Liaison Psychiatry

8/14/2019 Liaison Psychiatry

1/22

3 September 20093 September 2009

Liaison psychiatryLiaison psychiatry


2/22


IntroductionIntroduction

also known asalso known as consultative psychiatryconsultative psychiatry ororconsultation-liaison psychiatryconsultation-liaison psychiatry

overlap with other distinct disciplines includingoverlap with other distinct disciplines includingpsychosomatic medicine, health psychology andpsychosomatic medicine, health psychology and

neuropsychiatryneuropsychiatry It is served by psychiatrist, nurses, psychologist andIt is served by psychiatrist, nurses, psychologist and

social workersocial worker provide consultation regarding medical or surgicalprovide consultation regarding medical or surgical

settings and follow up psychiatric treatmentsettings and follow up psychiatric treatment It is also associated with diagnostic, therapeutic,It is also associated with diagnostic, therapeutic,

research and teaching service (between psychiatrist andresearch and teaching service (between psychiatrist andother specialities).other specialities).


3/22


4/22


Common Consultation-Liaison ProblemsCommon Consultation-Liaison Problems

Suicide attempt or threatSuicide attempt or threat Risk factor : men over 45, no social support, alcoholRisk factor : men over 45, no social support, alcohol

dependent, previous attempt, suicidal ideationdependent, previous attempt, suicidal ideation

DepressionDepression Assess suicidal riskAssess suicidal risk

Check for history of substance abuse or depressantCheck for history of substance abuse or depressant

drugs (eg : propanolol, reserpine)drugs (eg : propanolol, reserpine)

AgitationAgitation Related cognitive disorder, withdrawal from drugsRelated cognitive disorder, withdrawal from drugs

Need to rule out toxic reaction to medicationNeed to rule out toxic reaction to medication


5/22


HallucinationHallucination

Common cause is delirium tremensCommon cause is delirium tremens Need to rule out brief psychotic disorder,Need to rule out brief psychotic disorder,

schizophrenia, cognitive disorderschizophrenia, cognitive disorder

Sleep disorderSleep disorder Common cause is painCommon cause is pain

Need to rule out ; Depression early morningNeed to rule out ; Depression early morning

awakening, anxiety difficulty in falling asleepawakening, anxiety difficulty in falling asleep


6/22


7/22


Psychiatric aspects ofPsychiatric aspects of

physical disorderphysical disorderCancerCancer

Surgical treatmentSurgical treatment

Screening for physical disorderScreening for physical disorder

Genetic counselingGenetic counseling


8/22


CancerCancer

Problems:Problems: Distress to patients, families or carers especially:-Distress to patients, families or carers especially:-

at diagnosisat diagnosis

during treatment (surgery, radiotherapy/chemotherapy)during treatment (surgery, radiotherapy/chemotherapy)

financial & workfinancial & work

worries about appearanceworries about appearance

What can be done?What can be done?

discussion of information as patient required, practicaldiscussion of information as patient required, practicaland social support, encourage patients to talk aboutand social support, encourage patients to talk about

their worriestheir worries


9/22


Psychiatric consequences of cancerPsychiatric consequences of cancer

Emotional reaction on diagnosis orEmotional reaction on diagnosis or

recurrencerecurrence

AnxietyAnxiety

DepressionDepression

Anticipatory of chemotherapy side effectsAnticipatory of chemotherapy side effects

Neuropsychiatric syndromes (due toNeuropsychiatric syndromes (due to

metastasis, paraneoplastic syndromes)metastasis, paraneoplastic syndromes)


10/22


Surgical treatmentSurgical treatment

Consequences :Consequences : Anxiety : before surgeryAnxiety : before surgery Distress : after surgeryDistress : after surgery

Delirium (elderly) : after surgeryDelirium (elderly) : after surgery changes to body appearance (mastectomy) orchanges to body appearance (mastectomy) or

function (colostomy)function (colostomy)

What can be done ?What can be done ?

clear explanation of the operation, its consequencesclear explanation of the operation, its consequencesand plan for postoperative care (including effectiveand plan for postoperative care (including effectivetreatment of pain)treatment of pain)

Provide written handouts since anxious patients doProvide written handouts since anxious patients donot remember all that they have been toldnot remember all that they have been told


11/22


Screening for physical disorderScreening for physical disorder

ConsequencesConsequences Anxious result of the screening procedureAnxious result of the screening procedure

DistressDistress

Example :Example : HypertensionHypertension

CancerCancer

DMDM


12/22


Genetic counselingGenetic counseling

Who are the persons involved?Who are the persons involved? contemplating marriage or expecting a childcontemplating marriage or expecting a child

Family history of hereditary diseaseFamily history of hereditary disease

previous abnormal pregnancyprevious abnormal pregnancy

What can be done?What can be done? help in taking well-informed decisions abouthelp in taking well-informed decisions about

family planning and treatmentfamily planning and treatment


13/22


Psychiatric aspects ofPsychiatric aspects of

O&GO&GPregnancyPregnancy

Postpartum mental disordersPostpartum mental disorders

Menstrual disorderMenstrual disorder


14/22


PregnancyPregnancy

More common in women with a history ofMore common in women with a history ofprevious psychiatric disorderprevious psychiatric disorder

