Psychiatry

An understanding of psychiatric illness is critical to the practice of internal medicine. Since 30% to 40% of ambulatory primary care visits have a psychiatric component to the chief complaint, successful disease management often hinges on successful treatment of comorbid psychiatric illness. A comprehensive psychiatric evaluation is essential because many psychiatric symptoms are nonspecific. This situation is analogous to a patient presenting in general internal medicine with fever or nausea. The presence of a single symptom (eg, depressed mood) is never pathognomonic for a specific disorder. For patients with psychiatric symptoms, the biopsychosocial model is widely used. With this approach, the biologic, psychologic, and social factors contributing to the patient's clinical presentation are evaluated. Some psychiatric symptoms indicate severe disease, whereas others may be less problematic and may not be clinically relevant.