Adequacy of the Comprehensive Clinical Evaluation Program A Focused Assessment (1997) / Chapter Skim
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5 IOM Review: Stress, Psychiatric Disorders, and Their Relationship to Physical Signs and Symptoms
5 IOM Review: Stress, Psychiatric Disorders, and Their Relationship to Physical Signs and Symptoms
Pages 37-44
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From page 37... ...
Presentations were focused on providing the latest information in these areas Mat could assist the committee in its review of the adequacy of the Comprehensive Clinical Evaluation Program in diagnosing stress and psychiatric disorders and in determining whether or not effective treatments existed for these conditions. STRESSORS AND STRESS As discussed earlier, individuals deployed to the Persian Gulf were exposed to a number of stressors.
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From page 38... ...
. Primary stressors are primary in the sense that they are the root origin of a series of other problematic life circumstances called secondary stressors.
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From page 39... ...
Of the patients found by screening during the primary care visit to have a major ongoing depression, 59% received no medication and were not in psychotherapy. Of those who received medication, 19% received only a minor tranquilizer, and 12% only an antidepressant, and of the ones receiving antidepressants, 39% received homeopathic doses.
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From page 40... ...
The language of episodes can be translated into the language of the primary care clinician. An episode is a syndrome (i.e., a collection of signs and symptoms)
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From page 41... ...
It has been shown that as many as 15% of patients with inadequately treated depression kill themselves. In diagnosing depression in primary care, it is important to screen populations at elevated risk, to increase the clinical sensitivity of primary care providers, to ensure that there is adequate time to perform the evaluation, to remove barriers to specialty care, to encourage multidisciplinary management, to assess comorbidity, and to overcome stereotypes.
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From page 42... ...
Substance Abuse Substance abuse problems are fairly prevalent in primary care. About 20% to 30% of patients who visit primary care physicians do so for problems that relate in some way to substance abuse or misuse.
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From page 43... ...
There is also a great deal of comorbidity between substance abuse and psychiatric disorders such as schizophrenia, affective disorders, anxiety disorders, and antisocial personality disorders. The second major responsibility of the primary care physician is to conduct substance abuse screening.
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From page 44... ...
conducted a review of the literature on physical health outcomes associated with traumatic events including exposure to a war zone, sexual or other criminal victimization, natural or human-made disasters, and serious accidents. They concluded that "the trauma and health literature is impressive for the consistency of results showing that exposure to catastrophic stress is associated with adverse health reports, medical utilization, morbidity, and mortality among survivors." Although there is some concern that this literature includes work with methodological flaws, Friedman and Schnurr (1995)
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