Learn to im prove your assessment, investigation, and management of physical health conditions in people with severe mental illness  

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry offers psychiatric and general practitioners an evidence-based and practical guide for the appropriate assessment, investigation, and management of common physical health conditions seen in people with severe mental illness. Written by a renowned team of respected experts in medicine, surgery, pharmacy, dietetics, physiotherapy, and psychiatry, the book bridges the gap between psychiatric and physical health services for the severely mentally ill.  

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry also provides practitioners with expert guidance on making effective referrals to other medical and surgical subspecialties, telling readers what information subspecialties would expect to receive. Its use will improve the quality of clinical care received by mentally ill patients and, by promoting a holistic approach to treatment that considers both body and mind, will enhance the therapeutic relationship between patient and practitioner.   

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry covers the following: 

Guidance on assessment and management of well over a hundred different medical and surgical presentations commonly seen in people with serious mental illness Management of physical health emergencies in a psychiatric setting Evidence-based approaches to management of physical side effects of psychiatric medications Advice on approaches to promote a healthy lifestyle in people with serious mental illness, such as smoking cessation and changes to diet and physical activity 

Perfect for both psychiatrists and general practitioners who wish to improve the quality of care they provide to people with serious mental illness, The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry will be of use to anyone setting out to navigate the divide between the treatment of psychiatric and physical health conditions.  

 

TABLE OF CONTENTS

Preface xxi

List of abbreviations xxiii

 

Part 1 Cardiology 1

 

Chapter 1 Tachycardia 3

Sinus tachycardia 3

Atrial fibrillation 4

Supraventricular tachycardia 4

Ventricular tachycardia 6

Diagnostic principles 6

Management 10

References 14

 

Chapter 2 Bradycardia 17

Diagnosis 19

Management and when to refer to a specialist 21

References 22

 

Chapter 3 QT Interval Prolongation 23

Prescribing QTc‐prolonging medication 27

Diagnostic principles 28

Management 29

References 32

 

Chapter 4 Syncope 35

Causes of syncope 35

Syncope and serious mental illness 36

Diagnostic principles 36

Diagnosis and management 38

References 39

 

Chapter 5 Hypertension 41

Diagnostic principles 43

Diagnosis 44

Management 45

References 48

 

Chapter 6 Postural Hypotension 51

Diagnostic principles 53

Management 54

References 58

 

Chapter 7 Peripheral Oedema 59

Diagnostic principles 60

Management 66

References 67

 

Chapter 8 Myocarditis 71

Diagnostic principles 71

Management 75

Clozapine‐induced myocarditis 75

References 77

 

Chapter 9 Hypercholesterolaemia 79

Diagnostic principles 80

Diagnostic criteria 81

Management 81

References 84

 

Chapter 10 Physical Activity 85

Physical activity and serious mental illness 85

How much physical activity and exercise should people be doing? 86

Practical tips 87

Messages to include in discussions with patients 87

References 88

 

Part 2 Endocrinology 91

 

Chapter 11 Diabetes Mellitus 93

Diagnostic principles 93

Management 97

References 102

 

Chapter 12 Thyroid Disease 105

Hypothyroidism 105

Diagnostic principles 107

Management 110

Hyperthyroidism 111

Diagnostic principles 112

Management 113

References 114

 

Chapter 13 Hyperprolactinaemia 117

Diagnostic principles 119

Management and when to refer to a specialist 121

Hyperprolactinaemia and osteoporosis risk in serious mental illness 122

Hyperprolactinaemia and cancer risk 123

References 123

 

Chapter 14 Obesity 125

Monitoring 127

Prevention and treatment of weight gain 129

References 134

 

Part 3 Haematology 137

 

Chapter 15 Anaemia 139

Diagnostic principles 140

Management and referral pathways 143

References 145

 

Chapter 16 Neutropenia 147

Drug‐induced neutropenia and agranulocytosis 149

Diagnostic principles 150

Management 151

References 153

 

Chapter 17 Thrombocytopenia 155

Diagnostic principles 156

Management and when to refer 158

References 158

 

Chapter 18 Venous Thromboembolism and Anticoagulation 159

Risk factors 159

Prophylaxis 161

Diagnosis 162

Management 164

References 168

 

Part 4 Gastroenterology 169

 

Chapter 19 Gastro‐oesophageal Reflux and Peptic Ulcer Disease 171

Gastro‐oesophageal reflux disease 171

Peptic ulcer disease 176

References 178

 

Chapter 20 Gastrointestinal Bleeding 181

Diagnostic principles 183

Management 185

References 188

 

Chapter 21 Nausea and Vomiting 191

Diagnostic principles 193

Management 195

References 198

 

Chapter 22 Dysphagia 199

Causes of dysphagia in the general population 199

Diagnostic principles 200

Management 203

Oesophageal cancer in psychiatric populations 203

Dysphagia in the elderly 204

References 204

 

Chapter 23 Deranged Liver Function Tests 207

Diagnostic principles 207

Management 212

References 213

 

