Psychiatry refers to the prevention and treatment of mental disorders and associated emotional,

behavioral, and stress-related problems. In general internal medicine practice, management of

risk factors for mental disorders and early diagnosis and intervention for established disease

(primary and secondary prevention) are important elements. The general internist should have a

wide range of competency in psychiatric disease, particularly as it is encountered in outpatient

settings and should be able to diagnose symptoms and use pharmacotherapy, behavioral

modification, and counseling to provide primary and secondary preventive care and initially

manage many mental disorders.

Patients hospitalized for general medical problems and those in the intensive care unit may have

significant psychiatric comorbidity that contributes to general medical morbidity and length of

stay. In these and all other settings, the general internist must be able to evaluate and manage

psychiatric comorbidity effectively with appropriate specialty consultation.

The range of competencies expected of a general internist will depend on the availability of

psychiatrists in the primary practice setting. In some communities, the general internist may be

responsible for both initial and maintenance psychopharmacologic management of many mental

disorders. Refractory cases and patients with mental disorders requiring psychotherapeutic

interventions will generally be referred to a mental health professional, as will patients who are

suicidal, psychotic, or dangerous and those in need of psychiatric hospitalization.

Mental State Exam) when indicated