Psychosomatic Medicine :An Introduction to Consultation-Liaison Psychiatry

Publication subTitle :An Introduction to Consultation-Liaison Psychiatry

Author: James J. Amos; Robert G. Robinson  

Publisher: Cambridge University Press‎

Publication year: 2010

E-ISBN: 9780511770951

P-ISBN(Paperback): 9780521106658

Subject: R395.1 medical psychology

Keyword: 神经病学与精神病学

Language: ENG

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Psychosomatic Medicine

Description

Psychosomatic medicine or consultation-liaison psychiatry is the branch of psychiatry that focuses on the mental health issues which accompany, or develop as a result of, other medical disorders. This subdiscipline forms an important part of training in psychiatry. This book provides an ideal first exposure to the inseparable nature of physical and psychological health and illness, and a comprehensive introduction to the broad range of disorders seen on the psychiatric consult service. Organized into a series of bitesized chapters, each focusing on a typical consult question, this handbook provides a practical and portable reference which should set both strategy and tactics for the next generation of consulting psychiatrists. Essential reading for medical students, psychiatry residents and psychosomatic fellows, this manual will provide immediate, in-the-field guidance on the evaluation and management of common consultation requests.

Chapter

Chapter 2 Assessing capacity in the medically ill: I don't want to!

Typical consult question

Please assess competency in this patient

Background

Misconceptions

Reasons for evaluation

Legal issues

Maladaptive denial

Work-up

Clinical decision-making and treatment

References

Chapter 3 The difficult patient encounter: understanding what just happened

Typical consult question

Background

Work-up

Personality types

Coping styles

Defense mechanisms

Countertransference

The “Hateful” Patient

Dependent Clingers

Entitled Demanders

Manipulative Help-Rejecters

Self-Destructive Deniers

Clinical decision-making and treatment

Behavioral management

Psychopharmacology

References

Chapter 4 Psychopharmacology in the medically ill

Typical consult questions

Developing an approach to psychopharmacology in psychosomatic medicine patients

Relevant psychopharmacologic principles

Pharmacodynamics and pharmacokinetics

Classes of medications

Anticonvulsants

Gabapentin and pregabalin

Valproic acid

Carbamazepine and oxcarbazepine

Lamotrigine

Topiramate

Lithium

Antidepressants

MAOIs and TCAs

SSRIs and SNRIs

Other/atypical antidepressants

Anxiolytics and sedatives

Benzodiazepines

Non-benzodiazepine sedative/hypnotic medications

Buspirone

Antipsychotics

Conventional/first-generation antipsychotics

Atypical/second-generation antipsychotics

Psychostimulants

References

Chapter 5 Suicide risk assessment

Typical consult question

Background

Work-up

1. Behavioral incident

2. Denial of the specific

3. Shame attenuation

4. Normalization

5. Gentle assumption

6. Symptom amplification

Clinical decision-making and treatment

References

Chapter 6 Assessment and management of the violent patient

Typical consult question

Background

Work-up

Clinical decision-making and treatment

Psychopharmacologic management of the agitated, violent patient

References

Chapter 7 Evaluation and management of delirium

Typical consult questions

Background

Assessment and work-up

Clinical decision-making and treatment

Conclusion

References

Chapter 8 Management of somatoform disorders

Typical consult question

Background

Somatization disorder

Background

Work-up

Clinical decision-making and treatment

Conversion disorder

Background

Work-up

Clinical decision-making and treatment

Hypochondriasis

Background

Work-up; clinical decision-making and treatment

Body dysmorphic disorder

Background

Work-up

Clinical decision-making and treatment

Pain disorder

Background

Work-up; clinical decision-making and treatment

References

Chapter 9 Managing factitious disorder and malingering

Typical consult question

The Munchausen Saga

Background

Work-up

Clinical decision-making and treatment

References

Chapter 10 Agitation in patients with dementia

Typical consult question

Background

Cortical dementias

Alzheimer's disease

Fronto-temporal dementia

Dementia with Lewy bodies

Subcortical dementias

Parkinson's disease

Huntington's disease

Mixed dementias

Vascular dementia

Traumatic brain injury

Work-up

History

Physical exam/neuropsychiatric testing/labs/studies

Clinical decision-making and treatment

Medications for agitation in dementia

Antipsychotics

Anticonvulsants

Cholinesterase inhibitors and memantine

Antidepressants

Medications for agitation in Huntington's disease and traumatic brain injury

References

Chapter 11 Depression and heart disease

Typical consult question

Background

Screening and assessment

Work-up

Clinical decision-making and treatment

References

Chapter 12 Management of post-stroke depression

Typical consult question

Background

Work-up

Diagnosis

Clinical decision-making and treatment of post-stroke depression

Physical treatments

Antidepressants

Electroconvulsive therapy

Effect of antidepressants on outcome

Recovery in activities of daily living

Recovery in cognitive function

Mortality

Psychosocial interventions

Preventive intervention

References

Chapter 13 Psychiatric aspects of Parkinson's disease

Typical consult question

Background

Overview of Parkinson's disease

Work-up

Clinical decision-making and treatment

Psychiatric disturbances: background

Work-up for the patient with Parkinson's disease and psychiatric illness

Clinical decision-making and treatment

Specific psychiatric disorders in Parkinson's disease

Mood disorders: background

Depression, apathy, and pseudobulbar affect

Work-up

Clinical decision-making and treatment

Mania

Anxiety disorders: background

Work-up

Clinical decision-making and treatment

Psychotic disorders: background

Work-up

Clinical decision-making and treatment

Cognitive disorders: background

Work-up

Clinical decision-making and treatment

Other psychiatric symptoms in Parkinson's disease: background, work-up, and clinical decision-making and treatment

