Liaison Psychiatry

Liaison psychiatry Identification & treatment of psychiatric morbidity in medically ill patients

Medical illnesses causing psychiatric symptoms Endocrine

Metabolic

Hyperthyroidism: anxiety, paranoid psychosis Hypothyroidism: depression, dementia, psychosis Cushing’s syndrome: depression, psychosis Phaeochromocytoma: anxiety

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

Infections

Nervous system

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

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

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

Drug induced psychological problems Depression • • • • • •

Antihypertensives Anticancer Anti diabetics Hormones Analgesics H1 receptor antagonists

Delirium

• Anticholinergics • Digoxin • Cimetidine

Anxiety • • • • • • •

Amphetamines Sympathomimetics Caffeine Organophosphates Sulphonamides Penicillin Mercury & arsenic

• • • •

Hallucinogens, Appetite suppressants Corticosteroids Anticholinergics

Psychosis

Psychiatric disorders presenting with physical symptoms Somatisation disorder:

Somatoform pain disorder:

• Multiple somatic complaints • Seek immediate relief

• • •

Hypochondriasis:

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

• Preoccupation with body disfigurement • Medical shopping Dissociative disorder:

• Physical symptoms without organic pathology • Stress related

Continuous, dull, diffuse, Aggravated by stress, Relieved with tranquilisers

Anxiety disorder: • Fear of heart attack •

Autonomic dysfunction

Masked depression • •

Multiple somatic symptoms Biological symptoms of depression

Management (Principles) Consider Illness • • •

Threat to life Duration Disability

Treatment • •

Side effects Uncertainty of outcome

Patient reaction • • • • •

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

Management • • • • • •

Meaning of the illness Facilitate expression Address patient concern Reassure Develop therapeutic alliance Ensure follow up