Chapter 24 Alcohol and Physical Health 215

What is harmful use? 215

Physical complications of alcohol use 216

Approach to the patient with suspected alcohol misuse 217

Management 220

References 222

 

Chapter 25 Unintentional Weight Loss 223

Diagnostic principles 225

Management 227

References 227

 

Chapter 26 Dry Mouth 229

Diagnostic principles 231

Management 231

References 232

 

Chapter 27 Hypersalivation 235

Diagnostic principles 235

Management 236

References 239

 

Chapter 28 Constipation 241

Diagnostic principles 243

Management 244

References 249

 

Part 5 Renal and Urology 251

 

Chapter 29 Urinary Retention 253

Urinary retention and serious mental illness 253

Diagnostic principles 254

Management 256

References 256

 

Chapter 30 Urinary Incontinence 259

Diagnostic principles 261

Management 262

References 264

 

Chapter 31 Polyuria 267

Diagnostic principles 268

Management 269

References 271

 

Chapter 32 Sodium Derangement 273

Diagnostic principles 274

Management 276

References 277

 

Chapter 33 Potassium Derangement 279

Hyperkalaemia 279

Hypokalaemia 282

References 285

 

Chapter 34 Chronic Kidney Disease 287

Diagnostic principles 289

Management 291

References 295

 

Part 6 Sexual and Reproductive Health 297

 

Chapter 35 Sexual Dysfunction 299

Assessment of a patient with sexual dysfunction 299

Management 301

References 304

 

Chapter 36 Contraception 307

Clinical approach 308

Contraceptive options 308

Ethical and legal considerations 312

When to refer 313

Special considerations in patients with serious mental illness 313

References 314

 

Chapter 37 Infertility 317

Addressing infertility in psychiatric practice 317

Onward referral and further tests for infertility 318

Infertility treatments 318

References 318

 

Chapter 38 Sexually Transmitted Infection 319

History 319

STI testing in psychiatry 320

Determining urgency of clinical action/referral 321

Referral to sexual health services 322

References 324

 

Part 7 Infectious Diseases 325

 

Chapter 39 Pneumonia 327

Pneumonia and serious mental illness 329

Diagnostic principles 329

Management 332

References 335

 

Chapter 40 Influenza 337

Diagnostic principles 338

Management 339

Preventing spread of influenza 341

References 342

 

Chapter 41 Urinary Tract Infection 343

Urinary tract infection and serious mental illness 344

Diagnostic principles 344

Management 347

References 350

 

Chapter 42 Gastroenteritis 251

Diagnostic principles 251

Management 254

References 256

 

Chapter 43 Viral Hepatitis 357

Hepatitis B 357

Hepatitis C 361

References 364

 

Chapter 44 Tuberculosis 365

Diagnostic principles 366

Management 369

References 371

 

Chapter 45 Human Immunodeficiency Virus 373

Testing for HIV 374

HIV and the central nervous system 374

Antiretroviral therapy 375

References 380

 

Part 8 Respiratory 383

 

Chapter 46 Smoking Cessation 385

Identifying those who want to stop smoking and degree

of nicotine dependence 385

Approaches to smoking cessation 387

References 392

 

Chapter 47 Chronic Obstructive Pulmonary Disease 395

Common causes of COPD in the general population and patients

with serious mental illness 395

The asthma&COPD overlap 396

Diagnostic principles 397

Management 400

References 403

 

Chapter 48 Asthma 405

Causes in the general population and people with serious

mental illness 405

Diagnostic principles 406

Management 409

References 412

 

Chapter 49 Obstructive Sleep Apnoea 413

Diagnostic principles 414

Management 415

References 416

 

Part 9 Neurology 419

 

Chapter 50 Delirium 421

Diagnostic principles421

Management 426

References 429

 

Chapter 51 Autoimmune Encephalitis 431

Autoimmune disease mechanisms 431

Clinical approach 432

Management 437

References 439

 

Chapter 52 Catatonia 441

Diagnostic principles 442

Management 444

References 448

 

Chapter 53 Seizure Disorders 451

Acute seizure 452

Psychiatric comorbidity in people with epilepsy 455

Psychiatric side effects of antiepileptic drugs 457

Psychiatric drug therapy in people with epilepsy 457

Psychogenic non‐epileptic seizures 458

Epilepsy surgery 459

Epilepsy and learning disability 459

References 459

 

Chapter 54 Headache 461

Diagnostic principles 463

Management 466

References 468

 

Chapter 55 Disorders of Sleep and Circadian Rhythm 471

Definitions of common sleep disorders in psychiatric

populations 471

Diagnostic principles 474

Management 476

References 477

 

Chapter 56 Extrapyramidal Side Effects 479

Clinical approach 480

Management 482

References 483

 

Chapter 57 Tardive Dyskinesia 485

Clinical approach 486

Management 487

References 489

 

Chapter 58 Tremor 491

Clinical approach 491

Management 494

References 496

 

Part 10 Rheumatology and Musculoskeletal Health 497

 

Chapter 59 Low Back Pain 499

Diagnostic principles 500

Management 502

References 503

 

