Massachusetts General Hospital Handbook of General Hospital Psychiatry: Expert Consult - Online and Print (Expert Consult Title: Online + Print), 6 Ed

Cover......Page 1
Front Matter......Page 2
ISBN     9781437719277......Page 3
Copyright
......Page 4
Dedication......Page 5
Contributing Authors......Page 8
Preface......Page 14
History......Page 15
Teaching......Page 17
Summary......Page 18
References......Page 19
Psychological Reactions to Medical Conditions or Treatments......Page 21
Clinical Approach......Page 22
Speak Directly with the Referring Clinician......Page 23
Interview and Examine the Patient......Page 24
Formulate a Diagnosis and Management Plan......Page 25
Drug–Drug Interactions......Page 26
Adverse Effects......Page 27
References......Page 28
Unique Aspects of the  Doctor–Patient Relationship in The General Hospital......Page 29
The Optimal Healing Environment: Patient-Centered Care......Page 30
Collaboration Around 
History-Taking......Page 31
Effective Clinical Interviewing......Page 32
Planning The Path Forward: Creating a Clinical Formulation......Page 33
Obstacles and Difficulties in The Doctor–Patient Relationship......Page 34
Conclusion......Page 35
References......Page 36
Lessons from Attachment Theory, Narrative Medicine, and Mindful Practice......Page 39
The Setting......Page 40
The Situation......Page 41
Establishing an Alliance and Fostering Effective Communication......Page 42
Building the Relationship and Therapeutic Alliance......Page 43
Behavioral Observation......Page 44
Presenting Problems......Page 45
Past Medical History......Page 46
The Mental Status Examination......Page 47
Sharing Information and Preparing the Patient for Treatment......Page 48
Disagreements about Assessment and Treatment......Page 50
References......Page 51
Functional Neuroanatomy......Page 53
Peripheral Sensory Examination......Page 54
Optic Nerve (Cranial Nerve II)......Page 55
The Mental Status Examination......Page 56
Motor Examination......Page 57
References......Page 58
Mind–Brain......Page 59
History of the Limbic System......Page 60
Psychologists’ Views......Page 61
Amygdala......Page 62
Clinical Aspect of the Limbic System......Page 63
References......Page 64
Test of Intelligence......Page 67
Tests of Personality, Psychopathology, and Psychological Function......Page 69
Neuropsychological Assessment......Page 70
Types of Neuropsychological Assessment......Page 71
Obtaining nnd Understanding Test Reports......Page 73
References......Page 74
Mood Disorders......Page 75
Anxiety Disorders......Page 76
Cognitive Disorders......Page 77
Routine Screening......Page 78
Mood Disorders and Affective Symptoms......Page 79
Substance Abuse......Page 80
The Electroencephalogram......Page 81
Computed Tomography......Page 82
PET and SPECT......Page 83
References......Page 84
Mood-Disordered Patients......Page 87
Major Depression......Page 88
Excluding Organic Causes of Depression......Page 90
Stroke......Page 91
Prescribing Antidepressants for the Medically III......Page 92
Anticholinergic Effects......Page 94
Myocardial Depression......Page 96
Use of Lithium Carbonate in the Medically III......Page 97
Bereavement......Page 98
Management of Post-Acute Despondencies: Planning for Discharge and After......Page 99
Geriatric Implications......Page 101
References......Page 103
Diagnosis......Page 107
Differential Diagnosis......Page 108
The Examination of the Patient......Page 111
Specific Management Strategies for Delirium......Page 112
Drug Management......Page 113
Delirium in Specific Diseases......Page 115
References......Page 116
Diagnosis......Page 119
Alzheimer’s Disease......Page 121
Dementia Caused by Other Medical Conditions......Page 122
History......Page 123
Medical and Neurologic Examination......Page 124
Bedside Cognitive Assessment......Page 125
Treatment Considerations......Page 126
Pharmacotherapy for Cognitive Symptoms......Page 128
Pharmacotherapy for Neuropsychiatric Symptoms......Page 129
References......Page 131
Diagnostic Evaluation......Page 133
Clinical Pictures And Corresponding Problems 
on The Medical Ward......Page 136
The Patient with Negative Symptoms 
or Neurocognitive Deficits......Page 137
