Recognition and Differential Diagnosis of Psychosis in Primary Care.

Psychosis is a symptom complex that may include hallucinations, delusions, disorders of thought, and disorganized speech or behavior. Acute psychosis is primary if it is symptomatic of a psychiatric disorder, or secondary if caused by a specific medical condition. Patients with primary psychiatric disorders are likely to have auditory hallucinations, prominent cognitive disorders, and complicated delusions. If psychosis is caused by a medical condition, the patient may exhibit cognitive changes and abnormal vital signs, and may have visual hallucinations. Illicit drug use is the most common medical cause of acute psychosis. Clinicians should ask about recent head injury or trauma, seizures, cerebrovascular disease, or new or worsening headaches. A subacute onset of psychosis should raise suspicion for an oncologic cause. Collateral history from family members is helpful in establishing the presentation and course of the illness. The physical examination should include complete neurologic and mental status assessments. Tachycardia or severe hypertension may indicate drug toxicity or thyrotoxicosis; fever may suggest encephalitis or porphyria. Suggested initial laboratory tests include a complete blood count, metabolic profile, thyroid function tests, urine toxicology, and measurement of parathyroid hormone, calcium, vitamin B12, folate, and niacin. Testing for human immunodeficiency virus infection and syphilis should also be considered. Prompt recognition of the etiology of psychosis may improve treatment, consultation, and prognosis.

Improving residents' performance on the PRITE: is there a role for peer-assisted learning?

OBJECTIVE: The authors implemented a peer-assisted learning approach to prepare residents for the Psychiatry Resident-In-Training Examination (PRITE), with the goal of increasing test performance. METHOD: The authors developed a PRITE review curriculum utilizing a peer-assisted learning approach. The residents were randomly assigned to teams and instructed to teach assigned topic(s). The participants' PRITE scores before and after the intervention were compared with the PRITE scores of the previous residents. RESULTS: PGY-2 residents achieved the highest psychiatry percentile increase, and PGY-3 residents achieved the highest psychiatry percentile in the past 7 years. PGY-4 residents' psychiatry percentile decreased, although two residents from the previous year left for a fellowship, and the program accepted one PGY-4 transfer. All of the groups' neurology percentile increased, but were not substantially different from the previous years. CONCLUSION: Our preliminary study has shown that implementing a peer-learning strategy to prepare residents for the PRITE is feasible and may lead to promising results.

Social Security Claims of Psychiatric Disability: Elements of Case Adjudication and the Role of Primary Care Physicians.

When first introduced into law, social security was designed to safeguard economic security for U.S. citizens who were retired or disabled. Primary care physicians are often contacted by the Social Security Administration (SSA) to provide clinical information about the impairments affecting their patients who have applied for disability. The disability determination process is often elusive to physicians. This article is written to describe the process involved in adjudicating disability claims according to SSA standards. Because psychiatric disturbances constitute the largest reason for applications for disability, this article addresses the sorts of information required of clinicians that would expedite disability adjudication of claims involving psychiatric disorders. Practical suggestions are offered for clinicians to employ when preparing medical reports. The potential impact of the disability claim on the doctor-patient relationship is also discussed.