Magazine article Clinical Psychiatry News

Take Steps to Handle Referrals for Depression: Discuss Measures of Disease Severity

Magazine article Clinical Psychiatry News

Take Steps to Handle Referrals for Depression: Discuss Measures of Disease Severity

Article excerpt

SAN FRANCISCO -- Data show that collaboration between primary care physicians and psychiatrists improves primary care of patients with depression--but what does that collaboration look like?

Psychiatrists can take specific steps to build a good consultative relationship with primary care physicians, said Dr. Larry Culpepper, professor and chairman of family medicine at Boston University.

When a primary care physician diagnoses a patient with depression or other psychiatric disorder and refers the patient or consults with a psychiatrist, the primary care physician wants to know what the psychiatrist thinks of the diagnosis and why, Dr. Culpepper said in an industry-sponsored symposium at the annual meeting of the American Psychiatric Association.

Primary care physicians respond to patient symptoms, not disorder criteria, resulting in less accurate diagnoses than those made by psychiatrists, he explained. Unpublished data on 467 patients with a mood or anxiety disorder at his institution showed that primary care physicians correctly diagnosed 84% as having some kind of mood or anxiety disorder, but the exact diagnosis matched one made by a psychiatrist in only 26% of cases. Primary care physicians missed the diagnosis altogether in 16% of cases. "They generally get in the ballpark of mood or anxiety disorders" but need to hear the psychiatrist's diagnostic considerations, Dr. Culpepper said.

Psychiatrists also can improve the consultative relationship by discussing measures of disease severity and response with the primary care physician. The Patient Health Questionnaire for nine DSM-IV major depression criteria (PHQ-9) is widely available in primary care practices but not much used. "Ask us to use it," he urged.

Discuss the potential need for medication adjustment, if appropriate. Psychiatrists should remind primary care physicians that the patient's hopelessness may continue during treatment and that they should watch for suicidality, he added. …

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