,
, Psychiatry
Algorithms
for Primary Care
,
, Psychiatry
Algorithms for
Primary Care
GAU TAM GULATI
MBBS MD FRCPsych FRCPI PGDipLATHE (Oxon) FHEA
University of Limerick,
Ireland
WA LTER CULLEN
MB BCh BAO DCH DObs MD MICGP MRCGP
GradDipUTL
University College Dublin,
Ireland
B RE NDAN KELLY
MB BCh BAO MA MSc MA MD PhD DGov PhD MA (jure
officii) MCPsychI FRCPsych FRCPI FTCD
Trinity College Dublin,
Ireland
,This edition first published 2021
© 2021 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmit-
ted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except
as permitted by law. Advice on how to obtain permission to reuse material from this title is available at
http://www.wiley.com/go/permissions.
The right of Gautam Gulati, Walter Cullen, and Brendan Kelly to be identified as the authors of this work
has been asserted in accordance with law.
Registered Office
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Office
9600 Garsington Road, Oxford, OX4 2DQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products
visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that
appears in standard print versions of this book may not be available in other formats.
Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion
only and are not intended and should not be relied upon as recommending or promoting scientific method,
diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment
modifications, changes in governmental regulations, and the constant flow of information relating to the use
of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided
in the package insert or instructions for each medicine, equipment, or device for, among other things, any
changes in the instructions or indication of usage and for added warnings and precautions. While the pub-
lisher and authors have used their best efforts in preparing this work, they make no representations or war-
ranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all
warranties, including without limitation any implied warranties of merchantability or fitness for a particular
purpose. No warranty may be created or extended by sales representatives, written sales materials or promo-
tional statements for this work. The fact that an organization, website, or product is referred to in this work
as a citation and/or potential source of further information does not mean that the publisher and authors
endorse the information or services the organization, website, or product may provide or recommendations
it may make. This work is sold with the understanding that the publisher is not engaged in rendering profes-
sional services. The advice and strategies contained herein may not be suitable for your situation. You should
consult with a specialist where appropriate. Further, readers should be aware that websites listed in this
work may have changed or disappeared between when this work was written and when it is read. Neither
the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including
but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data
Names: Gulati, Gautam, 1979– author. | Cullen, Walter, author. | Kelly,
Brendan (Brendan D.), author.
Title: Psychiatry algorithms for primary care / Gautam Gulati, Walter
Cullen, Brendan Kelly.
Description: First edition. | Hoboken, NJ : Wiley-Blackwell, 2021. |
Includes bibliographical references and index.
Identifiers: LCCN 2020026511 (print) | LCCN 2020026512 (ebook) | ISBN
9781119653561 (paperback) | ISBN 9781119653660 (adobe pdf) | ISBN
9781119653677 (epub)
Subjects: MESH: Mental Disorders–diagnosis | Mental Disorders–therapy |
Primary Health Care–methods | Clinical Decision-Making–methods
Classification: LCC RC454 (print) | LCC RC454 (ebook) | NLM WM 141 | DDC
616.89–dc23
LC record available at https://lccn.loc.gov/2020026511
LC ebook record available at https://lccn.loc.gov/2020026512
Cover Design: Wiley
Set in 10/12pt STIX Two Text by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
,To our families. . .
,
,Contents
FORE WORD ix
AC KN OWL E D GEMEN TS xi
AU TH OR PR O F IL ES xii
Part 1 Introduction 1
1 How to Use This book 3
2 History Taking in General Practice 5
3 The Rapid Mental State Examination 8
Part 2 Common Psychiatric Disorders 13
4 Generalised Anxiety Disorder (GAD) 15
5 Panic Disorder 19
6 Obsessive Compulsive Disorder (OCD) 22
7 Social Phobia 25
8 Post-Traumatic Stress Disorder (PTSD) 28
9 Depression 31
10 Bipolar Affective Disorder (BPAD) 35
11 Psychosis 39
12 Eating Disorders 43
13 Personality Disorders 46
14 Alcohol Use Disorder 50
15 Substance Use Disorder 54
16 Opiate Use Disorder 57
17 Adult Attention Deficit Hyperactivity Disorder (ADHD) 60
18 Autism Spectrum Disorder (ASD) 63
19 Delirium 65
20 Dementia 68
Part 3 Common Presentations in
Primary Care 71
21 Fatigue 73
22 Insomnia 76
23 Medically Unexplained Symptoms 79
vii
, viii Contents
Part 4 Complex Scenarios 83
24 Suicide and Self Harm 85
25 Aggression 89
26 Referrals for Involuntary Care 91
Part 5 Special Considerations in
Prescribing 95
27 Special Considerations: Older Adults 97
28 Special Considerations in Prescribing: Children
and Adolescents 100
29 Special Considerations in Prescribing: People with
Intellectual Disabilities 103
30 Special Considerations in Prescribing: Pregnancy
and Breastfeeding 105
Part 6 Appendices 107
31 Commonly Prescribed Drugs 109
32 Physical Health in Patients with Severe Mental Illness 119
Part 7 Self-Assessment 123
33 Self-Assessment Cases 125
34 Self-Assessment Answers 138
IND E X 140
, Psychiatry
Algorithms
for Primary Care
,
, Psychiatry
Algorithms for
Primary Care
GAU TAM GULATI
MBBS MD FRCPsych FRCPI PGDipLATHE (Oxon) FHEA
University of Limerick,
Ireland
WA LTER CULLEN
MB BCh BAO DCH DObs MD MICGP MRCGP
GradDipUTL
University College Dublin,
Ireland
B RE NDAN KELLY
MB BCh BAO MA MSc MA MD PhD DGov PhD MA (jure
officii) MCPsychI FRCPsych FRCPI FTCD
Trinity College Dublin,
Ireland
,This edition first published 2021
© 2021 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmit-
ted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except
as permitted by law. Advice on how to obtain permission to reuse material from this title is available at
http://www.wiley.com/go/permissions.