General Considerations......Page 138
Extrapyramidal Side Effects and 
Tardive Dyskinesia......Page 139
Second-Generation Antipsychotics......Page 140
Drug Interactions with Antipsychotic Agents......Page 141
Polydipsia (Water Intoxication)......Page 142
References......Page 143
The Nature And Origin Of Anxiety......Page 147
Anxiety In The Medical Setting......Page 149
Anxiety That Results from Traumatic Procedures......Page 150
Anxiety That Interferes with Evaluation or Treatment......Page 151
Medical Illness That Mimics Anxiety Disorder......Page 152
Anxiety That Mimics Medical Illness......Page 154
Panic Disorder......Page 156
Posttraumatic Stress Disorder......Page 157
Other Psychiatric Disorders......Page 158
Pharmacologic Treatment of Panic Disorder......Page 159
Benzodiazepines......Page 160
Pharmacologic Treatment 
of Generalized Anxiety......Page 161
Pharmacologic Alternatives to Benzodiazepines......Page 162
References......Page 163
Management......Page 167
Alcoholic Coma......Page 168
Diagnosis......Page 169
Prediction......Page 170
Diagnosis......Page 171
Korsakoff’s Psychosis......Page 172
Referral After Hospitalization......Page 173
References......Page 175
Management......Page 177
Club Drugs......Page 178
Narcotics......Page 179
Patterns of Chronic Use Versus Abuse......Page 181
Abuse......Page 182
Treatment for Withdrawal......Page 183
Inpatient Management and Referral......Page 184
Suggested Readings......Page 185
Anxiety Disorders......Page 187
Factitious Disorders......Page 188
Somatoform Disorders......Page 191
Functional Medical Syndromes......Page 197
Conclusion......Page 198
References......Page 199
Onset And Course......Page 203
Clinical Detection of an Occult Eating Disorder......Page 204
Differential Diagnosis......Page 206
Weight Assessment......Page 207
Engaging the Reluctant Patient......Page 208
Considerations in Initiating Treatment......Page 210
Medical Intervention for Eating Disorders......Page 211
Nutritional Rehabilitation......Page 213
Pharmacologic Management......Page 215
Treatment Of Patients With Bulimia Nervosa......Page 216
Treatment Of Patients With 
Binge-Eating Disorder......Page 218
Summary......Page 219
References......Page 220
Pathophysiology Of Pain......Page 225
Pain Terminology......Page 227
Measurement Of Pain......Page 229
Depression......Page 230
Conversion Disorder......Page 232
Pain Disorder......Page 233
Psychosis......Page 234
Placebo Response Accompanies 
a Variety of Syndromes......Page 235
Medication For Pain: Analgesia 
And Adjuvants......Page 236
Special Features......Page 237
Oral Potency......Page 238
Dosing......Page 239
Analgesic Adjuvants......Page 240
Reviews of Efficacy......Page 242
Antiepileptic Drugs......Page 243
Sympathetic Blockade......Page 244
Central Neuropathic Pain States......Page 245
Hypnosis......Page 246
References......Page 247
The Management Of Psychiatric Symptoms In Patients With Seizure Disorders......Page 251
Periictal Neuropsychiatric Phenomena......Page 252
Interictal (Chronic) Neuropsychiatric Phenomena......Page 254
Nonepileptic Seizures......Page 255
Clinical Considerations......Page 256
Cerebrovascular Disease......Page 257
Poststroke Depression......Page 258
Other Poststroke Psychiatric Phenomena......Page 260
Pathophysiology......Page 261
Mood and Anxiety Disorders......Page 262
Pharmacology......Page 263
References......Page 264
Parkinson’s Disease......Page 269
Depression in Parkinson’s Disease......Page 270
Psychosis in PD......Page 271
Wilson’s Disease......Page 272
Mood and Behavior......Page 273
Systemic Lupus Erythematosus......Page 274
Rheumatoid Arthritis......Page 275
Mood......Page 276
Psychosocial Interventions......Page 277
Bacterial Meningitis......Page 278
Human Immunodeficiency Virus Infection......Page 279
Lyme Meningitis......Page 280
References......Page 281
Definition......Page 287
Clinical Features and Diagnosis......Page 288
Clinical Features and Diagnosis......Page 292
Neuropathophysiology......Page 293
Management and Treatment......Page 295
Definition......Page 297
Clinical Features and Diagnosis......Page 298
Management and Treatment......Page 299
References......Page 300
Polysomnography......Page 303
Insomnia......Page 304
