BOOK
Psychiatric Diagnosis and Management in Primary Care, An Issue of Medical Clinics, E-Book
(2014)
Additional Information
Book Details
Abstract
This issue of the Medical Clinics of North America is devoted to Psychiatric Diagnosis and Management in Primary Care and is edited by Dr. Genevieve Pagalilauan. Articles in this issue include: Psychopharmacology; Office-based Screening of Common Psychiatric Conditions; Depression; Anxiety Disorders; Bipolar Disorder; Borderline Personality Disorder; Grief Reaction, Adjustment Disorder, Seasonal Affective Disorder; Somatiform Disorders; Addiction Disorders; Sleep disorders; Geriatric Psychiatry; Autism Spectrum Disorders in Adults; and Medical Conditions with Neuropsychiatric Manifestations.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Psychiatric Diagnosis\rand Management in\rPrimary Care\r | i | ||
| Copyright | ii | ||
| Medical clinics of north america\r | v | ||
| Contributors | vii | ||
| Contents | xi | ||
| Foreword\r | xv | ||
| Preface\r | xvii | ||
| Erratum | xxi | ||
| Psychopharmacology | 927 | ||
| Key points | 927 | ||
| Introduction | 927 | ||
| General approach to treatment | 927 | ||
| Disease-Specific Considerations | 928 | ||
| Antidepressants | 928 | ||
| Antianxiety medications | 929 | ||
| Mood stabilizers | 929 | ||
| Antipsychotics | 930 | ||
| Mood disorder medications | 930 | ||
| Discussion | 930 | ||
| SSRIs | 931 | ||
| SNRIs | 934 | ||
| Unique Mechanism Antidepressants | 935 | ||
| TCAs | 936 | ||
| MAOIs | 936 | ||
| Benzodiazepines | 937 | ||
| Mood stabilizer medications | 938 | ||
| Lithium | 938 | ||
| Anticonvulsants | 940 | ||
| Antipsychotics | 942 | ||
| Antipsychotic medications | 943 | ||
| Use in Schizophrenia | 948 | ||
| Use in Mood Disorders | 949 | ||
| Use in Geriatrics for Dementia-Related Behaviors and Symptoms | 950 | ||
| Summary/future directions | 951 | ||
| References | 952 | ||
| Office-Based Screening of Common Psychiatric Conditions | 959 | ||
| Key points | 959 | ||
| Introduction | 959 | ||
| Screening asymptomatic patients for psychiatric conditions—general considerations | 960 | ||
| Case Definitions | 961 | ||
| Depression | 961 | ||
| Burden of Disease | 961 | ||
| Screening Tools | 961 | ||
| General population | 961 | ||
| PHQ-9 and PHQ-2 | 961 | ||
| Other scales | 964 | ||
| Effectiveness of screening for depression | 964 | ||
| Anxiety disorders | 964 | ||
| Burden of Disease | 964 | ||
| Screening Tools | 965 | ||
| Beck anxiety inventory | 965 | ||
| Hospital anxiety and depression scale | 966 | ||
| Generalized anxiety disorder-7 | 966 | ||
| Multistage screening tools | 966 | ||
| Effectiveness of Screening for Anxiety | 967 | ||
| Other common psychiatric conditions | 967 | ||
| ADHD | 967 | ||
| Burden of Disease | 967 | ||
| Screening Tools | 968 | ||
| Effectiveness of screening for ADHD | 968 | ||
| Posttraumatic stress disorder | 968 | ||
| Burden of Disease | 968 | ||
| Screening Tools | 969 | ||
| Effectiveness of screening for PTSD | 970 | ||
| Limitations of existing evidence | 970 | ||
| Optimal Cutoffs for Screening Tools | 970 | ||
| Funding Source | 971 | ||
| Screening for One Diagnosis or More | 971 | ||
| The elderly | 971 | ||
| Targeted versus general screening | 972 | ||
| Novel and alternative screening modalities | 972 | ||
| Recommendations | 972 | ||
| General Recommendations | 972 | ||
| Depression Screening | 973 | ||
| Recommendations from major organizations | 974 | ||
| Anxiety Screening | 974 | ||
| Recommendations from major organizations | 976 | ||
| Summary | 976 | ||
| References | 976 | ||
| Major Depression | 981 | ||
| Key points | 981 | ||
| Introduction | 981 | ||
| The syndrome of major depression and its presentation | 982 | ||
| Depression subtypes | 982 | ||
