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

351 Pages·2005·2.5 MB·English

by  Michael G. Wise, James R. Rundell

Clinical Manual of
Psychosomatic Medicine
A Guide to
Consultation-Liaison Psychiatry
This page intentionally left blank
Clinical Manual of
Psychosomatic Medicine
A Guide to
Consultation-Liaison Psychiatry
Michael G. Wise, M.D.
Clinical Professor of Psychiatry
University of California, Davis
Adjunct Professor of Psychiatry
Uniformed Services University of the Health Sciences
F. Edward Hébert School of Medicine
Bethesda, Maryland
James R. Rundell, M.D.
Professor of Psychiatry
Uniformed Services University of the Health Sciences
F. Edward Hébert School of Medicine
Bethesda, Maryland
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with general psychiatric and medical standards,
and that information concerning drug dosages, schedules, and routes of administration
is accurate at the time of publication and consistent with standards set by the U.S.
Food and Drug Administration and the general medical community. As medical
research and practice continue to advance, however, therapeutic standards may change.
Moreover, specific situations may require a specific therapeutic response not included
in this book. For these reasons and because human and mechanical errors sometimes
occur, we recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views and
opinions of the individual authors and do not necessarily represent the policies and
opinions of APPI or the American Psychiatric Association.
Copyright © 2005 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
09 08 07 06 05 5 4 3 2 1
First Edition
Typeset in AGaramond and Formata.
American Psychiatric Publishing, Inc.
1000 Wilson Boulevard
Arlington, VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Wise, Michael G., 1944–
Clinical manual of psychosomatic medicine : a guide to consultation-liaison
psychiatry / by Michael G. Wise, James R. Rundell.—1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-201-X (alk. paper)
1. Consultation-liaison psychiatry. 2. Medicine, Psychosomatic.
[DNLM: 1. Psychophysiologic Disorders—diagnosis. 2. Psychophysiologic
Disorders—therapy. 3. Diagnosis, Differential. 4. Mental Disorders—diagnosis.
5. Mental Disorders—Therapy. 6. Psychology, Medical—methods. 7. Psychotherapy—
methods. 8. Referral and Consultation. WM 90 M813c 2005] I. Rundell, James R.,
1957– II. Title.
RC455.2.C65W568 2005
616.89′14—dc22 2004026969
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1 Effective Psychiatric Consultation in a
Changing Health Care Environment. . . . . . . . . . . 1
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cost-Effectiveness of Psychiatric Consultation. . . . . . . . . 2
Approach to the Consultation . . . . . . . . . . . . . . . . . . . . . . 3
Consultation or Liaison Psychiatry?. . . . . . . . . . . . . . . . . .6
Outpatient Psychosomatic Medicine . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2 Mental Status Examination and
Other Tests of Brain Function. . . . . . . . . . . . . . . 11
Mental Status Examination . . . . . . . . . . . . . . . . . . . . . . .13
Screening Mental Status Examinations. . . . . . . . . . . . . .17
Other Useful Tests of Cognitive Function . . . . . . . . . . . .19
Tests of Executive Function . . . . . . . . . . . . . . . . . . . . . . .21
Neurological Examination . . . . . . . . . . . . . . . . . . . . . . . .22
The Consultation Psychiatrist as Neuropsychiatrist . . . .22
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26
Additional Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
3 Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Epidemiology and Risk Factors . . . . . . . . . . . . . . . . . . . .29
Clinical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . .34
Treatment and Management. . . . . . . . . . . . . . . . . . . . . .40
Course (Prognosis) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .44
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47
4 Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Clinical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . .50
Differential Diagnosis and Evaluation . . . . . . . . . . . . . . .57
Treatment and Management. . . . . . . . . . . . . . . . . . . . . .60
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64
5 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Interrelations Between Depression
and Other Medical Illnesses . . . . . . . . . . . . . . . . . . . . .67
Clinical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . .68
Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . .71
Treatment and Management. . . . . . . . . . . . . . . . . . . . . .72
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . .87
6 Mania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Clinical Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . .89
Treatment and Management. . . . . . . . . . . . . . . . . . . . . .91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .99
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .101
7 Anxiety and Insomnia . . . . . . . . . . . . . . . . . . . . 103
Anxiety and Anxiety Disorders . . . . . . . . . . . . . . . . . . . .103
Insomnia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .119
8 Somatoform and Related Disorders . . . . . . . . 121
Somatization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123
Somatization Disorder (Briquet’s Syndrome) . . . . . . .126
Undifferentiated Somatoform Disorder . . . . . . . . . . . .128
Hypochondriasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .130
