the personthrough the collaboration of major global medicaland health organizations and a growing group of com-mitted individuals

The institutions formally involved in the GenevaConferences have included the World MedicalAssociation (WMA) the World Organization ofFamily Doctors (Wonca) the International Networkfor Person-centred Medicine and other organisationssuch as the Council for International Organizations ofMedical Sciences (CIOMS) the World Federation forMental Health (WFMH) the World Federation ofNeurology (WFN) the World Association for SexualHealth (WAS) the International Association ofMedical Colleges (IAOMC) the World Federation forMedical Education (WFME) the InternationalFederation of Social Workers (IFSW) the InternationalCouncil of Nurses (ICN) the European Federation ofAssociations of Families of People with Mental Illness(EUFAMI) the International Alliance of PatientsrsquoOrganizations (IAPO) the University of GenevaSchool of Medicine and the Paul Tournier AssociationSince 2010 the Geneva conferences have been organisedtogether with WHO (Health Systems and otherDepartments)

The Person-centred Integrative Diagnosis (PID)

The PID is a person-centred approach to diagnosis thatcontinues and expands the previous work made atIGDA Psychiatric diagnosis is here regarded as anassessment process not only for nosological or differ-ential diagnosis but also for the understanding of theperson experience and its contextual instances Thedevelopment of PID included three focus or discussiongroups with psychiatrists health professionals andother health stakeholders (patients families and advo-cates) and a survey of a global network of nationalclassification and diagnosis groups The main findingsfrom these consultations include the perception thatplanning of treatment and care (rather than illnessidentification or inter-clinician communication) is the

132 L Salvador-Carulla and J E Mezzich

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at

main purpose of diagnosis the desirability of simplify-ing standard psychopathological classificationsthrough clusters and prototypes and that diagnosisshould cover not only disorders but also disabilitiespositive aspects of health risk and protective factorsand the patientrsquos values and experience on illnessand health These consultations also supported theuse of dimensions and narratives in addition to cat-egories as descriptive tools and the importance ofbasing the diagnostic process on an active partnershipamong clinicians patients and families These consist-ently expressed perspectives seem to strongly supporta person-centred diagnostic approach in contrast to theconventional disease-centred diagnosis (Mezzich et al2010a)

The PID conceptual framework covers domains ofboth ill health and positive health along three comp-lementary levels Health Status Experience of Healthand Contributors to Health (Fig 1) (Mezzich et al2010a)

The domain level on Health Status includes first ill-nesses or disorders of both mental and physical formswhich should be assessed according to the inter-national standards (mainly WHOrsquos InternationalClassification of Diseases and related diagnostictools) Disabilities would be assessed through pro-cedures such as those based on the InternationalClassification of Functioning and Health (ICF)(WHO 2001) The assessment of the well-being aspectof Health Status should be developed through scalesappraising quality of life and related constructs(Cloninger amp Cloninger 2011) The domain level on

Experience of Health appraises the patientrsquos illness-and health-related values and cultural experienceswhich should take into account guided narrative pro-cedure built on world-wide experience with theCultural Formulation (Mezzich et al 2009) The thirddomain level on Contributors to Health covers the intrin-sic and extrinsic biological psychological and socialfactors of both risk and protective types Their assess-ment should involve a combination of proceduresaimed at assessing healthy and unhealthy life-style fac-tors and related health contributors (Alonso et al 2010Cloninger amp Cloninger 2011)

The PID conceptual model is also linked to a novelevaluation system and new cooperation needs ThePluralistic Descriptive Procedures system (Mezzich et al2010a) follows an open building-blocks approach togenerate an evaluation system usable within the PIDframework For example the diagnostic evaluationprocess should be broadened to incorporate probabilis-tic and prototypical categories (Westen 2012) clini-metrics (Feinstein 1987) and categoricalndashdimensionalhybrid models (Mutheacuten 2006) It should also incorpor-ate narratives as a critical component of the evaluationprocess given its importance of understandingpatientsrsquo illness experience in the context of their lifestories and current illness narratives The personrsquos ill-ness narrative and account of health and resilienceoffer the clinician a clear picture of issues and prioritiesthat can organise and guide clinical intervention(Kirmayer 2000)

Psychiatric research has already incorporated manyof the components of PID in transcultural studies

