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  1. Home
  2. Books
  3. Handbook of Liaison Psychiatry
  • Cited by 6
Publisher:
Cambridge University Press
Online publication date:
December 2009
Print publication year:
2007
Online ISBN:
9780511543975
DOI:
https://doi.org/10.1017/CBO9780511543975
Subjects:
Psychiatry and Clinical Psychology, Medicine, Psychiatry
Information

Book description

Liaison psychiatry, the recognition and management of psychiatric problems in the general medical setting, is an essential component of many doctors' work. Depression, anxiety and somatization disorders occur in about 50% of cases presented to primary care physicians. The Handbook of Liaison Psychiatry was first published in 2007 and is a comprehensive reference book for this fast-growing subspecialty. A team of experts in the field cover the full range of issues, from establishing a service and outlining the commonest problems encountered in general hospitals and primary care, to assessment and treatment guidelines, working with specific units within the hospital setting, disaster planning and legal-ethical considerations. It will be essential reading for doctors and other professionals concerned with the psychological health of patients in acute general hospitals and in primary care.

Awards

British Medical Association 1st Prize Winner in the Mental Health category 2008

Reviews

Review of the hardback:'The book could have been categorised by symptom, such as pain or depression. However, this would have led to a lot of repetition. … It has an excellent section on establishing a service, which is amusingly pragmatic. I also liked the 'How to do a referral guide', with carefully laid out steps that need to be taken. … There is an excellent index … All budding and established liaison psychiatrists should have this manual and medical libraries should stock it.'British Medical Journal

Review of the hardback:'It will be essential reading for liaison psychiatrists, liaison nurses, other members of the mental health team and services managers. It enthusiastically conveys the excitement and breadth of this developing subspecialty.'Clinical Medicine Journal of the Royal College of Physicians of London

Review of the hardback:'The setup and the extensive index makes it a very useful book for the practising CL psychiatrist. Because of its different character, this book is a good alternative for, or a welcome addition to, the existing American textbooks.'Journal of Psychosomatic Research

Review of the hardback:'This book is a very welcome addition to liaison psychiatry literature. It is the first really comprehensive textbook of liaison psychiatry by authors predominantly working in the UK; however, the inclusion of a number of eminent international contributors greatly enhances it. … Were I asked to recommend a single liaison psychiatry textbook for liaison psychiatrists and trainees it would now be this one.'The British Journal of Psychiatry

Review of the hardback:'… this book can be strongly recommended as a useful introduction to an important subject.'Journal of Mental Health

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Contents

Page 2 of 2

Contents
  • 24 - Head and neck cancer
    pp 564-591
  • View abstract

    Summary

    Head and neck cancer is the sixth most common cancer worldwide and within the developed world ranks third. Primary care doctors detect most tumours on complaint of soreness in the mouth by their patients. Treatment consists of three modalities including surgery, radiotherapy and chemotherapy, either singly or in combination. The prevention of head and neck cancer has relied principally on early identification and a careful review programme for patients with precancerous signs and exhortations to quit smoking and moderate excessive alcohol consumption. The psychological care of the patient with head and neck cancer is a neglected area and moreover is traditionally a less developed service compared to more common cancers. The literature demonstrates an interest in understanding the psychological processes that interfere with improving self-care practices of patients and preventing good recovery from initial treatment.
  • 25 - Palliative care
    pp 592-616
  • View abstract

    Summary

    Palliative care arose as a discipline with the birth of the modern hospice movement. From its earliest origins, palliative care championed what has come to be known as a patient-centred approach to delivering care. This chapter discusses the clinical assessment of patients with advanced disease, followed by a description of a number of common clinical problems that may be referred to psychiatrists working in palliative care. It reviews first models of coping in advanced disease. As in any other groups of patients with established physical disease, comorbid depression is a familiar problem. In palliative care, depression may have dramatic consequences. Compared to depression, anxiety has received much less attention in the literature. There are a large number of reasons why patients with advanced disease, particularly those in hospices, might present with confusion or disturbed behaviour.
  • 26 - Cosmetic procedures
    pp 617-631
  • View abstract

    Summary

    Aesthetic cosmetic surgery is a popular lifestyle choice, and attractiveness is a valued attribute in all societies. This chapter guides the reader through the minefield of cosmetic surgery and especially its role in psychosis, body dysmorphic disorder (BDD), amputee identity disorder (AID) and eating disorders. The role of a psychiatrist or psychologist is to advise the surgeon and patient on the patient's psychiatric status. Even when patients agree to stop seeking cosmetic surgery, the next goal is attitudinal change and modifying the dream of changing their appearance. This is often seen in mirror gazing and mental cosmetic surgery when patients alter their appearance in their mind. Although this is lot cheaper and less risky than real cosmetic surgery, it is a major obstacle in therapy for overcoming BDD. Amputee identity disorder (AID) is a term used to describe individuals who desire one or more digits or limbs to be amputated.
  • 27 - Perinatal and gynaecological disorders
    pp 632-672
  • View abstract

