Psychiatric and Medical Comorbidity in the Primary Care Geriatric Patient-An Update.

The mental health needs of older primary care patients are now widely recognized if not widely addressed. The range of behavioral health approaches including co-locating psychiatrists and integrating mental health professionals as care managers into primary care sites is extensive and growing. Nonetheless the primary care provider remains the first line of defense against mental disorders, most commonly depression and anxiety that accompany and exacerbate common physical conditions. The excess, potentially avoidable disability that results from comorbidity makes it imperative that early recognition and evidence based intervention occur. Multi-morbidity and polypharmacy make intervention a challenge. Psychotherapy can help overcome comorbidity depression however the most accessible intervention would be an antidepressant FDA approved for both anxiety and depressive disorders. For all these reasons, a focus on physical conditions most commonly associated with mental disorders can foster early recognition before the older patient's care becomes overwhelmingly complicated.

Utility of a New Spanish RQC and PSC in Screening with CBCL Validation.

Various screening questionnaires have been established to identify psychopathology in children and adolescents. Some of these instruments include the pediatric symptom checklist (PSC), the pediatric symptom checklist (CBCL) and reporting questionnaire for children (RQC). However, many of the patients and their families may not speak English, and this can be a barrier to identifying and properly treating monolingual Spanish-speaking patients and families. There is a need for optimal mental health screening in Spanish speaking populations given the continued growth of the United States as a diverse country with complex demographic structure. Because of the diversity within the use of Spanish in Hispanic countries of origin, the aim of this study is to present unified Spanish versions of the RQC and PSC achieved through simultaneously and independently translating them into three versions of Spanish (RQC-SP and PSC-SP). To test the psychiatric validity of RQC-SP and PSC-SP, these both were administered simultaneously along with the Spanish version of the CBCL, which had already been well established. All three of these tools were given to Spanish speaking parents of pediatric outpatients (n = 22) while waiting for their clinic appointments. The RQC-SP had a correlation to the CBCL with R = 0.779 and p < 0.001. The RQC-SP as compared with the CBCL had a false negative of 0/8 (0.00) with a sensitivity of 8/8 = 1.00. The false positives were 2/14 (0.143) and specificity 12/15 (0.85). The PSC-SP correlated with the CBCL with R = 0.897 and p < 0.001. The PSC-SP correlation with the CBCL had false negative of 7/8 (0.875) and sensitivity of 1/8 (0.125) and false positive 0/14 (0.00) and specificity 14/14 (1.00). The RQC-SP and PSC-SP are brief, well-validated, reliable instruments designed.

Confounding psychosis in the postpartum period.

This case report alerts the psychiatric clinician to consider nonpsychiatric etiologies of psychosis appearing during the postpartum period besides postpartum psychosis. The case includes a description of the patient's psychiatric presentation, admission to the inpatient psychiatric unit with subsequent transfer to the medicine department including neuroimaging and neurological consultation. The patient had a remission of psychosis after only two and half days of antipsychotic medication administration. Positive findings on the MRI suggested a demyelinating disease and a 4-month follow up MRI continued to be positive. The etiology was presumed to be a demyelinating disease. In conclusion, psychiatrists need to be alert to include nonpsychiatric pathologies in the differential diagnosis when a patient presents with psychosis in the postpartum period.

Psychiatric presentations/manifestations of medical illnesses.

Psychiatry is clearly an integral part of medicine. With a history and physical exam (called the mental status exam in psychiatry), appropriate laboratory or imaging studies, a differential diagnosis is made. If a specific DSM-IV-TR diagnosis is made, then the treatment will naturally follow. The diagnoses are scientifically established with good validity, specificity, sensitivity and inter-rater reliability. Similarly the treatments are established through scientific research. However, sometimes medical illnesses may present with symptoms seemingly pointing to a psychiatric origin. Making a misdiagnosis can be quite problematic and dangerous for the patient. The opposite is also true, that psychiatric illnesses may present with symptoms implying a medical diagnostic origin. Finally, psychiatric patients may have more than one psychiatric diagnosis and in addition, a medical diagnosis too. A high degree of suspicion should always be entertained by the diagnosing physician, psychiatric or non-psychiatric. This paper reviews the literature regarding these situations and then presents several clinical cases where this conundrum was present. Making the correct diagnosis was critical in the successful treatment outcome of each of the clinical cases. When asked to consult on a patient by non-psychiatric physicians, the psychiatrist must be careful to also look for non-psychiatric origins for the referring symptoms. It is important for psychiatrists to build on their medical knowledge from medical school and internship and continue to be kept abreast of confounding symptomatology.