DETECTION AND DIAGNOSIS OF PSYCHIATRIC DISORDERS IN PRIMARY MEDICAL CARE SETTINGS
Section snippets
DEPRESSIVE DISORDERS
Depression is a common illness that places a considerable burden on the individual and on society. It is estimated that the total cost of depressive disorders in the United States is $44 billion from lost productivity, lost wages, and increased medical utilization.30 In this regard, depression exacts as high a price as heart disease, diabetes, and other chronic medical illnesses.21 The National Comorbidity Survey found that the 30-day prevalence of major depression in the general population of
ANXIETY DISORDERS
It is estimated that 27.4 million Americans suffer from anxiety disorders, with nearly 12 million suffering from anxiety complicated by at least one other psychiatric disorder.38 The nonpsychiatric medical care of these individuals is estimated to cost $23 billion, not to mention the loss of work productivity, estimated at $4.1 billion.29 Most of these patients present initially to their primary care physician. A method for early detection and diagnosis of anxiety disorders is needed in the
COGNITIVE IMPAIRMENT
Data from the Epidemiologic Catchment Area studies show a 4.9% prevalence of cognitive impairment for adults age 65 and older living in the community.55 This rate increases with age to nearly 16% for adults age 85 and older. In contrast, nearly 50% of the aged in long-term care facilities can have severe cognitive impairment.32 McCormick et al,46 using a rigorous case-finding technique, found that the average duration of symptoms of dementia was about 2 years before diagnosis. There often is a
SUBSTANCE-RELATED DISORDERS
Alcohol and drug abuse affects 16% to 20% of general medical outpatients.20, 70 Despite the commonality of these problems, the addicted patient may be overlooked in a busy primary care practice. A routine screening process can enhance the detection of patients with substance-related problems and lead to successful treatment recommendations. The first step in this process is to identify the nature and severity of the problem. One survey showed, however, that only 41% of primary care physicians
SUMMARY
Research efforts accelerated in the 1990s to define the presentation of common psychiatric disorders in primary care settings. Two diagnostic instruments, the DSM-IV-PC and the PRIME-MD, were introduced in 1994, and a self-report form of the PRIME-MD, the PHQ, was published in 1999. These tools have streamlined the larger, often cumbersome psychiatric nomenclature of the DSM-III and DSM-IV and appear to be more useful in general medical settings. It still is not practical to use either
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Cited by (55)
Psychiatric disorders impacting critical illness
2014, Critical Care Nursing Clinics of North AmericaPrevalence and clinical characteristics of the DSM IV major depression among general internal medicine patients
2013, European Journal of Internal MedicineCitation Excerpt :For all nine items of the SCID, we found no significant difference in terms of gender (Table 1). This study is in agreement with previous studies that show a high prevalence of MDD among general internal medicine patients [1–12]. In the present study we also investigated the clinical characteristics of MDD among IM patients.
Avatar-based simulation in the evaluation of diagnosis and management of mental health disorders in primary care
2012, Journal of Biomedical InformaticsRecognition of anxiety disorders by family physicians after rigorous medical record case extraction. Results of the Netherlands Study of Depression and Anxiety
2012, General Hospital PsychiatryCitation Excerpt :This is in line with earlier research [3,6,10]. In contrast to previous studies, we found no associations of recognition with FPs' characteristics such as knowledge level of FPs concerning mental disorders and FPs' time constraints [6,10,15]. Our study has some limitations.
The stigma of a psychiatric diagnosis: Prevalence, implications and nursing interventions in clinical care settings
2012, Critical Care Nursing Clinics of North AmericaCitation Excerpt :The primary intervention reported by the nurses to address anxiety was the administration of anxiolytic/sedative drugs or pain medication. Although anxiety is a normal part of life and most people experience more intensely during stressful life events, underdiagnosis of anxiety disorders in medical settings is due, at least in part, to the stigma associated with psychiatric disorders.6 Alcohol and drug abuse disorders are also underdiagnosed and, therefore, not proactively treated during medical admissions.
Psychological aspects of vestibular disorders
2010, Handbook of Clinical NeurophysiologyCitation Excerpt :“Have you lost interest in things?” This method is based on research in primary care settings that strongly supports the sensitivity of the screening questions for detecting depression (Staab et al., 2001, for review). However, the anxiety questions have not been similarly investigated and none of them has been evaluated in patients with dizziness.
Address reprint requests to Jeffrey P. Staab, MD, MS, Department of Psychiatry, Hospital of the University of Pennsylvania, Founders Pavilion F11.015 3400 Spruce Street, Philadelphia, PA 19104. e-mail: [email protected]