Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-16T10:18:20.933Z Has data issue: false hasContentIssue false

Recognising serious physical illness in the acutely unwell psychiatric patient

Published online by Cambridge University Press:  02 September 2009

Karthik Thangavelu
Affiliation:
Speciality Registrar in General Adult Psychiatry (ST5), Psychiatric Intensive Care Unit, Highbury Hospital, Nottinghamshire Healthcare NHS Trust
Vakkat Muraleedharan
Affiliation:
Clinical Research Fellow (Diabetes & Endocrinology), Barnsley Hospital NHS Foundation Trust
Michele Hampson
Affiliation:
Consultant Psychiatrist, Queens Medical Centre, Nottingham
Get access

Abstract

Psychiatric patients suffer high rates of mortality and morbidity. One of the major reasons for this is the high prevalence of physical health problems in psychiatric patients. Psychiatrists have tended to pay less attention to, and receive less training in, the management of the physical health of their patients with this role largely being left to general practitioners. Though there is an increasing awareness of long term physical morbidities in psychiatric patients, the literature on acute physical morbidity is sparse. In this article we aim to emphasise the importance of recognising serious physical illnesses that could arise in the acutely unwell psychiatric patient.

The scope of this article is not to provide a comprehensive list of physical complications and management strategies but to provide the psychiatrist with a conceptual framework to assist with the management of co-morbid physical and psychiatric illness.

