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Patsy Hoyer, CFNP October 27, 2010

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Approaches to Diagnosis and Treatment of Common Psychiatric Problems in General Medicine, and When to Refer. Patsy Hoyer, CFNP October 27, 2010. The Original Title: What To Do Until The Psychiatrist Arrives The psychiatrist rarely arrives!. Providers have to deal with a lot!. STATISTICS.

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Approaches to Diagnosis and Treatment of Common Psychiatric Problems in General Medicine, and When to Refer

Patsy Hoyer, CFNP

October 27, 2010

slide2
The Original Title: What To Do Until The Psychiatrist Arrives
  • The psychiatrist rarely arrives!
statistics
STATISTICS
  • 20% of general population, 25% office
  • 1/3 adult problems begin in childhood
  • Anxiety most prevalent
  • Depression more elusive
  • Adult depression, 21 million
  • Adult depression 5-10% of practice
  • CDC Study
  • Postpartum Blues 80% , Depression 20%
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Adults with depression 16 % ADHD
  • Childhood ADHD 7%
  • ADHD Adults present a anx/dep
  • OCD, 50% have ADHD
  • 10-12% Children ADHD have mood disorder
  • 1% true bipolar
  • 4% spectrum conditions
slide6
1/1000 Schizophrenia
  • Personality disorders may be as high as 10%-15%
  • The take away: There is a lot of suffering
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Presentation may be obscuring of dx
  • Often one or more co-morbid conditions
  • Alcohol and drug abuse may be present
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Take time and fit it in
  • Suck it up, it is important to do
  • Psychcentral.com
  • Primary care sees patients over time
  • Follow-up is key
  • Refer suicidal
history is important
History is important!
  • Current functioning
    • Perceived issues/precipitating event
    • Sleep
    • Appetite
    • Mood
    • Functioning/work/school, family, relationships
    • Recent drugs, alcohol, etc
    • Suicidal ideation
    • Specific other questions toward co-morbitities
longitudinal history
Longitudinal History
  • What were they like before, high school the last several years
  • Grades in school, jobs, troubles in job. law, marriage
  • Treatments in past
  • ---Key in ADHD, mood disorders, mania, previous suicide, etc
family social and genetic hx
FAMILY Social and Genetic Hx
  • Genetics is not a diagnosis, but it can give a clue
slide13
ANXIETY
    • Higher doses of SSRI’s
    • Inderal La may help instead of xanax
    • Clonazepam—sometimes it is needed
  • DEPRESSION
    • STAR D-uses citalopram
      • Most of us use by side effect
      • New Recommendations
slide14
buproprion
  • remeron
    • Cymbalta and Pristiq--niches
irritability
Irritability
  • Anxiety—don’t disrupt
  • Depressed---leave me alone
  • Bipolar spectrum—intense, random
  • Longitudinal and family hx helpful with this
slide16
Atypicals
  • Small doses, just might help
  • Refractory anxiety, depression, family hx, sleep
  • Side effect issues, weight, metabolic syndromes—need to discuss and monitor
  • “Activation” not mania
personality disorders how they make you feel
Personality Disorders—how they make you feel
  • Proposed Classifications in DSM 5
  • A—odd/eccentric-Odd ways of thinking—what was that?
  • C—anxious/fearful—down and depressed
  • B—dramatic/emotional—suck the life out of you
when do you refer
When do you refer?
  • Diagnosis ?—Personality disorders
  • Treatment Plan not working
  • Not comfortable with the medicine
  • Therapy,life coaching, CBP, skills training would help—most of the time!
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Refer with information about your question.
  • Refer with some history—esp of meds used
  • Refer with possible goals for therapy
  • Refer with your question for testing—not just “see a psychologist.”
improve your skills
Improve your skills
  • Talk to colleagues
  • Subscribe to Current Psychiatry
  • Buy Primary “Care Psychiatry”
  • Let Lafayette Medical Education know what topics you would like next year
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