Clinical Manual of Psychosomatic Medicine : A Guide to Consultation-Liaison Psychiatry

by Wise, Michael G.

• ISBN13: 9781585622016
• ISBN10: 158562201X
• Edition: 1st
• Format: Paperback
• Copyright: 2005-04-01
• Publisher: Amer Psychiatric Pub Inc

Summary

More concise, practical, and clinically oriented than other available texts, Clinical Manual of Psychosomatic Medicine: A Guide to Consultation-Liaison Psychiatryis designed to aid today's busy clinicians with bedside and office consultation. This manual presents the distilled wisdom of two highly experienced consultation-liaison psychiatrists and includes many illustrative figures and tables that offer quick, easy access to critical information about how to diagnose and treat psychiatric disorders in patients who have, or believe they have, other medical disorders. The authors of Clinical Manual of Psychosomatic Medicinebegin by summarizing how to do effective psychiatric consultation in a changing health care environment, citing key trends such as managed health care, reallocation of health care resources, medical care, and psychiatric consultation's shift from inpatient to outpatient settings, and to multidisciplinary teams. After discussing the mental status examination, the authors examine Epidemiology, clinical characteristics, differential diagnosis, and treatment and management of various syndromes and disorders-Delirium, dementia, depression, mania, anxiety, somatoform and related disorders, and substance-related disorders (alcohol, sedatives/hypnotics/anxiolytics, opiates/narcotics, amphetamines, and cocaine)-violence/aggression and suicidality. Pharmacological issues-Patients who are medically ill are usually taking one or more medications. Therefore, consultation-liaison psychiatrists must thoroughly understand drug actions, metabolism, and elimination; the cytochrome P450 system; and drug interactions, including the risks for pregnant and breast-feeding women. Other critical issues-Pain management, personality, ethical and legal, and geriatric psychiatry issues. Special consultation-liaison topics-Pregnant/postpartum, pediatric, burn, cancer, neurology and neurosurgery, HIV/AIDS, critically ill, and impotent patients, and organ transplant donors and recipients. The work of consultation-liaison psychiatrists has been proven to reduce mortality, morbidity, length of stay, and hospital costs in general hospital patients and medical-surgical outpatients. To accommodate the shift from inpatient to outpatient settings and to the evolving importance of psychiatric care delivered within specialty and primary care settings, this invaluable reference shows how consultation psychiatrists are the ideal clinicians to provide rapid, focused, and practical diagnostic assessments and treatment recommendations. Essentially an expanded fourth edition of the Concise Guide to Consultation Psychiatry, the eminently practical Clinical Manual of Psychosomatic Medicine: A Guide to Consultation-Liaison Psychiatrywill be welcomed by consultation-liaison and general psychiatrists, primary care physicians, consultation-liaison/psychosomatic fellows, psychiatry residents, and medical students. This manual is an outstanding resource for didactics and clinical rotations for those in training or reviewing for board examinations.

Author Biography

James R. Rundell is Professor of Psychiatry at the Uniformed Services University of the Health Sciences, Bethesda, Maryland; and Executive Director, TRICARE Europe. Michael G. Wise is Clinical Professor of Psychiatry at the University of California, Davis, and Adjunct Professor of Psychiatry at the Uniformed Services University of the Health Sciences, the F. Edward Hebert School of Medicine, Bethesda, Maryland.

