C-L Case Conference: Chronic Psychosis Managed in Collaborative Care

We present the case of a 60-year-old woman who presented to primary care with chronic mixed depressive and hypomanic symptoms consistent with schizoaffective disorder. Patients with serious mental illness such as psychotic disorders are ideally referred for treatment in specialty psychiatric settings; however, many patients with serious mental illness receive their care in primary care settings due to patient preference or unavailability of psychiatric services. Top experts in the CL field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. The Collaborative Care Model (CoCM) can support primary care providers in managing patients with serious mental illness. Key teaching topics include the application of the CoCM to patients with psychotic disorders, clinician- and systems-level facilitators and barriers to CoCM implementation, and quality improvement within the CoCM. Specifically, the differential diagnosis when a patient is not improving should include systems-level considerations.