Human Behavior and Mental Health
This document has been endorsed by the American Academy of Family Physicians and the American Psychiatric Association and was developed in cooperation with the American Psychological Association, the Association of Departments of Family Medicine, the Association of Family Practice Residency Directors and the Society of Teachers of Family Medicine.
Preamble
Family physicians have incorporated knowledge of human behavior, mental health, and mental disorders into their every day practice of medicine. This document represents the opinions of the American Academy of Family Physicians (AAFP) regarding appropriate suggestions for curricula in human behavior and mental health for family practice residents.
It is suggested that in all sections of the core educational guidelines the relationship between the patient and his or her family be considered basic to an understanding of the subject. A similar goal, which transcends the specific categories of the guidelines, is that the family practice resident should have sensitivity to, and knowledge of, the emotional aspects of organic illness.
Family physicians must be able to recognize interrelationships among biologic, psychologic and social factors in all patients. It is important that the ethical dimensions of patient care be considered among these interrelationships. Learning is facilitated if attention is paid to these principles as a continuum throughout the family practice training program.
It is suggested that in all sections of the core educational guidelines the relationship between the patient and his or her family be considered basic to an understanding of the subject. A similar goal, which transcends the specific categories of the guidelines, is that the family practice resident should have sensitivity to, and knowledge of, the emotional aspects of organic illness.
Family physicians must be able to recognize interrelationships among biologic, psychologic and social factors in all patients. It is important that the ethical dimensions of patient care be considered among these interrelationships. Learning is facilitated if attention is paid to these principles as a continuum throughout the family practice training program.
Knowledge
- Basic knowledge
- Normal and abnormal psychosocial growth and development across the life cycle, and variants
- Recognition of interrelationships among biologic, psychologic and social factors in all patients
- Reciprocal effects of acute and chronic illnesses on patients and their families
- Factors that influence adherence to a treatment plan
- Family functions and common interactional patterns in coping with stress
- Awareness of one's own attitudes and values, which influence effectiveness and satisfaction as a physician
- Stressors on physicians and approaches to effective coping
- Ethical issues in medical practice, including informed consent, patient autonomy, confidentiality and issues quality of life
- Mental health disorders
- Disorders principally diagnosed in infancy, childhood or adolescence
- Mental retardation
- Learning disorders
- Motor skills disorders
- Communication disorders
- Pervasive developmental disorders
- Attention deficit and disruptive behavior disorders
- Feeding and eating disorders of infancy or early childhood
- Tic disorders
- Elimination disorders
- Other disorders of infancy, childhood or adolescence
- Delirium, dementia, amnestic and other cognitive disorders
- Substance-related disorders
- Alcohol
- Amphetamines
- Caffeine
- Cannabis
- Cocaine
- Hallucinogens
- Inhalants
- Nicotine
- Opioids
- Phencyclidine
- Sedative-, hypnotic- or anxiolytic-related disorders
- Polysubstance-related disorder
- Schizophrenia and other psychotic disorders
- Paranoid
- Disorganized
- Catatonic
- Undifferentiated
- Residual
- Mood disorders
- Major depressive disorder
- Dysthymic
- Bipolar disorders, including hypomanic, manic, mixed and depressed
- Anxiety disorder
- Panic attack
- Phobias
- Obsessive/compulsive disorder
- Post-traumatic stress disorder
- Acute stress disorder
- Generalized anxiety disorder
- Somatoform disorders
- Somatization
- Conversion
- Pain
- Hypochondriasis
- Factitious disorders
- Dissociative Disorders
- Sexual and gender identity disorders
- Sexual desire disorder
- Sexual aversion disorder
- Orgasmic disorders
- Sexual pain disorders
- Sexual dysfunction related to a general medical condition
- Paraphillias
- Gender identity disorder
- Eating disorders
- Anorexia nervosa
- Bulimia nervosa
- Sleep disorders
- Insomnia
- Hypersomnia
- Narcolepsy
