Post-stroke depression in the elderly

Psychiatry in medical practice. Implications for the education of primary care physicians in the era of managed care: Part 2

In Part 1 of this 2-part series, the epidemiology of psychiatric disorders in primary care settings was reviewed as well as evidence that indicates that these conditions often go underrecognized and undertreated by primary care physicians. Educational studies to improve the psychiatric skills of primary care physicians were also reviewed. In Part 2 of this series, a core curriculum for primary care physicians in the diagnosis and treatment of psychiatric disorders that emphasizes competency-based learning is presented. Recommendations for the development and implementation of these competency-based training modules are offered in the conclusion.

Psychiatry in medical practice. Implications for the education of primary care physicians in the era of managed care: Part 1

In an effort to control the costs of mental health care, many medical care systems have emphasized the management of psychiatric illness by primary care physicians and curtailed specialty mental health referrals. While this trend mandates that primary care physicians have expertise in the diagnosis and treatment of psychiatric disorders, evidence indicates that not only are psychiatric disorders underrecognized in primary care settings, but also that treatment is often inadequate and accompanied by less than optimal outcomes. In Part 1 of this 2-part series, representative studies of the epidemiology of psychiatric disorders in primary care are reviewed in addition to data that has documented low rates of recognition and suboptimal management of psychiatric illness. In Part 2, to be published in the January-February 1997 issue of Psychosomatics, a core psychiatric curriculum for primary care physicians will be presented that emphasizes the use of competency-based training modules. Strategies for the development and implementation of these educational training modules will also be discussed.

The future of consultation-liaison psychiatry and medical-psychiatric units in the era of managed care

There has been increasing recognition and documentation of the impact of psychiatric problems on the outcome and cost of medical care. Because consultation-liaison psychiatrists have the expertise to address the psychiatric aspects of medical illness, this group should be in a strong position to facilitate integration of medical and psychiatric services in managed care delivery systems. Although consultation-liaison psychiatry (CLP) has documented its ability to shorten inpatient medical lengths of stay for some disorders, a greater challenge exists in developing comprehensive systems to identify and care for patients with mental health problems in primary care settings. This paper reviews the fiscal and programmatic implications for managed medical care systems of findings from outcome-based C-L research. The future role of CLP and combined medical-psychiatric units in an era of managed care is also discussed.

Diagnostic dilemmas presented by patients with anxiety and depression

Although anxiety and depression are among the most common symptoms of persons seen in medical practice, a number of dilemmas still exist in the identification and management of these disorders. The objectives of this paper are to review the prevalence and identification of anxiety, depression, and mixed anxiety-depression in medical practice; to review issues involving the medical evaluation of these disorders; to clarify the relevance of psychosocial issues to choice of treatment; and to review issues involving medication treatment choices.