Primary care
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Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical Manual V or ICD-11 definitions. ⋯ The prevalence of this disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences. There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies.
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Primary-care settings have a unique advantage to reaching a broad range of the population and the ability to address a wide array of presenting problems, including substance-use. With high rates of substance-use in the United States and low rates of substance-use treatment utilization, the primary-care office is key in assessing and supporting patients in changing substance-use behaviors. Motivational interviewing is a conversational tool physicians can use to highlight intrinsic motivation for change and support specific changes patients want to make. Providers can also apply motivational interviewing to a variety of chronic health care behaviors.
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Stepped-care (SC) models have been adopted in primary care settings as a method for treating mental health conditions within primary care. In a SC model, a patient's symptoms are assessed, and an intervention is prescribed that matches the severity of symptoms. Thus, the SC model offers a variety of steps and levels of treatment that range from low to high intensity. Progression in treatment is monitored on a weekly basis and patients are stepped up or down in level of care depending on their clinical response to the intervention.
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Attention-deficit hyperactivity disorder is a neurodevelopmental disorder involving dysregulation of multiple neural circuits, manifesting in symptoms such as inattention, impulsivity, and hyperactivity. Diagnosis requires onset of symptoms before age 12 years. ⋯ Management involves pharmacologic agents, such as stimulant and/or nonstimulant medications, and providers should monitor closely for any adverse effects. Nonpharmacologic interventions may be implemented and can be used in conjunction with pharmacotherapy, although medications should be at the forefront of treatment.
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Eating disorders are mental health disorders with complicating medical, psychiatric, and nutritional comorbidities. Common eating disorder diagnoses include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder, and other specified feeding or eating disorder. ⋯ Eating disorders occur across age, gender, racial, ethnic, and socioeconomic variables. Effective assessment, intervention, and collaborative treatment are needed to decrease risk factors and increase opportunities for recovery.