Mental Health, An Issue of Primary Care Clinics in Office Practice (The Clinics: Internal Medicine)

Cover......Page 1
Preface......Page 2
Stimulants......Page 4
Family studies......Page 5
Neurobiologic factors......Page 6
Diagnostic and Statistical Manual of Mental Disorders criteria......Page 7
Clinical presentation......Page 8
Associated features and impact......Page 9
Driving......Page 10
Assessment......Page 11
Rating scales......Page 12
Comorbidity......Page 13
Differential diagnosis......Page 14
Psychiatric diagnoses......Page 15
Treatment......Page 16
Pharmacological......Page 17
Nonstimulants......Page 18
Adverse effects......Page 19
Primary care/psychiatry......Page 20
Substance abuse......Page 21
Pearls......Page 22
References......Page 26
Recent Advances in the Understanding and Treatment of Anxiety Disorders......Page 33
Etiology and perpetuation......Page 34
Clinical presentation and impact......Page 35
Treatment......Page 36
Clinical presentation and impact......Page 39
Assessment......Page 40
Treatment......Page 41
Etiology and perpetuation......Page 42
Clinical presentation and impact......Page 43
Treatment......Page 44
Etiology and perpetuation......Page 45
Clinical presentation and impact......Page 46
Treatment......Page 47
Generalized anxiety disorder: pearls......Page 48
Etiology and perpetuation......Page 49
Clinical presentation and impact......Page 50
Treatment......Page 51
Obsessive-compulsive disorder: pearls......Page 52
Caution about evidence-based treatments......Page 53
Summary......Page 54
References......Page 55
Navigating the Sequenced Treatment Alternatives to Relieve Depression (STARlowastD) Study: Practical Outcomes and Implications for Depression Treatment in Primary Care......Page 63
Sequenced Treatment Alternatives to Relieve Depression study design......Page 64
Results......Page 68
Study limitations......Page 71
Lessons learned......Page 73
References......Page 75
Lithium......Page 78
Epidemiology and diagnostic characteristics of bipolar disorder......Page 79
Bipolar I disorder......Page 80
Bipolar II disorder......Page 81
Cyclothymic disorder......Page 82
Bipolar spectrum disorder......Page 83
Depression: trademark of bipolar disorder......Page 85
Why is differential diagnosis of bipolar disorder from major depressive disorder critical?......Page 86
Impact of bipolar disorder and suicide risk......Page 87
Implications for primary care......Page 88
Making the diagnosis of bipolar disorder in primary care......Page 89
Clinical clues to bipolar disorder......Page 90
Treatment......Page 92
General treatment principles......Page 93
‘‘Mood stabilizers’’......Page 94
Mania/hypomania/mixed states......Page 95
Bipolar depression......Page 96
Maintenance therapy in bipolar disorder......Page 97
Clinical use of specific partial mood stabilizers......Page 98
Olanzapine......Page 99
Tolerability and safety issues with atypicals......Page 100
Divalproex......Page 101
Carbamazepine......Page 102
Lamotrigine......Page 103
References......Page 104
The role of psychiatric distress in physical symptoms......Page 108
Obstacles to mental health care......Page 109
The BATHE technique......Page 110
FRAMES......Page 114
Precontemplation......Page 117
Preparation......Page 119
Kaizen: the principle of small steps......Page 120
Maintenance, lapse, and relapse......Page 121
Motivational interviewing......Page 123
References......Page 125
Integrating Mental Health and Primary Care......Page 128
Disease process level......Page 129
Patient level......Page 131
System level......Page 132
Systematized screening for mental health conditions......Page 133
Education and training of primary care practitioners......Page 134
Production and dissemination of treatment guidelines......Page 135
Increased referral to mental health specialists......Page 136
Collaborative care models, involving care managers and stepped care......Page 137
Why do some approaches work whereas others do not?......Page 141
References......Page 144
Adult Post-Traumatic Stress Disorder: Screening and Treating in Primary Care......Page 150
Epidemiology of post-traumatic stress disorder......Page 151
Acute stress disorder......Page 153
Biological underpinnings of post-traumatic stress disorder......Page 154
Association between post-traumatic stress disorder and medical morbidity......Page 155
Presentation......Page 156
Barriers to asking about post-traumatic stress disorder......Page 157
How to assess for trauma and post-traumatic stress disorder......Page 158
Special considerations in medical treatment of post-traumatic stress disorder......Page 160
Treatment of post-traumatic stress disorder: psychopharmacology......Page 161
Treatment of post-traumatic stress disorder: psychotherapy......Page 162
Vicarious trauma: taking care of the caregiver......Page 163
References......Page 164
Practical Behavior Change Counseling in Primary Care......Page 168
Strategies and tools......Page 169
Past medical history......Page 172
Step I: rapport and agenda setting......Page 173
Step 2: assessing readiness for change......Page 175
Step 4: maintenance......Page 176
Step 5: dealing with resistance......Page 177
References......Page 178
Prevalence/overview......Page 180
General comments on comorbidity......Page 182
Substance abuse comorbidity......Page 183
Understanding criterion sets......Page 184
Assessment......Page 187
Interventions in primary care......Page 190
Referral to mental health colleagues: when and how......Page 192
Special considerations......Page 193
References......Page 195
Prevalence......Page 198
Impact on physical health......Page 199
Barriers for victims of IPV......Page 201
Barriers for heath care providers......Page 202
Screening recommendations of professional groups......Page 203
Approaches to screening......Page 204
Interventions for interpersonal violence......Page 206
Summary......Page 211
References......Page 212
Definition......Page 215
Risk factors......Page 217
Consequences of insomnia......Page 218
Diagnosis......Page 219
Nonpharmacologic treatment......Page 221
Pharmacologic treatment......Page 223
Summary......Page 226
References......Page 227