Patients with mental complaints or concerns or disordered behavior present in a variety of clinical settings, including primary care and emergency treatment centers. Complaints or concerns may be new or a continuation of a history of mental problems. Physicians also must be aware that many physical disorders and drugs (including many prescription drugs) cause symptoms mimicking specific mental disorders and should not assume that psychiatric symptoms are caused by a psychiatric disorder.
Psychiatric Disorders Chapters (A-Z)
Anxiety and Stressor-Related Disorders
Everyone periodically experiences fear and anxiety. Fear is an emotional, physical, and behavioral response to an immediately recognizable external threat (eg, an intruder, a car spinning on ice). Anxiety is a distressing, unpleasant emotional state of nervousness and uneasiness; its causes are less clear. Anxiety is less tied to the exact timing of a threat; it can be anticipatory before a threat, persist after a threat has passed, or occur without an identifiable threat. Anxiety is often accompanied by physical changes and behaviors similar to those caused by fear.
Approach to the Patient With Mental Symptoms
Patients with mental complaints or concerns or disordered behavior present in a variety of clinical settings, including primary care and emergency treatment centers. Complaints or concerns may be new or a continuation of a history of mental problems. Complaints may be related to coping with a physical condition or be the direct effects of a physical condition. The method of assessment depends on whether the complaints constitute an emergency or are reported in a scheduled visit. In an emergency, a physician may have to focus on more immediate history, symptoms, and behavior to be able to make a management decision. In a scheduled visit, a more thorough assessment is appropriate.
Everyone occasionally experiences a failure in the normal automatic integration of memories, perceptions, identity, and consciousness. For example, people may drive somewhere and then realize that they do not remember many aspects of the drive because they are preoccupied with personal concerns, a program on the radio, or conversation with a passenger. Typically, such a failure, referred to as nonpathologic dissociation, does not disrupt everyday activities.
(For mood disorders in children, see Depressive Disorders in Children and Adolescents.)
Obsessive-Compulsive and Related Disorders
Obsessive-compulsive disorder (OCD) is characterized by recurrent, persistent, unwanted, and intrusive thoughts, urges, or images (obsessions) and/or by repetitive behaviors or mental acts that patients feel driven to do (compulsions) to try to lessen or prevent the anxiety that obsessions cause. Diagnosis is based on history. Treatment consists of psychotherapy (specifically, exposure and response prevention), drug therapy (specifically, SSRIs or clomipramine), or, especially in severe cases, both.
Schizophrenia and Related Disorders
Schizophrenia and related disorders—brief psychotic disorder, delusional disorder, schizoaffective disorder, and schizophreniform disorder—are characterized by psychotic symptoms and often by negative symptoms and/or cognitive dysfunction. Psychotic symptoms include delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate motor behavior (including catatonia). Negative symptoms refer to a decrease in or lack of normal emotions and behaviors, such as having a flattened affect and lack of motivation. Cognitive dysfunction involves mainly sustained attention and working memory.
Sexuality, Gender Dysphoria, and Paraphilias
(For sexual dysfunction in men, see Overview of Male Sexual Function; for sexual dysfunction in women, see Overview of Female Sexual Function and Dysfunction.)
Somatic Symptom and Related Disorders
Somatization is the expression of mental phenomena as physical (somatic) symptoms. Disorders characterized by somatization extend in a continuum from those in which symptoms develop unconsciously and nonvolitionally to those in which symptoms develop consciously and volitionally. This continuum includes somatic symptom and related disorders, factitious disorders, and malingering. In all of the disorders, patients focus prominently on somatic concerns. Thus, somatization typically leads patients to seek medical evaluation and treatment rather than psychiatric care.