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INTRODUCTION
Mental health disorders are a leading cause of morbidity around the world with the prevalence of disease ranging from 4.3% to 26.4%.1 In the United States (US), an estimated 44 million Americans over 18 years of age, about 20% of all adults, are believed to have a psychiatric condition.2 The burden of disease is high and includes substantial direct and indirect treatment costs, the loss of productivity ($193 billion per year), short- and long-term functional impairment, and diminished quality of life for both patients and caregivers.2-3

Mental disorders including depression, bipolar disorder, anxiety disorders (eg, generalized anxiety, obsessive-compulsive, and panic disorders), and schizophrenia, are mostly seen in primary care settings: up to 70% of all psychiatric patients are diagnosed and treated by primary care professionals (PCPs), which include primary care physicians, physician assistants, nurse practitioners.4 The initial point of contact is usually a general practitioner, but nurse practitioners, physician assistants, and community pharmacists also interact with patients during the course of care. About 80% of adults see a PCP at least once a year, and between 30% and 40% of those have psychological symptoms.5-6 As a consequence, PCPs are being asked to provide appropriate care to patients with mental health problems while serving as the conduit to those requiring specialty care or the assistance of other community agencies such as public social services. However, the number of practicing psychiatrists is not sufficient to meet the demand for care, and treatment from a specialist is not cost-effective for either patients or third-party payers.7 Moreover, many psychiatric patients also have common physical comorbidities, such as diabetes mellitus or cardiovascular disease, that make treatment by a PCP the most appropriate source of care. Primary care settings are also more accessible, less stigmatizing, and more comprehensive, compared with care from a psychiatrist.8 Thus, primary care professionals have a crucial role to play in addressing the substantial social, economic, and health burden caused by patients with mental disorders.

Unfortunately, the delivery of care to people with common psychiatric conditions is less than ideal. A large number of patients are often uninformed about where to seek treatment and many feel stigmatized by their condition. Insurance problems and payment barriers also are common.9 More importantly, PCPs have not been trained to diagnose and treat patients with these disorders, and many clinicians lack confidence in their ability to care for patients with mental-health disorders. As a result, depression, bipolar disorders, and other common conditions are often undiagnosed or inadequately treated, inappropriate psychotropic drugs are prescribed with little follow-up, and overall physical and mental-health outcomes are poor.7 Numerous studies demonstrate the low rates of detection and treatment in the primary care setting, along with high rates of relapse and disease recurrence.10-11 Addressing the myriad of challenges facing PCPs, primary care nurses, and community pharmacists in recognizing and managing common mental disorders in the community, including major depressive and bipolar disorders, anxiety disorders such as generalized anxiety, obsessive-compulsive disorder, and panic disorders, and schizophrenia, is the focus of this educational activity.

Initial Patient Presentation/History
CF is a 59-year-old woman with no previous psychiatric history who reports that for the past month, she has been hearing the voice of her deceased husband who says that he misses her. He had a fatal heart attack while attending the wedding of one of their daughters. The couple was close and looking forward to celebrating their 35th wedding anniversary. Although denying thoughts of suicide, CF wonders if her life is still worth living. CF’s husband was a smoker and obese, and she claims that she “…should have seen it coming and saved him.” She has been feeling guilty since his death, especially at night, and has difficulty sleeping. During the day, she feels intermittently anxious or lethargic and has little appetite. Although she has returned to her office, she claims to be uninterested in her work and other activities that normally give her pleasure. CF drinks only at social functions.



Which of the following diagnoses BEST describes the CF’s condition?







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