Conversion Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . .132
Body Dysmorphic Disorder . . . . . . . . . . . . . . . . . . . . . .135
Pain Disorder. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .136
Somatoform Disorder Not Otherwise Specified . . . . .138
Psychological Factors Affecting Medical Condition . . .139
Factitious Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . .139
Malingering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .142
Differential Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . .143
Additional Treatment and Management
Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .148
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .152
9 Substance-Related Disorders . . . . . . . . . . . . . . 153
DSM-IV-TR Substance-Related Disorders . . . . . . . . . . .154
Alcohol-Related Disorders . . . . . . . . . . . . . . . . . . . . . . .154
Sedative-, Hypnotic-, or Anxiolytic-Related
Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .163
Opioid (Narcotic)–Related Disorders . . . . . . . . . . . . . .166
Amphetamine-Related Disorders . . . . . . . . . . . . . . . . .168
Cocaine-Related Disorders. . . . . . . . . . . . . . . . . . . . . . .170
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .175
10 Important Pharmacological Issues. . . . . . . . . . 177
Adherence to Pharmacological Treatment . . . . . . . . . .178
Drug Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178
Drug Interactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186
Neuroleptic Malignant Syndrome . . . . . . . . . . . . . . . . .189
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .203
11 Violence and Aggression . . . . . . . . . . . . . . . . . . 205
Emergency Consultation . . . . . . . . . . . . . . . . . . . . . . . .205
Physiological Basis for Violence and Aggression . . . . .208
Differential Diagnosis of Violence and Aggression . . .208
Treatment and Prevention of Chronic Aggression. . . .209
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .212
12 Pain and Analgesics. . . . . . . . . . . . . . . . . . . . . . 213
Pain Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215
Pain Behavior, Suffering, and Psychiatric Diagnoses. .220
Measurement of Pain . . . . . . . . . . . . . . . . . . . . . . . . . . .223
Additional Aids to Diagnosis . . . . . . . . . . . . . . . . . . . . .224
Pharmacotherapy and Adjunctive Treatments
for Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Treatment and Management of Chronic Pain . . . . . . .234
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .238
13 Personality, Response to Illness, and
Medical Psychotherapy . . . . . . . . . . . . . . . . . . . 239
Personality and Response to Illness . . . . . . . . . . . . . . .239
Personality and General Medical Conditions . . . . . . . .242
Personality Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . .242
Medical Psychotherapy. . . . . . . . . . . . . . . . . . . . . . . . . .248
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .250
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .251
14 Medicolegal Issues in Consultation . . . . . . . . . 253
Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .254
Competency Versus Capacity. . . . . . . . . . . . . . . . . . . . .256
Informed Consent and the Right to Refuse
Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . .259
Guardianship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .262
Involuntary Hospitalization . . . . . . . . . . . . . . . . . . . . . .263
Restraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .264
Prescribing “Unapproved” Medications . . . . . . . . . . . .265
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .266
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .267
15 Suicidality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .269
Clinical Features and Risk Factors . . . . . . . . . . . . . . . . .273
Approach to the Patient . . . . . . . . . . . . . . . . . . . . . . . . .275
Treatment and Management. . . . . . . . . . . . . . . . . . . . .275
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .278
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .279
16 Geriatric Psychiatry . . . . . . . . . . . . . . . . . . . . . . 281
Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .281
Psychiatric Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . .281
Diagnostic Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . .285
Treatment and Management. . . . . . . . . . . . . . . . . . . . .286
Elder Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .291
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .294
17 Special Psychosomatic Medicine Settings
and Situations . . . . . . . . . . . . . . . . . . . . . . . . . . 295
Pregnancy and the Postpartum Period. . . . . . . . . . . . .295
Pediatric Psychosomatic Medicine . . . . . . . . . . . . . . . .298
Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .301
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
Death and Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .307
Neurology and Neurosurgery. . . . . . . . . . . . . . . . . . . . .308
HIV Disease and AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . .311
Organ Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . .314
Critically Ill Patients and the ICU . . . . . . . . . . . . . . . . . .316
Male Erectile Disorder (Impotence) . . . . . . . . . . . . . . .319
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .321
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . .324
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325