Delirium

Sleep disorders

Sexual disorders

Behavioral changes and impulse control disorders

Abuse of dopaminergic medications

References

Chapter 14 Managing depression in traumatic brain injury

Typical consult question

Background

Introduction

Epidemiology

Classification

Etiologic mechanisms

Risk factors for post-TBI depression

Clinical features of post-TBI depression

Work-up

Clinical decision-making and treatment

Pharmacologic treatments

Somatic treatments

Psychosocial treatments

Conclusion

References

Chapter 15 Managing psychiatric aspects of seizure disorders

Typical consult question

Background

Definitions and classification

Epidemiology

Work-up

1. Does the patient really have seizures?

2. If the patient has epilepsy, what is the type, is the cause known, what is the treatment, and is the epilepsy controlled?

3. What psychiatric symptoms are present, do they represent a psychiatric syndrome, and what is their relationship to seizures (i.e., are the symptoms preictal, postictal, or interictal) and epilepsy treatment?

4. How is the patient handling epilepsy?

5. Are AEDs playing a role in cognitive and psychiatric symptoms?

6. Is the patient suicidal?

7. Was neuropsychological testing completed?

Clinical decision-making and treatment

Epilepsy treatment

Psychiatric disorder treatment

Conclusion

References

Chapter 16 Distress and depression in cancer care

Typical consultation questions

Background

Screening for distress and the Mental Health Evaluation

Physical symptom burden and distress

Pharmacologic treatments for depression in cancer – A cautionary tale

Non-pharmacologic therapies for depression in cancer

Psychotherapy

Existential and spiritual care

Exercise and movement

Nutrition and supplements

Care for the caregivers

Cancer survivorship

References

Chapter 17 Depression in the patient with hepatitis C

Typical consult question

Introduction

Background

Screening and assessment

Clinical decision-making and treatment

Proposed mechanisms for interferon-induced depression

Pretreatment and the debate over prophylactic medications

Treatment of depression symptoms during IFN therapy

Future directions

References

Chapter 18 Psychiatric aspects of AIDS

Typical consult questions

Background

Work-up

Clinical decision-making and treatment

Treatment issues

Psychopharmacology and AIDS psychiatry (12–14)

Psychopharmacology and addictive disorders (12–15)

Psychopharmacology and other psychiatric disorders (12–15) – includes results of OAP Consensus Survey (12) – with examples of medicines and doses

Conclusion

References

Chapter 19 Managing depression and renal failure

Typical consult question

Background

Types and epidemiology of renal disease

Renal replacement therapies

Epidemiology of renal disease and depression

Work-up

Cause of depression in renal failure

Consequences of depression and renal failure

Clinical decision-making and treatment

Pharmacologic therapy in renal failure

Pharmacokinetic and pharmacodynamic issues in renal failure

Pharmacodynamic

Pharmacokinetic

Antidepressant medications in renal failure

Nonpharmacologic therapy for depression in renal failure

Conclusion

References

Chapter 20 Management of psychiatric syndromes due to endocrine and metabolic diseases

Typical consult question

Background

Hypothyroidism

Hyperthyroidism

Hyperparathyroidism

Hypoparathyroidism

Adrenal disorders

Hypocortisolism

Diabetes mellitus

Hyperprolactinemia

Work-up

Clinical decision-making and treatment

References

Chapter 21 Management of alcohol withdrawal and other selected substance withdrawal issues

Typical consult question

Alcohol withdrawal

Background

Work-up

Clinical decision-making and treatment

Sedative/hypnotic withdrawal

Opioid withdrawal

Background

Work-up

Clinical decision-making and treatment

Opioid agonist therapy for patients in the hospital

Opioid-assisted detoxification in the hospital

Methadone and buprenorphine drug interactions

Symptomatic detoxification

Accelerated methods

Pregnancy

References

Chapter 22 Managing depression in pregnancy

Typical consult question

Background

Epidemiology of depression during pregnancy and the post-partum period

Consequences of depressive disorders in the perinatal period

Work-up

Clinical decision-making and treatment

Nonpharmacologic treatments

Pharmacologic treatments

Antidepressants and lactation

Alternative options for depression treatment in the perinatal period

Treatment with mood stabilizers and antipsychotics in the perinatal period

Role of healthcare providers

References

Chapter 23 Psychiatric aspects of organ transplantation

Typical consult question

Background

Work-up

a. Pre-transplant period

Clinical decision-making and treatment

a. Pre-transplant period

b. Perioperative period

c. Post-transplant period

References

Chapter 24 Preoperative psychiatric evaluation for bariatric surgery

Typical consult question

Background

Work-up

Psychometric evaluation of bariatric surgery candidates

Pre-operative and post-operative adherence

References

Chapter 25 Psychiatric care at the end of life: hospice and palliative medicine

Typical consult question

Background

Work-up

Clinical decision-making and treatment

References

Chapter 26 Demoralization in the medical setting

Typical consult question

Background

Work-up

Clinical decision-making and treatment

Case discussion

References

Chapter 27 Psychotherapy for the hospitalized medically ill patient

Typical consult question

Background

Work-up

The system perspective

The patient

Role disputes and interpersonal deficits

Clinical decision-making and treatment

Case example

Conclusion

References

Chapter 28 Children’s reactions and consequences of illness and hospitalization and transition of care from pediatric to adult settings

Typical consult question

Background

Work-up

Clinical decision-making and treatment

Transition from pediatric to adult care

References

Index

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