| Determination of degree of impairment | 983 | ||
| Epidemiology and course of MDD | 984 | ||
| Screening | 984 | ||
| Pathophysiology | 987 | ||
| Identification, comorbidity, and differential diagnosis | 987 | ||
| Substance Use Disorder | 987 | ||
| General Medical Conditions | 988 | ||
| Prescription Medications | 988 | ||
| Adjustment Disorders and Demoralization | 988 | ||
| Sleep Disorders | 988 | ||
| Posttraumatic Stress Disorder | 988 | ||
| Grief and Bereavement | 989 | ||
| Minor and Persistent Depression | 989 | ||
| Personality | 989 | ||
| Suicide, depression, and assessment | 990 | ||
| Treatment and management | 990 | ||
| Behavioral Interventions and Self-Care | 990 | ||
| Diet | 991 | ||
| Exercise | 991 | ||
| Sleep | 991 | ||
| Alcohol and tobacco use | 991 | ||
| Other lifestyle interventions | 992 | ||
| Psychotherapy for MDD | 992 | ||
| Pharmacotherapy | 992 | ||
| General approach | 994 | ||
| Mechanism of action, efficacy and tolerability | 995 | ||
| Serious side effects | 995 | ||
| Medication interactions | 997 | ||
| Treatment-resistant depression | 997 | ||
| Summary | 998 | ||
| References | 999 | ||
| Anxiety Disorders in Primary Care | 1007 | ||
| Key points | 1007 | ||
| Introduction | 1007 | ||
| Methods | 1008 | ||
| Diagnostic challenges | 1008 | ||
| Co-occurring mental disorders | 1008 | ||
| Human and financial cost | 1010 | ||
| Impact of subthreshold symptoms | 1010 | ||
| Increased risk of suicide | 1010 | ||
| Screening tools | 1010 | ||
| Changes from Diagnostic and Statistical Manual of Psychiatric Disorders-IV to Diagnostic and Statistical Manual of Psychiat ... | 1010 | ||
| Epidemiology, course of illness, and prognosis | 1011 | ||
| GAD | 1011 | ||
| SAD | 1011 | ||
| PD | 1011 | ||
| PTSD | 1012 | ||
| OCD | 1012 | ||
| Treatment | 1012 | ||
| Pharmacotherapy | 1012 | ||
| Psychotherapy | 1014 | ||
| Combination treatment | 1014 | ||
| Adjunctive treatments | 1015 | ||
| Complementary and alternative medicine | 1015 | ||
| Use of rating scales in treatment | 1015 | ||
| Specific treatments and recommendations | 1015 | ||
| GAD | 1015 | ||
| PD | 1017 | ||
| SAD | 1017 | ||
| OCD | 1017 | ||
| PTSD | 1018 | ||
| Discussion and conclusion | 1018 | ||
| References | 1019 | ||
| Diagnosis and Management of Bipolar Disorder in Primary Care | 1025 | ||
| Key points | 1025 | ||
| Introduction | 1025 | ||
| Epidemiology | 1026 | ||
| Genetics | 1026 | ||
| Impact of BD | 1026 | ||
| Diagnosis | 1027 | ||
| Screening | 1028 | ||
| Medical workup | 1029 | ||
| Psychiatric comorbidities and differential diagnosis | 1031 | ||
| Pharmacologic management | 1032 | ||
| Psychotherapeutic and psychosocial management | 1038 | ||
| Systems of care | 1041 | ||
| Controversies | 1041 | ||
| Summary | 1042 | ||
| References | 1043 | ||
| Borderline Personality Disorder in the Primary Care Setting | 1049 | ||
| Key points | 1049 | ||
| Case | 1049 | ||
| Epidemiology | 1050 | ||
| Remission | 1050 | ||
| Suicide | 1051 | ||
| Criteria and clinical characteristics | 1051 | ||
| Comorbidity | 1052 | ||
| Pathophysiology | 1053 | ||
| Genetics | 1053 | ||
| Brain Abnormalities | 1053 | ||
| Neurohormones | 1053 | ||
| Environmental Factors | 1054 | ||
| Treatment | 1054 | ||
| Psychotherapy | 1054 | ||
| Psychopharmacology | 1055 | ||
| Management in the primary care setting | 1056 | ||
| Future directions | 1060 | ||
| References | 1060 | ||
| Seasonal Affective Disorder, Grief Reaction, and Adjustment Disorder | 1065 | ||
| Key points | 1065 | ||
| Introduction | 1065 | ||
| Seasonal affective disorder | 1066 | ||
| Symptoms | 1066 | ||
| Diagnostic Tests | 1066 | ||
| Who Is at Risk for Developing SAD? | 1067 | ||
| Differential Diagnosis | 1067 | ||
| Treatment | 1067 | ||
