1. Assessment:
a.
b. Many mental health d_is_orders are masked by other clinical conditions;
20% of primary care outpatients have mental d_is_orders(50-70% go
undetected and untreated)
c. Physical symptoms account
...
1. Assessment:
a.
b. Many mental health d_is_orders are masked by other clinical conditions;
20% of primary care outpatients have mental d_is_orders(50-70% go
undetected and untreated)
c. Physical symptoms account _for_ approx 50% of office v_is_its
d. ⅓ of physical symptoms are unexplained; in 20-25% those symptoms
become chronic
e. Symptoms and Behaviors:
i. Sorting symptom _is_ a challenge; can be unexplained symptoms
1. Patients who have unexplained symptoms depression and
anxiety exceeds 50%
ii. Physical or “somatic” symptoms account _for_ 50% of U.S. office
v_is_its
1. Pain, fatigue, palpitations, GI symptoms, sexual dysfunction,
dizziness or loss of balance
2. Symptoms that present as clusters are called “functional
syndromes” such as IBS, fibromyalgia, chronic fatigue, TMJ
d_is_order, and multiple chemical sensitivity
3. The presence of symptom overlap _is_ high in the common
functional syndromes such as fatigue, headache, sleep
d_is_turbance, pain, GI upset
iii. Patients with unexplained and somatic symptoms are often frequent
users of the health care system and termed “difficult patients”
iv. Patients with symptoms that last longer than 6 weeks are recognized
as chronic and should be screened _for_ depression and anxiety.
a. A two tiered approach _is_ recommended _for_ screening. A
brief screening with questions that yield high sensitivity then
a more detailed investigation when indicated
V. Patient who warrant a mental health screening include:
1. medically unexplained physical symptoms
2. Multiple physical or somatic symptoms
3. High severity of the presenting somatic symptom
4. Chronic pain
5. Symptoms longer than 6 weeks
6. Physician stating “a difficult encounter”
7. Recent stress
8. Low self-rating of overall health
9. Frequent use of health care services
10.Substance abuse
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