    Summary

    This chapter seeks to emphasize the place of women's mental health requirements in the context of normal reproductive events. The concept of a systematic change in physiological and psychological function across the menstrual phase in women is not new. Some view premenstrual syndrome (PMS) as a culture-bound syndrome that constitutes a negotiated reality between those who treat it and those who suffer. Pregnancy should always be considered by clinicians when prescribing medical interventions to any woman of reproductive age. In a large American study, 45% of women with known bipolar affective disorder (BPAD) reported high levels of emotional disturbance during pregnancy and within the first month post-partum. Women experiencing a lengthy perimenopause did have a moderately increased rate of depressive symptoms. Women show different handling and metabolism, and side-effect profiles for a number of drugs.
  • 28 - The intensive care unit
    pp 673-696
  • View abstract

    Summary

    Intensive care medicine is a relatively new speciality made possible by technological advances in artificial life support. Intensive care unit (ICU) development took its first steps at Copenhagen, with treatment using positive pressure ventilation of poliomyelitis cases. Although there are now several studies of the prevalence of depression in ICU and critically ill patients, there are relatively few in which semi-structured psychiatric assessments have been employed to measure psychiatric disorder according to strict diagnostic criteria. There are differing viewpoints about whether psychiatric conditions that are unique to, and produced by, the unusual environment of the ICU exist. This chapter discusses the impact on relatives and approaches to liaison with the ICU. The psychosocial impact of critical illness on both patient and their relatives cannot be underestimated. Patients referred from the ICU can often present with highly complex problems.
  • 29 - The burns unit
    pp 697-713
  • View abstract

    Summary

    Burn trauma is a significant cause of mortality and morbidity. There are many possible factors that could explain why some individuals appear to develop psychological sequelae following burn trauma and some individuals do not. It is perhaps commonly assumed that the greater total body surface area (TBSA) burn an individual sustains the more likely that individual is to develop a distressing psychological reaction. One group of burn trauma victims of particular concern to the liaison psychiatrist is those who self-inflict burn trauma. It is important to focus on ensuring that burns units provide an environment and package of care that openly acknowledges the importance of psychosocial factors, deals with them in a caring and sympathetic manner and identifies individuals with specific needs. Departments of liaison psychiatry have a key role to play in the provision of a service that caters for burn trauma victims' psychosocial needs.
  • 30 - Psychocutaneous disorders
    pp 714-732
  • View abstract

    Summary

    A relationship between dermatological conditions and psychological factors has long been observed. It has been estimated that approximately a third of the patients presenting with dermatological disorders have some psychological comorbidity. The term psychocutaneous disorder describes several distinct psychiatric disorders in which the skin is affected. Psychogenic parasitosis includes conditions in which a person has a belief that he or she is suffering an infestation with living organisms despite a lack of evidence that such infestation exists. Dermatologists' perception of the patients' psychological wellbeing is influenced by their conceptual models of illness. Adolescents and young adults may be more vulnerable to develop depression as a result of the cosmetic impact on their body image and self-esteem. Face transplantation is now a realistic treatment for people with severe facial disfigurement from burns, trauma or malignant disease.
  • 31 - Genitourinary disorders
    pp 733-750
  • View abstract

    Summary

    Genitourinary medicine (GUM) attracted the attention of liaison psychiatrists decades before the emergence of HIV. Although many psychiatrists are accustomed to working in HIV departments, fewer contemporary practitioners have experience of general GUM clinics. The sections of this chapter describes specific illnesses found in GUM settings. Where applicable, the relevance of various International Classification of Disease (ICD)-10 diagnoses is discussed. Almost any psychiatric condition may exist comorbidly in patients attending GUM clinics. The conditions described in the sections are therefore clinical pictures where psychiatry and GUM overlap through more than a chance association. The high levels of psychological disturbance in GUM clinics are not matched by high levels of referral to psychiatrists. Although any number from 20 to 50% of patients may score as distressed, fewer than 1% are referred to mental health services.
  • 32 - The emergency department
    pp 751-760
  • View abstract

    Summary

    Emergency department (ED) staff may see patients with mental health and substance misuse problems as a numerically small, but potentially high-risk, group and quietly resent being the unacknowledged out-of-hours support to local community mental health services. An extensive working knowledge of local mental health and substance misuse services (both in the state-run and voluntary sectors) and housing services (including options for the homeless) is required if alternatives to unnecessary hospital admission are to be generated, especially out-of-hours. The starting point for this work varies from place to place and from country to country. This chapter assumes that ED is currently served round the clock by a rota of junior psychiatrists who are on-site at the general hospital but employed by a separate mental health trust. EDs in Australia and the USA often have dedicated spaces where intoxicated patients can be nursed.
  • 33 - Psychopharmacological treatment in liaison psychiatry
    pp 763-794
  • View abstract

