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Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care

By Charles B. Nemeroff, M.D., Ph.D., and Alan F. Schatzberg, M.D. Washington, D.C., American Psychiatric Press, 1999, 269 pp., $35.00.

Mental disorders are already a major public health problem and promise to be the major cause of disability days in the next 10–20 years. A survey of a representative sample of the population of the United States indicated that approximately 30% of the sample reported having a mental disorder in the previous 12 months (1). Less than half of Americans who report a mental disorder during their lifetime have received treatment for that disorder. It is clear that mental disorders are insufficiently recognized, let alone treated.

The authors of Recognition and Treatment of Psychiatric Disorders note correctly that primary care has become a de facto mental health system. The use of the term "system" is somewhat autistic when we recognize that the so-called system does not work for the mental disorders and may not work that well for much else. The authors attempt through this volume to assist primary care physicians in their task of rendering mental health services. It is not clear that any book, no matter how well written, can address the problem. Primary care physicians do not receive adequate training in the recognition and management of psychiatric disorders. This deficiency is compounded by the expectations that the primary care physician must see six or more patients per hour. It would be difficult under these conditions to recognize auditory hallucinations, let alone more subtle manifestations of mental disorder. Self-administered screening tools have been used, but they have not proven to be of great assistance.

Rational analysis of the situation might lead to the conclusion that psychiatrists should act as gatekeepers. The psychiatrist is trained to recognize and treat mental disorders and to recognize and refer medical disorders. This could lead to early intervention in psychiatric disorders and undoubtedly would prove to be cost effective as well. The likelihood of this approach being realized approaches zero.

Neither this volume nor its review will resolve the problems of health care delivery in the United States. Although the book will not solve the problems of the current primary care deliverers, it is, nevertheless, of genuine value. The fact that it is not a Germanic Handbuch is both a strength and a weakness. It is not meant to replace a more complete explication of psychiatric knowledge, but it is an excellent starting place for a resident and an even better review source for the board applicant.

References

1. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS: Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:8–19[Abstract]

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