title: Approach to risk identification in undifferentiated mental disorders.
abstract: OBJECTIVE
  To provide primary care physicians with a novel approach to risk identification and related clinical decision making in the management of undifferentiated mental disorders.
  
  
  METHODS
  We conducted a review of the literature in PubMed, CINAHL, PsycINFO, and Google Scholar using the search terms diagnostic uncertainty, diagnosis, risk identification, risk assessment/methods, risk, risk factors, risk management/methods, cognitive biases and psychiatry, decision making, mental disorders/diagnosis, clinical competence, evidence-based medicine, interviews as topic, psychiatry/education, psychiatry/methods, documentation/methods, forensic psychiatry/education, forensic psychiatry/methods, mental disorders/classification, mental disorders/psychology, violence/prevention and control, and violence/psychology.
  
  
  RESULTS
  Mental disorders are a large component of practice in primary care and often present in an undifferentiated manner, remaining so for prolonged periods. The challenging search for a diagnosis can divert attention from risk identification, as diagnosis is commonly presumed to be necessary before treatment can begin. This might inadvertently contribute to preventable adverse events. Focusing on salient aspects of the patient presentation related to risk should be prioritized. This article presents a novel approach to organizing patient information to assist risk identification and decision making in the management of patients with undifferentiated mental disorders.
  
  
  CONCLUSIONS
  A structured approach can help physicians to manage the clinical uncertainty common to risk identification in patients with mental disorders and cope with the common anxiety and cognitive biases that affect priorities in risk-related decision making. By focusing on risk, functional impairments, and related symptoms using a novel framework, physicians can meet their patients' immediate needs while continuing the search for diagnostic clarity and long-term treatment.
authors.affiliation: Associate Professor in the Department of Psychiatry at the University of Toronto in Ontario, Psychiatrist-in-Chief at St Joseph's Health Centre, and Co-chair of the Ontario College of Family Physicians Collaborative Mental Health Network. JSilveira@stjoestoronto.ca.
authors.forename: José
authors.initials: J
authors.lastname: Silveira
authors.affiliation: Associate Professor in the Department of Family and Community Medicine, cross-appointed to the Department of Psychiatry, at the University of Toronto, Senior Director of Education and Clinical Services at the Centre for Mindfulness Studies, and Founder of the Collaborative Mental Health Care Network.
authors.forename: Patricia
authors.initials: P
authors.lastname: Rockman
authors.affiliation: Doctoral candidate in clinical psychology at the University of Ottawa in Ontario.
authors.forename: Casey
authors.initials: C
authors.lastname: Fulford
authors.affiliation: Associate Professor in the Division of Consultation-Liaison Psychiatry at the University of Toronto and a founding member of the Collaborative Mental Health Care Network.
authors.forename: Jon
authors.initials: J
authors.lastname: Hunter
mesh_terms: D003657:Decision Making; D019468:Disease Management; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors