How to Identify Mental Illness in the Primary Care Setting - Screening

Aetna Announces Plan to Pay for Depression Screening, Follow-Up Care
In a move sparked by employers who cite workers' depression as a frequent cause of absenteeism and low productivity, health insurance company Aetna announced last week that it will begin paying for primary care depression screening and follow-up care. The additional screenings costs will be more than offset by reducing medical costs associated with untreated depression, including the effects of the condition on heart disease, diabetes and other conditions, according to Aetna. The company's announcement came just after the Institute of Medicine released a report calling for greater coordination between mental health experts and primary care physicians. New York Times - 11/2/05

Several Signs Should Alert Clinicians to Suicide Risk
The winner of this year's Manfred S. Guttmacher Award. Dr. Simon argues for a complex approach to assessing suicide risk. Psychiatric News - 07/01/05

Diagnosing and Treating Depression and Anxiety Disorders in Family Practice
Earn CME as you learn about the importance of distinguishing between anxiety and depression and review current treatments for both conditions, including cognitive-behavioral therapy and psychopharmacology. Medscape - 02/23/05

Working with Your Older Patient: A Clinican's Handbook
This newly revised guide offers tips and strategies for clinicians - physicians, nurses, physician assistants, and other health professionals - seeking to build relationships and bridge communication gaps with their older patients. Working with Your Older Patient addresses difficult to discuss issues, provides practical tips to promote adherence to treatment, and lists resources for more information. Useful for primary care providers and health professionals working seniors in outpatient settings, and as a training tool for students and new practitioners. Topic areas include: Encouraging Prevention and Wellness; Talking about Sensitive Subjects; Driving; Abuse; End-of-Life Care; Incontienence; Sexuality; Supporting Patients with Chronic Conditions; Breaking Bad News; Working with Diverse Older Patients, Families and Caregivers and Talking about Cognitive Problems. National Institute on Aging www.nia.nih.gov - August 2004

Child & Adolescent Bipolar Foundation (CABF)
Parent-led, not-for-profit, Web-based membership organization of families raising children diagnosed with, or at risk for, early-onset bipolar disorder. CABF educates families, professionals, and the public about pediatric bipolar disorder; connects families with resources and support; advocates for and empowers affected families; and supports research on pediatric bipolar disorder and its cure.
www.bpkids.org

Screening for Psychiatric Disorders in Primary Care
Two-thirds of all patients with psychiatric disorders are seen exclusively in primary care settings. Thirty percent of all primary care patients meet DSM-IV-TR criteria for a psychiatric disorder, but many of these patients go undiagnosed.
Wisconsin Medical Journal - 2004

Macarthur Initiative on Depression and Primary Care
The Macarthur Initiative on Depression and Primary Care at Dartmouth and Duke offers primary care providers tools for the recognition, diagnosis and treatment of clinical depression within the primary care setting. Their web site offers a free, downloadable depression toolkit that includes clinician memory aids and a patient questionnaire for the diagnostic purposes. It also includes patient handouts, treatment information including drug administration information and monitoring and follow-up tools. www.depression-primarycare.org

Brighter Futures in Practice: Mental Health Practice Guide, Volumes I and II
The U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, funded the development of Bright Futures in Practice: Mental Health Practice Guide, Volumes I and II. These guidelines, supported by more than 50 national organizations, are written for primary health professionals and families.
www.brighterfutures.org

DEPRESSION

The Macarthur Initiative on Depression and Primary Care at Dartmouth and Duke offers primary care providers tools for the recognition, diagnosis and treatment of clinical depression within the primary care setting. Their web site offers a free, downloadable depression toolkit that includes clinician memory aids and a patient questionnaire for the diagnostic purposes. It also includes patient handouts, treatment information including drug administration information and monitoring and follow-up tools.

Depression Hangs Heavy on the Heart: Cardiology patients need monitory, study shows
At age 30, Yvonne Herr went to the emergency room thinking she was suffering from a bad bout of bronchitis. She was stunned to learn she was having a heart attack and jolted again when she found that she would have to undergo quintuple bypass surgery. The unpleasant surprises continued in the weeks after the surgery when a dark, ever-present mood set in. "I got very depressed," said Herr, now 39. "It was like, 'Wow, why is this happening to me?' I knew I needed help." Click here for the full-text article. Milwaukee Journal Sentinel - 01/14/07

Depression and Risk for Alzheimer Disease
Systematic Review, Meta-analysis, and Metaregression Analysis by Raymond L. Ownby, MD, PhD, MBA; Elizabeth Crocco, MD; Amarilis Acevedo, PhD; Vineeth John, MD; and David Loewenstein, PhD. Context: A history of depression may increase risk for developing Alzheimer disease later in life. Clarifying this relation might improve understanding of risk factors for and diesease mechanisms in Alzheimer Disease. http://www.archgenpsychiatry.com/

