Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic skills
- 1 The development of general hospital psychiatry
- 2 Establishing a service
- 3 Legal and ethical issues in liaison psychiatry
- 4 Understanding psychological reactions to physical illness
- 5 Detection of psychiatric disorders in the general hospital
- 6 The role of the nurse in liaison psychiatry
- Part II Common psychiatric problems across the general hospital
- Part III Working with specific units
- Part IV Treatment
- Part V Different treatment settings
- Index
- References
5 - Detection of psychiatric disorders in the general hospital
from Part I - Basic skills
Published online by Cambridge University Press: 10 December 2009
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Part I Basic skills
- 1 The development of general hospital psychiatry
- 2 Establishing a service
- 3 Legal and ethical issues in liaison psychiatry
- 4 Understanding psychological reactions to physical illness
- 5 Detection of psychiatric disorders in the general hospital
- 6 The role of the nurse in liaison psychiatry
- Part II Common psychiatric problems across the general hospital
- Part III Working with specific units
- Part IV Treatment
- Part V Different treatment settings
- Index
- References
Summary
Introduction
Trainees in liaison psychiatry are frequently surprised to find that the detection and management of psychiatric disorders in the general hospital is a complex and time-consuming process. Liaison psychiatrists need to integrate a broad range of skills – communication, clinical, diagnostic, medical, legal and pharmacological. Interviewing patients in challenging situations, for example on intensive care units or following maxillo-facial surgery, requires the development of unique clinical skills and a certain amount of improvisation. This chapter considers those aspects of psychiatric assessment that are unique to the general hospital, and offers guidance on the assessment of the most prevalent psychiatric symptoms. The supportive use of objective questionnaires is also considered.
Clinical skills
Information gathering
The assessment process starts as soon as the referral is received. Ideally, the referral should ask a specific question about a patient's psychological health, or ask for guidance on the psychological components of a more complex management problem (for example in situations where capacity to consent is a problem). Often, a telephone call to the referrer clarifies the nature of the clinical conundrum, and it helps establish whether the referral has been made with the agreement of both the patient and the patient's senior physician. Previous psychiatric notes should be obtained at this stage.
It is essential to telephone the ward prior to the consultation to establish a mutually convenient time for both the patient and the ward staff.
Keywords
- Type
- Chapter
- Information
- Handbook of Liaison Psychiatry , pp. 83 - 101Publisher: Cambridge University PressPrint publication year: 2007
References
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: APA.
, , , et al. (2005). Psychiatric symptoms and diagnoses in thyroid disorders: a cross-sectional study. International Journal of Psychiatry in Clinical Practice, 9 (3), 187–92.Google Scholar
, , , et al. (2005). Using the Hospital Anxiety and Depression Scale to screen for depression in cardiac patients. General Hospital Psychiatry, 27 (4), 275–84.Google Scholar
, , , et al. (1988). Patterns of psychiatric morbidity in a genito-urinary clinic: a validation of the Hospital Anxiety Depression scale (HAD). British Journal of Psychiatry, 152, 698–700.Google Scholar
, , , et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–71.Google Scholar
, , , et al. (2005). Impact of fibromyalgia pain on health-related quality of life before and after treatment with tramadol/acetaminophen. Arthritis & Rheumatism: Arthritis Care & Research, 53 (4), 519–27.Google Scholar
, , , et al. (1997). ‘Are you depressed?’ Screening for depression in the terminally ill. American Journal of Psychiatry, 154 (5), 674–6.Google Scholar
, , , et al. (2005). Emotional distress and quality of life in caregivers of patients awaiting lung transplant. Journal of Psychosomatic Research, 59 (1), 1–6.Google Scholar
, , , et al. (2005). Reductions in health-related quality of life in patients with ankylosing spondylitis and improvements with etanercept therapy. Arthritis & Rheumatism: Arthritis Care & Research, 53 (4), 494–501.Google Scholar
(1992). The SCL-90-R Manual-II: Scoring, Administration and Procedures for the SCL-90-R, 2nd edn. Towson, MD: Clinical Psychometric Research.
