Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

; Fiona Gaughran ; Toby Pillinger

Learn to improve your assessment, investigation, and management of physical health conditions in people with severe mental illness


The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry offers psychiatric and general practitioners an evidence-based and practical guide for the appropriate assessment, investigation, and management of common physical health conditions seen in people with severe mental illness. Les mer
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Learn to improve your assessment, investigation, and management of physical health conditions in people with severe mental illness


The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry offers psychiatric and general practitioners an evidence-based and practical guide for the appropriate assessment, investigation, and management of common physical health conditions seen in people with severe mental illness. Written by a renowned team of respected experts in medicine, surgery, pharmacy, dietetics, physiotherapy, and psychiatry, the book bridges the gap between psychiatric and physical health services for the severely mentally ill.


The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry also provides practitioners with expert guidance on making effective referrals to other medical and surgical subspecialties, telling readers what information subspecialties would expect to receive. Its use will improve the quality of clinical care received by mentally ill patients and, by promoting a holistic approach to treatment that considers both body and mind, will enhance the therapeutic relationship between patient and practitioner.


The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry covers the following:





Guidance on assessment and management of well over a hundred different medical and surgical presentations commonly seen in people with serious mental illness

Management of physical health emergencies in a psychiatric setting

Evidence-based approaches to management of physical side effects of psychiatric medications

Advice on approaches to promote a healthy lifestyle in people with serious mental illness, such as smoking cessation and changes to diet and physical activity



Perfect for both psychiatrists and general practitioners who wish to improve the quality of care they provide to people with serious mental illness, The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry will be of use to anyone setting out to navigate the divide between the treatment of psychiatric and physical health conditions.


Fakta

Innholdsfortegnelse

Preface xxiii


List of Abbreviations xxv


Part 1 Cardiology 1


Chapter 1 Tachycardia 3
Guy Hindley, Eromona Whiskey, Nicholas Gall


Sinus tachycardia 3


Atrial fibrillation 4


Supraventricular tachycardia 4


Ventricular tachycardia 6


Diagnostic principles 6


Management 10


References 14


Chapter 2 Bradycardia 17
Eleanor Croft, Nicholas Gall


Diagnosis 19


Management and when to refer to a specialist 21


References 22


Chapter 3 QT Interval Prolongation 23
Guy Hindley, Nicholas Gall


Prescribing QTc?prolonging medication 27


Diagnostic principles 28


Management 29


References 32


Chapter 4 Syncope 35
Luke Vano, Nicholas Gall


Causes of syncope 35


Syncope and serious mental illness 36


Diagnostic principles 36


Diagnosis and management 38


References 39


Chapter 5 Hypertension 41
Luke Vano, Toby Pillinger, J. Kennedy Cruickshank


Diagnostic principles 43


Diagnosis 44


Management 45


References 48


Chapter 6 Postural Hypotension 51
Toby Pillinger, Ian Osborne, Thomas Ernst, J. Kennedy Cruickshank


Diagnostic principles 53


Management 54


References 58


Chapter 7 Peripheral Oedema 59
Thomas Whitehurst, Theresa McDonagh


Diagnostic principles 60


Management 66


References 67


Chapter 8 Myocarditis 71
Thomas Whitehurst, Theresa McDonagh


Diagnostic principles 71


Management 75


Clozapine?induced myocarditis 75


References 77


Chapter 9 Hypercholesterolaemia 79
Dipen Patel, Toby Pillinger, Narbeh Melikian


Diagnostic principles 80


Diagnostic criteria 81


Management 81


References 84


Chapter 10 Physical Activity 85
Garcia Ashdown-Franks, Brendon Stubbs


Physical activity and serious mental illness 85


How much physical activity and exercise should people be doing? 86


Practical tips 87


Messages to include in discussions with patients 87


References 88


Part 2 Endocrinology 91


Chapter 11 Diabetes Mellitus 93
Yuya Mizuno, Toby Pillinger, Dan Siskind, Sophie Harris


Diagnostic principles 93


Management 97


References 102


Chapter 12 Thyroid Disease 105
Harriet Quigley, Jackie Gilbert


Hypothyroidism 105


Diagnostic principles 107


Management 110


Hyperthyroidism 111


Diagnostic principles 112


Management 113


References 114


Chapter 13 Hyperprolactinaemia 117
John Lally, Toby Pillinger, Olubanke Dzahini, Sophie Harris