The right of Gautam Gulati, Walter Cullen, and Brendan Kelly to be identified as the authors of this work
has been asserted in accordance with law.
Registered Office
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Office
9600 Garsington Road, Oxford, OX4 2DQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products
visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that
appears in standard print versions of this book may not be available in other formats.
Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion
only and are not intended and should not be relied upon as recommending or promoting scientific method,
diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment
modifications, changes in governmental regulations, and the constant flow of information relating to the use
of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided
in the package insert or instructions for each medicine, equipment, or device for, among other things, any
changes in the instructions or indication of usage and for added warnings and precautions. While the pub-
lisher and authors have used their best efforts in preparing this work, they make no representations or war-
ranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all
warranties, including without limitation any implied warranties of merchantability or fitness for a particular
purpose. No warranty may be created or extended by sales representatives, written sales materials or promo-
tional statements for this work. The fact that an organization, website, or product is referred to in this work
as a citation and/or potential source of further information does not mean that the publisher and authors
endorse the information or services the organization, website, or product may provide or recommendations
it may make. This work is sold with the understanding that the publisher is not engaged in rendering profes-
sional services. The advice and strategies contained herein may not be suitable for your situation. You should
consult with a specialist where appropriate. Further, readers should be aware that websites listed in this
work may have changed or disappeared between when this work was written and when it is read. Neither
the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including
but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data
Names: Gulati, Gautam, 1979– author. | Cullen, Walter, author. | Kelly,
Brendan (Brendan D.), author.
Title: Psychiatry algorithms for primary care / Gautam Gulati, Walter
Cullen, Brendan Kelly.
Description: First edition. | Hoboken, NJ : Wiley-Blackwell, 2021. |
Includes bibliographical references and index.
Identifiers: LCCN 2020026511 (print) | LCCN 2020026512 (ebook) | ISBN
9781119653561 (paperback) | ISBN 9781119653660 (adobe pdf) | ISBN
9781119653677 (epub)
Subjects: MESH: Mental Disorders–diagnosis | Mental Disorders–therapy |
Primary Health Care–methods | Clinical Decision-Making–methods
Classification: LCC RC454 (print) | LCC RC454 (ebook) | NLM WM 141 | DDC
616.89–dc23
LC record available at https://lccn.loc.gov/2020026511
LC ebook record available at https://lccn.loc.gov/2020026512
Cover Design: Wiley
Set in 10/12pt STIX Two Text by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
,To our families. . .
,
,Contents
FORE WORD ix
AC KN OWL E D GEMEN TS xi
AU TH OR PR O F IL ES xii
Part 1 Introduction 1
1 How to Use This book 3
2 History Taking in General Practice 5
3 The Rapid Mental State Examination 8
Part 2 Common Psychiatric Disorders 13
4 Generalised Anxiety Disorder (GAD) 15
5 Panic Disorder 19
6 Obsessive Compulsive Disorder (OCD) 22
7 Social Phobia 25
8 Post-Traumatic Stress Disorder (PTSD) 28
9 Depression 31
10 Bipolar Affective Disorder (BPAD) 35
11 Psychosis 39
12 Eating Disorders 43
13 Personality Disorders 46
14 Alcohol Use Disorder 50
15 Substance Use Disorder 54
16 Opiate Use Disorder 57
17 Adult Attention Deficit Hyperactivity Disorder (ADHD) 60
18 Autism Spectrum Disorder (ASD) 63
19 Delirium 65
20 Dementia 68
Part 3 Common Presentations in
Primary Care 71
21 Fatigue 73
22 Insomnia 76
23 Medically Unexplained Symptoms 79
vii
, viii Contents
Part 4 Complex Scenarios 83
24 Suicide and Self Harm 85
25 Aggression 89
26 Referrals for Involuntary Care 91
Part 5 Special Considerations in
Prescribing 95
27 Special Considerations: Older Adults 97
28 Special Considerations in Prescribing: Children
and Adolescents 100
29 Special Considerations in Prescribing: People with
Intellectual Disabilities 103
30 Special Considerations in Prescribing: Pregnancy
and Breastfeeding 105
Part 6 Appendices 107
31 Commonly Prescribed Drugs 109
32 Physical Health in Patients with Severe Mental Illness 119
Part 7 Self-Assessment 123
33 Self-Assessment Cases 125
34 Self-Assessment Answers 138
IND E X 140
