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Consultation-Liaison Psychiatry: Contributions to Medical Practice

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Adam Sims

on 10 February 2010

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Transcript of Consultation-Liaison Psychiatry: Contributions to Medical Practice

Consultation-Liaison Psychiatry: Contributions to Medical Practice
Weissman and Hackett 1958
Consultation Liaison Psychiatry
Advised that bilateral eye patching following cataract surgery
contributes to delirium
Delirium
New England Journal of Medicine
Open Heart Surgery
Recovery room delirium
uninterrupted sleep
quick transfer
Influence on architecture and design of ICU
Competence
Is this person competent?
Kornfeld et al. 1965
New Eng Jnl of Med
Why is this person making such a self destructive request?
Albert and Kornfeld
1975
Ann Int Med
Anxiety
Angry
Psychotic
Dementia
Cancer
Psycho-oncology
Avoidance of the "C" word
Truth dumping
Truth telling
What truth, for which patient
at which time?

New York Times 1978
Oken D. What to tell cancer patients: A study of medical attitudes. JAMA 1961
Blumenfeld 1979 current attitudes of medical students
and house staff towards terminal illness. Gen Hosp Psych
Colectomy and Colostomy
Cancer vs Ulcerative Colitis
Druss 1968 Psych Response to Colectomy
Mastectomy
Wellisch et al Psychosocial outcomes of breast cancer therapies
lumpectomy vs mastectomy
Stevens L et al. The psych impact of immediate breast reconstruction for
women with early breast cancer. Plast Reconstr Surg 1984
Spiegel et al. Effect of psychosocial txt on survival of patients with breast cancer.
Lancet 1989
Medical Training
Friedman 1971 New Eng Jnl Med
Sleep deprivation in interns
Transplantation
Psycho-nephrology
Selection of patients to transplant
Abram et al. Selection of patients for artifical and transplanted organs. Ann Int Med. 1968
Predicting compliance
Shapiro et al. Psychosocial evaluation and prediction of
compliance problems and morbidity after heart transplantation.
Transplantation. 1995
Given the current limitations of prediction, a statistical likelihood
of a poor outcome does not vitiate the physician's ethical duty to help
the patient. the most appropriate inference to draw is that transplantation programs should identify prospective patients who need
psychosocial help in order to improve the likelihood of a good outcome.
Cardiac
"That emotions may precipitate sudden death is part of world
wide folklore and goes back to antiquity"
Lown B et al. Basis for recurring VF in
the absence of coronary heart disease.
N Engl Jnl Med 1976.
Heller et al. Psychosocial outcome after ICD implantation
a current perspective. PACE, Pacing Clin Electrophysiol 1997
Lipsey et al. Nortriptyline txt of post-stroke depression.
a double blind study. Lancet 1984
HIV
Samuel Perry. 1990s
dementia associated with HIV
contributions to counselling patients undergoing genetic testing
Cost/Benefit
1937 Billings et al. Psych Consultation at
Denver General Hospital reduced length of
stay from
28 to 16 days
1986
Smith et al. teaching GPs to deal with
hypochondriasis reduced medical costs by
49-53% without altering patient satisfaction
N Engl Jnl Med
Consultation Liaison
Saves money for the hospital
Teaching
Psychiatry and Medical Practice in
a General Hospital
Taking care of the hateful patient
Management of the Borderline Patient on a Medical or Surgical Ward
Striking advances in surgical techniques have increased
the number of cancer survivors. The radical surgery necessary for prolongation of life however has resulted in severe impairment of function in many instances. The medical management of these patients has made evident the importance of psychological factors in invalidism that exceeds the limitations set by surgery. Despite growing awareness there has been little systematic study of the impact of cancer and the attending surgical procedures to guide the clincian in the practical problem of managing the cancer survivor in his total situation.
Katon /Beitman 1988. Significant numbers of patients with chest pain suffer from panic disorder.
Frasure-Smith et al. JAMA
depressed and MI = times four
chance of dying in next year.
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