Diagnostic principles 119


Management and when to refer to a specialist 121


Hyperprolactinaemia and osteoporosis risk in serious mental illness 122


Hyperprolactinaemia and cancer risk 123


References 123


Chapter 14 Obesity 125
Yuya Mizuno, Toby Pillinger, Dan Siskind, Ian Osborne, Kate Moffat, Donal O'Shea


Monitoring 127


Prevention and treatment of weight gain 129


References 134


Part 3 Haematology 137


Chapter 15 Anaemia 139
Sanjena Mithra, Aleksander Mijovic


Diagnostic principles 140


Management and referral pathways 143


References 145


Chapter 16 Neutropenia 147
John Lally, Toby Pillinger, Aleksander Mijovic


Drug?induced neutropenia and agranulocytosis 149


Diagnostic principles 150


Management 151


References 153


Chapter 17 Thrombocytopenia 155
Sanjena Mithra, Aleksander Mijovic


Diagnostic principles 156


Management and when to refer 158


References 158


Chapter 18 Venous Thromboembolism and Anticoagulation 159
Helen Doolittle, Lara Roberts, Roopen Arya


Risk factors 159


Prophylaxis 161


Diagnosis 162


Management 164


References 168


Part 4 Gastroenterology 169


Chapter 19 Gastro?oesophageal Reflux and Peptic Ulcer Disease 171
Luke Vano, Seema Varma, John O'Donohue


Gastro?oesophageal reflux disease 171


Peptic ulcer disease 176


References 178


Chapter 20 Gastrointestinal Bleeding 181
Douglas Corrigall, David Dewar


Diagnostic principles 183


Management 185


References 188


Chapter 21 Nausea and Vomiting 191
Mary Denholm, Matthew Cheetham


Diagnostic principles 193


Management 195


References 198


Chapter 22 Dysphagia 199
Mary Denholm, Jason Dunn


Causes of dysphagia in the general population 199


Diagnostic principles 200


Management 203


Oesophageal cancer in psychiatric populations 203


Dysphagia in the elderly 204


References 204


Chapter 23 Deranged Liver Function Tests 207
John Lally, Aisling Considine, Kosh Agarwal


Diagnostic principles 207


Management 212


References 213


Chapter 24 Alcohol and Physical Health 215
Musa Sami, Joseph Cooney, Michael Heneghan


What is harmful use? 215


Physical complications of alcohol use 216


Approach to the patient with suspected alcohol misuse 217


Management 220


References 222


Chapter 25 Unintentional Weight Loss 223
Mary Denholm, John O'Donohue


Diagnostic principles 225


Management 227


References 227


Chapter 26 Dry Mouth 229
Enrico D'Ambrosio, Andrea Falsetti, Stephen Challacombe


Diagnostic principles 231


Management 231


References 232


Chapter 27 Hypersalivation 235
Enrico D'Ambrosio, Andrea Falsetti, Toby Pillinger, Stephen Challacombe


Diagnostic principles 235


Management 236


References 239


Chapter 28 Constipation 241
John Lally, Toby Pillinger, Kalliopi Vallianatou, Immo Weichert


Diagnostic principles 243


Management 244


References 249


Part 5 Renal and Urology 251


Chapter 29 Urinary Retention 253
Atheeshaan Arumuham, Vimoshan Arumuham


Urinary retention and serious mental illness 253


Diagnostic principles 254


Management 256


References 256


Chapter 30 Urinary Incontinence 259
Atheeshaan Arumuham, Vimoshan Arumuham


Diagnostic principles 261


Management 262


References 264


Chapter 31 Polyuria 267
Atheeshaan Arumuham, Toby Pillinger, Benjamin Whitelaw


Diagnostic principles 268


Management 269


References 271


Chapter 32 Sodium Derangement 273
Atheeshaan Arumuham, Peter Conlon


Diagnostic principles 274


Management 276


References 277


Chapter 33 Potassium Derangement 279
Ellis Onwordi, Peter Conlon


Hyperkalaemia 279


Hypokalaemia 282


References 285


Chapter 34 Chronic Kidney Disease 287
Ellis Onwordi, Toby Pillinger, Anne Connolly, Peter Conlon


Diagnostic principles 289


Management 291


References 295


Part 6 Sexual and Reproductive Health 297


Chapter 35 Sexual Dysfunction 299
Rudiger Pittrof


Assessment of a patient with sexual dysfunction 299


Management 301


References 304


Chapter 36 Contraception 307
Neha Pathak, Usha Kumar


Clinical approach 308


Contraceptive options 308


Ethical and legal considerations 312


When to refer 313


Special considerations in patients with serious mental illness 313


References 314


Chapter 37 Infertility 317
Rudiger Pittrof


Addressing infertility in psychiatric practice 317


Onward referral and further tests for infertility 318


Infertility treatments 318


References 318


Chapter 38 Sexually Transmitted Infection 319
Harriet Le Voir, Rudiger Pittrof


History 319


STI testing in psychiatry 320


Determining urgency of clinical action/referral 321


Referral to sexual health services 322


References 324


Part 7 Infectious Diseases 325


Chapter 39 Pneumonia 327
Emma McGuire, Loren Bailey, Peter Saunders, Meera Chand


Pneumonia and serious mental illness 329


Diagnostic principles 329


Management 332


References 335


Chapter 40 Influenza 337
Anna Riddell, Eithne MacMahon


Diagnostic principles 338


Management 339


Preventing spread of influenza 341


References 342


Chapter 41 Urinary Tract Infection 343
Sian Cooper, Conor Maguire


Urinary tract infection and serious mental illness 344


Diagnostic principles 344


Management 347


References 350


Chapter 42 Gastroenteritis 351
Maria Krutikov, Luke Snell


Diagnostic principles 351


Management 354


References 356


Chapter 43 Viral Hepatitis 357
Klara Doherty, Aisling Considine, Kosh Agarwal


Hepatitis B 357


Hepatitis C 361


References 364


Chapter 44 Tuberculosis 365
Sakib Rokadiya, Adrian R. Martineau


Diagnostic principles 366


Management 369


References 371


Chapter 45 Human Immunodeficiency Virus 373
Rebecca Marcus, Jessica Gaddie, Toby Pillinger, Ben Spencer, Kalliopi Vallianatou, Rudiger Pittrof


Testing for HIV 374


HIV and the central nervous system 374


Antiretroviral therapy 375


References 380


Part 8 Respiratory 383


Chapter 46 Smoking Cessation 385
Harriet Quigley, Mary Yates, John Moxham


Identifying those who want to stop smoking and degree of nicotine dependence 385


Approaches to smoking cessation 387


References 392


Chapter 47 Chronic Obstructive Pulmonary Disease 395
Mary Docherty, Jenny Docherty, Peter Saunders


Common causes of COPD in the general population and patients with serious mental illness 395


The asthma-COPD overlap 396


Diagnostic principles 397


Management 400


References 403


Chapter 48 Asthma 405
Mary Docherty, Jenny Docherty, Peter Saunders


Causes in the general population and people with serious mental illness 405


Diagnostic principles 406


Management 409


References 412


Chapter 49 Obstructive Sleep Apnoea 413
Nicholas Meyer, Hugh Selsick, Kai Lee


Diagnostic principles 414


Management 415


References 416


Part 9 Neurology 419


Chapter 50 Delirium 421
Luke Jelen, Sean Cross


Diagnostic principles 421


Management 426


References 429


Chapter 51 Autoimmune Encephalitis 431
Adam Al-Diwani, Julia Thompson, Sarosh Irani


Autoimmune disease mechanisms 431


Clinical approach 432


Management 437


References 439


Chapter 52 Catatonia 441
Jonathan P. Rogers, Ali Amad


Diagnostic principles 442


Management 444


References 448


Chapter 53 Seizure Disorders 451
Emanuele F. Osimo, Brian Sweeney


Acute seizure 452


Psychiatric comorbidity in people with epilepsy 455


Psychiatric side effects of antiepileptic drugs 457


Psychiatric drug therapy in people with epilepsy 457


Psychogenic non?epileptic seizures 458


Epilepsy surgery 459


Epilepsy and learning disability 459


References 459


Chapter 54 Headache 461
Ines Carreira Figueiredo, Nazia Karsan, Peter Goadsby


Diagnostic principles 463


Management 466


References 468


Chapter 55 Disorders of Sleep and Circadian Rhythm 471
Nicholas Meyer, Hugh Selsick