Treatment......Page 306
Treatment......Page 307
Circadian Rhythm Sleep Disorders......Page 308
Sleep-Related Movement Disorders......Page 309
Anxiety Disorders......Page 310
Substance-Induced Sleep Disorder......Page 311
Approach To The Patient With Disordered Sleep......Page 312
References......Page 314
Anxiety Among Cardiac Patients......Page 317
Association Between Anxiety and Cardiac Illness......Page 318
Psychopharmacologic Issues in the Anxious 
Cardiac Patient......Page 319
Approach to the Anxious Cardiac Patient......Page 320
Depression in Patients with Established Cardiac Illness......Page 322
Depression as a Risk Factor for 
Cardiac Disease......Page 323
Psychopharmacologic Issues in the Depressed Cardiac Patient......Page 324
Approach to the Management of the Depressed Cardiac Patient......Page 326
Delirium and Cardiac Disease......Page 327
Differential Diagnosis of Delirium 
in the Cardiac Patient......Page 328
Psychopharmacologic Issues in the 
Delirious Cardiac Patient......Page 329
The Practical Management of the Delirious Cardiac Patient......Page 330
References......Page 331
Epidemiology And Risk Factors......Page 337
Approach To Sexual History-Taking......Page 338
Male Disorders of Sexual Function......Page 339
Female Disorders of Sexual Function......Page 340
Sexual Dysfunction Disorders Affecting Both Genders......Page 341
Differential Diagnosis Of 
Sexual Disorders......Page 342
Premature Ejaculation......Page 343
Female Sexual Dysfunction......Page 344
Gender Identity Disorder......Page 346
Conclusion......Page 347
References......Page 348
The Need For Psychiatric Intervention......Page 351
Quality of Life and Choice of Renal Failure Therapy......Page 352
End-Stage Heart Disease......Page 353
Patient Selection and End-Stage Alcoholic 
Liver Disease......Page 354
Organ Donorship......Page 355
End-Stage Lung Disease......Page 356
Informed Consent......Page 357
Psychopharmacologic Treatment......Page 358
Psychiatrist’s Role......Page 359
Mechanisms for Increased Organ Donation......Page 360
Organic Brain Syndromes......Page 361
Long-Term Care......Page 362
References......Page 363
Epidemiology......Page 367
Hiv Infection and the Central Nervous System......Page 368
Integrase Inhibitors......Page 369
Other Medications......Page 370
Differential Diagnosis of Psychiatric Distress......Page 371
Depression......Page 372
Sleep......Page 374
Collaboration......Page 375
Individual Psychotherapy......Page 376
Antidepressants......Page 377
Depression......Page 378
Benzodiazepines......Page 379
Pain......Page 380
References......Page 381
Distress......Page 385
Psychosocial Interventions......Page 387
Anxiety Syndromes......Page 388
Fatigue......Page 389
Hyponatremia......Page 390
Cushing’s Syndrome......Page 391
Cognition and Sleep Changes Related to Chemotherapy or Hormonal Change......Page 392
References......Page 393
Epidemiology......Page 397
Risk Factors......Page 398
Infancy (Birth to 2.5 Years Old)......Page 399
Adolescence......Page 400
Acute Stress Disorder......Page 401
Opiates......Page 402
Drug Side Effects, Toxicity, and Adverse Interactions......Page 403
Body Image and Plastic and Reconstructive Surgery......Page 404
General Outcomes......Page 405
Chronic Pain......Page 406
References......Page 407
Problems That Occur during Rehabilitation......Page 411
Psychiatric Problems Common in Patients Undergoing Rehabilitation......Page 412
The Potential Impact of Disabling Neurologic Conditions on Psychiatric Diagnosis and Treatment......Page 413
Diagnostic Dilemmas......Page 415
Diagnosis and Treatment......Page 416
References......Page 417
The Psychiatrist In The Intensive Care Unit......Page 419
References......Page 422
Epidemiology of Psychiatric Disorders......Page 423
Gene-by-Environment Interactions......Page 424
Identification of Genes and Genomic Regions Linked to Psychiatric Disorders......Page 425
Selected Genetic Disorders......Page 426
Disorders Due to Chromosomal Abnormalities 
and Microdeletions......Page 427
Autosomal Dominant Single-Gene Disorders......Page 428
Assessment of the Patient for Metabolic Illness......Page 429
Autosomal Dominant Disorders......Page 430
Autosomal Recessive Disorders......Page 431