Recognizing Minor Depression
According to the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV), depressive mood can be seen in a number of psychiatric and medical disorders.^[1] Some physiologic effects of general medical conditions or medications can result in a diagnosis of mood disorders attributed to these causes. Involvement of manic symptoms can prompt a diagnosis of bipolar or cyclothymic disorder; and involvement of psychotic symptoms can result in a diagnosis of bipolar or schizoaffective disorder. Medscape - 08/09/06

POST PARTUM DEPRESSION

Postpartum Depression: Identification, Screening, and Treatment
Depression during the postpartum period is a significant public health concern, affecting 8%-15% of women and resulting in considerable morbidity for women, and their infants and families. Risk, prevalence, and distinguishing features of postpartum mood disorders are provided. Anxiety and depression frequently co-occur, suggesting symptoms of anxiety should also be attended to when screening for postpartum depression. Recommendations include the use of a brief, valid screening instrument as a routine clinical practice and the unique role of the obstetrician/gynecologist, pediatrician, and family practice physician in identification and referral. A summary of evidence-based treatment options for postpartum depression, along with current information about psychotropic medication, is provided to assist in risk-benefit analyses and decision making with patients. Wisconsin Medical Society Volume 103, Number 6 - 2004

SUICIDE

Several Signs Should Alert Clinicians to Suicide Risk
The winner of this year's Manfred S. Guttmacher Award, forensic psychiatrist Robert Simon, M.D., argues for a complex approach to assessing suicide risk.
Psychiatric News - 07/01/05

Suicide: A Focus On Primary Care
The judgment of the primary care physician is critical in preventing suicide since most mental health care is provided by a primary care doctor. This article will briefly discuss the epidemiology of suicide, then turn to the pragmatic assessment of suicide in the primary care office and treatment issues in patients with elevated suicide risk. Special attention is paid to the risk of suicide with antidepressants because of the recent publicity and the concerns many practitioners have expressed. Wisconsin Medical Journal Volume 103, Number 6 - 2004

POST TRAUMATIC STRESS SYNDROME AND OTHER TRAUMA RELATED ILLNESS

Post-traumatic Stress Disorder Following Traumatic Injuries in Adults
The residuals of traumatic injuries from home or workplace accidents, automobile accidents, physical assault, or other unintentional human error can affect victims both physically and psychologically. Symptoms of post-traumatic stress disorder (PTSD) are common among survivors of accidents and nonsexual assaults and can impede recovery. Early identification of PTSD and timely referrals to mental health providers can greatly reduce medical expenses, disability payments, lost wages, lost work productivity, and direct mental health costs. A physician-screening tool to identify PTSD is outlined in this article and can be completed in a few minutes. Implementation of this screening following traumatic injuries can promote early diagnosis of possible psychological complications and facilitate referral to appropriate mental health professionals. Wisconsin Medical Journal Volume 103, Number 6 - 2004

Post-traumatic Stress Disorder Within a Primary Care Setting: Effectively and Sensitively Responding to Sexual Trauma Survivors
It is estimated that 1 in 4 females and 1 in 6 males have experienced sexual assault or abuse before the age of 18.1 While the response to such experiences vary, a significant number of survivors will develop post-traumatic stress disorder or another mental illness. Post-traumatic responses can persist for years and may impact a patient's experience of medical care. Unfortunately, consistent inquiry around sexually traumatic experiences is not implemented in primary care settings. As a result, patients may feel retraumatized while receiving care or their mental health symptoms may be misdiagnosed, resulting in inappropriate treatment or referrals. Screening for sexual trauma and gaining an understanding of how to respond empathically to post-traumatic responses enable primary care physicians to provide sensitive and effective care to trauma survivors.
Wisconsin Medical Journal Volume 103, Number 6 - 2004

Emergency Care Practitioners' Barriers to Mental Health Assessment, Treatment, and Referral of Post-Injury Patients
Nearly half of all severely injured patients suffer some form of post-trauma mental stress, but little is known about factors that influence emergency care practitioners' decisions to refer injured patients to mental health care services.
Wisconsin Medical Journal Volume 103, Number 6 - 2004

PTSD and the practitioner
Part of the art of medicine, like in Goldilocks and the Three Bears, is getting it "just right" when it comes to under-diagnosing or over-diagnosing conditions-providing false negatives or false positives-in day-to-day practice. This is especially important, but problematical, when a new diagnosis appears on the scene because, in my experience, such new conditions often either continue to be unrecognized by some practitioners, or are over-recognized by others. Post-traumatic Stress Disorder (PTSD) is one such relative newcomer to "official" diagnoses. PTSD first appeared officially coded as such in DSM-III in 1980, although it had been known by various names before that: "soldiers heart," "shell shock," "traumatic neurosis," or "Gross Stress Reaction," to name several.
Wisconsin Medical Journal Volume 103, Issue 6 - 2004

