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Handbook of Liaison Psychiatry
Cambridge University Press
978-0-521-82637-2 - Handbook of Liaison Psychiatry - by Geoffrey Lloyd and Elspeth Guthrie
Front Matter

Handbook of Liaison Psychiatry



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 presenting to primary care physicians. The Handbook of Liaison Psychiatry is a comprehensive reference book for this fast growing subspeciality. 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 hospital 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.

Geoffrey Lloyd is Visiting Consultant Psychiatrist at the Priory Hospital North London.

Elspeth Guthrie is Honorary Professor of Psychological Medicine and Medical Psychotherapy at the University of Manchester, and Consultant in Psychological Medicine at the Manchester Royal Infirmary.





Handbook of Liaison Psychiatry


Edited by

Geoffrey Lloyd

and

Elspeth Guthrie





CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo

Cambridge University Press
The Edinburgh Building, Cambridge CB2 2RU, UK

Published in the United States of America by Cambridge University Press, New York

www.cambridge.org
Information on in this title: www.cambridge.org/9780521826372

© Cambridge University Press 2007

This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press.

First published 2007

Printed in the United Kingdom at the University Press, Cambridge

A catalogue record for this publication is available from the British Library

Library of Congress Cataloguing in Publication data

Handbook of liaison psychiatry / edited by Geoffrey Lloyd and Elspeth Guthrie.
  p. ; cm.
 Includes bibliographical references and index.
 ISBN-13: 978-0-521-82637-2 (hardback)
 ISBN-10: 0-521-82637-3 (hardback)
 1. Consultation-liaison psychiatry–Handbooks, manuals, etc. I. Lloyd, Geoffrey Gower. II. Guthrie, Elspeth.
 [DNLM: 1. Psychiatry–methods. 2. Referral and Consultation. WM 64 H2355 2007] III. Title.

 RC455.2.C65H36 2007
 616.89–dc22
                            2006100689

ISBN-13 978-0-521-82637-2 hardback
ISBN-10 0-521-82637-3 hardback


Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.





Contents





List of contributorspage ix
Prefacexiii
Part IBasic skills

 1The development of general hospital psychiatry3
Richard Mayou
 
 2Establishing a service24
Stella Morris
 
 3Legal and ethical issues in liaison psychiatry47
Eleanor Feldman
 
 4Understanding psychological reactions to physical illness64
Geoffrey Lloyd
 
 5Detection of psychiatric disorders in the general hospital83
Damien Longson
 
 6The role of the nurse in liaison psychiatry102
Anthony Harrison
 
Part IICommon psychiatric problems across the general hospital

 7Functional somatic syndromes125
Lisa Page and Simon Wessely
 
 8Alcohol problems in the general hospital149
Jonathan Chick
 
 9Drug misuse in medical patients180
 
Ilana Crome and Hamid Ghodse
10Sexual problems in medical patients221
Michael King
 
11Suicide and deliberate self-harm245
Julia Sinclair and Keith Hawton
 
12Delirium270
Paul Gill, Marco Rigatelli and Silvia Ferrari
 
13Childhood experiences290
Mark Berelowitz
 
Part IIIWorking with specific units

14Neurological disorders305
Alan Carson, Adam Zeman, Lynn Myles and Michael Sharpe
 
15Cardiorespiratory disorders365
Christopher Bass
 
16Gastrointestinal disorders390
Elspeth Guthrie
 
17Liver disorders416
Geoffrey Lloyd
 
18Endocrine disorders432
Antonio Lobo, M. Jesús Pérez-Echeverría and Antonio Campayo
 
19Diabetes454
Khalida Ismail and Robert Peveler
 
20HIV and AIDS474
Russell Foster and Ian Everall
 
21Renal disease506
Janet Butler
 
22Musculo-skeletal disorders527
Chris Dickens and Graham Ash
 
23Oncology547
Geoffrey Lloyd
 
24Head and neck cancer564
Gerry Humphris
 
25Palliative care592
Matthew Hotopf and Max Henderson
 
26Cosmetic procedures617
David Veale
 
27Perinatal and gynaecological disorders632
Kathryn M. Abel
 
28The intensive care unit673
Simon Turner, Daniel Conway, Jane Eddleston and Elspeth Guthrie
 
29The burns unit697
Jonathan I. Bisson
 
30Psychocutaneous disorders714
Nora Turjanski
 
31Genitourinary disorders733
David Osborn
 
32The emergency department751
Andrew Hodgkiss
 
Part IVTreatment

33Psychopharmacological treatment in liaison psychiatry763
Ulrik Fredrik Malt and Geoffrey Lloyd
 
34The role of psychological treatments795
Elspeth Guthrie and Tom Sensky
 
35Problem cases818
Damien Longson and Sarah Burlinson
 
Part VDifferent treatment settings

36Developing links with primary care847
Richard Morriss, Linda Gask, Christopher Dowrick, Peter Salmon and Sarah Peters
 
37Frequent attenders in primary care871
Navneet Kapur
 
38Major disaster planning896
Jonathan I. Bisson, Jim Bolton, Kevin Mackway-Jones and Elspeth Guthrie
Index913




List of contributors



EDITORS
Geoffrey Lloyd
Priory Hospital North London
Elspeth Guthrie
University of Manchester