Mitochondrial Disorders......Page 432
Teratogen Exposure......Page 433
References......Page 434
Suggested Reading......Page 437
What Exactly Is Coping?......Page 439
What Interferes With Our Ability To Adapt To Illness?......Page 440
Coping And Social Support......Page 441
Assessment Of Vulnerability......Page 442
How To Find Out More About Coping......Page 443
How To Be A Better Coper......Page 444
References......Page 445
Indications......Page 447
Risk Factors For Adverse Events......Page 448
Technique......Page 449
References......Page 451
Initiating Treatment......Page 455
Selecting and Administering Medication......Page 456
Dosage......Page 457
Discontinuing Medications......Page 458
Absorption......Page 459
Metabolism......Page 460
Excretion......Page 462
Drug Interactions......Page 463
Antipsychotic Drugs......Page 464
Lithium......Page 466
Valproic Acid......Page 467
Lamotrigine......Page 468
Gabapentin and Pregabalin......Page 469
SSRIs and Other Newer Antidepressants......Page 470
Tricyclic Antidepressants......Page 471
Monoamine Oxidase Inhibitors......Page 472
Serotonin Syndrome......Page 473
Modafinil......Page 474
Medications for Psychotropic 
Drug Side Effects......Page 475
alpha2-Adrenergic Agonists......Page 476
References......Page 477
Medical Precautions And Contraindications......Page 481
Childhood Anxiety Disorders......Page 483
Akathisia......Page 484
Tic Disorders......Page 485
Methylphenidate......Page 486
Pemoline......Page 488
Mood, Anxiety, and Substance Abuse......Page 489
Atomoxetine......Page 490
Clonidine......Page 491
Depression......Page 492
Updates on Antidepressant-
Associated Suicidality......Page 493
Fluoxetine......Page 494
Paroxetine......Page 495
Pharmacokinetics of Antidepressants 
in Children and Adolescents......Page 496
Clinical Use of SSRIs......Page 497
Bipolar Disorder......Page 498
Carbamazepine......Page 499
Aripiprazole......Page 500
Developmental Disorders......Page 501
Psychotic Disorders......Page 502
Combined Agents......Page 503
References......Page 504
Stress......Page 513
Cognitive Coping......Page 514
Relaxation Training......Page 515
References......Page 516
Mood Disorders......Page 519
Premenstrual And Menopausal Symptoms......Page 521
Conclusion......Page 522
References......Page 523
Types of Difficult Patients......Page 525
Borderline Personality Disorder......Page 526
Difficult Behavior And The Consultee......Page 527
Helping the Consultee......Page 529
Consultant’s Role......Page 531
Medication......Page 532
Suicide Assessment......Page 533
Substance Abuse......Page 534
Brief Tactical Psychotherapy......Page 535
References......Page 538
Demographics......Page 541
The Psychiatric Interview......Page 542
The Safety Evaluation......Page 543
The Anxious Patient......Page 544
Opiates......Page 545
The Patient with a Change in Mental Status......Page 546
Management of Acute Symptoms......Page 547
Intervention with Medication......Page 548
Treatment After the Acute Crisis......Page 549
Demographics......Page 550
The Evaluation......Page 551
Civil Commitment......Page 552
References......Page 553
Psychiatric Risk Factors......Page 555
Medical Risk Factors......Page 557
Past and Present Suicidality......Page 558
Clinical Features and Diagnosis......Page 559
Treatment of Suicide Risk......Page 561
Difficulties in the Assessment 
of Suicide Risk......Page 563
References......Page 564
Suggested Readings......Page 568
Goals of Treatment......Page 569
Personality Considerations......Page 570
Psychosocial Considerations......Page 571
Principles......Page 572
Physician-Assisted Suicide......Page 573
References......Page 574
Developmental and Family-Centered Approach to Consultation......Page 579
Preschool Age......Page 580
Family-Centered Care......Page 581
Techniques of Child Psychiatric Consultation......Page 582
Depression......Page 583
Suicide Gestures and Attempts......Page 584
Somatoform Disorders......Page 585
Psychiatric Factors that Affect a 
Medical Illness......Page 586
Nonadherence......Page 587
Child Maltreatment......Page 588
Sexual Abuse......Page 589
Living With Chronic Illness......Page 590
Care at the end of life......Page 591
Future Considerations......Page 592