Fig 1 PID domains

Person-centred medicine and mental health 133

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at

(Mezzich et al 2009) managerial epidemiology(Krumholz et al 2006) and translational research(Wang et al 2009 Ruggeri 2011) However the practi-cal implementation of Pluralistic Descriptive Proceduresimplies a full change of mental health evaluation par-ticularly as regards to the incorporation of narrativespersonal experiences and positive health componentssuch as resilience or flourishing Narratives havebeen used extensively in qualitative research and area valuable source of information (Charon 2006) butthe development of a set of metaphors for quantitativeanalysis and its use in routine practice or to generateevidence-informed care poses many challenges topsychiatric evaluation The use of Semantic WebKnowledge techniques (Tao et al 2010) in the analysisof narratives may allow for extensive review of thepersonal experiences of patients with severe mental dis-orders including positive accounts of recovery (Roberts2000) The development of narrative banks of healthexperiences may contribute to a better understandingof positive and negative aspects of ill health and mayalso contribute to improve diagnosis and treatmentplanning based on personal preferences and experi-ences This approach has been suggested to improveknowledge on medication intake attitudes and adher-ence in mental disorders (Tibaldi et al 2011) PID hasbeen adopted by the Revision of the Latin AmericanGuide for Psychiatric Diagnosis (GLADP) producedby the Latin American Psychiatric Association(Saavedra et al 2011a) It is important to note that thescientific application of the PID principles should notbe limited to high income countries as they are particu-larly important in low- and middle-income countries

The World Health Organisation has recently pro-duced Community-Based Rehabilitation (CBR) guide-lines (WHO 2010a) within its CBR programmescurrently applied in over 90 countries In order to pro-vide a common framework for the CBR programmes aCBR matrix was developed in 2004 which consists offive key components health (including promotion andprevention) education livelihood social and empower-ment The later includes advocacy and communicationcommunity mobilisation political participation self-help groups and disabled peoples organisationsRecent psychiatric epidemiological studies in Peru cov-ered ill- and positive-health and employed narrativesin addition to categories and dimensions (InstitutoNacional de Salud Mental 2002 Saavedra et al 2011b)

In order to put the PID model into practice thedevelopment of cooperation is essential ThereforePartnership for Evaluation is a fundamental element ofperson-centred care and involves the pursuit ofengagement empathy and empowerment as well asrespect for the autonomy and dignity of the consultingperson In fact it is crucial for achieving shared

understanding for diagnosis and shared decision mak-ing for treatment planning with the patient and hisherfamily (Mezzich et al 2010a)

Bridging and knowledge transfer in person-centredmedicine

Being a multidisciplinary and relational field (Mezzich2011a) person-centred medicine is closely linked to thenew science of bridging knowledge management andknowledge transfer

Bridging encompasses a broad range of conceptstasks technologies and practices aimed at improvingknowledge sharing and cooperation in care and sup-port for persons with health problems Bridgingconcepts should be based in health ontology anddevelop a common terminology knowledge base(Salvador-Carulla 2009) Once a PID model has beenagreed it may be helpful to agree to the developmentof a conceptual map of related concepts as well as alink with the ontology health databases such asSNOMED-CT (Rosenbloom et al 2009) For exampleit is necessary to clarify the existing difference betweenthe concepts of well-being quality of life healthexperiences and values and contributors to healthThe ontology and the semantic interoperability ofthe information systems developed in areas related toperson-centred care has to be established Bridgingtasks may include all activities of disseminationcoordination assessment empowerment deliverymanagement financing and policy within the field ofperson-centred medicine Bridging technologiesinclude mainly information technologies and theevaluation system that may eventually provide ausable battery of assessment instruments analysistechniques and evaluation guidelines Bridging prac-tices in the field of person-centred medicine shouldalso be registered and incorporated to practice banks

Knowledge transfer is not a linear one-time event itrequires ongoing active dialogue and exchangesbetween researchers policy makers practitioners andclient groups in order to develop and to implementa holistic integrative care and support or to effectivelyexchange the procedures and experiences in transla-tional research transdisciplinarity and in the develop-ment ofmultidisciplinary groups in research educationprovision management and policy (McDaid et al 2009)The role of networks knowledge brokering and part-nerships deserve special attention The coordinationand partnership may include all stakeholders fromhealth researchers to policy decision makers andsociety In 2009 the Barcelona declaration on bridgingand knowledge transfer opened the road for a formaldevelopment of this field (Salvador-Carulla et al

134 L Salvador-Carulla and J E Mezzich

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at

2009) Several members of the International Network ofPerson-Centred Medicine participated in the relatedinternational conference and contributed to define thisnew field of expertise