Post-traumatic stress disorder: Early recognition and intervention in the emergency department
Post-traumatic stress disorder (PTSD) has become an increasingly recognized condition in society, with significant and far-reaching consequences to the affected individual as well as those close to them. In this issue of the Wisconsin Medical Journal, Lee et al explore the awareness of and procedures for evaluation of PTSD risk in emergency departments (EDs) for victims of trauma. The study evaluates the awareness of the disorder and brings to light how under-appreciated the disorder actually is and how much more there is yet to learn about it. The importance of allied health professionals such as social workers, pastoral care, psychologists, and others in the total care of these patients is emphasized. Equally important is the awareness that effective and consistent risk recognition and intervention is best achieved with on-site professionals. Wisconsin Medical Journal - 2004

PSYCHIATRIC AND MEDICAL CO-MORBIDITY

Psychiatric Comorbidity in Epilepsy and End Stage Renal Disease
Many chronic serious medical conditions are associated with increased psychiatric comorbidity. Two such conditions are epilepsy and chronic renal failure. While specialists are often involved in the care of these patients, well-established primary care remains an important part of their treatment. When psychiatric conditions arise, primary care providers will often be the first to see these disorders. These can be very complicated patients, and coordination of care between primary care physicians, specialists, and other health care providers is essential. Recognition, treatment initiation, and referral when needed are reviewed in this article. Wisconsin Medical Journal Volume 103, Issue 6 - 2004

Depression Often not Appreciated in Stroke Survivors Even Though It's Treatable: Although 17 percent of long-term stroke survivors in an Australian study published in the journal Stroke had depression, only 22 percent of these people had been prescribed antidepressant medications. But among those who were taking antidepressants, a majority didn't have symptoms of the depression for which they originally sought treatment, leading the study's researchers to conclude that antidepressant drugs appear to be effective in treating depression among stroke survivors. Post-stroke depression has been linked both to reduced quality of life and to death. Reuters,September 28, 2006

Managing medical and psychiatric comorbidities
The task of assessing and treating patients with combined medical and psychiatric problems can seem daunting, especially as patients become older, acquire chronic conditions, encounter acute illnesses, and take increasing numbers of medications. Add intercurrent social stressors as well as personality issues that affect how patients cope and this task can seem bewildering.
Wisconsin Medical Journal Volume 103, Issue 6 - 2004

Physical Disability and Mental Health: An Epidemiology of Psychiatric and Substance Disorders
This is the first in a series of reports from a community epidemiologic study of a racially - ethnically diverse representative sample of individuals from South Florida with and without a physical disability. The primary objectives of the study were (a) to develop epidemiological estimates of the lifetime and current prevalence of psychiatric and substance disorders among community-residing individuals with and without a physical disability and to document variations in prevalence across age, gender, and categories of race- ethnicity and (b) to identify factors that increase and decrease risk for psychiatric and substance disorders as they vary by the presence of disability, by the level of impairment among those with such limitations, and across age, gender, and race- ethnicity. This article limits consideration to the first of these objectives. Rehabilitation Psychology - 2006, Vol 51 Nov 3

SOMATOFORM DISORDERS

Medically Unexplained Symptoms and the Concept of Somatization
Somatization, the physical expression of psychological distress, is a prevalent and important problem. It is seen in a wide variety of clinical settings and represents a significant evaluation and management dilemma. The burden to the patient - coupled with the consequential economic and social costs-can be substantial. As a result, the identification and appropriate management of these patients and their often-challenging symptoms is imperative. The following review attempts to summarize the significant body of work committed to the concept of somatization in the medical, surgical, and psychiatric literature. Wisconsin Medical Journal Volume 103, Issue 6 - 2004

Managing Somatizing Patients Recognizing and Managing Somatizing Patients in Primary Care
What are the root causes of somatic complaints? What strategies are both effective and efficient for these patients? This program provides the tools to guide your care of somatizing patients. Medscape, released August 30, 2006. Valid for CME credit through August 30, 2007

SCHIZOPHRENIA

What primary care physicians need to know about people with schizophrenia
Schizophrenia is an illness that attacks people as they first move into adolescence and adulthood, just at the time when they are starting their dreams of what they want their lives to be. It is a disorder that comes with a surprisingly high risk of mortality, from both suicide and medical illness. Even among health professionals, there are many misconceptions about schizophrenia, including the belief that there is invariably a downhill course to the illness. Actually, schizophrenia is an episodic illness, often with ups and downs, and a surprisingly large number of people affected by it are able to live independently, work at jobs they like, and have social relationships that are satisfying. Living with schizophrenia is never easy, but many people with this illness are able to live more complete and normal lives than is commonly believed. Wisconsin Medical Journal Volume 103, Number 6 - 2004