| Light therapy is the most studied treatment of SAD | 1067 | ||
| Antidepressants offer another treatment option for SAD | 1068 | ||
| Cognitive-behavioral therapy can be used to augment light therapy | 1068 | ||
| Several complementary and alternative treatments have been suggested for SAD | 1068 | ||
| There is scant evidence comparing available treatments or their use in combination | 1068 | ||
| The duration of treatment should last at least the typical SAD season | 1068 | ||
| Management | 1069 | ||
| Grief reaction | 1069 | ||
| Symptoms | 1069 | ||
| Healthy Grieving Is a Normal Process | 1069 | ||
| Differential Diagnosis | 1070 | ||
| Several Risk Factors Exist for Complex Grief | 1070 | ||
| Diagnostic Tests | 1070 | ||
| Distinguishing Between Grief and Depression | 1070 | ||
| Treatment | 1071 | ||
| Management | 1071 | ||
| Adjustment disorder | 1071 | ||
| Symptoms | 1071 | ||
| Risk Factors for Adjustment Disorder Depend on the Patient or the Stressor | 1072 | ||
| Diagnostic Tests | 1072 | ||
| Differential Diagnosis | 1073 | ||
| Many Other Disorders Can Co-Occur with Adjustment Disorder | 1073 | ||
| Treatment | 1074 | ||
| Management | 1074 | ||
| Summary | 1075 | ||
| References | 1075 | ||
| Approach to the Patient with Multiple Somatic Symptoms | 1079 | ||
| Key points | 1079 | ||
| Introduction | 1079 | ||
| Spectrum of severity of somatic symptoms: a biopsychosocial approach to diagnosis and management | 1081 | ||
| Psychiatric disorders among patients with somatic symptoms | 1085 | ||
| Management recommendations | 1087 | ||
| General Principles of Management | 1087 | ||
| Engagement and building a sound therapeutic alliance with the patient | 1087 | ||
| Biopsychosocial history and physical examination | 1087 | ||
| Diagnostic evaluation to rule out medical illness | 1088 | ||
| Educate patients how psychosocial stressors and symptoms interact | 1088 | ||
| Specific Management Strategies | 1088 | ||
| Screening for depression and anxiety | 1088 | ||
| Evaluate somatic symptom burden | 1088 | ||
| Treatment of comorbid psychiatric disorders | 1089 | ||
| Psychiatric consultation and the role of collaborative care model | 1090 | ||
| Summary | 1091 | ||
| References | 1091 | ||
| Addiction Disorders | 1097 | ||
| Key points | 1097 | ||
| Introduction | 1097 | ||
| SUD assessment and diagnosis | 1098 | ||
| Approach to Assessing Patients for Substance Use | 1098 | ||
| Screening | 1098 | ||
| Assessing for SUD | 1099 | ||
| Alcohol use disorders | 1099 | ||
| Brief Interventions | 1101 | ||
| Pharmacotherapy for Alcohol Use Disorders | 1103 | ||
| Ambulatory medically supervised withdrawal | 1103 | ||
| Medication management for relapse prevention | 1105 | ||
| Motivational Interviewing | 1107 | ||
| Harm Reduction | 1107 | ||
| Cognitive Behavioral Therapy | 1107 | ||
| 12-Step Facilitation and 12-Step Programs | 1107 | ||
| AA | 1107 | ||
| Substance use disorder issues in chronic pain management | 1108 | ||
| Opioid Treatment Risks | 1108 | ||
| Naltrexone | 1109 | ||
| XR Naltrexone IM | 1109 | ||
| Acamprosate | 1109 | ||
| Disulfiram | 1109 | ||
| Topiramate | 1109 | ||
| Gabapentin | 1109 | ||
| Approaching Patients on High-Dose Opioids | 1110 | ||
| Detection and Management of Problems During Opioid Prescribing | 1110 | ||
| General Considerations | 1113 | ||
| Opioids | 1113 | ||
| Stimulants | 1113 | ||
| Cannabis | 1113 | ||
| Benzodiazepines | 1113 | ||
| Alcohol | 1113 | ||
| Other Drugs | 1113 | ||
| Treatment of opioid use disorders | 1114 | ||
| Methadone Maintenance Treatment | 1114 | ||
| Sample Test Panel for Patients on Long-term Opioids for Chronic Pain | 1114 | ||
| Methadone | 1115 | ||
| Buprenorphine/Naloxone | 1115 | ||
| Buprenorphine (mono) | 1115 | ||
| Naltrexone | 1115 | ||
