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      A unity of opposites: A prototypical case for the importance of primary-care providers in addressing mental health issues

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          Primary-care providers are most often the first point of contact for patients presenting with mental illness. Highly stigmatized and with a litany of other medical issues requiring redress by providers, it may receive inadequate attention, despite its unintuitive consequences. Therefore, the purpose of this case is to demonstrate the potential catastrophic consequences of untreated mental illness by providers. As a result of a serious suicide attempt by a patient afflicted with bipolar disorder, this patient presented with significant blood loss secondary to multiple self-inflicted lacerations to the wrist, parasternal stab wounds, and a resultant hemopneumothorax. By juxtaposing this patient's mental illness with his other traditionally “more” concerning medical history (i.e., multiple myeloma, Factor V Leiden, and recurrent DVTs), we are forced to reexamine where mental illness resides in the hierarchy of treatment.

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          Most cited references 6

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          Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication.

          An understudied crucial step in the help-seeking process is making prompt initial contact with a treatment provider after first onset of a mental disorder. To provide data on patterns and predictors of failure and delay in making initial treatment contact after first onset of a mental disorder in the United States from the recently completed National Comorbidity Survey Replication. Nationally representative face-to-face household survey carried out between February 2001 and April 2003. A total of 9282 respondents aged 18 years and older. Lifetime DSM-IV disorders were assessed with the World Mental Health (WMH) Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (WMH-CIDI), a fully structured interview designed to be administered by trained lay interviewers. Information about age of first professional treatment contact for each lifetime DSM-IV/WMH-CIDI disorder assessed in the survey was collected and compared with age at onset of the disorder to study typical duration of delay. Cumulative lifetime probability curves show that the vast majority of people with lifetime disorders eventually make treatment contact, although more so for mood (88.1%-94.2%) disorders than for anxiety (27.3%-95.3%), impulse control (33.9%-51.8%), or substance (52.7%-76.9%) disorders. Delay among those who eventually make treatment contact ranges from 6 to 8 years for mood disorders and 9 to 23 years for anxiety disorders. Failure to make initial treatment contact and delay among those who eventually make treatment contact are both associated with early age of onset, being in an older cohort, and a number of socio-demographic characteristics (male, married, poorly educated, racial/ethnic minority). Failure to make prompt initial treatment contact is a pervasive aspect of unmet need for mental health care in the United States. Interventions to speed initial treatment contact are likely to reduce the burdens and hazards of untreated mental disorder.
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            Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis.

            Despite the potential importance of understanding excess mortality among people with mental disorders, no comprehensive meta-analyses have been conducted quantifying mortality across mental disorders.
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              Delays in treatment for mental disorders and health insurance coverage.

               G McLaughlin (2004)

                Author and article information

                J Family Med Prim Care
                J Family Med Prim Care
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                August 2020
                25 August 2020
                : 9
                : 8
                : 4412-4414
                [1 ] Department of Psychiatry, Cape Fear Valley Medical Center, Fayetteville, United States
                [2 ] Associate Program Director for the Cape Fear Valley Psychiatric Residency Program with Campbell University, Fayetteville, United States
                [3 ] Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC, United States
                [4 ] Department of Research, Campbell University School of Osteopathic Medicine, Lillington, NC, University of Mary Washington, Fredericksburg, VA, United States
                [5 ] University of California Santa Barbara, Santa Barbara, CA United States
                Author notes
                Address for correspondence: Dr. Kevin M. Lamm, 711 Executive Place, Fayetteville, NC 28305, USA. E-mail: klamm@
                Copyright: © 2020 Journal of Family Medicine and Primary Care

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

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