CONTRIBUTORS
Kathryn Abel
University of Manchester

Graham Ash
Ormskirk & District General Hospital

Christopher Bass
John Radcliffe Hospital, Oxford

Mark Berelowitz
Royal Free Hospital, London

Jonathan Bisson
University of Wales Hospital, Cardiff

Jim Bolton
St Helier Hospital, Surrey

Sarah Burlinson
Royal Oldham Hospital

Janet Butler
University of Southampton

Antonio Campayo
University of Zaragoza

Alan Carson
University of Edinburgh

Jonathan Chick
Royal Edinburgh Hospital

Daniel Conway
Manchester Royal Infirmary

Ilana Crome
Keele University Medical School (Harplands Campus), Stoke on Trent

Chris Dickens
University of Manchester

Christopher Dowrick
University of Liverpool

Jane Eddleston
Manchester Royal Infirmary

Ian Everall
University of California, San Diego

Eleanor Feldman
John Radcliffe Hospital, Oxford

Silvia Ferrari
Universita de Modena

Russell Foster
Institute of Psychiatry, King’s College London

Linda Gask
University of Manchester

Hamid Ghodse
St George’s Hospital Medical School, University of London

Paul Gill
The Longley Centre, Sheffield

Elspeth Guthrie
University of Manchester

Anthony Harrison
Avon and Wiltshire Partnership Mental Health NHS Trust, Bath

Keith Hawton
University of Oxford

Max Henderson
Institute of Psychiatry, King’s College London

Andrew Hodgkiss
St Thomas’ Hospital, London

Matthew Hotopf
Institute of Psychiatry, King’s College London

Gerry Humphris
University of St Andrews

Khalida Ismail
Institute of Psychiatry, King’s College, London

Navneet Kapur
University of Manchester

Michael King
Royal Free & University College Medical School, London

Geoffrey Lloyd
Priory Hospital North London

Antonio Lobo
University of Zaragoza

Damien Longson
North Manchester General Hospital

Kevin Mackway-Jones
Manchester Royal Infirmary

Ulrich Frederick Malt
University of Oslo

Richard Mayou
University of Oxford

Stella Morris
Hull Royal Infirmary

Richard Morriss
University of Nottingham

Lyn Myles
University of Edinburgh

David Osborn
Royal Free and University College Medical School, London

Lisa Page
Institute of Psychiatry, Kings College London

M. Jesús Pérez-Echeverría
University of Zaragoza

Sarah Peters
University of Liverpool and Royal Liverpool Hospital

Robert Peveler
University of Southampton

Marco Rigatelli
Universita de Modena

Peter Salmon
University of Liverpool

Tom Sensky
West Middlesex University Hospital

Michael Sharpe
University of Edinburgh

Julia Sinclair
University of Oxford

Nora Turjanski
Royal Free Hospital, London

Simon Turner
Stepping Hill Hospital, Stockport

David Veale
Institute of Psychiatry, King’s College London; Priory Hospital North London

Simon Wessely
Institute of Psychiatry, King’s College London

Adam Zeman
Peninsula Medical School, Universities of Exeter and Plymouth





Preface



The provision of psychiatric services to general hospitals has increased considerably during the last 10 years. New consultant posts have been created, multidisciplinary teams have been established and junior doctors are acquiring experience in an area of psychiatry hitherto denied them. Clinical psychologists have long made significant contributions to this field. They have recently been joined by an expanding number of nurses who have made major improvements particularly to the management of patients with acute behavioural disturbances and of those who have deliberately harmed themselves. But expansion has been uneven, concentrated on university-linked hospitals and dependent on the creative energies of individual clinicians. Many district hospitals in the UK and elsewhere still have a very rudimentary psychiatric service even though the high prevalence of psychiatric disorders in general hospital patients is now widely acknowledged.

This area of clinical practice is known by various terms – liaison psychiatry, consultation-liaison psychiatry, psychological medicine or psychosomatic medicine. Indeed the latter term has been revived by the American Board of Medical Specialties which now recognizes it as a new psychiatric subspeciality with its own training programme and certification examination. Whatever term is used in a particular country the clinical problems are similar, being concerned with the diagnosis and management of patients with combined medical and psychiatric problems and those whose psychiatric disorder presents with physical symptoms. The ultimate goal is to improve the quality of care and the outcome of patients attending general hospitals.

This book aims to provide clinicians from a variety of backgrounds with sufficient information to develop the necessary skills. It covers a wide range of medical specialities and clinical settings. It is concerned predominantly with adult patients although the implications of illness on children are also considered. Within the adult population no age discrimination is made. Our aim has been to cover psychiatric problems throughout the entire spectrum from early adulthood to old age. We have also aimed to transcend national boundaries and hope the book will be relevant to clinicians wherever they practise.

The pattern of medical care is changing steadily. More treatment is being conducted in day-patient or outpatient facilities. Those who are admitted to hospital stay for a shorter duration than was the case only a few years ago. These changes create problems for liaison psychiatrists and the provision of treatment needs to evolve accordingly. More clinical work will be provided in outpatient clinics, in conjunction with specialists from other disciplines. Treatment commenced in a hospital environment will be continued in primary care alongside the patient’s primary care doctor. However, whatever the setting, the diagnostic and therapeutic skills required remain the same.

A further challenge for liaison psychiatry arises from uncertainties about the funding and management of clinical services. Where medical and psychiatric services are funded separately it is not clear which budget should fund liaison psychiatry. There is a danger that liaison psychiatry will be neglected unless the case for the service is presented persuasively to comissioners. A model which works in one hospital or community setting may not be appropriate in another. Arrangements need to be made which are flexible and responsive to local requirements. It is important that for each service a managerial and funding policy is established, which is agreed by managers of medical and psychiatric services and by those responsible for commissioning healthcare in general.

Although we intend the book to have an international appeal it undoubtedly has a British emphasis with significant contributions from continental Europe. We believe its contents reflect liaison psychiatry as it is currently practised in many parts of the world. We hope it will help clinicians to develop services further and particularly to establish services where none exist at present.

GEOFFREY LLOYD, London

ELSPETH GUTHRIE, Manchester
June 2006


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