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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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Patsy hoyer cfnp october 27 2010

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

Patsy Hoyer, CFNP

October 27, 2010


Patsy hoyer cfnp october 27 2010



Statistics
STATISTICS Arrives

  • 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%


Patsy hoyer cfnp october 27 2010

  • Adults with depression 16 % ADHD Arrives

  • 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


Patsy hoyer cfnp october 27 2010

  • 1/1000 Schizophrenia Arrives

  • Personality disorders may be as high as 10%-15%

  • The take away: There is a lot of suffering


Patsy hoyer cfnp october 27 2010



Patsy hoyer cfnp october 27 2010

  • Take time and fit it in Arrives

  • 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! Arrives

  • 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 Arrives

  • 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 Arrives

  • Genetics is not a diagnosis, but it can give a clue


Patsy hoyer cfnp october 27 2010

  • ANXIETY Arrives

    • 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


Patsy hoyer cfnp october 27 2010

  • buproprion Arrives

  • remeron

    • Cymbalta and Pristiq--niches


Irritability
Irritability Arrives

  • Anxiety—don’t disrupt

  • Depressed---leave me alone

  • Bipolar spectrum—intense, random

  • Longitudinal and family hx helpful with this


Patsy hoyer cfnp october 27 2010

  • Atypicals Arrives

  • 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 Arrives

  • 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? Arrives

  • Diagnosis ?—Personality disorders

  • Treatment Plan not working

  • Not comfortable with the medicine

  • Therapy,life coaching, CBP, skills training would help—most of the time!


Patsy hoyer cfnp october 27 2010


Improve your skills
Improve your skills Arrives

  • Talk to colleagues

  • Subscribe to Current Psychiatry

  • Buy Primary “Care Psychiatry”

  • Let Lafayette Medical Education know what topics you would like next year