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Rheumatologists encounter psychiatric illness daily in their practice, yet formal training in rheumatology rarely provides instruction in the psychiatric conditions commonly faced. In this article, we review common clinical situations that involve psychiatric disease, their relationship to the rheumatologic condition, how they impact the clinical presentation and their management. We illustrate key principles in a case-based format and reflect on the management of the psychiatric components. Prefacing these discussions is a brief review of the epidemiology of psychiatric disease emphasizing the prevalence and importance of these issues in daily practice.