Type
Review
Copyright
Copyright © NAPICU 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Appleby, L. et al. (2006) Avoidable Deaths – Five year report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. www.medicine.manchester.ac.uk/psychiatry/research/suicide/prevention/nci/reports/avoidabledeathsfullreport.pdfGoogle Scholar
Baxter, D.N. (1996) The mortality experience of individuals in the Salford psychiatric case register. I. All-cause mortality. British Journal of Psychiatry. 168: 772779.Google Scholar
Black, D.W. (1998) Iowa record-linkage study: Death rates in psychiatric patients. Journal of affective disorders. 50: 227282.Google Scholar
Campbell, I. (2004) Starvation, exercise, injury and obesity. Anaesthesia and Intensive Care Medicine. 5(7): 243248.Google Scholar
Chen, Y., Guo, J.J., Li, H., Wulsin, L. and Patel, N. (2008) Risk of cerebrovascular events associated with antidepressant use in patients with depression. A population-based, nested case-control study. The Annals of Pharmacotherapy. 42(2): 177184.Google Scholar
Coverdale, J.H., Aruffo, J. and Grunebaum, H. (1992) Developing family planning services for female chronically mentally ill outpatients. Hospital Community Psychiatry. 43: 475478.Google Scholar
Craddock, N., Antebi, D., Attenburrow, M.J. et al. (2008) Wake-up call for psychiatry. British Journal of Psychiatry. 193: 69.Google Scholar
De Leon, J., Verghese, C., Joseph, I., Josiassen, R.C., and Simpson, G.M. (1994) Polydipsia and water intoxication in psychiatric patients: A review of the epidemiological literature. Biological Psychiatry. 35(6): 408419.Google Scholar
Department of Health (1999) National Service Framework for Mental Health (NSF). HMSO: London.Google Scholar
Department of Health (2008) Refocusing the Care Programme Approach. Policy and positive practice guidance. HMSO: London.Google Scholar
Dome, P., Teleki, Z., and Kotanyi, R. (2007) Paralytic ileus associated with combined atypical antipsychotic therapy. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 31(2): 557560.Google Scholar
Haddad, P. and Anderson, I. (2002) Antipsychotic-related QTc prolongation, torsade de pointes and sudden death. Drugs. 62(11): 16491671.Google Scholar
Harris, E.C. and Barraclough, B. (1998) Excess mortality of mental disorder. British Journal of Psychiatry. 173: 1153.Google Scholar
Hearing, S.D. (2004) Refeeding syndrome. British Medical Journal. 328: 908909.Google Scholar
Hughes, S. (1991) The physical examination in psychiatry. Psychiatric Bulletin. 15: 615616.Google Scholar
Ignatowski, M., Sidhu, S. and Rueve, M. (2007) Pulmonary embolism as a complication of major depressive disorder with catatonic features: A case report. Psychiatry. 4(6): 5156.Google Scholar
Lester, H. (2005) Shared care for people with mental illness: A GP’s perspective. Advances in Psychiatric Treatment. 11: 133139.Google Scholar
Levenson, J.L. (1985) Neuroleptic malignant syndrome. American Journal of Psychiatry. 142: 11371145.Google Scholar
Levin, J.B. and Mendelowitz, A. (2002) Death from clozapine-induced constipation: Case report and literature review. Psychosomatics. 43: 7173.Google Scholar
McCall, W.V., Mann, S.C., Shelp, F.E. and Caroff, S.N. (1995) Fatal pulmonary embolism in the catatonic syndrome: Two case reports and a literature review. Journal of Clinical Psychiatry. 56(1): 2125.Google Scholar
Meijer, W.E.E., Heerdink, E.R., Nolen, W.A. et al. (2004) Association of risk of abnormal bleeding with degree of serotonin reuptake inhibition by antidepressants. Archives of Internal Medicine. 164: 23672370.Google Scholar
Metherall, A., Worthington, R., and Keyte, A. (2006) Twenty four hour medical emergency response teams in a mental health in-patient facility – New approaches for safer restraint. Journal of Psychiatric Intensive Care. 2(1): 2129.Google Scholar
Mildred, L. (2002) Seclusion and restraints: A failure, not a treatment. California Senate Office of Research. This report can be found online at www.sen.ca.gov/sor under ‘Publications’.Google Scholar
Miller, L.J. and Finnerty, M. (1996) Sexuality, pregnancy and childrearing among women with schizophrenia spectrum disorder. Psychiatric services. 47: 502506.Google Scholar
Movig, K.L.L., Janssen, M.W.H.E., Malefijt, J.d.W. et al. (2003) Relationship of serotonergic antidepressants and need for blood transfusion in orthopaedic surgical patients. Archives of Internal Medicine. 163: 23542358.Google Scholar
National Institute for Health and Clinical Excellence (2005) Violence: The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. Clinical Guidelines 25.Google Scholar
Newcomer, J., and Hennekens, C. (2006) Severe mental illness and risk of cardiovascular disease. Journal of the American Medical Association. 298: 17941796.Google Scholar
Paton, C. and Ferrier, I.N. (2005) SSRIs and gastrointestinal bleeding. British Medical Journal. 331: 529530.Google Scholar
Phelan, M., Stradind, L., and Morrison, S. (2001) Physical health of people with severe mental illness. British Medical Journal. 322: 443444.CrossRefGoogle ScholarPubMed
Phelan, M., and Blair, G. (2008) Medical history taking in psychiatry. Advances in Psychiatric Treatment. 14: 229234.CrossRefGoogle Scholar
Politi, P., Picinelli, M., Klersy, C. et al. (2002) Mortality in psychiatric patients 5–21 years after hospital admission in Italy. Psychological medicine. 32: 227237.Google Scholar
Pomeroy, C., Mitchell, J.E., Pharm, J.R., Crow, S. (2002) Medical Complications of Psychiatric Illness. pp81. American Psychiatric Publications: Washington.Google Scholar
Pope, H.G., Keck, P.E. Jr., McElroy, S.L. (1986) Frequency and presentation of neuroleptic malignant syndrome in a large psychiatric hospital. American Journal of Psychiatry. 143: 12271233.Google Scholar
Ruschena, D., Mullen, P.E., Burgess, P. et al. (1998) Sudden death in psychiatric patients. British Journal of Psychiatry. 172: 331336.Google Scholar
Sailas, E., and Fenton, M. (2000) Seclusion and restraint for people with serious mental illnesses. Cochrane Database of Systematic Reviews. Issue 1. Art. No.: CD001163. DOI: 10.1002/14651858.CD001163Google Scholar
Siegel, A.J. (2008) Hyponatremia in psychiatric patients: Update on evaluation and management. Harvard Review of Psychiatry. 16(1): 1324.CrossRefGoogle ScholarPubMed
Skop, B.P. and Brown, T.M. (1996) Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors. Psychosomatics. 37: 1216.Google Scholar
Sternbach, H. (1991) The seratonin syndrome. American Journal of Psychiatry. 148: 705713.Google Scholar
Tarrant, J.C. (2006) Blood glucose testing for adults prescribed atypical antipsychotics in primary and secondary care. Psychiatric Bulletin. 30: 287288.Google Scholar
Taylor, D., Paton, C. and Kerwin, R. (2007) The Maudsley Prescribing Guidelines 9th edition. Taylor & Francis.Google Scholar
Thangavelu, K. and Geethanjali, S. (2006) Menstrual disturbance and galactorrhea in people taking conventional antipsychotic medications. Experimental and Clinical Psychopharmacology. 14(4): 459460.Google Scholar
Vieweg, W.V.R., Pandurangi, A., Levenson, J. and Silverman, J. (1994) The consulting psychiatrist and the polydipsia-hyponatremia syndrome in schizophrenia. International Journal of Psychiatry in Medicine. 24: 275303.CrossRefGoogle ScholarPubMed