Literature Collection

Psychiatric conditions are prevalent among adults with intellectual and developmental disabilities (IDDs), with studies estimating that 33% of this population experiences psychiatric disorders such as mood, anxiety, and behavioral issues. These rates are significantly higher than the general population, underscoring the need for proper management within primary care settings. Although the integration of mental health services into primary care is increasing, general practitioners often report a lack of training and time to treat psychiatric conditions in adults with IDDs. Collaborative care models, involving partnerships between primary care providers and mental health specialists, have emerged as a promising solution, offering tailored, patient-centered treatment. Barriers like diagnostic overshadowing, communication challenges, and stigmatization hinder access to appropriate care, however. In recent years, the inclusion of genetic testing in psychiatric care has gained traction, especially in managing IDDs associated with specific genetic conditions like fragile X syndrome and DiGeorge syndrome. Genetic testing can help identify the underlying causes of psychiatric symptoms, offering valuable insights into appropriate treatment pathways. Pharmacogenetic insights provided by genetic testing can guide more personalized medication management, reducing adverse effects and improving outcomes. Effective management of psychiatric conditions in adults with IDDs requires further research, particularly randomized controlled trials, to establish evidence-based treatment approaches. Expanding research on interventions, including psychotherapy, pharmacotherapy, and genetic testing, is essential to improve patient outcomes in this underserved population.

BACKGROUND: Psychiatric problems have been a growing and significant public health challenge. Community-based psychiatric services have been shown to contribute to the improvement of health and social-related outcomes, but with limited specialists in this field. Consequently, Thailand has integrated these services into the primary care system delivered by community nurses working in primary care units (PCUs). AIM: To describe the experiences of psychiatric patients in receiving services provided by non-specialist community nurses. METHOD: A phenomenological approach was used. Eleven psychiatric patients with 10 major depressive disorders and 1 with schizophrenia were interviewed. The results were evaluated using thematic content analysis. RESULTS: The results revealed two main themes as barriers and facilitators experienced in receiving services from community nurses. CONCLUSION: Community-based services should be concerned about developing psychiatric nursing competency for community nurses to extend basic services to patients in communities and to assist family members.

Access to outpatient psychiatric care is often delayed, with many patients unable to obtain timely specialty evaluation. Integrated care models such as Collaborative Care Management (CoCM) and co-located care improve outcomes but have not been widely adopted due to resource and structural barriers. Direct outpatient psychiatric consultation may offer a feasible alternative, yet its effectiveness remains understudied.We conducted a retrospective review of the Psychiatry Consultation Clinic (PCC) at a large academic medical center. The PCC provides diagnostic clarification and treatment recommendations to primary care providers (PCPs) rather than longitudinal psychiatric care. Adult patients (≥18 years) referred between October 2019 and October 2022 from family and internal medicine practices were included (N = 545). Primary outcomes were: (1) time to implementation of consult recommendations; (2) rate of psychotropic medication implementation; and (3) changes in anxiety (Gretrospective review of the Psychiatry Consultation AD-7) and depression (PHQ-9) scores. Secondary outcomes included psychiatric diagnoses and subsequent referrals for specialty care.The median time from referral to consultation was 5 weeks, substantially shorter than the average 6-month wait for traditional psychiatry appointments within the same system. Most patients (88.1%) were seen once, and 83.1% of visits were conducted via telemedicine. Pharmacotherapy was recommended for 81.8% of patients, and 81.4% had at least one recommendation implemented, typically within 1-3 weeks. Antidepressants accounted for two-thirds of recommendations. For patients with pre- and post-consultation data, mean GAD-7 and PHQ-9 scores decreased significantly (-2.9 and -5.0 points, respectively; both p < 0.0001), with clinically meaningful improvements observed in depression symptoms. Nearly one-quarter of patients were referred for longitudinal specialty psychiatric care, with 70% establishing follow-up within six months.The direct consultation model was feasible, resulted in high uptake of recommendations by PCPs, and was associated with improvements in patient symptoms, particularly depression. Compared with integrated models, this approach may be easier to implement in primary care settings with limited behavioral health infrastructure. Prospective controlled studies are warranted to establish the efficacy of this outpatient consultation model and compare it to other paradigms within the continuum of psychiatric care.