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Update in Psychiatry
- Robert K. Schneider, MD; and
- James L. Levenson, MD
In 1978, Regier (1) coined the term “de facto mental health services system” after finding that most patients with mental illness are treated in the general medical sector, not in psychiatric settings. Despite this, many patients with mental disorders treated in the medical sector do not have a diagnosis; they go untreated or are treated for a “medical” problem instead of their mental disorder. This first Update in Psychiatry reviews the pertinent psychiatric literature published in 1998. We polled journal editors from leading psychiatric and general medical journals and leaders in consultation liaison psychiatry to develop a list of important publications. We did not include substance abuse because the relevant literature is so extensive that this topic warrants a separate discussion. Our goal is to expand on and in some cases introduce information about psychiatry that may not be readily available to the general clinical internist.
Affective Disorders
Depressive disorders, dysthymia, bipolar disorders, and cyclothymia are the major affective disorders. Major depression is the most common mental disorder seen by internists. Because of this high prevalence, much research has recently been done on depression and its management in primary care. The publications summarized in this section are a review of recent data that updated the Agency for Health Care Policy and Research (AHCPR) Depression Guidelines, a report on the optimal length of the continuation phase of treatment (how long should therapy with an antidepressant agent be continued after a good response?), and two reports examining the cost-effectiveness of different treatment models for depression in primary care settings.
Recent Studies Support AHCPR Guidelines in the Primary Care Setting and Suggest a More Prominent Role for Mental Health Specialists in Severely Depressed Patients
Schulberg HC, Katon W, Simon GE, et al. Treating major depression in primary care practice: an update of the Agency for Health Care Policy and Research Practice Guidelines. Arch Gen Psychiatry. 1998; 55:1121-7.
Many of the studies that were used in developing the AHCPR Depression …
