Putting it all together

It can be hard enough to deal with the complicated needs of individual patients in a busy medical practice. When psychiatric conditions are involved, it can make the job of the provider even more difficult. Add to this the multitude of information and changes contained in the DSM-5, and it can become overwhelming. As with any health condition, approaching the patient in a stepwise fashion is important so that nothing is missed.

Screening laboratory studies to rule out a physiological reason for symptoms while using screening tools and suicide assessments is the best place to start. When necessary, consider the choices for medication carefully, based on the patient’s presentation, age, and lifestyle.


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Always consider a referral to a mental health professional, especially to help your patients deal with the stressors in their lives, whether an “official” diagnosis of a mental health condition exists. Having a low threshold for involving a psychiatrist — even via telepsychiatry — is also important. Taking all these steps can improve your delivery of care for your patient with psychiatric disorders, and it can ease a job that is otherwise tough.

Deanna Bridge Najera, MPAS, MS, PA-C, NCC, is a physician assistant and certified counselor, splitting her time between an emergency department and a community mental health center. She also works seasonally with a migrant farm worker program in south central Pennsylvania.

References

  1. American Psychiatric Association. Highlights of changes from DSM-IV-TR to DSM-5. 2013. Available at http://bit.ly/1dlPTZf.
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
  3. McCulloch J, Ramesar S, Peterson H. Psychotherapy in primary care: The BATHE technique. Am Fam Physician. 1998;57(9):2131-2134. Available at aafp.org/afp/1998/0501/p2131.html.
  4. Whirl-Carrillo M, McDonagh EM, Hebert JM, et al. Pharmacogenomics knowledge for personalized medicine. Clin Pharmacol Ther. 2012;92(4):414-417. Available at nature.com/clpt/journal/v92/n4/full/clpt201296a.html.
  5. US Food and Drug Administration. Table of pharmacogenomics biomarkers in drug labeling. Available at fda.gov/Drugs/ScienceResearch/ResearchAreas/Pharmacogenetics/ucm083378.htm
  6. Howland RH. Pharmacogenetic testing in clinical psychiatry. The Carlat Report: Psychiatry. 2014;12(10):1-3,
  7. Barbey JT and Roose S.P. SSRI safety in overdose. J Clin Psychiatry. 1998;59(suppl 15):42-48.
  8. Renoir T. Selective serotonin reuptake inhibitor antidepressant discontinuation syndrome: A review of the clinical evidence and mechanisms involved. Front Pharmacol. 2013;4(45). Available at ncbi.nlm.nih.gov/pmc/articles/PMC3627130/.
  9. Haddad PM, Anderson IM. Recognizing and managing antidepressant discontinuation symptoms. Advances Psych Treatment. 2007;13:447-457. Available at http://apt.rcpsych.org/content/13/6/447
  10. National Institute of Mental Health. Questions and answers about the NIMH STAR*D Study. Sequenced treatment alternatives to relieve depression (STAR*D) study.
  11. Zimmerman M, Posternak MA, Attiullah N, et al. Why isn’t bupropion the most frequently prescribed antidepressant? J Clin Psychiatry. 2005;66(5):603-610.
  12. Salvadore G, Quiroz JA, Machado-Vieira R, et al. The neurobiology of the switch process in bipolar disorder: A review. J Clin Psychiatry. 2010;71(11):1488-1501.
  13. Qureshi NA, Al-Bedah AM. Mood disorders and complementary and alternative medicine: A literature review. Neuropsychiatr Dis Treat. 2013;9:639-658. Available at ncbi.nlm.nih.gov/pmc/articles/PMC3660126/?report=classic
  14. Carlat D. Unhinged: The Trouble with Psychiatry — A Doctor’s Revelations about a Profession in Crisis. 1st ed. New York, NY: Free Press; 2010.
  15. Webb T. Emergency mental health: Assessment and treatment. Cross Country Education audio seminar. Available at bit.ly/1b0eEzP
  16. National Institute of Mental Health. Which groups have special needs when taking psychiatric medications?” Mental Health Medications. Available at http://1.usa.gov/1fkyGkt
  17. Kalikow KT. Kids on Meds: Up-to-date Information about the Most Commonly Prescribed Psychiatric Medications. 1st ed. New York, NY; W.W. Norton; 2011.

All electronic documents accessed on May 12, 2015.