Liaison psychiatry

Identification & treatment

of psychiatric morbidity
in medically ill patients
 Medical illnesses causing
psychiatric symptoms
Endocrine Metabolic
Hyperthyroidism: anxiety, paranoid Hypoglycaemia: anxiety,
psychosis confusional state
Hypothyroidism: depression, Vitamin deficiency: depression,
dementia, psychosis dementia
Cushing’s syndrome: depression, Neoplastic
psychosis Pancreas & lung: depression
Phaeochromocytoma: anxiety Brain: personality change,
Infections psychosis
HIV: anxiety, depression, delirium, Nervous system
dementia Parkinson's disease: depression,
Viral infections: depression dementia
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
Psychosis
Delirium • Hallucinogens,
• Anticholinergics • Appetite suppressants
• Digoxin • Corticosteroids
• Cimetidine • 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 & • Autonomic dysfunction
reassurances Masked depression
Dysmorphophobia: • Multiple somatic symptoms
• Preoccupation with body • Biological symptoms of depression
disfigurement
• 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