Mental Health Resources for Family Medicine Physicians
Welcome! Below are resources for physicians and patients related to various mental health topics. If you cannot find what you are looking for, have something you think would be helpful, or otherwise wish to contact us, please email the FMP chief resident.
Current Epic smart phrases include .psychref___(x7), .suicidal, .grief, .housing, .psychconsult (detailed psych H&P template), .supportgroup, .sleephygiene, .deliriumprecaution
Referral List by insurance and county (mostly Hamilton).
Referral List by patient and/or service needed (includes substance abuse, child/adolescent, geriatric psychiatric, adult, family therapy, neuropsych/cognitive testing, crisis lines, and referrals for other counties).
This is a document FMP residents have put together to assist outpt fammed residents (and faculty) with making mental health referrals. This list is certainly not comprehensive, but can provide a good framework and copy/pastable resources. Because getting into one of these places can take several months even if your patient is persistant and calls repeatedly (something I would encourage them to do), please feel free to call us at any time to discuss patients you are trying to manage in the meantime. Family med docs can do a lot, and we want to support you in whatever you are comfortable managing.
FMP faculty that are willing to be consulted by phone regarding psychiatric patients in the office or after hours can be reached at the following numbers: Lawson Wulsin (202-415-2884c, 513-269-1487p) or Chris White (513-460-0933c). Also, if you are having trouble finding a therapist/counselor through the channels below, feel free to speak with one of the upper-level FMP residents about whether or not your patient would be a good candidate for the psychiatry resident psychotherapy clinic (RPC) - these referrels generally go better if an FMP resident helps you make them.
Expanded Substance Abuse Referral list: used in PES (Psychiatric Emergency Services)
Mental Health Resources for Spanish-Speaking Patients. courtesy of Brittany Almarez.
72-hr hold pdf
NOTE: when referring to MHAP, must have one of these diagnoses.
NOTE: For support groups based around specific diseases/conditions (mental health or otherwise) in Hamilton and neighboring counties, this is a great website to refer your patient to or take 5minutes to help them navigate it (just need a dx and county of residence): http://www.mhaswoh.org/support.asp
Adult ADHD
AAFP article from 2012: "Diagnosis and Management of ADHD in Adults"
Adult ADHD Self-Report Scale Symptom Checklist v1.1 Official instrument of the World Health Organization. 18-item questionnaire intended for use in patients who are at risk of ADHD; a quick six-item screening version also available. Available in multiple languages.
Wender Utah Rating Scale Retrospective assessment of childhood ADHD symptoms from ages eight to 10 years. Regular version contains 61 questions, short version contains 25
DSM-IV TR diagnostic criteria technically apply only if symptoms were present <7yo, but this may change with DSM-V
Psychostimulant-Abuse or misuse: screening tools include CRAFFT test for adolescents (available in multiple languages) and 5-question RAFFT test for adults. Also consider toxicology screenings, exended-release formulations, and other medications/formulas (brief article from Current Psychiatry on psychostimulant abuse in college students).
Pediatric ADHD:
For Patients: :
Booklet handouts from the NIMH (National Institute for Mental Health) on ADHD: easy-to-read (6-pages) and more detailed (24-pages).
Patient handout on ADHD from familydoctor.org.
Packet on Behavioral interventions for school-age child with ADHD, includes suggested reading list last 2 pages (total 18 pages).
For Providers:
Vanderbilt Forms: parent (print 1) and teacher (print 2).
AAFP Article on Tourette's as this is often comorbid with ADHD.
2014 AAFP ADHD Management article, and Short AAFP Article on Management of ADHD in Preschool-Aged Children
Depression:
For Patients: The following can be copy/pasted and/or turned into a quicktext:
There are many different causes for depression and, therefore, many different ways to treat it. Often what works for one person may not work for another. In general, there are four main ways to treat depression, and most people do best when a combination of these are used.
1. Counseling and/or therapy.
2. Self-management techniques
3. Improve sleep
4. Medications
Great patient handout on "Major Depression" from familydoctor.org.
Variety of handouts (one, two, and three) on self-management.
Daily Mood Chart (or different format): good way to aid diagnosis and/or encourage patient self-management, for short-term or long-term.
Patient handout on Insomnia from familydoctor.org, has a great section on sleep hygiene, also another good patient handout on Sleep Hygeine Do's and Don't (1 page).
Several websites, such as MoodGYM, Blue Pages, and ODIN, have been shown in randomized trials to help improve depressive symptoms (SOR C).
For Providers:
PHQ-9 (English or Spanish): helpful scoring system for tracking "response" to depression treatments whether pharmacologic, therapeutic or (hopefully) both.
APA Depression treatment guidelines (2009) & AAFP article on Treatment-Resistent Depression (2012).
AAFP article on Postpartum Depression, includes Edinburgh Postnatal Depression Scale (EPDS).