    Summary

    There is still limited systematic research on the effectiveness of psychotropic drugs used in liaison psychiatry settings. All drugs available in clinical psychiatry for the treatment of psychiatric disorders can be used in liaison settings. However, before choosing a specific drug, liaison psychiatrists must address additional important issues beyond those related to the indication for a psychotropic drug. Most psychotropic drugs used today are aimed at g-protein coupled receptors such as serotonergic (5HT). The availability of psychotropic drugs varies to some extent between countries within the European Union. This chapter discusses the most frequently used drugs. Depressive disorders accompanying physical illness should be treated to improve quality of life and treatment adherence. The main indications in liaison psychiatry settings are behavioural disorders caused by organic brain dysfunction including temporal lobe epilepsy, acute mania, pain disorders and prophylactic treatment of bipolar disorders.
  • 34 - The role of psychological treatments
    pp 795-817
  • View abstract

    Summary

    Physical illness is associated with worry and uncertainty. People react differently to illness, and their distress can seldom be adequately conceptualized in purely biomedical terms. There are many different types of psychotherapy, but this chapter focuses on three main approaches: basic supportive techniques and problem solving, relational therapies and cognitive-behavioural therapies. A relatively greater proportion of the chapter is devoted to cognitive-behavioural therapies because of the large evidence base supporting this kind of therapy for a wide variety of different psychological and emotional problems. Problem solving therapy (PST) is a clinical intervention approach aimed at increasing an individual's ability to cope with stressful problems. Relational therapies focus upon emotions or feeling states and their relationship to interpersonal functioning. Psychotherapy is not effectively targeted at present. Referrals for psychotherapy treatment in patients with physical illness are fairly random processes.
  • 35 - Problem cases
    pp 818-844
  • View abstract

    Summary

    Every referral to liaison psychiatry presents its own clinical dilemmas. Some cases are straightforward and can be assessed and managed easily. Others are complex and require a whole host of liaison skills and a large investment of time. This chapter is composed of a number of 'problem cases'. They are intended to replicate the process of referral, assessment and management by liaison psychiatry. The cases have provided a different perspective and way of thinking about liaison psychiatry which is more familiar to the clinician. It is important to remember that liaison psychiatrists cannot possibly be familiar with the latest developments across the whole of the field of medicine, but they may well be expected to provide advice about patients with a wide range of physical and psychological problems. Mentoring is also useful for newly appointed consultant liaison psychiatrists, where a more experienced liaison psychiatrist can provide support and guidance.
  • 36 - Developing links with primary care
    pp 847-870
  • View abstract

    Summary

    Most liaison psychiatry is practised in the general-hospital setting, but increasingly services for the physically ill are becoming community based. Family practitioners play a key role in identifying patients with comorbid physical and psychological distress. This chapter describes the developments over the last 10 years in the detection and treatment of patients with medically unexplained symptoms (MUS) in a primary-care setting. MUS are defined as physical symptoms that doctors cannot explain by physical pathology, which distress or impair the functioning of the patient. Family doctors are faced with the whole range of physical and psychosocial health problems. Four approaches to the management of persistant MUS (PMUS) that might be employed by family doctors have been explored in randomized controlled trials (RCTs): antidepressants, exercise, psychiatric consultation and emotional disclosure. There is a need for simple, effective, evidence-based interventions that family doctors can provide for patients with PMUS.
  • 37 - Frequent attenders in primary care
    pp 871-895
  • View abstract

    Summary

    This chapter reviews the patient factors associated with frequent attendance in primary care, and suggests strategies for managing patients who attend unusually frequently. There are also fairly consistent findings when data from studies which have examined the sociodemographic characteristics of frequent attenders are compared. Frequent attenders are more likely to be female, older, less likely to be married, and less likely to be in paid employment. A number of studies have examined the association between frequent attendance and psychiatric morbidity. The most common psychiatric disorders in frequent attenders are episodes of minor depression or anxiety. Studies that have examined the association between frequent attendance and physical disorder have used case-note data, self-report measures or physiological measures. Consistent associations have been reported between frequent attendance and female sex, older age, unemployment, socio-economic deprivation, marital status, psychiatric disorder, physical illness, and health concerns.
  • 38 - Major disaster planning
    pp 896-912
  • View abstract

    Summary

    In the last few decades there have been a number of high-profile disasters, memories of which can be evoked by the mention of a place name. There have been criticisms regarding the unplanned and uncoordinated nature of psychosocial input following several disasters, leading to calls for the creation of multiagency planning groups that include mental health professionals to plan appropriate responses before disasters occur. Post-traumatic stress disorder (PTSD) is the most discussed psychiatric disorder following disaster but it is important to remember that it is not the only psychiatric disorder or emotional response experienced following a disaster. In over 50% of cases of PTSD, another comorbid psychiatric diagnosis will be present. There are eight completed randomized controlled trials of multiple-session early psychosocial interventions including a total of 625 individuals. The availability of psychosocial support should be communicated to those involved and co-ordinated by the psychosocial response team.

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