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Creation of a new book by the American Psychiatric Press Inc. (APPI) and the AMA's Publishing Division may be the herald of a new partnership and future projects between APA and the AMA, say the book's editors. Psychiatry for Primary Care Physicians was written as a reference for primary care practitioners on how to recognize, diagnose, and manage common mental health disorders.
The book consists of chapters cowritten by both psychiatrists and primary care physicians and edited by Larry S. Goldman, M.D., Thomas N. Wise, M.D., and David S. Brody, M.D. Topics include the basics of assessment and diagnosis, including techniques for gathering data by interview, examination, and testing. The book describes common psychiatric disorders by symptoms and provides information on epidemiology and psychopathology. Contributors include experts on assessment and diagnosis, family practice, behavioral science, geriatric psychiatry, consultation liaison, alcohol and addiction, and community medicine.
In working together to produce this book, said Wise, medical director of behavioral services at Inova Health Systems in Fairfax, Va., "we are reifying the importance of psychiatry in primary care at an organizational level."
Wise and Goldman came up with the idea of Psychiatry for Primary Care Physicians at the same time the AMA was developing an official Publications Division. They asked David Brody, M.D., a professor of medicine and director of the Division of General Internal Medicine at MCP-Hahnemann School of Medicine, to assist them in creating the book.
"I see this book as a metaphor for a growing collaboration between the AMA and APA," said Wise.
Goldman is the first psychiatrist to work within the AMA in a staff position. As director of the Office of Mental Health Affairs, he was able to establish the link between the organizations through which this book was published.
Wise hopes that by building a better link with the AMA, psychiatrists can not only help primary care physicians with diagnosing, treating, and referring patients with mental health problems, but also educate their physician colleagues about neglect of psychiatric populations within managed care systems.
"My hope is that the more educated physicians become in behavioral science and developmental psychology, the more they will seek to work with psychiatrists, and the rate of recognition of psychiatry will rise." A collaboration with physicians will lead to better treatment for mental health patients, he said.
"I think this book moves us toward the ability to consider mental health problems the way we consider physical problems," said Brody. At present, he noted, up to half of people with depression and other disorders are not being identified. One reason for this is that primary care physicians are unsure of what to do once they diagnose a behavioral disorder. If they develop greater confidence in the ability to manage these problems, Brody said, they are more likely to detect them.
The straw man for psychiatrists is the concern that if primary care physicians become more knowledgeable about mental health, they will begin to do psychiatrists' work, said Wise. In reality, primary care physicians have more than enough to do already. If they become more aware of mental health issues for their patients, he continued, they will pass on plenty of work to psychiatrists.
Brody agreed. "If we're doing our jobs right, we'll identify more mental health problems and be able to treat more patients successfully."
Psychiatry for Primary Care Physicians (0892) can be ordered for $49.95, hardcover, by calling (800) 368-5777; in the Washington, D.C., area the number is (202) 682-6269; fax: (202) 789-2648; e-mail: order @appi.org.