and (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine, 13 (3), 595–605.Google Scholar
and (2005). The factor structure of the Hospital Anxiety and Depression Scale in older individuals with acquired amputations: a comparison of four models using confirmatory factor analysis. International Journal of Geriatric Psychiatry, 20 (4), 344–9.Google Scholar
(2005). The Brief Symptom Inventory (BSI) as a screening tool for psychological disorders in patients with epilepsy and mild intellectual disabilities in residential care. Epilepsy & Behavior, 7 (1), 85–94.Google Scholar
, and (1975). ‘Mini-Mental Stak’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12 (3), 189–98.Google Scholar
, and (1995). The Symptom Checklist (SCL-90–R): an application among patients with HIV infections. Zeitschrift fur Differentielle und Diagnostische Psychologie, 16 (3), 195–208.Google Scholar
, and (2005). The validity of the Beck Depression Inventory-Short Form as a screening and diagnostic instrument for moderate and severe depression in medical inpatients. Journal of Affective Disorders, 86 (1), 87–91.Google Scholar
and (1996). Basic skills. In Seminars in Liaison Psychiatry, ed. , and . London: Gaskell Publications, Royal College of Psychiatrists, pp. 21–52.
, , , et al. (2005). Quality of life of people with venous leg ulcers: a comparison of the discriminative and responsive characteristics of two generic and a disease specific instruments. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation, 14 (7), 1705–18.Google Scholar
, , , et al. (1997). A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies?Journal of Public Health Medicine, 19 (2), 179–86.Google Scholar
, and (2000). Construct validation of the hospital anxiety and depression scale with clinical populations. Journal of Psychosomatic Research, 48 (6), 579–84.Google Scholar
, , , et al. (1998). Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatrica Scandinavica, Supplementum, 393, 6–11.Google Scholar
and (2000). A psychometric evaluation of the Hospital Anxiety and Depression Scale in coronary care patients following acute myocardial infarction. Psychology, Health & Medicine, 5(2), 193–201.Google Scholar
, , , et al. (2005). Anxiety and depression in patients with lower back pain. Psychological Reports, 96 (3), 553–8.Google Scholar
and (1975). Depression in medical in-patients. British Journal of Psychiatry, 125, 346–53.Google Scholar
, , , et al. (2005). Health related quality of life of patients with refractory angina before and one year after enrolment onto a refractory angina program. European Journal of Pain, 9 (3), 305–10.Google Scholar
, , , et al. (2003). An international perspective on gender differences in anxiety early after acute myocardial infarction. Psychosomatic Medicine, 65 (4), 511–16.Google Scholar
, , , et al. (2002). Cognitive-based measures screening for depression in the medically ill: the DMI-10 and the DMI-18. Acta Psychiatrica Scandinavica, 105 (6), 419–26.Google Scholar
, , , et al. (1990). Screening for adjustment disorders and major depressive disorders in cancer in-patients. British Journal of Psychiatry, 156, 79–83.Google Scholar
, , , et al. (2005). Symptoms of depression and anxiety in functionally disabled rheumatic pain patients. Nordic Journal of Psychiatry, 59 (2), 109–13.Google Scholar
, , , et al. (2005). Measurement of depressive symptoms in women with breast cancer and women with clinical depression: a differential item functioning analysis. Journal of Clinical Psychology in Medical Settings, 12 (2), 127–41.Google Scholar
World Health Organization. (1992). 10th Revision of the International Statistical Classification of Diseases and Related Health Problems. Geneva: World Health Organization.
and (1992). The MOS 36-item short-form health survey (SF-36): 1. Conceptual framework and item selection. Medical Care, 30, 473–83.Google Scholar
and (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67 (6), 361–70.Google Scholar
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