Definitions of common sleep disorders in psychiatric populations 471


Diagnostic principles 474


Management 476


References 477


Chapter 56 Extrapyramidal Side Effects 479
Graham Blackman, R. John Dobbs, Sylvia Dobbs


Clinical approach 480


Management 482


References 483


Chapter 57 Tardive Dyskinesia 485
Graham Blackman, Toby Pillinger, R. John Dobbs, Sylvia Dobbs


Clinical approach 486


Management 487


References 489


Chapter 58 Tremor 491
Graham Blackman, R. John Dobbs, Sylvia Dobbs


Clinical approach 491


Management 494


References 496


Part 10 Rheumatology and Musculoskeletal Health 497


Chapter 59 Low Back Pain 499
Jennifer Ireland, Matthew Cheetham


Diagnostic principles 500


Management 502


References 503


Chapter 60 Arthritis 505
Sarah Griffin, Joseph Nathan, Richard Campbell


Clinical approach 510


Management 512


References 512


Part 11 Ophthalmology 515


Chapter 61 Eye Disease 517
Ernest Iakovlev, Radwan Almousa


Clinical approach to a patient with visual disturbance or orbital/periorbital disorders 517


Disorders of the eyelids 522


Disorders of the conjunctiva 526


Disorders of the cornea 529


References 533


Part 12 Obstetrics and Gynaecology 535


Chapter 62 Pregnancy 537
Katherine Beck, Ruth Cochrane, Louise M. Howard


The pre?conception period 538


During pregnancy 539


Psychiatric medication in pregnancy 543


Postpartum psychosis 547


Electroconvulsive therapy in pregnancy 547


References 548


Chapter 63 Menopause 551
Deirdre Lundy


Physiology and symptoms of perimenopause 551


Clinical approach 552


Treatment 553


References 556


Part 13 Dermatology 559


Chapter 64 General Dermatology 561
Jonathan Kentley, Ruth Taylor, Anthony Bewley


Infectious skin disease 561


Non?infectious skin disease 564


References 566


Chapter 65 Psychodermatology 569
Jonathan Kentley, Ruth Taylor, Anthony Bewley


Psychiatric disorders with skin manifestations 569


Psychophysiological conditions 571


Secondary psychological disorders 571


Cutaneous sensory disorders 572


References 572


Part 14 Electroconvulsive Therapy 573


Chapter 66 Electroconvulsive Therapy 575
James Kelly, Mariese Cooper, Mario Juruena


Indications and contraindications 575


The ECT procedure 576


Physiological effects of ECT 576


Pre?ECT assessment 578


Safety of ECT 579


ECT prescribing 579


Guidance for the doctor administering ECT 579


Side effects of ECT 580


Special patient groups 581


References 581


Part 15 Emergencies 583


Chapter 67 Chest Pain 585
Luke Vano, Immo Weichert


Diagnostic principles 586


Management 590


Information to provide in a 'chest pain' referral to medical services 591


References 591


Chapter 68 Acute Shortness of Breath 593
Martin Osugo, Toby Pillinger, Vivek Srivastava


Diagnostic principles 593


Management 595


References 596


Chapter 69 Acute Coronary Syndrome 597
Laura O'Sullivan, Narbeh Melikian


Diagnostic principles 598


Management 602


References 603


Chapter 70 Arrhythmia 605
Martin Osugo, Nicholas Gall


Tachycardia 605


Bradycardia 605


Reference 608


Chapter 71 Hypertensive Crisis 609
Luke Vano, J. Kennedy Cruickshank


Diagnostic principles 609


Management 610


References 611


Chapter 72 Sepsis 613
Laura O'Sullivan, Immo Weichert


When to think sepsis 613


Septic shock 614


Management 614


Post?sepsis syndrome 615


References 616


Chapter 73 Acute Kidney Injury 617
Phillipa Brothwood, Toby Pillinger, Anne Connolly, Peter Conlon


