Abstract: Background　Mental illness seriously endangers the health and life of residents.General practitioners（GPs）' collaborated with the psychiatric specialists is conductive to the diagnosis，treatment and management of mental disorders.But there are still many problems and obstacles in the current collaboration.More optimization strategies still need to be explored.Objective　 To analyze and explore the collaboration bottlenecks and strategies of GPs' diagnosis and treatment for outpatients with mental disorders，to provide theoretical basis for the application and optimization of strategies，so as to promote the diagnosis and treatment of mental diseases in communities.Methods　Searching the title of（“mental” OR “psycho” OR “psychiatry”）AND（“primary care” OR “general practice” OR “general practitioner” OR “family medicine”）in the databases of Web of Science，Pubmed，Elservier，China National Knowledge Infrastructure，WAN-FANGDATA and CQVIP，we retrieved literatures from January 1，2104 to December 31，2017.With the repeated literatures excluded，we analyzed the selected literatures involving the collaboration between general practice and psychiatric department.Results　 We retrieved 157 literatures.Eight of them involved the significance of collaboration，which mentioned its important values of clinical effects，cost saving，disease management，reducing stigma and discrimination，improving skills of GPs and saving general psychiatric resources.Three of them involved the deficiency of the collaboration status.Seventy-two of the literatures involved the collaboration strategies between general practice and psychiatric department，41 of which mentioned system plans，programs and models，31 of which mentioned other ways and channels of non-system strategies of collaboration; however，collaboration strategies were mostly in the construction stage，and their application effects in practice needed further study.Seventy-four of the literatures involved subjects being treated in general practice and psychiatric department，29 of which mentioned adolescents and children，and the rest of which mentioned other kinds of peoples.Sixteen of the literatures involved influencing factors of collaborations，including aspects of economy，manpower，drug prescription and technology，and obstacles in clinic，economy，duty and supervision.Seven of the literatures involved opinions of collaborations from GPs，psychiatrists，staff and patients.Eleven of the literatures involved the training of collaboration; they reported the cooperation between general practitioners and psychiatric specialists and the training of related knowledge and skills，but its long-term application and development in practice needed further study.Four of the literatures explored the collaboration between general practitioners and psychiatrists.Conclusion　GPs had collaboration obstacles and bottlenecks in the diagnosis and treatment of outpatients with mental disorders，including：the inadequacy of GPs' diagnosis and treatment，both GPs and psychiatrists lacking knowledge in collaboration，and many other obstacles influencing the collaboration.This also indicates the optimized strategies lies in program supports and resource optimizing.It is worth noting that the practice and persistence of the collaboration programs is needed.Resource optimization is reflected in rational investment and application of resources related to limited collaboration and policy support.

Key words: Affective disorders, psychotic；Outpatients；General practitioners；Hospitals, special；Cooperative behavior；Meta analysis；Bottlenecks；Strategies

摘要： 背景　精神心理疾病严重危害居民的健康和生活。全科医师协作精神心理专科有利于对精神心理障碍的诊治和管理，但当前其协作也存在不少的问题和障碍，仍需探索更多优化的策略。目的　分析和探索全科医师诊治门诊精神心理障碍患者的专科协作瓶颈与策略，为其策略应用和优化提供理论依据，以促进社区精神疾病的诊治。方法　2018-01-01至2018-05-31，在Web of Science、PubMed、Elservier数据库标题检索（“mental” OR “psycho” OR “psychiatry”）AND（“primary care” OR “general practice” OR “general practitioner” OR “family medicine”），在中国知网、万方数据知识服务平台、维普网数据库标题检索“全科”与“心理”“全科”与“精神”“家庭医生”与“精神”“家庭医生”与“心理”，获得发表时间为2014-01-01至2017-12-31的文献。剔除重复及未能获取的文献，入选涉及全科与精神心理专科协作的文献进行荟萃分析。结果　经过对文献的检索和筛选，共得到157篇涉及全科与精神心理专科协作诊治的文献。涉及全科与精神心理专科协作意义的文献有8篇，分别提到了全科与专科协作诊治精神心理障碍在获得临床诊治疗效、节省费用、管理疾病、降低病耻感和被歧视率、提高基层技能以及节省普通精神服务医疗资源等多方面的重要价值。涉及全科与精神心理专科协作现况调查的文献有3篇，皆提示了当前协作不佳的现况。涉及全科与精神心理专科协作策略的文献有72篇，其中41篇涉及的协作策略为系统计划、项目及模型，其余31篇涉及各种非系统性协作策略；但协作策略多处于构建阶段，其在实践中的应用效果有待进一步研究。涉及全科与精神心理专科协作诊治对象的文献有74篇，其中涉及青少年、儿童的最多，为29篇，其余涉及各类人群。涉及全科与精神心理专科协作影响因素与障碍方面的文献有16篇，其中协作影响因素包括经济、人力、药物处方和技术水平等，协作障碍涉及临床、经济、职能、法律和监管机构多个层面。涉及全科与精神心理专科协作观点的文献有7篇，包括全科医师、精神科医师、相关工作人员以及患者。涉及全科与精神心理专科协作培训的文献有11篇，其对全科与精神心理专科协作及相关知识、技能的培训开展进行了报道和反馈，但这在实际工作中的长期应用和开展有待进一步研究。涉及全科与精神心理专科协作探索的文献有4篇。结论　全科医师在诊治社区门诊精神心理障碍患者方面与精神心理专科的协作存在问题和瓶颈，包括全科诊治不足、双方对协作诊治认知欠缺以及其他影响协作诊治的障碍多。而协作策略的方向包括项目支持和资源优化，其中项目支持需注意对协作项目的落实和持续，资源优化体现在对有限协作相关资源的合理投入和应用以及给予政策支持。

关键词: 情感障碍, 精神病性；门诊病人；全科医生；医院, 专科；合作行为；文献荟萃；瓶颈；策略