Liaison psychiatry

Identification & treatment of psychiatric morbidity in medically ill patients

Medical illnesses causing psychiatric symptoms
Endocrine
Hyperthyroidism: anxiety, paranoid psychosis Hypothyroidism: depression, dementia, psychosis Cushing’s syndrome: depression, psychosis Phaeochromocytoma: anxiety

Metabolic
Hypoglycaemia: anxiety, confusional state Vitamin deficiency: depression, dementia

Neoplastic
Pancreas & lung: depression Brain: personality change, psychosis

Infections
HIV: anxiety, depression, delirium, dementia Viral infections: depression

Nervous system
Parkinson's disease: depression, dementia Multiple sclerosis: anxiety, euphoria, depression

Drug induced psychological problems
Depression
• • • • • • Antihypertensives Anticancer Anti diabetics Hormones Analgesics H1 receptor antagonists

Anxiety
• • • • • • •
• • • •

Delirium

• Anticholinergics • Digoxin • Cimetidine

Psychosis

Amphetamines Sympathomimetics Caffeine Organophosphates Sulphonamides Penicillin Mercury & arsenic
Hallucinogens, Appetite suppressants Corticosteroids Anticholinergics

Psychiatric disorders presenting with physical symptoms
Somatisation disorder:

Somatoform pain disorder:
• • • Continuous, dull, diffuse, Aggravated by stress, Relieved with tranquilisers

• Multiple somatic complaints • Seek immediate relief
Hypochondriasis:

• Preoccupation with bodily illhealth • Seek investigations & reassurances
Dysmorphophobia:

Anxiety disorder: • Fear of heart attack
• • • Autonomic dysfunction Multiple somatic symptoms Biological symptoms of depression

Masked depression

• Preoccupation with body disfigurement • Medical shopping
Dissociative disorder:

• Physical symptoms without organic pathology • Stress related

Management
(Principles)
Consider
Illness
• • • • • • • • • • Threat to life Duration Disability Side effects Uncertainty of outcome Anxiety Denial Depression Non compliance Social circumstances

Recognise psychiatric disorder
• • • • • • • • • • • • • Feeling state Worried about health Sleep On medication for nerves History of psychiatric disorder Problems at home/work Observe behaviour Meaning of the illness Facilitate expression Address patient concern Reassure Develop therapeutic alliance Ensure follow up

Treatment Patient reaction

Management

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