11stst trimester: unwanted pregnanciestrimester: unwanted pregnancies

associated with anxiety and depressionassociated with anxiety and depression 33rdrd trimester: fears about impendingtrimester: fears about impending

delivery or doubts about the normality ofdelivery or doubts about the normality of

the fetusthe fetus Sometimes it can become worsen asSometimes it can become worsen as

more obstetric problem may arise due tomore obstetric problem may arise due toirregular antenatal care visitirregular antenatal care visit


15/22


Psychological problems inPsychological problems in

pregnancypregnancy Unwanted pregnancyUnwanted pregnancy

Planned pregnancy miscarriage/stillbirthPlanned pregnancy miscarriage/stillbirth

Termination due to medical reasonTermination due to medical reason

Hyperemesis gravidarumHyperemesis gravidarum

PseudocyesisPseudocyesis Believe as if she is pregnant (amenorrhea, abdominalBelieve as if she is pregnant (amenorrhea, abdominal

distension and changes in early pregnancy)distension and changes in early pregnancy) Couvade syndromeCouvade syndrome

Husband experience symptoms of pregnancyHusband experience symptoms of pregnancy


16/22


Postpartum mental disorderPostpartum mental disorder

Maternity bluesMaternity blues Brief episode of irritability, disorganizedBrief episode of irritability, disorganized

thinking, tearfullnes, lability of moodthinking, tearfullnes, lability of mood

Peak on 3Peak on 3rdrd or 4or 4thth postpartum daypostpartum day

No pharmacolgical treatment needed, justNo pharmacolgical treatment needed, just

reassurerancereassurerance

Puerperal psychosisPuerperal psychosis Other puerperal depressive disorderOther puerperal depressive disorder


17/22


Puerperal psychosisPuerperal psychosis

Typically 2-3 days after delivery or in the first/secondTypically 2-3 days after delivery or in the first/secondpostpartum weekspostpartum weeks

More frequent among:-More frequent among:-

- primiparous women- primiparous women

- single mother- single mother- those who suffered previous psychiatric disorder- those who suffered previous psychiatric disorder

- those with family history of psychiatric disorder- those with family history of psychiatric disorder 3 types of psychosis are:-3 types of psychosis are:-

- delirium (secondary to puerperal sepsis)- delirium (secondary to puerperal sepsis)

- mood disorder- mood disorder

- schizophrenia- schizophrenia(mood disorder more common than schizophrenia)(mood disorder more common than schizophrenia)


18/22


AssessmentAssessment

Determine whether mother concern about babyDetermine whether mother concern about babyconditioncondition

Delusional ideas either the child is malformed orDelusional ideas either the child is malformed or

imperfect and any attempt of killing her childimperfect and any attempt of killing her child

Suicidal intentSuicidal intent TreatmentTreatment

ECTECT

Pharmacological stop breast-feedingPharmacological stop breast-feeding

PrognosisPrognosis Recover fullyRecover fully

Recurrence : puerperal depressive disorderRecurrence : puerperal depressive disorder


19/22


Other puerperal depressiveOther puerperal depressive

disorderdisorder Puerperal depression more common thanPuerperal depression more common than

puerperal psychosespuerperal psychoses

Tiredness, irritability, anxiety, phobic symptomsTiredness, irritability, anxiety, phobic symptoms

more common than depressive moodmore common than depressive mood Early detection is important, so thatEarly detection is important, so that

mother/infant relationship is well establish formother/infant relationship is well establish for

cognitive and emotional development of infantcognitive and emotional development of infant

Treatment : antidepressantTreatment : antidepressant


20/22


Menstrual disorderMenstrual disorderPremenstrual syndromePremenstrual syndrome

MenopauseMenopause


21/22


Premenstrual syndromePremenstrual syndrome

Refers to psychologicalRefers to psychological (anxiety, irritability, depression)(anxiety, irritability, depression)and physicaland physical ( breast tenderness, abdominal discomfort,( breast tenderness, abdominal discomfort,feeling of distension)feeling of distension) symptoms few days before andsymptoms few days before andend shortly after onset of menstrual periodend shortly after onset of menstrual period

Physiological changes around menstruation mayPhysiological changes around menstruation mayexacerbate psychological symptomsexacerbate psychological symptoms

Treatment :Treatment :

Biological : progestrone, OCP, bromocriptine,Biological : progestrone, OCP, bromocriptine,psychotrophic drugspsychotrophic drugs Psychosocial : cognitive behavioral therapy andPsychosocial : cognitive behavioral therapy and

psychological supportpsychological support


22/22

Date post:	30-May-2018
Category:	Documents
Upload:	burd2008
View:	222 times
Download:	0 times

Liaison Psychiatry

Documents