Setting links with people-centred care andpersonalised medicine

Health-related person-centredness and PID encom-passes all health sciences and person-centred medicineshould be defined within the broader context ofperson-centred care However the relationshipboundaries and hierarchy of person-centred medicineshould be established with the areas of people-centredcare and personalised medicine to enable a more effectivemodel of integrated care

According to WHO people-centred care coversperson-centred care as it is an umbrella term that betterencapsulates the foremost consideration of the patientacross all levels of health systems (WHO 2010a) TheWHO vision for people-centred health care lsquois one inwhich individuals families and communities areserved by and are able to participate in trusted healthsystems that respond to their needs in humane andholistic ways The health system is designed aroundstakeholder needs and enables individuals familiesand communities to collaborate with health prac-titioners and health care organizations in the publicprivate and not-for-profit health and related sectorsin driving improvements in the quality and respon-siveness of health carersquo (WHO 2007) Providingequitable access to people-centred care has beendescribed as one of the key components of an effectivehealth system by WHO (WHO 2010b)

However differences exist between the individualcare approach and the population policy approachthat go beyond this perspective The WHO proposalof a hierarchical relationship of these terms into oneparent category (people-centred care) and a child cat-egory (person-centred care) should be revised Recentdevelopments in people-centred care and person-centred care are closely coordinated particularlythrough the partnership developed at the Geneva con-ference series since 2010 (Mezzich 2011b)

The advances in new diagnostic and treatment tech-nologies have coalesced in the model of personalisedmedicine (Abrahams et al 2005) aimed at tailoringdiagnosis and treatment to every individualrsquos genomicprofile and biomedical characteristics As person-centred medicine has produced an integrative modelof diagnosis a similar process has occurred in thefield of individualised medicine lsquoTheranosticsrsquo (aterm formed by the combination of lsquoTherapeuticsrsquoand lsquoDiagnosticsrsquo) describes the process of diagnostic

therapy for individual patients using biomarkers totest possible reaction to taking a new medication andto predict the most suitable drug for a patient alongwith assessing the efficacy of the drug and other careinterventions (eg changes in health-related habits)based on the test results Theranostics is broadlyused in functional imaging and nanomedicine Bothpersonalised medicine and theranostics are highlycommoditised and have raised an increasing interestby health companies and governments in contrastwith the limited commercial support provided toimplement person-centred medicine into actual prac-tice A lsquoGenomics and PersonalizedMedicine Actrsquowas introduced to the US Congress in 2006 2007 and2010 to address scientific barriers adverse marketpressures and regulatory obstacles even though thereliability the health economic aspects and usabilityof personalised medicine is still in its infancy (Nget al 2009)

In spite of their evident complementarities person-alised medicine and person-centred medicine are cur-rently at odds These two approaches will certainlyhave a major impact in mental health care trainingand policy It may be path-opening that high-tech per-sonalised medicine and person-centred medicine thatarticulates science and humanism build bridges todevelop an integrative medical practice that finallyencompasses high technology with high human con-tact Current models of integrative care do provide aframework for supporting this common perspectiveon behavioural sciences and mental health (Singer ampRyff 2001)

Declaration of interest

None

References

Abrahams E Ginsburg GS Silver M (2005) Thepersonalized medicine coalition goals and strategiesAmerican Journal of Pharmacogenomics 5 345ndash355

Alanen YO (1997) Schizophrenia Its Origins and Need-adaptiveTreatment Karnak London

Alonso F Walsh CO Salvador-Carulla L eVITAL Group(2010) Methodology for the development of a taxonomyand toolkit to evaluate health-related habits and lifestyle(eVITAL) BMC Research Notes 24 83

Anthony WA (1993) Recovery from mental illness Theguiding vision of the mental health service systems in the1990s Psychosocial Rehabilitation 16 11ndash23

Anthony WA (2004) The principle of personhood the fieldrsquostranscendent principle Psychiatric Rehabilitation Journal 27205

Person-centred medicine and mental health 135

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at

Banzato CE Mezzich JE Berganza CE (2005) Philosophicaland methodological foundations of psychiatric diagnosisIntroduction Psychopathology 38 159ndash161

Cassell EJ (1982) The nature of suffering and the goals ofmedicine New England Journal of Medicine 306 639ndash645

Cassell EJ (2010) The person in medicine In conceptualexplorations on person-centered medicine InternationalJournal of Integrated Care 10 (Suppl)

