Women's Mental Health in Primary Care

By Kathryn J. Zerbe | Go to book overview

Preface

The complete answer is not to be found on the outside, in an outward mode of living. This is only a technique, a road to grace. The final answer, I know, is always inside. But the outside can give a clue, can help one to find the inside answer. One is free, like the hermit crab, to change one's shell.

Anne Morrow Lindbergh, 1955, p. 35.

This is a book for practicing clinicians. It is designed to help those in the primary care specialties—family practice, internal medicine, pediatrics, and obstetrics/gynecology—increase their "comfort zone" in working with the array of mental health issues in patients who present every week in a busy medical practice.

Every clinician should know that psychiatric problems require a huge amount of health care dollars. If patients are untreated, overall medical costs rise exponentially.

By the year 2020, depression is projected to be the second leading cause of death. Depression, alcohol misuse, bipolar disorder (manic-depressive illness), schizophrenia, and anxiety disorders are already among the top 10 causes of disability. In The Global Burden of Disease: Summary, psychiatric disorders are demonstrated to play a central but until now almost invisible role in causing disability and impaired health across all cultures and countries (Murray and Lopez, 1996). In all likelihood, the measures of disease burden will gradually change funding and health care policies, but the clinician will still be left with the often unsettling, puzzling questions about how to intervene with an individual patient in a practical way.

In this book, I hope that my readers will have a greater array of tools and principles that are not too prescriptive but nonetheless helpful in offering patients concrete advice, empathic concern, and personal strategies about their emotional concerns and psychological struggles. In essence, my aim is to integrate the latest pharmacologic and psychotherapeutic approaches to assist readers in treatment planning.

On an individual basis in a primary care situation, the care of a patient with a psychiatric problem can be uniquely rewarding but can also cause management challenges. A patient struggling with an emotional issue finds it difficult to comply with treatment; she may have trouble adjusting to life experiences; and she is often perplexing to the clinician, both diagnostically and therapeutically. For these reasons, I have tried to help clinicians recognize how patients with psychiatric problems present in the real world of practice. I have also included Additional Guidelines for the Primary Care Clinician in each chapter to assist in the beginning of effective and useful intervention. The intent is not to make the primary care clinician a psychiatrist or a mental health professional, rather it is to increase the understanding of the patients' emotional needs that lie just

-vii-

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Women's Mental Health in Primary Care
Table of contents

Table of contents

  • Women's Mental Health in Primary Care *
  • Preface vii
  • Acknowledgments xi
  • Contents *
  • Chapter 1 - Anxiety Disorders 1
  • Chapter 2 - Depression 31
  • Chapter 3 - Bipolar Disorder 55
  • Chapter 4 - Misuse of Substances 73
  • Chapter 5 - Eating Disorders 109
  • Chapter 6 - Trauma and Violence 139
  • Chapter 7 - Insomnia 165
  • Chapter 8 - Somatization 181
  • Chapter 9 - Catastrophic Loss and Bereavement 199
  • Chapter 10 - Major Medical Illness 219
  • Chapter 11 - Menstruation, Pregnancy, and Menopause 247
  • Chapter 12 - Psychosis 273
  • Chapter 13 - Sexuality and Intimacy 291
  • Chapter 14 - The Older Patient 319
  • Afterword 347
  • General Resources for Patients 350
  • Index 353
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