References......Page 593
Parental Illness: a Review of the Literature......Page 597
Childhood Coping......Page 598
Latency/School-Age Children (7–12)......Page 599
Communicating About Parental Illness......Page 600
Routines......Page 601
Saying Goodbye......Page 602
Funerals and Memorial Services......Page 603
Conclusion......Page 604
References......Page 605
Depression......Page 607
Delirium and Dementia......Page 608
Psychosis......Page 610
Anxiety......Page 611
Emergency Department Care......Page 612
References......Page 613
Definitions, Epidemiology, And Genetics......Page 615
Neuromodulators and Other Neuroactive Substances......Page 616
Medical Causes......Page 617
Impulse-Control Disorders......Page 618
Interview of the Potentially Violent Patient......Page 619
Examination of the Violent Patient......Page 620
Acute Medical Management......Page 621
References......Page 623
Diagnosis and Treatment of Mood Disorders During Pregnancy......Page 627
Using Antidepressants During Pregnancy......Page 628
Pharmacologic Treatment of Depression during Pregnancy: Clinical Guidelines......Page 629
Bipolar Disorder During Pregnancy......Page 631
Psychotic Disorders During Pregnancy......Page 632
Anxiety Disorders During Pregnancy......Page 633
Breast-Feeding And Psychotropic Drug Use......Page 634
Diagnosis......Page 635
Postpartum Panic Attacks and Obsessive–Compulsive Disorder......Page 636
References......Page 637
Determination of Cultural Explanations......Page 643
Acculturation and Immigration......Page 644
Working with Interpreters......Page 645
Recommendations When Working with Interpreters......Page 646
Biological Aspects of Psychopharmacology......Page 647
References......Page 650
Liability and Managed Care......Page 653
Confidentiality and Privacy......Page 654
Refusal to Treat Patients......Page 655
End-of-Life Care and Advance Directives......Page 656
Informed Consent and Evaluation 
of Competency......Page 657
Civil Commitment and Restraint......Page 660
Right to Refuse Treatment......Page 661
References......Page 662
Epidemiology......Page 665
Barriers to Treatment......Page 666
Roles, Relationships, and Expectations......Page 667
The Three-Component Model......Page 668
Collaborative Management......Page 669
Choosing the Right Model......Page 670
References......Page 671
Transference and Countertransference......Page 673
The Perception of Failure......Page 674
A Profound and Enduring Effect......Page 675
Coping with a Lawsuit......Page 676
How to Recognize Stress in Oneself......Page 677
Decrease Vulnerability to Stress......Page 678
Couples Therapy......Page 679
Suggested Readings......Page 680
Follow the Medicare Guidelines for All Entries in the Medical Record......Page 681
Develop a Standard Format for Writing the Consultation Note......Page 682
Bill the Appropriate Code......Page 683
Evaluation of the Costs and Benefits of a Consultation Service......Page 692
References......Page 693
Donabedian’s Model......Page 695
Process Measures of Consulting Quality......Page 696
Guiding Principles of Quality Measurement......Page 697
References......Page 698
The Research Question and Planning the Study......Page 699
Retrospective Studies......Page 700
What Is a Randomized, Placebo-Controlled, Double-Blind Clinical Trial?......Page 701
Psychological Assessments......Page 703
Choosing the Research Tools......Page 704
Executing the Study......Page 705
Regulatory Responsibilities......Page 707
Publishing Research Results......Page 708
Recommended Readings......Page 709
Controlling Health Care Costs......Page 711
New Populations in Psychiatric Treatment......Page 712
Psychosomatic Medicine and Consultation-Liaison Psychiatry......Page 713
Outpatient Psychosomatic Medicine and Consultation–Liaison Psychiatry......Page 714
Building Integrated Delivery Systems......Page 715
International Movement Toward Psychosomatic Medicine......Page 716
References......Page 717
A
......Page 721
B
......Page 723
C
......Page 724
D
......Page 727
E
......Page 729
G
......Page 730
H
......Page 731
J
......Page 732
M
......Page 733
N
......Page 735
P
......Page 736
R
......Page 739
S
......Page 740
T
......Page 741
W
......Page 742
Z
......Page 743