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All medical practitioners should be able to recognize stress-induced psychiatric illness and be prepared to do basic interventions. Psychiatric help is often not immediately available in austere situations.

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In austere medical situations, mental health professionals and psychiatric facilities will usually be inadequate or nonexistent. Psychiatric medications may be scarce or of limited variety. The first step for the nonpsychiatrist when working with patients with psychiatric disorders is to review Table 35-1. It describes the general approaches for common psychiatric presentations.

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Table 35-1 Common Psychiatric Presentations and Clinical Responses
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The most critical patients are those with new presentations of psychiatric disorders, including delirium. These symptoms represent serious disease states, often from a systemic disease or drug effect, that often respond to rapid treatment.

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In any setting, use Table 35-2 to screen patients for mental health problems. It can be helpful with both mentally healthy people who are responding to abnormal situations and individuals with preexisting mental health problems who are in abnormal situations. Note that if the patient has more than a "moderate symptom" rating for any of the first six items or exhibits any symptom in items 7 to 18, the presence of a mental disorder (psychiatric or organic) must be investigated.

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