Mental Disorders

  • Mary P. Harward
  • Julia E. Connelly


Primary-care practice includes the diagnosis and treatment of both medical and mental disorders. However, primary-care practitioners infrequently diagnose mental disorders.1,2 Such “missed diagnoses” may be due to several factors: lack of education about detection and treatment of mental disorders; the constraints on time in a busy office practice that preclude indepth psychiatric interviews with every patient; and the difficulty of distinguishing symptoms of mental disorders amid physical complaints. Just as with medical illnesses, preventing the complications of mental disorders begins with early and accurate diagnosis. This chapter outlines the means of improving the detection of mental disorders by discussing (1) the role of prevention in mental disorders; (2) the epidemiology of mental disorders in the community and in the medical office; (3) the groups at risk for mental disorders; and (4) the symptoms (anxiety and depression) associated with the major mental disorders seen in office practices.


Mental Disorder Bipolar Disorder Generalize Anxiety Disorder Depressed Mood Panic Disorder 
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  1. 1.
    Brody, D. S.: Physician recognition of behavioral, psychological, and social aspects of medical care. Arch. Intern. Med. 140: 1286–1289, 1980.PubMedCrossRefGoogle Scholar
  2. 2.
    Thompson, T. L., Stoudmire, A., Mitchell, W. D., et al.: Underrecognition of patients’ psychosocial distress in a university hospital medical clinic. Am. J. Psychiatry 140: 158–161, 1983.PubMedGoogle Scholar
  3. 3.
    Report of the Task Force on the Periodic Health Examination. Can. Med. Assoc. J., 121: 1193–1254, 1974.Google Scholar
  4. 4.
    Johnstone, A., and Goldberg, D.: Psychiatric screening in general practice. Lancet 1: 605–608, 1976.PubMedCrossRefGoogle Scholar
  5. 5.
    Hamilton, M.: A rating scale for depression. J. Neurol. Neurosurg. Psychiatry 23: 56–62, 1960.PubMedCrossRefGoogle Scholar
  6. 6.
    Beck, A. T.: Depression: Clinical, Experimental, and Theoretical Aspects. Hoeber, New York, 1967.Google Scholar
  7. 7.
    Rucker, L., Frye, E. B., and Cygan, R. W.: Feasibility and usefulness of depression screening in medical outpatients. Arch. Intern. Med. 146: 729–731, 1986.PubMedCrossRefGoogle Scholar
  8. 8.
    Koranyi, E. K.: Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population. Arch. Gen. Psychiatry 36: 414–419, 1978.CrossRefGoogle Scholar
  9. 9.
    Regier, D. A., Meyers, J. K., Kramer, M., et al.: The NIMH epidemiologic catchment area program. Historical context, major objectives, and study population characteristics. Arch. Gen. Psychiatry 41: 934–941, 1984.PubMedCrossRefGoogle Scholar
  10. 10.
    Meyers, J. K., Weissman, M. M., Tischler, G. L., et al.: Six-month prevalence of psychiatric disorders in three communities. 1980 to 1982. Arch Gen. Psychiatry 41: 959–967, 1984.CrossRefGoogle Scholar
  11. 11.
    Shapiro, S., Skinner, E. A., and Kessler, L. G.: Utilization of health and mental health services. Arch. Gen. Psychiatry 41: 971–978, 1984.PubMedCrossRefGoogle Scholar
  12. 12.
    Stoeckle, J. D., Zola, I. K., and Davidson, G. E.: The quality and significance of psychological distress in medical practice. J. Chronic Dis. 17: 959–976, 1966.CrossRefGoogle Scholar
  13. 13.
    Hoeper, E. W., Nycz, G. R., Cleary, P. D., et al.: Estimated prevalence of RDC mental disorder in primary medical care. Int. J. Mental Health 8: 6–15, 1979.Google Scholar
  14. 14.
