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Liaison psychiatry

Identification & treatment


of psychiatric morbidity
in medically ill patients
Medical illnesses causing
psychiatric symptoms
Endocrine Metabolic
Hyperthyroidism: anxiety, paranoid Hypoglycaemia: anxiety, confusional
psychosis state
Hypothyroidism: depression, Vitamin deficiency: depression,
dementia, psychosis dementia
Cushing’s syndrome: depression, Neoplastic
psychosis Pancreas & lung: depression
Phaeochromocytoma: anxiety Brain: personality change, psychosis
Infections Nervous system
HIV: anxiety, depression, delirium, Parkinson's disease: depression,
dementia dementia
Viral infections: depression Multiple sclerosis: anxiety, euphoria,
depression
Drug induced psychological
problems
Depression Anxiety
• Antihypertensives • Amphetamines
• Anticancer • Sympathomimetics
• Anti diabetics • Caffeine
• Hormones • Organophosphates
• Analgesics • Sulphonamides
• H1 receptor antagonists
• Penicillin
• Mercury & arsenic
Delirium Psychosis
• Anticholinergics • Hallucinogens,
• Digoxin • Appetite suppressants
• Cimetidine • Corticosteroids
• Anticholinergics
Psychiatric disorders presenting
with physical symptoms
Somatisation disorder: Somatoform pain disorder:
• Multiple somatic complaints • Continuous, dull, diffuse,
• Seek immediate relief • Aggravated by stress,
Hypochondriasis: • Relieved with tranquilisers
• Preoccupation with bodily ill- Anxiety disorder:
health • Fear of heart attack
• Seek investigations & •
reassurances Autonomic dysfunction
Dysmorphophobia: Masked depression
• Preoccupation with body • Multiple somatic symptoms
disfigurement • Biological symptoms of depression
• Medical shopping
Dissociative disorder:
• Physical symptoms without
organic pathology
• Stress related
Management
(Principles)
Consider Recognise psychiatric disorder
Illness • Feeling state
• Threat to life • Worried about health
• Duration • Sleep
• Disability • On medication for nerves
• History of psychiatric disorder
Treatment
• • Problems at home/work
Side effects
• • Observe behaviour
Uncertainty of outcome
Patient reaction Management
• • Meaning of the illness
Anxiety
• • Facilitate expression
Denial
• • Address patient concern
Depression
• • Reassure
Non compliance
• • Develop therapeutic alliance
Social circumstances
• Ensure follow up