| XR Naltrexone IM | 1115 | ||
| α-2 Adrenergic Agonists | 1115 | ||
| Naloxone with Overdose Education | 1115 | ||
| Buprenorphine Treatment of Opioid Use Disorders | 1116 | ||
| Summary and future directions | 1117 | ||
| References | 1117 | ||
| Psychiatric Disorders and Sleep Issues | 1123 | ||
| Key points | 1123 | ||
| Introduction | 1123 | ||
| Neurobiology common to sleep, wakefulness, and mental health | 1124 | ||
| Insomnia: state of the art | 1124 | ||
| Insomnia and psychiatric illness | 1129 | ||
| Depressive disorders and bipolar disorder | 1130 | ||
| Sleep Deprivation | 1130 | ||
| Insomnia | 1130 | ||
| Circadian Rhythm Disorders | 1131 | ||
| RLS | 1132 | ||
| Obstructive Sleep Apnea | 1132 | ||
| Sleepwalking | 1132 | ||
| Narcolepsy | 1132 | ||
| Isolated Sleep Paralysis | 1133 | ||
| Anxiety disorders | 1133 | ||
| Insomnia | 1133 | ||
| Circadian Rhythm Disorders | 1134 | ||
| RLS | 1134 | ||
| OSA | 1134 | ||
| Sleepwalking | 1134 | ||
| Narcolepsy | 1134 | ||
| ISP | 1134 | ||
| Schizophrenia | 1135 | ||
| Insomnia and Circadian Rhythm Disorders | 1135 | ||
| OSA | 1135 | ||
| Narcolepsy | 1135 | ||
| Attention-deficit/hyperactivity disorder | 1135 | ||
| Insomnia | 1135 | ||
| Circadian Rhythm Disorders | 1136 | ||
| RLS | 1136 | ||
| OSA | 1136 | ||
| Treatment considerations | 1136 | ||
| Summary/future considerations | 1137 | ||
| References | 1137 | ||
| Psychiatric Care of the Older Adult | 1145 | ||
| Key points | 1145 | ||
| Introduction: approach to older adult patients | 1145 | ||
| Delirium | 1146 | ||
| Dementia | 1148 | ||
| Mild Cognitive Impairment | 1150 | ||
| AD | 1153 | ||
| Dementia with Lewy Bodies | 1153 | ||
| Vascular Dementia | 1155 | ||
| Frontotemporal Dementia | 1156 | ||
| Neuropsychiatric Complications of Dementia | 1156 | ||
| Depression | 1156 | ||
| Comorbidity | 1158 | ||
| Suicide | 1158 | ||
| Treatment | 1159 | ||
| Alcohol and substance misuse | 1161 | ||
| Caregivers | 1162 | ||
| Case summary | 1162 | ||
| Summary | 1163 | ||
| References | 1163 | ||
| Primary Care for Adults on the Autism Spectrum | 1169 | ||
| Key points | 1169 | ||
| Introduction | 1169 | ||
| ASD diagnosis in adults | 1170 | ||
| Referrals for assistive technologies and therapies | 1171 | ||
| Associated conditions | 1174 | ||
| Mortality | 1175 | ||
| Epilepsy | 1175 | ||
| Gastrointestinal Disorders | 1177 | ||
| Feeding and Nutrition | 1177 | ||
| Metabolic Syndrome | 1177 | ||
| Mental Health | 1177 | ||
| Sleep Disturbances | 1178 | ||
| Violence and Abuse | 1178 | ||
| Facilitating effective health care interactions | 1178 | ||
| Understanding and addressing behavior change | 1184 | ||
| Challenging Behavior | 1184 | ||
| Pharmacologic and Nonpharmacologic Approaches to Challenging Behavior | 1185 | ||
| Legal and ethical considerations | 1186 | ||
| Decision-Making Capacity; Surrogate Decision Makers | 1186 | ||
| Access to Care | 1187 | ||
| Summary | 1187 | ||
| Acknowledgments | 1187 | ||
| References | 1187 | ||
| Medical Conditions with Neuropsychiatric Manifestations | 1193 | ||
| Key points | 1193 | ||
| Introduction | 1193 | ||
| Infectious | 1194 | ||
| Human Immunodeficiency Virus | 1194 | ||
| Syphilis | 1196 | ||
| Lyme Disease | 1197 | ||
| Rheumatologic | 1197 | ||
| SLE | 1198 | ||
| Sarcoidosis | 1199 | ||
| Endocrinologic | 1199 | ||
| Thyroid Disorders | 1199 | ||
| Cushing Syndrome | 1200 | ||
| Adrenal Insufficiency, Including Primary Adrenal Insufficiency (Addison Disease) | 1200 | ||
| Metabolic | 1201 | ||
| Vitamin Deficiencies | 1201 | ||
| Calcium Disorders | 1202 | ||
| Porphyrias | 1202 | ||
| Wilson Disease | 1202 | ||
| Neoplastic | 1203 | ||
| Paraneoplastic Syndromes | 1203 | ||
| Future considerations/summary | 1203 | ||
| References | 1204 | ||
| Index | 1209 |