Table of Contents

Preface	xi
1 Effective Psychiatric Consultation in a Changing Health Care Environment	1	(10)
History	1	(1)
Cost-Effectiveness of Psychiatric Consultation	2	(1)
Approach to the Consultation	3	(3)
Consultation or Liaison Psychiatry?	6	(1)
Outpatient Psychosomatic Medicine	6	(2)
References	8	(1)
Additional Readings	9	(2)
2 Mental Status Examination and Other Tests of Brain Function	11	(18)
Mental Status Examination	13	(4)
Screening Mental Status Examinations	17	(2)
Other Useful Tests of Cognitive Function	19	(2)
Tests of Executive Function	21	(1)
Neurological Examination	22	(1)
The Consultation Psychiatrist as Neuropsychiatrist	22	(4)
References	26	(1)
Additional Reading	27	(2)
3 Delirium	29	(20)
Epidemiology and Risk Factors	29	(1)
Clinical Characteristics	30	(4)
Differential Diagnosis	34	(6)
Treatment and Management	40	(4)
Course (Prognosis)	44	(1)
References	45	(2)
Additional Readings	47	(2)
4 Dementia	49	(18)
Epidemiology	49	(1)
Clinical Characteristics	50	(7)
Differential Diagnosis and Evaluation	57	(3)
Treatment and Management	60	(3)
References	63	(1)
Additional Readings	64	(3)
5 Depression	67	(22)
Epidemiology	67	(1)
Interrelations Between Depression and Other Medical Illnesses	67	(1)
Clinical Characteristics	68	(3)
Differential Diagnosis	71	(1)
Treatment and Management	72	(12)
References	84	(3)
Additional Readings	87	(2)
6 Mania	89	(14)
Clinical Characteristics	89	(2)
Treatment and Management	91	(8)
References	99	(2)
Additional Readings	101	(2)
7 Anxiety and Insomnia	103	(18)
Anxiety and Anxiety Disorders	103	(13)
Insomnia	116	(2)
References	118	(1)
Additional Readings	119	(2)
8 Somatoform and Related Disorders	121	(32)
Somatization	123	(3)
Somatization Disorder (Briquet's Syndrome)	126	(2)
Undifferentiated Somatoform Disorder	128	(2)
Hypochondriasis	130	(2)
Conversion Disorder	132	(3)
Body Dysmorphic Disorder	135	(1)
Pain Disorder	136	(2)
Somatoform Disorder Not Otherwise Specified	138	(1)
Psychological Factors Affecting Medical Condition	139	(1)
Factitious Disorders	139	(3)
Malingering	142	(1)
Differential Diagnosis	143	(3)
Additional Treatment and Management Considerations	146	(2)
References	148	(4)
Additional Readings	152	(1)
9 Substance-Related Disorders	153	(24)
DSM-IV-TR Substance-Related Disorders	154	(1)
Alcohol-Related Disorders	154	(9)
Sedative-, Hypnotic-, or Anxiolytic-Related Disorders	163	(3)
Opioid (Narcotic)-Related Disorders	166	(2)
Amphetamine-Related Disorders	168	(2)
Cocaine-Related Disorders	170	(3)
References	173	(2)
Additional Readings	175	(2)
10 Important Pharmacological Issues	177	(28)
Adherence to Pharmacological Treatment	178	(1)
Drug Actions	178	(8)
Drug Interactions	186	(3)
Neuroleptic Malignant Syndrome	189	(6)
Pregnancy	195	(3)
References	198	(5)
Additional Readings	203	(2)
11 Violence and Aggression	205	(8)
Emergency Consultation	205	(3)
Physiological Basis for Violence and Aggression	208	(1)
Differential Diagnosis of Violence and Aggression	208	(1)
Treatment and Prevention of Chronic Aggression	209	(3)
References	212	(1)
Additional Readings	212	(1)
12 Pain and Analgesics	213	(26)
Pain Terminology	215	(5)
Pain Behavior, Suffering, and Psychiatric Diagnoses	220	(3)
Measurement of Pain	223	(1)
Additional Aids to Diagnosis	224	(2)
Pharmacotherapy and Adjunctive Treatments for Pain	226	(8)
Treatment and Management of Chronic Pain	234	(1)
References	235	(3)
Additional Readings	238	(1)
13 Personality, Response to Illness, and Medical Psychotherapy	239	(14)
Personality and Response to Illness	239	(3)
Personality and General Medical Conditions	242	(1)
Personality Disorder	242	(6)
Medical Psychotherapy	248	(2)
References	250	(1)
Additional Readings	251	(2)
14 Medicolegal Issues in Consultation	253	(16)
Confidentiality	254	(2)
Competency Versus Capacity	256	(3)
Informed Consent and the Right to Refuse Medical Treatment	259	(3)
Guardianship	262	(1)
Involuntary Hospitalization	263	(1)
Restraints	264	(1)
Prescribing "Unapproved" Medications	265	(1)
References	266	(1)
Additional Readings	267	(2)
15 Suicidality	269	(12)
Epidemiology	269	(4)
Clinical Features and Risk Factors	273	(2)
Approach to the Patient	275	(1)
Treatment and Management	275	(3)
References	278	(1)
Additional Readings	279	(2)
16 Geriatric Psychiatry	281	(14)
Epidemiology	281	(1)
Psychiatric Disorders	281	(4)
Diagnostic Evaluation	285	(1)
Treatment and Management	286	(5)
Elder Abuse	291	(1)
Conclusion	292	(1)
References	292	(2)
Additional Readings	294	(1)
17 Special Psychosomatic Medicine Settings and Situations	295	(30)
Pregnancy and the Postpartum Period	295	(3)
Pediatric Psychosomatic Medicine	298	(3)
Burns	301	(3)
Cancer	304	(3)
Death and Dying	307	(1)
Neurology and Neurosurgery	308	(3)
HIV Disease and AIDS	311	(3)
Organ Transplantation	314	(2)
Critically III Patients and the ICU	316	(3)
Male Erectile Disorder (Impotence)	319	(2)
References	321	(3)
Additional Readings	324	(1)
Index	325