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This book presents case-based descriptions of models for the inclusive, multispecialty and multidisciplinary clinical care of complex cases. Cases range from primary care patients with complex systemic medical and psychiatric comorbidity, to those requiring specialty care, to those with potentially terminal illnesses. While each category and case has its unique requirements often necessitating different models of care, the commonalities in approaching complex clinical situations is underscored. Extended case narratives written by the treating physicians, summarizing both the course of clinical care and physicians´ reflections on the challenges of managing complex patients, comprise the bulk of the book. Five additional chapters on systems issues associated with care of complex patients, together with a chapter on end of life considerations, a narrative analysis of the physicians reflections about complex patients, and a concluding chapter are prominently included to anchor the case narratives. Written by experts in the field, these descriptions form unique models for assessing and treating complex cases.

Integrated Care for Complex Patients is a useful guide for all health practitioners and health administrators who are responsible for clinically complex cases, including physicians in primary care and psychiatry, physician assistants and nurse practitioners, and psychologists.

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Part I. Introductory Section.- 1. Historical perspectives.- 2. Description of the "outpatient" settings for the cases reported in this book.- 3. Assessment.- 4. Beyond Algorithms.- 5. Measurement of progress and outcome in complex medical situations.- Part II. Case Studies.- 6. Incremental decisions and models for care in complex pediatric cases.- 7. Incremental decisions and models for care in family medicine.- 8. Incremental decisions and models for care for paraphilia with medical complexity.- 9. Incremental decisions and models for care in neurodegenerative disease.- 10. Incremental decisions and models for care in complex neurological cases.- 11. Incremental decisions and models for care with neuromuscular illness.- 12. Incremental decisions and models for care with Medical- Psychiatric illness: the need for integration of care.- 13. Incremental decisions and models for care in complex geriatric cases.- 14. Incremental decisions and models for care for cases emphasizing pain and palliative care.- 15. Incremental decisions and models for care for substance use disorders.- 16. Incremental decisions and models for treating medically complex cases involving end of life care.- Part III. Summary and Conclusions.- 17. Summary of our observations and experience drawn from the case studies presented in this book.- 18. Conclusions and new ideas about care and care delivery for complex patients in outpatient settings, using our experience as represented in the case studies presented in this book.

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Steven A. Frankel, MD
Director, The Center for Collaborative Psychiatry, Psychology, and Medicine
Marin County, California

Associate Clinical Professor
University of California at San Francisco
School of Medicine
San Francisco, California

Faculty, San Francisco Psychoanalytic Institute
Psychiatric Consultant
Kentfield Rehabilitation and Specialty Hospital
Kentfield, CA

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