AAFP article on Treatment of Child & Adolescent Depression. CBT +/- SSRIs (fluoxetine, sertraline, citalopram, then venlafaxine or escitalipram).
AAFP article on Seasonal Affective Disorder. includes light therapy appropriate specs.
PMDD (Pre-menstrual Dysphoric Disorder): AAFP article from 2011, Current Psychiatry article from 2012 (discusses herbal/OTC treatments as well), and an example of a PMDD daily mood chart handout (have the patient record daily mood for 2months or more).
AAFP article on Grief vs Depression at End of Life
Bipolar:
For Patients: pending
Daily Mood Chart (or different format): good way to aid diagnosis and/or encourage patient self-management, for short-term or long-term.
For Providers:
MDQ (Mood Disorder Questionnaire): a screening tool for Bipolar Disorder and/or other mood disorders. Note that this is very sensitive but not specific, so just because a patient screens "positive" does not mean they have Bipolar Disorder. The Ddx is broad and includes PTSD, Borderline Personality Disorder, Anxiety/Panic Disorders, Hyperthyroid, medication/substance-induced-mania.
PSS (PTSD Symptom Scale): a screening tool for Post Traumatic Stress Disorder, as this is very comorbid with and/or often difficult to distinguish from Bipolar Affective Disorder. A shorter (4-question) version is the PC-PTSD Screen, designed for use inprimary care and other medical settings and currently used to screen for PTSD in veterans at the VA.
AAFP article on "Bipolar Disorders: A Review" from 2012.
Anxiety:
For Patients:
Patient handout on GAD from familydoctor.org (includes a simple deep breathing exercise).
Patient handouts on Panic Disorder from familydoctor.org and NAMI.
Patient handouts on OCD from familydoctor.org and NAMI.
Patient handout on PTSD from familydoctor.org.
Patient handout on Social Phobia from familydoctor.org.
For Providers:
GAD-7: helpful screening/scoring tool to diagnosis and then follow a person with GAD (General Anxiety Disorder)
PC-PTSD (Primary Care PTSD, 4-question screen) or the longer PSS (PTSD Symptom Scale) or PCL-C which has Spanish, Chinese, and Bosnian versions: both are screening tools for Post Traumatic Stress Disorder. Short article about childhood sexual trauma and its effects on Adults.
Florida Obsessive Compulsive Inventory: screening tool for OCD, and Yale-Brown-Inventory (YBOCS): more detailed but quite helpful.
AAFP article "Generalized Anxiety Disorder" from 2009: includes table with DSMIV-TR criteria for GAD.
AAFP Article "Panic Disorder" from 2005: includes table with DSMIV-TR criteria for a panic attack
AAFP Article "Herbal and Dietary Supplements for treatment of Anxiety Disorders" from 2007
NEJM OCD article 2014, and AAFP Article "OCD: Dx and Management" from 2009.
AAFP Article "PTSD Identifying and Managing" from 2013
Dementia/Cognitive Evals:
For Patients: pending
For Providers:
MOCA (Montreal Cognitive Assesment): has been translated into many other languages as well. Can usually be administered in 30-45minutes; use these instructions for how to administer and score.
NEJM article about decision-making capacity (DMC). Although "capacity" and "competence" are often used interchangeable, "capacity" broadly refers to the ability to perform a specific tast, whereas "competance" refers to the legally defined standard for performing a specific task. "Competence" is legally determined," whereas "capcity" may be determined clinically. Every physician (not just psychiatrist) can determine capacity. That being said, capacity can only be determined moment by moment and is subject to change with the clinical picture. If someone is determined not to have DMC now it does not mean they may not have DMC later. In your notes you can say "At the time of evaluation, Mr J appears to lack ecision making capacity on the basis that he is unable to [here you state which of the 4 essential questions he was unable to answer, see NEJM article Table 1). He should be reevaluated as the clinical picture is subject to change."
Insomnia:
For Patients:
Patient handout on Insomnia from familydoctor.org, has a great section of sleep hygiene.
Patient handout on Sleep Hygeine Do's and Don't (1 page).
For Providers:
AAFP article on "Nonpharmacologic Management of Chronic Insomnia" from 2009. Includes great tables on ddx, secondary-causes, and sleep hygiene. Another AAFP article on "Treatment Options for Insomnia" from 2007 includes pharmacologic options as well. A mostly comprehensive Chart of pharmacotherapy options for primary insomnia (add to this Gabapentin and Chloral Hydrate); just because benzos are listed first doesn't mean they're at-all first line though!
Maternity/Perinatal (includes Breastfeeding):
For Patients:pending
For Providers:
AAFP article on Postpartum Depression, includes Edinburgh Postnatal Depression Scale (EPDS).
SSRI Use in Pregnancy Review Article, 2012 OB/Gyn Journal. Conclusion: "The overall benefit of treatment seems to outweigh the potential risks." Sertraline still the best. Avoid Paxil first trimester if possible.