Charon R (2006) Narrative Medicine Honoring the Stories ofIllness Oxford University Press New York

Cloninger CR Cloninger KM (2011) Development ofinstruments and evaluative procedures on contributors toillness and health International Journal of Person CenteredMedicine 1 456ndash459

Department of Health (2009) New Horizons A Shared Visionfor Mental Health Department of Health London

Feinstein AR (1987) Clinimetrics Yale University Press NewHaven

Fulford KWM Dickenson D Murray TH (eds) (2002)Healthcare Ethics and Human Values An Introductory Textwith Readings and Case Studies Blackwell Malden

Garrabe J (2008) Historical views on Psychiatry for thePerson Paper presented at the Paris Conference onPerson-centered Psychiatry World Psychiatric AssociationFrench Member Societies Association 6ndash8 February 2008

Heath I (2005) Promotion of disease and corrosion ofmedicine Canadian Family Physician 51 1320ndash1322

Institute of Medicine (2001) Crossing the Quality Chasm ANew Health System for the 21st Century National AcademiesPress Washington DC

Instituto Nacional de Salud Mental (2002) EstudioEpidemiologico Metropolitano de Salud Mental InformeGeneral Anales de Salud Mental 18 1ndash197

Kirmayer LJ (2000) Broken narratives clinical encountersand the poetics of illness experience In Narrative and theCultural Construction of Illness and Healing (ed C MattinglyL Garro) pp 153ndash180 University of California PressBerkeley

Kirmayer LJ (2004) The cultural diversity of healingmeaning metaphor and mechanism British Medical Bulletin69 33ndash48

Krumholz HM Currie PM Riegel B Phillips CO PetersonED Smith R Yancy CW Faxon DP American HeartAssociation Disease Management Taxonomy WritingGroup (2006) A taxonomy for disease management ascientific statement from the American Heart AssociationDisease Management TaxonomyWriting Group Circulation114 1432ndash1445

McDaid D Cieza A Gomez AR (2009) Bridging knowledgereflections on crossing the boundaries between long-term careand support International Journal of Integrated Care 9 e60

McWhinney IR (1989) Family Medicine A Textbook OxfordUniversity Press Oxford

Mezzich JE Ustun TB (2002) International classification anddiagnosis critical experience and future directionsPsychopathology 35 (Special Issue) 55ndash202

Mezzich JE Caracci G Fabrega Jr H Kirmayer LJ (2009)Cultural formulation guidelines Transcultural Psychiatry 46383ndash405

Mezzich JE Salloum IM Cloninger CR Salvador-Carulla LKirmayer LJ Banzato CE Wallcraft J Botbol M (2010a)Person-centred integrative diagnosis conceptual basesand structural model Canadian Journal of Psychiatry 55701ndash708

Mezzich JE Snaedal J Van Weel C Heath I (2010b)Introduction to conceptual explorations on person-centeredmedicine International Journal of Integrated Care 2010 Jan 2910e002n

Mezzich JE (2011a) Building person-centered medicinethrough dialogue and partnerships perspective from theInternational Network for Person-centered MedicineInternational Journal of Person Centered Medicine 1 10ndash13

Mezzich JE (2011b) The Geneva Conferences and theemergence of the International Network forPerson-centered Medicine Journal of Evaluation and ClinicalPractice 17 333ndash336

Miles A Mezzich J (2011) Advancing the globalcommunication of scholarship and research forpersonalized healthcare International Journal of PersonCentered Medicine 1 1ndash5

Mutheacuten B (2006) Should substance use disorders beconsidered as categorical or dimensional Addiction 101(Suppl 1) 6ndash16

Ng PC Murray SS Levy S Venter JC (2009) An agenda forpersonalized medicine Nature 461 (7265) 724ndash726

Pfeifer HR (2010) Paul Tournier and Meacutedecine de laPersonnersquo-The man and his vision International Journal ofIntegrated Care 10 (Suppl) e022

Presidential Commission onMental Health (2003) Achievingthe Promise Transforming Mental Health Care in AmericaFinal Report DHHS Publication No SMA-03-3832Department of Health and Human Services RockvilleMaryland

Roberts GA (2000) Narrative and severe mental illness whatplace do stories have in an evidence-based world Advancesin Psychiatric Treatment 6 432ndash441

