liason psych

• Mental illness can causephysical symptoms

  • Depression can cause low energy, amenorrhoea and constipation

  • Panic and anxiety cause unpleasant physical sensations
• People with physical health problems are more likely to

  Experience mental illness
• Psychological factors can affect

  The level of disability associated with physical disorder
• People with mental illness are more likely to


  Experience physical illness and to have poor physical health outcomes
• Bodily distress/somatisation


  A common presentation
• Adverse effects of psychiatric medication


  Increase risk of diabetes, hyponatraemia
• Primary care: 40% have psychiatric illness
• General hospital wards: 45% have psychiatric illness
• 5% of ED attendances are for a mental health problem
• Over 25% of ED attendances have a mental illness
• Delirium


  A psychological complication of physical illness
• Direct effects of physical disorder


  Can cause depression due to hypothyroidism or cerebrovascular disease OR anxiety caused by hyperthyroidism
• Indirectly, psychological consequences of physical illness - causing disability and handicap

  Anxiety, depression
• Medications can have


  Psychiatric side effects
• Medications that can cause depression


  • Some antihypertensives - beta blockers, calcium channel blockers
  • Interferon
  • NSAIDs
  • Corticosteroids - e.g. prednisolone, note: can also cause mania and psychosis
  • Roaccutane (isotretinoin)
  • Combined oral contraceptive pill
• Medications that can cause psychosis


  • Corticosteroids
  • L-Dopa
  • Dexamphetamine - for narcolepsy and refractory ADHD
• Risk factors for psychiatric illness when physically unwell (related to physical illness)


  • Severe illness
  • Unpleasant treatment
  • Unpredictable course/outcome
  • High disability
  • Worsening disability
  • Appearance to others e.g. deformity
  • High impact of treatment on day to day life
• Risk factors for psychiatric illness when physically unwell (psychological/psychiatric)


  • Previous mental illness
  • Dysfunctional beliefs about the illness
  • Unhelpful coping styles
• Risk factors for psychiatric illness when physically unwell (social)


  • Poor social support
  • Negative reactions of friends/family/colleagues
  • Financial difficulties
  • Any adverse social situation (e.g. related to accommodation)
• Psychiatric assessment when patient is physically ill


  • Important not to see distress as inevitable outcome of severe illness
  • Some patients need support not just with the severe illness but its psychological consequences
  • Assessment is similar to any other psychiatric assessment but also need to consider:
  • 1. knowledge of the physical illness, its treatment and likely outcomes,
  • 2. effects/side effects of medication and other treatment,
  • 3. reviewing medical notes for additional information,
  • 4. the need to understand symptoms which may be due to either physical or mental illness
• Reduced life expectancy of 10-25 years in people with severe mental illness
• Increased risk of obesity, diabetes and cardiovascular disease in people with mental illness is 1.4-2 times that of general population
• Modifiable risk factors more likely to be present in people with mental illness


  • Smoking
  • Excessive alcohol intake
  • Sleep disturbance
  • Physical inactivity
  • Dietary risks
• Adverse effects of medication e.g. antipsychotics


  Increase risk of diabetes, obesity and cardiovascular disease
• Reducing physical health disparities for people with mental illness


  • Physical health culture in mental health services (regular screening as part of care plans, integration of physical and mental healthcare services)
  • Avoiding diagnostic overshadowing
  • Ensuring access to screening and treatment
  • Better referral pathways and access to support from substance use services
  • Specific diabetes prevention lifestyle interventions
• Annual medical review in severe mental illness includes


  • Use of substances
  • Blood pressure
  • Body mass index
  • HbA1c
  • Cholesterol
  • Medications
  • Cervical screening if appropriate
• Liaison psychiatry team


  Team that provide mental health care to patients in physical health care settings

  
  

  in the general hospital setting they:

  • assessment and management of mental health presentations in ED
  • input to inpatient wards
  • advice and training for other teams
  • may be further specialist teams e.g. psycho-oncology, diabetes psych liason
• What does the liaison psychiatry team do in the acute hospital?


  • Make a psychiatric diagnosis
  • Develop a formulation and care plan
  • Advise on vulnerability, risk and safeguarding
  • Biopsychosocial assessment
  • Identify triggers to symptoms and behaviours
  • Psychological interventions
  • Advice on mental capacity
  • Psychiatric assessment and management in emergency dept
• The most common cause of psychotic illnesses are schizophrenia and bipolar disorder
• Psychosis is the loss of contact with reality, including delusions (fixed false beliefs) and hallucinations (perception without stimulus)
• Delirium tremens is an acute withdrawal syndrome from alcohol