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Book Forum: Medical Psychiatry   |    
Medical Complications of Psychiatric Illness
DONALD M. HILTY, M.D.; THOMAS S. NESBITT, M.D.
Am J Psychiatry 2003;160:1535-1535. doi:10.1176/appi.ajp.160.8.1535
View Author and Article Information
Sacramento, Calif.

By Claire Pomeroy, M.D., James E. Mitchell, M.D., James Roerig, Pharm.D., B.C.P.P., and Scott Crow, M.D. Washington, D.C., American Psychiatric Publishing, 2002, 228 pp., $29.95 (paper).

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Written by a multidisciplinary team representing internal medicine, psychiatry, and pharmacology, this book has the goal of informing practicing psychiatrists of the medical complications of psychiatric disease and suggesting guidelines for routine health maintenance. The authors report that psychiatrists have increasing responsibility for medical care of patients. Our experience is that many psychiatric patients are unable or unwilling to access services in primary care. The book is divided into two sections: one on psychiatry’s relationship to health maintenance and reproductive health and the other on the evaluation and treatment of medical problems associated with specific psychiatric disorders. The book is a useful contribution to the literature, and portions of it are excellent models for future books to follow in addressing the topic.

Chapter 1, "Routine Medical Evaluation and Health Maintenance," discusses higher rates of morbidity and mortality (e.g., annual death rates 2–4 times those of healthy people) in psychiatric patients, partly due to medical disorders. Unfortunately, medical disorders are diagnosed as psychiatric disorders in 6%–20% of patients. The authors correctly point out that medical training is compartmentalized, resulting in psychiatrists not having the knowledge and/or skills for the patient population with whom they work. Our experience is that not all psychiatrists maintain medical knowledge and skills unless they are actively involved in consultation-liaison psychiatry, sit on an institutional review board, or take continuing medical education courses. The authors do an excellent job of providing an overview of the biopsychosocial reasons for misdiagnosis and provide guidelines for routine medical examinations for psychiatric patients.

"Reproductive Health," chapter 2, focuses on patients’ sexual behaviors, lack of family planning, teratogenic effects of psychotropic medication, patients’ exposure to danger (e.g., HIV, abuse), and prevention of illness. This is an absolutely critical topic—one that deserves a book of its own. The authors do a splendid job of informing psychiatrists how to promote health and how to prevent, identify, and manage problems. As important, our experience is that primary care and specialty physicians must collaborate on prevention and management, which is still something to strive for in the integrated care of psychiatric patients.

Chapters 3–8 focus on the medical illnesses that patients with a given psychiatric disorder (e.g., schizophrenia) experience. Chapter 3, "Affective, Anxiety, and Somatoform Disorders and Dementia," is most helpful for consultation-liaison psychiatrists or for psychiatrists working with primary care physicians, since it talks mainly about rates of these disorders in medical populations. In addition, it explores the potential relationships between medical and psychiatric disorders: does one cause the other or do they have a common etiology? There are very practical tips for treating common problems for patients with dementia (e.g., urinary incontinence). Chapters 4 and 7 are outstanding in that they methodically outline common medical problems in patients with schizophrenia and those with eating disorders, respectively. For example, patients with schizophrenia have higher rates of ingestion of objects, self-mutilation, coronary artery disease, and cancer than the general population. These chapters quickly bring the practicing psychiatrist up to date. Chapter 5, "Munchausen’s Syndrome and Other Factitious Disorders," and chapter 6, "Self-Injurious Behavior," each includes a section on when to get a medical consultation—a section that would be good for all of the chapters. Chapter 8, "Alcohol and Drug Abuse," is well written but less critical, since most psychiatrists have exposure to this topic in practice and in continuing medical education.

Overall, Medical Complications of Psychiatric Illness is a useful contribution to the literature because it highlights the importance of health maintenance as well as the identification and the management of medical problems in psychiatric patients. The book is well written, well referenced, and concise. It is a practical resource for practicing psychiatrists, and it would also be useful for psychiatry residents, medical students, and other mental health staff. In addition, there is sufficient value for primary care physicians and/or hospital physicians who care for psychiatric patients.

We have a few suggestions for future editions and/or similar books. First, an entire chapter on mood disorders would be helpful, focusing on what medical disorders are commonly comorbid and how to manage them (e.g., like chapters 4 and 7). Second, tiered guidelines would be helpful on what medical problems the psychiatrist could manage and when to refer to routine, subacute, or emergency medical settings. Third, we suggest a chapter on the management of disorders or symptoms that plague so many of our psychiatric patients (e.g., obesity, sexual dysfunction, and pain).

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