Use of antidepressants in Nursing Mothers: 2008, ABM (Academy of BreastFeeding Medicine). Sertraline & Paxil best.
Smoking/Nicotine-dependence:
For Patients: The following can be copy/pasted or turned into a quicktext:
If you are interested in more information or resources related to quitting smoking, please feel free to visit the following websites or call 1-800-QUIT-NOW
1. http://www.smokefree.gov/ A website dedicated to helping you quit smoking. In addition to information and resources, you can sign up for free motivational text messaging (which has been shown to improve chances of successfully quitting) as well as learn about clinical trials that may be able to offset the cost of nicotine-replacement or medicines.
2. http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/you_can_quit/five_keys/ Five Ways to Quit Now
3. http://women.smokefree.gov/topic-pregnancy.aspx A website dedicated to help women quit smoking (but helpful for men too!)
4.CDC's list of other helpful websites: http://www.cdc.gov/tobacco/campaign/tips/quit-smoking/
For Providers:
Medications: Nicotine-Replacement and/or Psychpharm Table (coming soon)
List of chemicals found in cigarettes
Opioid-Abuse/Dependence:
For Patients: pending
For Providers:
ORT (Opioid Risk Tool): Score to be calculated prior to initiating opioids to determine a patient's potential risk for developing aberrant behaviors when prescribed opioids for chronic pain. Can be self-administered (patient version) or completed by the physician (physician version) as part of interview. If moderate risk, consider referring to pain management; if high-risk then strongely recommend referral.
Great educational modules about Adolescent Subtance Abuse Treatment (specifically for primary care setting!)
Alcohol Abuse/Dependence:
For Patients:
If patient is precontemplative: Informational handout and FastFacts sheet.
If patient is ready for a change, this referral list to local resources (includes AA, SMART Recovery, etc) can be printed out and the appropriate resources circled.
If patient is a relative or friend of someone with an alcohol use disorder, they should be referred to Al-Anon or AlaTeen, 513-947-3700. http://www.cincinnatiafg.org/.
The following can be copied/pasted into discharge instructions or a quicktext,in addition to the referral list:
At this time your use of alcohol is concerning and a major risk to your short-term as well as long-term health. If you are interested in help and support in decreasing your use in addition to discussing further with your doctor, please consider contacting one of the following community support agencies:
1. AA (Alcoholics Anonymous): 513-351-0422. http://www.aacincinnati.org/
2. SMART Recovery: 513-521-2391. http://www.smartrecovery.org/
For Providers:
Screening tools like CAGE (4-questions) or MAST (22-questions).
AAFP Article on "Outpatient Alcohol Withdrawal" from 2013
Illicit Drugs:
For Patients & Providers:
Screening tools to calculate a person's risk of having a substance-abuse problem in general include the DAST and CRAFFT tests.
Great up to date website ("Above The Influence") that provides information about street drugs including their various "street names" and effects.
Helpful Urine Drug Screen reference: when (if ever) to suspect false positives, how long substances can be detected in the urine, etc.
Substance Abuse Referral list: used in PES (Psychiatric Emergency Services)
Primary Care Approach to Substance Abuse AAFP 2013 article, helpful phrases/appraoch
Psychopharmacology:
SSRI Induced Sexual Dysfunction: great Current Psychiatry articel from 2013 with helpful tables
Benzodiazepines: Current Psychiatry article from 2012, includes dose equivalences and tapering recommendations.
QTC Prolongation and Psychiatric Medications explanatory paper: Includes lists of non-antipsychotics that are also implicated. Bottom line: get baseline and followup ECGs.
Miscellaneous:
Pediatric:
General: The Pediatric Psychiatry Network (PPN) offers a (new-ish) free service that provides primary care providers with free telephone consultation 24/7. Providers can call 1-877-PSY-OHIO or visit www.pedpsychiatry.org and a child psychiatrist will phone back within 30 minutes.
Autistic Spectrum Disorders, DD, etc: pending
M-CHAT (includes how to score)
Tourette's Disorder: AAFP article from 2011. Often comorbid w/ ADHD.
Eating Disorders:
Short article about Childhood Sexual Trauma
Adolescent Substance Abuse: Helpful modules for primary care setting specifically
Somatization Disorders: pending
Psychogenic NonEpileptic Seizures (PNES): AAFP article from 2005
Personality Disorders: pending
Anger/Impulsivity: pending
Psychosis: ddx includes substance-induced vs delirium vs MDD w/ psychotic features vs Bipolar, mania w/ psychotic features vs Bipolar, Depressed w/ psychotic features, vs shizophrenia vs schizoaffective vs secondary to GMC (General Medical Condition)
Helpful article in Schizophrenia in Primary Care, table 4 lists the metabolic s/e risk profile (lowest for Aripiprazole and Ziprasidone).
Sexual Addictions: brief AAFP article "Evaulating and Treating Sexual Addiction" includes table of helpful resources to refer patients