Role of Psychiatry in General Practice of Medicine is very well established, specially in developed countries. Residents from Internal medicine as well as family medicine have roatations in Psychiatry during their residency period.
This article intends to be a little dossier for the medicine people who come across various Psychiatric manifestations in their patients.
Group 1: This group consists of the patients with multiple somatic complaints like unexplained and vague body aches, head aches, neck pains and several other pain symptoms which cannot be explained physically.
what to do? These patients require low dose anti depressants in combination with some anxiolytics. Low dose antidepressants have been known to work wonders with this patient population and have been frequently prescribed by the Psychiatrists.
Prescription choices can vary from Tablet Aculip H, Nexito Plus, Censpram Plus and several others. Start with BD dosing and treat for 4 to 6 weeks,most of the patients would show some improvement but if no improvement is observed than the patient should be reassesed for frank depression.
Group 2: This group consists of the patients with mild to moderate depressive symptoms like low mood, low self esteem, crying when alone, feelings of hopelessness and worthlessness.
What to do? Starting the patient on SSRI's is the best bet. Start with Fluoxetine 20 mg od or start on Escitalopram 10 mg od and raise to maximum of 20 mg od according to the patient response. Advise the patient to take these drugs in the morning as they may cause sleep disturbances if taken at bed time.
Word of Caution: Always figure out if your patient has any suicidal ideation or plan or has attempted suicide or self harm however vague it may be, it is a psychiatric emergency and should be best left for the psychiatrist to handle it.
Group 3: This group consists of patients with sexual complaints like erectile dysfunction , Dhaat Syndrome or premature ejaculation.
What to do? These patients are best treated with low dose Paroxetine along with phospodiestrase inhibitors like sildenafil and others. You can start with Paroxetine 12.5 mg and continue for 4 to 6 weeks.
Group 4: This group consists of patients with complaints of Insomnia or sleep disturbances or sleep difficulty.
What to do? Use clonapam instead of Alprazolam as it has low abusive potential than the later.
Thanks to Dr.Anupam Rathod for his valuable inputs.
