by John Chapman Urbaitis, M.D.
[November 1995; Vol. 22 No. 5]
American Psychiatric Press, Inc. published DSM-IV-PC (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Primary Care Version) in September. This is the first manual of mental disorders created specifically for use by primary care physicians. Physicians from eight primary care organizations, from the AMA, and from the APA worked together over four years to develop this concise, user-friendly manual. As a member of this work group, I was impressed by the cooperative spirit that developed among representatives from the APA and primary care organizations.
Representatives from the DSM-IV Task Force, with APA Deputy Medical Director Harold Alan Pincus, M.D., met with representatives from such groups as American Academy of Family Physicians, American College of Gynecology, American College of Physicians, Society of General Internal Medicine, and American Academy of Pediatrics. Dr. Pincus and Thomas N. Wise M.D. co-chaired the work group, and Michael B. First, M.D. served as editor for text and criteria. I was a member of the work group, as Assembly Liaison for DSM-IV. The work group, and all sub work groups, included both psychiatrists and primary care physicians. This helped promote team work and good communication, modeling what we hope will also occur in the clinical use of this manual.
The work group divided into sub work groups to address diagnostic criteria for mental disorders which present commonly in primary care. We selected common conditions, such as anxiety, depression, and substance abuse, for the chapters. The work group decided on an algorithm or flow-chart format, to make differential diagnosis easy for the physician unfamiliar with DSM-IV organization. This format assists clinicians in moving from presenting symptoms to probable diagnosis.
The book is organized on epidemiological principles, with the most common presentations first. Physicians in the sub work groups developed algorithms that assure that most critical conditions, such as psychotic thinking are suicidal ideation are addressed. This will assist the primary care physician in identifying patients who should be referred for urgent specialty care by a psychiatrist.
Since the DSM-IV-PC is fully compatible with its parent publication, DSM-IV, the primary care version gives physicians a common language and frame of reference in assessing and discussing patients with psychiatric problems. This is intended to foster communication and learning, and to improve patient care by identifying psychiatric problems earlier.
If you as a psychiatrist are looking for gifts for some of your physician colleagues, consider the DSM-IV-PC. It might turn out to be the gift that gives you some extra returns!