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clinician toward focused questioning, appropriate baseline medical workup or timely referral.
Algorithm Diagram: MERON Decision Pathway
The MERON framework can be summarized as a simple algorithm suitable for figure format:
Output: Structured differential diagnosis and decision about treatment in primary care versus referral to psychiatry.
This algorithm translates the framework into a visual decision pathway that aligns with how primary care physicians typically think through clinical problems.
Why This Matters for Primary Care
Primary care remains the front line of mental health detection and early intervention. As expectations grow for primary care clinicians to diagnose and manage common psychiatric conditions, they must do so under significant time pressure and with many competing demands. A concise, structured framework like MERON, paired with a brief screener such as the 7SDS, can help reduce several common diagnostic errors: missing early psychotic symptoms, misclassifying bipolar disorder as unipolar depression, overlooking medical contributors, and fragmenting assessment across multiple unrelated tools. By organizing symptoms into a coherent, hierarchical structure, MERON offers a practical cognitive aid that complements existing guidelines and screening instruments.
References
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
2. Hirschfeld RMA. Bipolar disorder: Clinical presentation and diagnostic dilemmas in primary care. J Clin Psychiatry. 2001; 62( Suppl 14): 11 – 16.
3. Mitchell AJ, Coyne JC. Do ultra-short screening instruments accurately detect depression in primary care? A pooled analysis and meta-analysis. Br J Psychiatry. 2007; 190:119 – 126.
Dr. Gupta is a psychiatrist who has practiced in Louisville, Kentucky, for more than three decades. He completed psychiatric residency and fellowship training at the University of Rochester School of Medicine and served as Assistant Professor of Psychiatry and Family Medicine at LSU School of Medicine. Dr. Gupta has held academic appointments including Clinical Professor roles at Sullivan University College of Pharmacy and still fulfills a Clinical Professor role at University of Pikeville School of Osteopathic Medicine. His research interests include mood disorders, schizophrenia, neurobiology of depression and innovative approaches to mental health treatment.
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President’ s Celebration to celebrate an incredible year under the leadership of President Thomas Higgins, MD, MBA and welcome incoming President Aneeta Bhatia, MD, MBA Sunday, May 17, 2026
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