Categorisation of acute kidney injury 617


Diagnostic principles 620


Management 622


Psychiatric medication and acute kidney injury 622


References 623


Chapter 74 Diabetic Emergencies 625
Toby Pillinger, Yuya Mizuno, Sophie Harris


Hypoglycaemia 625


Diabetic ketoacidosis 626


Hyperosmolar hyperglycaemic state 627


References 627


Chapter 75 Acute Upper Gastrointestinal Bleeding 629
Douglas Corrigall, David Dewar


Signs of acute upper gastrointestinal bleeding 629


Waiting for transfer 629


Handing over to the acute medical team 630


Chapter 76 Status Epilepticus 631
Emanuele F. Osimo, Brian Sweeney


Chapter 77 Anaphylaxis 633
James Kelly, Immo Weichert


Management 633


References 636


Chapter 78 Reduced Consciousness and Coma 637
James Kelly, Immo Weichert


Clinical approach 637


References 640


Chapter 79 Thyroid Emergencies 641
Harriet Quigley, Jackie Gilbert


Hypothyroid crisis/myxoedema coma 641


Hyperthyroid crisis/thyroid storm 642


References 643


Chapter 80 Head Injury 645
Susie Bradwell, Sophie Williams, Joanna Manson


Clinical approach 645


Types of intracranial haemorrhage 649


References 650


Chapter 81 Acute Meningitis and Infective Encephalitis 651
Hina Khan, Brian Sweeney


Meningitis 651


Infective encephalitis 653


References 655


Chapter 82 Stroke and Transient Ischaemic Attack 657
Toby Pillinger, James Teo


Stroke 657


Diagnostic principles 658


Management 659


Transient Ischaemic Attack 660


Diagnostic principles 660


Management 661


References 661


Chapter 83 Overdose 663
Stephen Kaar, Immo Weichert


General principles 663


Information gathering 664


Emergency assessment and management 664


Specific scenarios 667


Management of a person who refuses admission to hospital after an overdose 670


References 670


Chapter 84 Acute Dystonia 673
Jonathan P. Rogers, R. John Dobbs, Sylvia Dobbs


Diagnostic principles 673


Management 675


References 677


Chapter 85 Neuroleptic Malignant Syndrome 679
Robert A. McCutcheon, James Kelly, Toby Pillinger


Diagnostic principles 679


Management 680


References 681


Chapter 86 Serotonin Syndrome 683
Robert A. McCutcheon, James Kelly, Toby Pillinger


Diagnostic principles 683


Management 684


References 685


Chapter 87 Emergencies in Obstetrics and Gynaecology 687
Hanine Fourie, Ruth Cochrane


Maternal collapse 689


Pre?eclampsia 689


Major obstetric haemorrhage 691


Amniotic fluid embolism 691


Ectopic pregnancy 691


Miscarriage 693


Hyperemesis gravidarum 694


Ovarian cyst accidents 695


Pelvic inflammatory disease 697


References 697


Chapter 88 The Acute Abdomen 699
Sophie Williams, Joanna Manson


History 699


Causes of the acute abdomen based on pain location 702


Examination 705


Investigations 706


Onward referral 706


References 707


Chapter 89 The ABCDE Approach 709
Toby Pillinger, Immo Weichert


First steps 709


Airway (A) 711


Breathing (B) 711


Circulation (C) 711


Disability (D) 711


Exposure (E) 712


References 712


Index 713

Om forfatteren

David M. Taylor, BSc, MSc, PhD, FCMHP, FFRPS, FRPharmS, FRCP (Edin), is Director of Pharmacy and Pathology at the Maudsley Hospital; Professor of Psychopharmacology at King's College, London, UK.
Fiona Gaughran, MD, FRCP(I), FRCP (Lon), FRCP (Edin), FRCPsych, FHEA, is Director of Research and Development at South London and Maudsley NHS Foundation Trust, where she is Lead Consultant for the National Psychosis Service; Reader in Psychopharmacology and Physical Health at King's College, London, UK.
Toby Pillinger, MA (Oxon), BM BCh, MRCP, PhD, is an Academic Clinical fellow at the Institute of Psychiatry, Psychology and Neuroscience, King's College, London; South London and Maudsley NHS Foundation Trust, London, UK.