Chapter 65: Common Psychological Complaints

Primary care settings, particularly in underserved areas, have become the frontline for identifying and managing psychiatric disorders that affect roughly one in five Americans annually. The chapter emphasizes person-centered care models, including the Circle of Caring framework and Patient-Centered Medical Homes, as effective approaches for integrating mental health into general medical practice. Diagnosis relies on the DSM-5-TR criteria aligned with ICD-10-CM coding, requiring clinicians to evaluate symptom duration, severity, and functional impact while considering cultural context through tools like the Cultural Formulation Interview. Anxiety emerges as the most prevalent psychiatric disorder, presenting across affective, cognitive, behavioral, and somatic dimensions, necessitating careful differential diagnosis to exclude medical causes such as thyroid dysfunction or cardiac arrhythmias. Major Depressive Disorder, more common in women and younger adults, is assessed using the SIGECAPS mnemonic, with recognition that gender and cultural backgrounds influence symptom presentation and reporting. The chapter addresses grief as a normative response to loss, distinguishing between adaptive grieving and Prolonged Grief Disorder when symptoms persist severely beyond one year. Substance Use Disorder is conceptualized as a chronic brain disease affecting dopamine reward pathways, best treated through Medication-Assisted Treatment combined with behavioral interventions. Additionally, the chapter provides guidance on screening for and managing intimate partner violence, emphasizing safety protocols, the four Cs framework for clinical response, and the importance of private patient assessment. Throughout, standardized screening instruments including the GAD-7, PHQ-9, and Columbia-Suicide Severity Rating Scale are presented as essential tools for primary care providers.