关键词: 精神障碍；情感障碍, 精神病性；全科医生；医院, 专科；多方访谈

Abstract: Background　The incidence of mental illness is increasing，and the cost of curing psychological disorders is burdensome，which sets a higher requirement for today's health service system and mode.The collaborative clinic system of general practitioners（GPs） and psychiatrists is of great value for the diagnosis and treatment of psychological disorders，but the current collaboration in China does not work quite satisfactorily.Objective　To discover and analyze the obstacles of the collaborative clinic system of GPs and psychiatrists with the purpose to optimize the collaborative strategies.Methods　A total of 20 GPs and 30 patients with mental disorders or their families from one general hospital（H1），two urban community hospitals（H2，H3） and one suburban community hospital（H4），and 10 psychiatrists from the same areas were randomly selected for the investigation and interviews from August 1st to September 30th in 2018.The interview covered five main aspects of interviewee's cognition，behavior，attitude，questions and opinions related to collaborative diagnosis and treatment system.The interview duration was about half an hour and it was recorded.The recording was transcribed electronically.First，each question was coded at the first level.Then，the corresponding content of each encoding was discussed and condensed to generate the descriptive label for further data induction and classification.Then the subjects were generated by classification，and representative interview speeches were cited by the respondents.Results　（1）GPs had a certain cognition of the collaborative diagnosis and treatment，but the current collaboration with psychiatrists did not work quite well.GPs thought that collaboration was of great significance，but it still faced multiple difficulties involving channels，resources，doctors and patients.GPs suggested that collaboration could be promoted with varied forms including collaborative resources and forms，and improving GPs' own expertise.（2）The psychiatrists carried out collaborative diagnosis and treatments in community，including community clinics，but they thought that the effects of collaboration were different.They thought the collaboration was necessary and beneficial to patients' physical and mental health，as well as their family and social problems.However，psychiatrists also mentioned that there were various problems and difficulties in the current collaboration from aspects of allocation of resources and patients.They advised that collaboration required more mutual learning and communication，expanded publicity and platform construction.（3）The patients or their family members had little cognition of collaboration，and they agreed with collaboration but lack of active suggestions.Most of patients had not accepted the collaborative diagnosis and treatment and many of them were sent to different medical institutions without standard treatments.The patients mainly relied on psychiatric drugs without suitable prescriptions.There was a need for collaborative clinic system in community，but patients distrusted the GPs.There were also other problems such as the lack of psychiatric drugs，or small prescriptions in community clinics.Conclusion　At present，there are problems and obstacles in the collaboration clinic system between GPs and psychiatrists in the diagnosis and treatment of patients with mental disorders，including the incoordinate information and resources between doctors and patients，and lack of effective implementation of collaboration platforms and strategies.The optimization strategies include improving the ability of GP to diagnose and treat mental disorders，improving the collaboration modes and channels，and implementing and utilizing the existing collaboration platforms and resources.Policy encouragement and patient education should also be strengthened.

Key words: Mental disorders；Affective disorders, psychotic；General practitioners；Hospitals, Special