    National Center for Health Statistics, Cypress, B. K.: Patterns of Ambulatory Care in General and Family Practice, the National Ambulatory and Medical Care Survey, United States, January 1980–December 1981. Vital and Health Statistics. Series 13, No. 73. DHHS Pub. No. (83) 1734. Public Health Service. US Government Printing Office, Washington, DC, 1983.Google Scholar
  15. 15.
    Warheit, G. J.: Life events, coping, stress, and depression symptomatology. Am. J. Psychiatry 136: 502–507, 1979.PubMedGoogle Scholar
  16. 16.
    Dunner, D. L., Patrick, V., and Fieve, R. R.: Life events at the onset of bipolar affective illness. Am. J. Psychiatry 136: 508–511, 1979.PubMedGoogle Scholar
  17. 17.
    Brown, G. W., and Berley, J. L. T.: Crises and life changes and the onset of schizophrenia. J. Health Social Behav. 9: 203–214, 1968.CrossRefGoogle Scholar
  18. 18.
    Paykel, E. S.: Suicide attempts and recent life events. Arch. Gen. Psychiatry 32: 327–333, 1978.CrossRefGoogle Scholar
  19. 19.
    Holmes, T. H., and Rahe, R. H.: The Social Readjustment Rating scale. J. Psychosom Res. 11: 213–218, 1967.PubMedCrossRefGoogle Scholar
  20. 20.
    Engel, G. L.: The need for a new medical model. A challenge for biomedicine. Science 196: 129–136, 1977.PubMedCrossRefGoogle Scholar
  21. 21.
    McWhinney, I. R.: Beyond diagnosis. An approach to the integration of behavioral science and clinical medicine. N. Engl. J. Med. 287: 384–387, 1972.PubMedCrossRefGoogle Scholar
  22. 22.
    Rainer, J. D.: Genetics and psychiatry, in Kaplan, H. I., and Sadoch, B. J. (eds.): Comprehensive Textbook of Psychiatry, 4th ed. Williams & Wilkins, Baltimore, 1985, pp. 36–41.Google Scholar
  23. 23.
    Kahana, R. J., and Bibring, G. L.: Personality types in medical management, in Zibring, N. (ed.): Psychiatry and Medical Practice in a General Hospital. International Universities Press, New York, 1964.Google Scholar
  24. 24.
    Barsky, A.: Hidden reasons some patients visit doctors. Ann. Intern. Med. 94: 492–498, 1981.PubMedGoogle Scholar
  25. 25.
    Connelly, J. E., and Mushlin, A. I.: The reasons patients request “checkups”: Implications for office practice. J. Gen. Intern. Med. 1: 163–165, 1986.PubMedCrossRefGoogle Scholar
  26. 26.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. APA, Washington, DC, 1980.Google Scholar
  27. 27.
    Lindemann, E.: The symptomatology and management of acute grief. Am. J. Psychiatry 101: 141–149, 1944.Google Scholar
  28. 28.
    DePaulo, J. R.: Affective disorders, in Barker, L. R., Burton, J. R., and Zieve, P. D. (eds.): Principles of Ambulatory Medicine, 2nd ed. Williams & Wilkins, Baltimore, 1986, pp. 183–195.Google Scholar
  29. 29.
    Centers for Disease Control: Premature mortality due to suicide and homicide—United States, 1983. Morbid. Mortal. Wkly. Rep. 35: 357–361, 1986.Google Scholar
  30. 30.
    Sheehan, D. V.: Monoamine oxidase inhibitors and alprazolam in the treatment of panic disorder and agoraphobia. Psychiatr. Clin. North Am. 8: 49–62, 1985.PubMedGoogle Scholar
  31. 31.
    Baile, W. F.: The anxious patient, in Barker, L. R., Burton, J. R., and Zieve, P. D. (eds.): Principles of Ambulatory Medicine, 2nd ed. Williams & Wilkins, Baltimore, 1986, pp. 156–175.Google Scholar
  32. 32.
    Ford, C. V.: Somatizing Disorders. Illness as a Way of Life. Elsevier, New York, 1983.Google Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Mary P. Harward
    • 1
  • Julia E. Connelly
    • 2
  1. 1.Department of Internal MedicineNorthwestern University School of MedicineChicagoUSA
  2. 2.Department of Internal MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA

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