Rogers C (1951) Client-Centered Therapy Riverside PressCambridge MA

Rogers C (1961) On Becoming a Person Houghton MifflinBoston MA

Rosenbloom ST Brown SH Froehling D Bauer BAWahner-Roedler DL Gregg WM Elkin PL (2009) UsingSNOMED CT to represent two interface terminologiesJournal of the American Medical Informatics Association 1681ndash88

Rosenthal TC (2008) The medical home growing evidence tosupport a new approach to primary care Journal of theAmerican Board of Family Medicine 21 427ndash440

Ruggeri M (2011) A Large Pragmatic Cluster RandomizedControlled Trial of a Multi-element Psychosocial Intervention forEarly Psychosis (GETUP-PIANO) Clinical Trials Gov (httpclinicaltrialsgovct2showNCT01436331) Accessed 15January 2012

Saavedra JE Otero A Salloum I Mezzich JE (2011a) TheRevision of the Latin American Guide for PsychiatricDiagnosis (GLADP) a person centered approach tointernational classification International Journal of PersonCentered Medicine 1 440ndash445

136 L Salvador-Carulla and J E Mezzich

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at

Saavedra JE Cruz V Mezzich JE (2011b) Person-centeredcare and economic deprivation an epidemiological view ofpositive mental health in a developing country InternationalJournal of Person Centered Medicine 1 62ndash75

Salloum IM Mezzich JE (eds) (2009) Psychiatric DiagnosisChallenges and Prospects Wiley-Blackwell Chichester UK

Salloum I Mezzich JE (2011) Outlining the bases forperson-centered integrative diagnosis Journal of Evaluationand Clinical Practice 17 354ndash356

Salvador-Carulla L (2009) Bridging knowledge in long-termcare and support Crossing boundaries between ageing anddisability International Journal of Integrated Care 9 e29

Salvador-Carulla L Balot J Weber G Zelderloo L Parent ASMcDaid D Solans J Knapp M Mestheneos L Wolfmayr FParticipants At The Conference (2009) The Barcelonadeclaration on bridging knowledge in long-term care andsupport Barcelona (Spain) March 7 2009 International Journalof Integrated Care 9 (Suppl) e179

Schaffner KF (2009) The Validity of Psychiatric DiagnosisEtiopathogenic and Clinical approaches In PsychiatricDiagnosis Challenges and Prospects (ed IM SalloumJE Mezzich) Wiley-Blackwell Chichester UK

Singer B Ryff CD (2001) New Horizons in Health On IntegrativeApproach National Academy Press Washington DC

Tao C Wei WQ Solbrig HR Savova G Chute CG (2010)CNTRO a semantic web ontology for temporal relationinferencing in clinical narratives AMIA Annual SymposiumProcedures Nov 13 787ndash791

Tibaldi G Salvador-Carulla L Garciacutea-Gutierrez JC (2011)From treatment adherence to advanced shared decisionmaking new professional strategies and attitudes inmental health care Current Clinical Pharmacology 691ndash99

Wang PS Heinssen R Oliveri M Wagner A Goodman W(2009) Bridging bench and practice translational researchfor schizophrenia and other psychotic disordersNeuropsychopharmacology 34 204ndash212

Westen D (2012) Prototype diagnosis of psychiatricsyndromes World Psychiatry 11 16ndash21

World Health Organization European Office (2005) WHOEuropean Ministerial Conference on a Mental Health ActionPlan for Europe Facing the Challenges Building SolutionsHelsinki Finland 12ndash15 January 2005 EUR0450478107

World Health Organization Western Pacific Office (2007)People-Centered Care A Policy Framework WHO ndash WesternPacific Region (httpwwwwprowhointNRrdonlyres55CBA47E-9B93-4EFB-A64E21667D95D30E0PEOPLECENTREDHEATLHCAREPolicyFrameworkpdf)Accessed 12 January 2012

World Health Organisation (2010a) Community-BasedRehabilitation CBR Guidelines Towards Community-BasedInclusive Development WHO Geneva

World Health Organisation (2010b) Key Components of a WellFunctioning Health System WHO Health System Geneva(httpwwwwhointhealthsystemsEN_HSSkeycomponentspdf) Accessed 12 January 2012

Person-centred medicine and mental health 137

httpswwwcambridgeorgcoreterms httpsdoiorg101017S204579601200008XDownloaded from httpswwwcambridgeorgcore IP address 541914080 on 10 Apr 2017 at 205822 subject to the Cambridge Core terms of use available at