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Twenty Years!

Larry Culpepper, MD, MPH

Published: March 1, 2018

Twenty Years!

With this issue, The Primary Care Companion for CNS Disorders enters its 20th year of publication. Since its first issue in 1999, PCC has been steadfast in its mission to provide information relevant to clinical practice at the interface of primary care with psychiatry and neurology. This clinical realm has seen drastic changes over these 20 years, both in practice and in the conveyance of cutting-edge professional information.

In 1999, evidence and guidelines did not support screening for major depressive disorder. Many in primary care practice reported, in good faith, that they had never or rarely ever encountered a patient with bipolar disorder. Primary care physicians routinely were ineligible for payment for visits with a psychiatric diagnostic code. All selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors were branded, and the tricyclic antidepressants remained in common use. The goal of treatment was to obtain a response. Practice mainly centered on solitary doctor-patient relationships, and contact between primary care physicians and psychiatrists was unusual—the sharing of even the most limited of clinical information was often considered a breach of patient confidentiality reinforced by completely separate record systems. Yet, Dr J. Sloan Manning eloquently captured in his inaugural editorial how some primary care clinicians were recognizing that treatment of psychiatric disease in the primary care setting leads to marked patient improvement, although not without risks. Professionally, many of us in primary care practice were limited by a lack of knowledge of psychiatry and expertise in psychiatric diagnosis and in use of medications and nonpharmacologic therapies. The field was limited by a dearth of publications responsive to this need. Our publisher, Dr John Shelton, was visionary in recognizing this gap and launched The Primary Care Companion to The Journal of Clinical Psychiatry. Only 5 years later, in 2004, the need for this quality initiative was recognized by PCC’s acceptance by the US National Library of Medicine (NLM) for inclusion in PubMed Central. The expansion to include full indexing and abstracting by NLM in PubMed/MEDLINE in late 2016 further affirmed Dr Shelton’s vision.

Over the past 20 years, primary care psychiatry has come into its own. Its scope has greatly expanded—primary care clinicians now routinely attend not only to major depressive disorder and anxiety but also to bipolar disorder, attention-deficit/hyperactivity disorder, posttraumatic stress disorder and other trauma-related disorders, eating disorders, addiction care, and even the long-term care of those with schizophrenia. This expansion has been made possible by the restructuring of clinical care from the solitary physician-patient visit to one that is team-based involving primary care advanced practice nurses, physician assistants, psychiatric social workers, psychologists, and clinical pharmacists and case managers. Patient visits have been augmented by continued contact using electronic modalities. The chasm between primary care physicians and psychiatrists is being replaced by collaborative engagement that responds to individual patient complexities and provides a rich vehicle for the bidirectional education of the primary care team and psychiatrist. The goal of treatment has evolved to include obtaining remission of symptoms and improving functioning.

The content and potential for benefit of primary care psychiatry also has expanded. The conceptual mind-body framework that historically separated psychiatry from the rest of medicine is being replaced by the realization that the brain does not recognize or abide by this split. We have advanced from recognizing that primary care clinicians can effectively treat psychiatric disease to understanding that an integrated approach of treating psychiatric and medical disease can improve the outcomes of both. To date, guidance regarding such integration has primarily focused on reducing the potential for deleterious treatment effects by psychiatric or medically oriented interventions on other conditions. However, advances in our understanding of the central nervous system provide opportunity for greater treatment synergy using a whole-person orientation. Exploration of the biological mechanisms by which alterations in the brain at the synaptic, network, and system levels lead to psychiatric symptoms as well as cardiac, endocrine, immunologic, and other vulnerabilities will most likely lead to treatments that simultaneously target an extended range of pathologies. The move by the National Institute of Mental Health to emphasize research domains rather than only symptom-based diagnostic criteria reflects this potential, as does the increasing interaction and overlap of psychiatry and neurology. At the clinical level, those of us in primary care will continue to expand our knowledge and skill so that our patients benefit. Currently, we often consider integrated treatment of psychiatric and medical disease of particular value for “treatment-resistant” patients. In the future, we may optimize initial treatment by seeking a much broader understanding of patient vulnerabilities at the early stages of their pathologies. In the future, we may seek to not only obtain full recovery but also strive to prevent the onset of first or new episodes of illness and improve the course of comorbid medical conditions as well.

In 2011, we modified the title of PCC to The Primary Care Companion for CNS Disorders in recognition of the importance of neurology and the brain sciences and their potential to benefit patients through clinical primary care practice. Changes in the organization, financing, and consequent practice of medicine from emphasizing the processes of care delivery to focusing on outcomes and improved health status of patients provide the impetus for a true integration of psychiatric and primary care practice. Physicians Postgraduate Press, Inc., and PCC will continue to provide the premier vehicle to educate medical and behavioral health professionals involved in primary care and to report new knowledge and clinical insights of relevance to them.