Chapter 60 Arthritis 505

Clinical approach 510

Management 512

References 512

 

Part 11 Ophthalmology 515

 

Chapter 61 Eye Disease 517

Clinical approach to a patient with visual disturbance or

orbital/periorbital disorders 517

Disorders of the eyelids 522

Disorders of the conjunctiva 526

Disorders of the cornea 529

References 533

 

Part 12 Obstetrics and Gynaecology 535

 

Chapter 62 Pregnancy 537

The pre‐conception period 538

During pregnancy 539

Psychiatric medication in pregnancy 543

Postpartum psychosis 547

Electroconvulsive therapy in pregnancy 547

References 548

 

Chapter 63 Menopause 551

Physiology and symptoms of perimenopause 551

Clinical approach 552

Treatment 553

References 556

 

Part 13 Dermatology 559

 

Chapter 64 General Dermatology 561

Infectious skin disease 561

Non‐infectious skin disease 564

References 566

 

Chapter 65 Psychodermatology 569

Psychiatric disorders with skin manifestations 569

Psychophysiological conditions 571

Secondary psychological disorders 571

Cutaneous sensory disorders 572

References 572

 

Part 14 Electroconvulsive Therapy 573

 

Chapter 66 Electroconvulsive Therapy 575

Indications and contraindications 575

The ECT procedure 576

Physiological effects of ECT 576

Pre‐ECT assessment 578

Safety of ECT 579

ECT prescribing 579

Guidance for the doctor administering ECT 579

Side effects of ECT 580

Special patient groups 581

References 581

 

Part 15 Emergencies 583

 

Chapter 67 Chest pain 585

Diagnostic principles 586

Management 590

Information to provide in a ‘chest pain& referral to medical services 591

References 591

 

Chapter 68 Acute Shortness of Breath 593

Diagnostic principles 593

Management 595

References 596

 

Chapter 69 Acute Coronary Syndrome 597

Diagnostic principles 598

Management 602

References 603

 

Chapter 70 Arrhythmia 605

Tachycardia 605

Bradycardia 605

Reference 608

 

Chapter 71 Hypertensive Crisis 609

Diagnostic principles 609

Management 610

References 611

 

Chapter 72 Sepsis 613

When to think sepsis 613

Septic shock 614

Management 614

Post‐sepsis syndrome 615

References 616

 

Chapter 73 Acute Kidney Injury 617

Categorisation of acute kidney injury 617

Diagnostic principles 620

Management 622

Psychiatric medication and acute kidney injury 622

References 623

 

Chapter 74 Diabetic Emergencies 625

Hypoglycaemia 625

Diabetic ketoacidosis 626

Hyperosmolar hyperglycaemic state 627

References 627

 

Chapter 75 Acute Upper Gastrointestinal Bleeding 629

Signs of acute upper gastrointestinal bleeding 629

Waiting for transfer 629

Handing over to the acute medical team 630

 

Chapter 76 Status Epilepticus 631

 

Chapter 77 Anaphylaxis 633

Management 633

References 636

 

Chapter 78 Reduced Consciousness and Coma 637

Clinical approach 637

References 640

 

Chapter 79 Thyroid Emergencies 641

Hypothyroid crisis/myxoedema coma 641

Hyperthyroid crisis/thyroid storm 642

References 643

 

Chapter 80 Head Injury 645

Clinical approach 645

Types of intracranial haemorrhage 649

References 650

 

Chapter 81 Acute Meningitis and Infective Encephalitis 651

Meningitis 651

Infective encephalitis 653

References 655

 

Chapter 82 Stroke and Transient Ischaemic Attack 657

Stroke 657

Diagnostic principles 658

Management 659

Transient Ischaemic Attack 660

Diagnostic principles 660

Management 661

References 661

 

Chapter 83 Overdose 663

General principles 663

Information gathering 664

Emergency assessment and management 664

Specific scenarios 667

Management of a person who refuses admission to hospital

after an overdose 670

References 670

 

Chapter 84 Acute Dystonia 673

Diagnostic principles 673

Management 675

References 677

 

Chapter 85 Neuroleptic Malignant Syndrome 679

Diagnostic principles 679

Management 680

References 681

 

Chapter 86 Serotonin Syndrome 683

Diagnostic principles 683

Management 684

References 685

 

Chapter 87 Emergencies in Obstetrics and Gynaecology 687

Maternal collapse 689

Pre‐eclampsia 689

Major obstetric haemorrhage 691

Amniotic fluid embolism 691

Ectopic pregnancy 691

Miscarriage 693

Hyperemesis gravidarum 694

Ovarian cyst accidents 695

Pelvic inflammatory disease 697

References 697

 

Chapter 88 The Acute Abdomen 699

History 699

Causes of the acute abdomen based on pain location 702

Examination 705

Investigations 706

Onward referral 706

References 707

 

Chapter 89 The ABCDE Approach 709

First steps 709

Airway (A) 710

Breathing (B) 711

Circulation (C) 711

Disability (D) 711

Exposure (E) 712

References 712