Primary care management of mental illness: medication as a tool

The central position of the primary care physician in providing mental health services in the United States is emphasized by two amply supported research conclusions: (1) more patients with diagnosable mental disorders are treated by primary care physicians than by all of the classically defined mental health disciplines combined; and (2) the majority of persons seeking care from the primary care system not only have no evidence of organic pathology, but have positive evidence that psychologic factors underlie their complaints. These patients frequently present particularly problematic treatment dilemmas in primary care because they so often have ill-defined but tenaciously defended somatic complaints and resist accepting the psychologic implications of their illnesses. Thus their treatment is often conceptualized in terms of "stress management" and psychopharmacologic interventions are frequently used. Adherence to proposed guidelines may help the primary care physician better integrate this aspect of the treatment of these often difficult patients.