PSYCHOTIC SYMPTOMS IN PRIMARY-CARE

BACKGROUND. Psychotic symptoms include a variety of disturbances in pe rception, reality testing, speech, and behavior. We examine the preval ence, distribution, treatment, and functional impairment associated wi th psychotic symptoms in primary care patients. METHODS. Data are draw n from a recent study of adult primary care patients (N=1001) in a lar ge, urban, prepaid group practice. At the medical visit, patients comp leted a questionnaire that probed demographic characteristics, health status, and mental health care utilization. Following the visit, patie nts received a telephone-administered, structured psychiatric intervie w that included 11 psychotic symptoms, Medication prescription data we re also available. Comparisons are presented of patients with and with out psychotic symptoms. RESULTS. Thirty-seven (3.7%) patients reported one or more psychotic symptoms, most commonly a belief that others we re spying on or following them (n=16). As compared with patients witho ut psychotic symptoms, a larger proportion of the patients with psycho tic symptoms reported mental health-related work loss (54.1% vs 17.9%, P<.0001), suicidal ideation (21.6% vs 2.6%, P<.0001), major depressiv e disorder (32.4% vs 6.3%, P<.0001), bipolar disorder (29.7% vs 1.2%, P<.0001), and several other mental disorders, An antipsychotic medicat ion had been prescribed during the previous 17 to 20 months for only t wo (5.4%) of the patients with psychotic symptoms. CONCLUSIONS, Psycho tic symptoms were relatively common (3.7%) in this practice and were s trongly associated with functional impairment and affective, anxiety, or substance use disorders. Primary care physicians are encouraged to examine patients with these mental disorders for the presence of psych otic symptoms.