Primary care practitioners treat the majority of patients with psychiatric disorders, but many patients in general medical practices continue to suffer from undiagnosed mental illnesses. Over the past 10 years, clinical investigators have focused on enhancing the detection of psychiatric disorders in primary care. Several diagnostic tools have been developed for use by clinicians who are not psychiatrists. However, the time constraints of real-world office practice and the often-cumbersome psychiatric nomenclature have limited their use. Recent studies have tested even more streamlined diagnostic methods that require only a few minutes of physician time while correlating strongly with formal psychiatric evaluations. This article consolidates these research findings with practical experience in the rapid detection of 5 psychiatric conditions commonly encountered in primary care: depression, anxiety, stress reactions, substance abuse, and cognitive impairment. An efficient, 2-step method is described that consists of carefully targeted screening questions followed by a confirmatory evaluation. The screening questions and confirmatory examination can be incorporated easily into most primary care practices.
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