Update in psychiatry.

I 1978, Regier (1) coined the term “de facto mental health services system” after finding that most patients with mental illness are treated in the general medical sector, not in psychiatric settings. Despite this, many patients with mental disorders treated in the medical sector do not have a diagnosis; they go untreated or are treated for a “medical” problem instead of their mental disorder. This first Update in Psychiatry reviews the pertinent psychiatric literature published in 1998. We polled journal editors from leading psychiatric and general medical journals and leaders in consultation liaison psychiatry to develop a list of important publications. We did not include substance abuse because the relevant literature is so extensive that this topic warrants a separate discussion. Our goal is to expand on and in some cases introduce information about psychiatry that may not be readily available to the general clinical internist.