Primary care commentary: fatigue and executive dysfunction in the primary care setting.

ost primary care physicians understand the importance of recognizing overt psychiatric symptoms among their patients. It is also important for these M physicians to understand that symptoms of an underlying psychiatric disorder may be subtle, such as fatigue, or hard to identify, such as the myriad symptoms that imply executive dysfunction. Not only should the primary care physician learn to identify these symptoms, but he or she must also learn to diagnose and treat the condition that causes them. Fatigue can be easy to spot, such as in the patient who comes in complaining of constant tiredness, but it can be challenging to differentiate fatigue from sleepiness. Whereas sleepiness is the consequence of not enough quality sleep, fatigue can be the result of both physical conditions, such as hypothyroidism, and mental disorders, such as depression, as well as a side effect of medication. Once fatigue is discerned and its root is identified, treatment can begin. Executive dysfunction may be more difficult to recognize than fatigue. It has no standard medical definition and is better regarded as a concept than an easy-to-spot symptom. As a concept, it may be unfamiliar and its outward effects puzzling to primary care clinicians since it exhibits itself as a collection of symptoms, such as fatigue, forgetfulness, apathy, a constant bad mood, and inability to communicate clearly. Again, as with fatigue, executive dysfunction is usually a signal that something else is wrong with the patient, whether it be a mood disorder, somatic condition, or a side effect of a medication. It is up to the physician to make the differential diagnosis and outline the appropriate treatment plan. Because so many people with psychiatric conditions, especially mood disorders, present to their primary care physician first, the diagnosis and treatment of these disorders has come to represent a basic standard of care in the primary care setting. Learning to identify fatigue and executive dysfunction and determine their psychiatric or somatic causes will aid the primary care physician as he or she strives to provide patients with the best possible care. This supplement will aid the primary care physician in achieving that goal.