The psychotic patient

The primary care physician is increasingly important in the delivery of mental health services in the primary care setting. A review of investigations from several decades reveals that mental disorders are present in approximately 25% of primary care patients.(24) Primary care practices serve as the de facto hidden mental health network, providing the sole contact for over 50% of patients with mental illness.(21) Overall, approximately 60% to 70% of patients with anxiety, mood, somatoform, chemical dependency, and psychotic disorders are seen within the primary care setting.(25) Psychotic disorders occur in about 1% of patients in the primary care setting(14) and 3% in the general population.(20) This rate is lower than rates for depression (5%-10%), general anxiety disorder (1.6%-11.9%), panic disorder (1.6%-11%), alcohol disorders (5%-15%), other substance disorders (5.0%-7.1%), somatization disorder (2%-3%), and hypochondriasis (0.5%-6.3).(13) At least 30% of patients with a psychotic disorder are treated in the primary care setting,(20) and in recent years, this may have increased. These patients have significantly decreased quality of life, capacity to work, and ability to maintain relationships. Patients with a psychotic disorder commit suicide at a rate of 10%.(19)