Depression in primary care: Strategies for a psychiatry-scarce environment.

More than an algorithm to guide primary care providers through treatment options, integrated care, also called collaborative care, is a validated, systematic, multidisciplinary approach to depression treatment in primary care. Historically, integrated care emerged in response to a mismatch between a growing demand for mental health treatment and scarce mental healthcare resources. Working together, psychiatrists and primary care providers have demonstrated that the principles and tools of chronic disease management improve depression outcomes in primary care. Currently, most antidepressants are prescribed by primary care providers, but with disappointing rates of full, sustained remission. Primary care patients may derive the greatest benefit from existing depression treatment guidelines when they are melded with an approach informed by integrated care principles. This paper will present established guidelines for pharmacologic management of depression as part of a broader framework for depression treatment in the primary care office.

Self-report tool for recognizing mania (SToRM): a new scale for aiding in the diagnosis of bipolar disorder.

OBJECTIVE: Bipolar disorder is a disabling disease that is difficult to diagnose. Primary care physicians share in the burden of diagnosing and caring for significant mental illness, including bipolar disorder, but they lack an adequate screening and diagnostic tool that can fit into use in a primary care practice. Modeling after the Patient Health Questionnaire-9, we created the Self-report Tool for Recognizing Mania (SToRM) to aid primary care physicians in the screening and diagnosis of bipolar disorder. METHODS: A 13-question tool was created and distributed to returning patients over an 11-month time period at the psychiatric clinic of a university health center. Each completed questionnaire was scored as positive or negative and then compared to the preexisting psychiatric diagnosis for that respondent, as shown on the problem list of the respondent's electronic medical record. RESULTS: A total of 102 subjects completed and returned their questionnaires. Twenty-eight surveys were scored as positive for bipolar disorder while 25 subjects carried this diagnosis on their problem list, giving a sensitivity of 72% and a specificity of 87% (CI at 95%). When alternative scoring was used, sensitivity increased to 96% with only a slight decrease in specificity to 84%. CONCLUSIONS: In this pilot study, we find that the SToRM shows potential in the pursuit of a highly reliable, self-report tool which could help primary care providers screen and diagnose bipolar disorder. As such, the SToRM deserves further study.