Our platform to provide clinicians with up-to-date information has expanded over the past 20 years, as exploration of the Physicians Postgraduate Press, Inc., website demonstrates. In addition to its 2 publications and their weekly updates, the website includes the CME Institute, Neurology Knowledge (a compendium of neurology resources), Strong Veterans (resources for those caring for veterans), curated content collections, blogs, and our publisher’s podcasts. Our PCC readership benefits from features including Rounds in the General Hospital, Psychotherapy Casebook, and Rounds From Banner Alzheimer’s Institute, which bring perspective from the inpatient setting, daily practice, and a neurologic consulting service thanks to the long-term support and wisdom of Dr Theodore A. Stern, Dr Dean Schuyler, and the staff at the Banner Alzheimer’s Institute. We also are indebted to the many contributions by authors and our reviewers, who bring their insights and judgment to you from all corners of the globe. PCC is supported by an incredible professional staff—Sallie Gatlin, our managing editor, attends to the journal with finesse and tremendous professionalism.

At the start of this milestone year, I reflect on the great potential PCC provides for improving the lives of our patients and thank all who contribute in the myriad ways.

Larry Culpepper, MD, MPH

Editor in Chief

Reviewers for The Primary Care Companion
for CNS Disorders

January 1, 2017-December 31, 2017

Kolawole Adediran

Lawrence W. Adler

Cengiz Akkaya

Joseph Alcorn

Kursat Altinbas

Paul J. Ambrosini

Donna Ames

Rohul Amin

Ion Anghelescu

Godspower E. Asekomeh

Ajay Kumar Bakhla

Richard Balon

Paula Banca

David A. Baron

Salah Basheer

Menachem Ben-Ezra

Saurabh Bhardwaj

William Bograkos

Maria Böttche

Laurent Boyer

Carrie Brown

Joseph Buxbaum

William Byne

Alba Calderone

Daniel M. Campagne

Ana Maria Candil Cano

Subhajit Chakravorty

Lakshminarayana Chekuri

Peijun Chen

Henry Chung

Gabriele Cipriani

Justin Coffey

Dan Cohen

Michelle D. Colvard

George Dawson

Vishal Dhiman

David Diaz

Tyler J. Dodds

Rémy Dumas

Ken Dunham

Norma Dunn

Rodney Eiger

Arthur Elstein

Tetsuro Enomoto

Jennifer M. Erickson

Xiaoduo Fan

Mohammad Farooque

Emily Fawcett

Alexandra Flynn

Katlein Franca

Sinem Ezgi Gülmez

Maximilian Gahr

João Gama Marques

David S. Geldmacher

Kiki Gorbatenko-Roth

Carolyn Green

Sandeep Grover

Nitin Gupta

Souheil Hallit

Rokuro Hama

Andrea S. Hartmann

Ana Hategan

Uwe Herwig

Donald M. Hilty

Eugene Ikhimiukor

Takashi Inoue

Ana-Maria Iosif

Dan Iosifescu

Gaurav Jain

Arash Javanbakht

Jonathan A. Javitch

Priyanga Jayakumar

R. C. Jiloha

Georg Juckel

Manisha Kamat

David A. Katerndahl

Charles Kellner

Kevin Kerber

Khurshid A. Khurshid

Ashok Kumar Jainer

Katie Lomax

Yassir Mahgoub

Vladimir Maletic

Lesley Manson

Sarah M. Markowitz

Josephine Mauskopf

Muhammed Mehtar

İpek Midi

Fatemeh Sadat Mirfazeli

Karen Moeller

Sahil Munjal

Louis Najarian

Subrata Naskar

Jennifer Nelson

Andres Neuhaus

Humberto Nicolini

Patrick O’ Malley

Mark A. Oldham

Ajay Parsaik

Maedeh Parvizi

Raymond Pary

Benjamin Perry

Zaheer Qureshi

Gunjan Raghuvanshi

Smitha Ramadas

Soham Rej

Sachin Relia

Patricia J. Robinson

Robert Roca

Robert Rosenheck

Katherine Sanchez

Simrat Sarai

Alan F. Schatzberg

Arjan Schröder

Daniel J. Serrani Azcurra

Bilal Shah

Vijay Shivaswamy

Sanjeev Sockalingam

Susan Solimine

Kenji Sumiya

Yutaro Suzuki

Abhishek Thandra

Melissa Thomas

Lucia Tomas-Aragones

Tara Pundiak Toohey

Akihito Uezato

Kayihan Uluc

Selene Veerman

Sumer Verma

Stephen Warnick

Glen L. Xiong

Carlos Zarate

Published online: March 1, 2018.

Prim Care Companion CNS Disord 2018;20(1):18ed02285

To cite: Culpepper L. Twenty years! Prim Care Companion CNS Disord. 2018;20(1):18ed02285.

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Volume: 20

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