- Breathing-related sleep disorder
- Circadian-rhythm sleep disorders
- Parasomnias
- Impulse control disorders
- Adjustment disorders
- Depressed mood
- Anxiety
- Mixed anxiety and depressed mood
- Disturbance of conduct
- Personality disorders
- Paranoid
- Schizoid
- Schizotypal
- Antisocial
- Borderline
- Histrionic
- Narcissistic
- Avoidant
- Dependent
- Obsessive-compulsive
- Problems related to abuse or neglect
- Additional conditions
- Noncompliance
- Malingering
- Borderline intellectual functioning
- Age-related cognitive decline
- Bereavement
- Academic problem
- Occupational problem
- Identity problem
- Religious or spiritual problem
- Acculturation problem
- Phase-of-life problem
- Disorders principally diagnosed in infancy, childhood or adolescence
Skills
- Evaluation skills
- Interviewing skills, which enhance data collection in short periods of time and optimize doctor/patient relationship
- Techniques to elicit the context of the visit (BATHE, e.g., including Background, Affect, Trouble, Handling and Empathy, or other techniques)
- Performance of mental status examination
- Indications for special procedures in psychiatric disorder diagnosis, including psychologic testing, laboratory testing and brain-imaging testing
- Capability to elicit and recognize the common signs and symptoms of the disorders under Knowledge
- Assessment of depression (Beck, Zung, Hamilton Scales, SIG-E-CAPS mnemonic, e.g., Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor and Suicidal ideation)
- Indications for psychiatric consultation
- Therapeutic skills
- Management of emotional aspects of nonpsychiatric disorders
- Skills in enhancing compliance with medical treatment regimens
- Initial management of psychiatric emergencies: the suicidal patient, the acutely psychotic patient
- Proper use of psychopharmacologic agents
- Diagnostic indications and contraindications
- Dosage, length of use, monitoring of response, side effects and compliance
- Drug interactions
- Associated medical problems
- Family support therapy
- Behavioral modification techniques
- Stress management
- Breathing
- Muscle relaxation
- Imagery
- Cognitive restructuring
- Smoking cessation, obesity management and other lifestyle changes
- Chronic pain management
- Stress management
- Utilization of community resources
- Community resources
- Patient care team of other mental health professionals
- Crisis-counseling skills
- Modification of patient environment
- Ability to vary treatment based on the patient's personality, lifestyle and family setting
- Identification of, intervention in and therapy for drug and alcohol dependency and abuse
- Appropriate care of health disorders listed under Psychopathology
- Appropriate referral procedures to ensure continuity of care and optimal information sharing, and to enhance patient compliance
- Indications
- Process
- Follow-up
Implementation
Training in human behavior and mental health should be accomplished primarily in the outpatient setting through a combination of longitudinal experiences, supervised experiences and didactic teaching. This combination should include experience in diagnostic assessment, psychotherapeutic techniques and psychopharmacologic management. Such learning tools as Balint Groups, videotape review, direct observation and role playing are useful and recommended. Collaboration with multiple mental health professionals including psychiatrists, psychologists and others working as a team is often essential.
Resources
- Goldman LS, Wise TN & Brody DS (Eds) Psychiatry for Primary Care Physicians Chicago: American Medical Association, 1998
- Diagnostic and statistical manual of mental disorders, fourth edition: primary care version/ in collaboration with representatives of American Academy of Family Physicians. 1st ed. Washington, DC: American Psychiatric Association, c1995.
- Primary Care Clinics in Office Practice: Mental Health, Stuart, MR and Liberman JA III (Eds) 26 32 6/1999
- Stuart MR and Liberman JA III, The Fifteen-Minute Hour: Applied Psychology for the Primary Physician, 2nd Ed. Westport, CT Praeger, 1993
Web Sites
- American Psychiatric Association: http://www.psych.org
- American Psychological Association: http://www.apa.org
- he@lth; Mental Health Touches (Everyone): http://www.athealth.com
- Center for Advancement of Health: http://www.cfah.org/home.cfm
- Psychwatch.Com; The; Online Resource for Professionals in Psychology and Psychiatry: http://www.psychwatch.com
Published 9/86
Revised and Retitled 7/94
Revised 06/00
Revised and Retitled 7/94
Revised 06/00
