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Dementia or Depression? Diagnostic Bias in Geriatric Practice
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The distinction between dementia and depression in the care of older adults is a common challenge made more difficult when other illnesses and medications confound the task.
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10/1/2009
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Cyclic Vomiting Syndrome, Part 1
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Cyclic vomiting syndrome is a potentially incapacitating disorder that affects all ages. It was first recognized in children but is increasingly documented in adults as well.
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6/2/2009
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Medical Aspects of Catatonia
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This column reviews medical aspects of catatonia, including medical disorders that can cause catatonia as well as medical complications of acute and chronic catatonia. Before the introduction of antipsychotics, most cases of primary psychiatric catatonia were due to (catatonic) schizophrenia.
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3/3/2009
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Psychiatric Issues in Dermatology, Part 3: Acne Vulgaris and Chronic Idiopathic Pruritus
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This column continues a series reviewing the interface between dermatology and psychiatry. Dermatologists and primary care physicians frequently encounter important psychiatric issues affecting diagnosis and management of patients with dermatologic complaints.
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11/26/2008
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Psychiatric Issues in Dermatology, Part 2: Alopecia Areata, Urticaria, and Angioedema
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This column continues a series reviewing the interface between dermatology and psychiatry. Part one focused on atopic dermatitis and psoriasis.1 This second installment reviews alopecia areata, urticaria, and angioedema.
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8/25/2008
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Psychiatric Issues in Dermatology, Part 1: Atopic Dermatitis and Psoriasis
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This column begins a series reviewing the interface between dermatology and psychiatry. Dermatologists and primary care physicians frequently encounter important psychiatric issues affecting diagnosis and management of patients with dermatologic complaints. Psychiatrists contend with frequent pruritus and rashes in their patients.
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6/26/2008
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Psychiatric Issues in Adults with Sickle Cell Disease
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sychiatric issues are common in sickle cell disease (SCD)1 but have not received sufficient attention in the clinical or research literature. These issues are further complicated by the social, economic, and healthcare disparities experienced by many African Americans.
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4/29/2008
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Psychiatric Issues in Neurology, Part 4: Amnestic Syndromes and Conversion Disorder
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Important psychiatric issues affecting diagnosis and management arise in patients with neurologic illness more often than any other area of medicine.
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2/25/2008
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Psychiatric Issues in Neurology, Part 3: Epilepsy
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Important psychiatric issues affecting diagnosis and management arise in patients with neurological illness more often than any other area of medicine. These include cognitive impairment either as a primary feature or a secondary complication of a known neurological disorder; other psychiatric symptoms as a manifestation or complication of neurological disease; and physical neurological symptoms that do not correspond to any recognized pattern of neurological disease, ie, conversion disorder or somatization disorder.
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12/27/2007
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Psychiatric Issues in Neurology, Part 2: Parkinson’s Disease and Multiple Sclerosis
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Important psychiatric issues affecting diagnosis and management arise in patients with neurologic illness more often than any other area of medicine. These include cognitive impairment either as a primary feature or a secondary complication of a known neurologic disorder, such as multiple sclerosis; other psychiatric symptoms as a manifestation or complication of neurologic disease; and physical neurologic symptoms that do not correspond to any recognized pattern of neurologic disease, ie, conversion disorder or somatization disorder.
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10/29/2007
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Psychiatric Issues in Neurology, Part I: Stroke
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Psychiatrists and other clinicians working in general medical or specialized neurologic settings frequently encounter important psychiatric issues affecting diagnosis and management of patients with neurologic illnesses.
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8/29/2007
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Psychiatric Issues in Surgery — Part 2: Specific Topics
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In a previous column, general psychiatric issues arising in surgical patients were reviewed. In this column, specifically selected topics are reviewed, including issues in neurosurgery and burn care as well as bariatric, cataract, and cosmetic surgery. More detailed reviews of these topics can be found elsewhere.
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6/26/2007
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Psychiatric Issues in Surgical Patients
Part I: General Issues
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Psychiatric disorders are quite common in surgical patients. However, surgeons are less likely to refer patients to psychiatrists than other physicians, who also have a tendency to under-recognize psychiatric disorders among their patients. Therefore, a large proportion of psychopathology in surgical patients is either undiagnosed or misdiagnosed and not optimally treated, if treated at all. This column focuses on common psychiatric issues that generally arise in surgical patients and reviews psychiatric issues specific to specialized surgical settings and patients (eg, burn units, obesity surgery).
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4/23/2007
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Psychiatric Issues in Pulmonary Disease
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Chronic pulmonary diseases are a global health problem and the number of patients being treated in primary care settings is increasing. The prevalence of a life-time diagnosis of asthma has increased in all age groups. Drug use for obstructive diseases of the airways have shown a sharp increase over the past decade. Acute exacerbations are a characteristic clinical expression of asthma and chronic obstructive pulmonary disease (COPD) and account for a significant amount of health care costs. This column reviews psychiatric issues in pulmonary disorders, including asthma, cystic fibrosis, COPD, and sarcoidosis, as well as psychopharmacology in patients with pulmonary disease. More comprehensive review of these and other lung diseases can be found elsewhere.1
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2/28/2007
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Psychiatric Issues in Gastrointestinal Disorders
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The effects of psychological, social, and behavioral factors in gastrointestinal (GI) disease have received considerable clinical attention. This column briefly reviews peptic ulcer, inflammatory bowel disease, and functional GI disorders, after discussing general issues of differential diagnosis.
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12/27/2006
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Psychiatric Issues in Rheumatology
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This column reviews psychiatric issues in rheumatologic disorders, including general principles of diagnosis, management, and treatment, followed by particular focus on systemic lupus erythematosus (SLE) and rheumatoid arthritis. Osteoarthritis, Sjögren’s syndrome, systemic sclerosis, temporal arteritis, polymyositis, and Behçet’s disease are also discussed, followed by secondary psychiatric syndromes caused by nonrheumatologic disorders and medications encountered in rheumatology patients.
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10/27/2006
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Psychiatric Issues in Oncology
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This column reviews psychologic factors affecting the incidence and course of cancer, the most common comorbid psychiatric disorders (depression, anxiety, and delirium), psychiatric issues in selected specific cancers, psychiatric aspects of cancer treatments, and psychiatric treatment in cancer patients. More comprehensive review of these issues is available elsewhere.
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8/31/2006
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Psychiatric Issues in Heart Disease
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This column briefly reviews common psychiatric disorders in heart disease, the effects of psychologic factors on heart disease, and heart disease’s effects on the psyche. Also discussed are psychiatric side effects of cardiac drugs, as well as neuropsychiatric sequelae of cardiac surgery and implanted defibrillators. Finally, precautions for the use of psychiatric drugs and electroconvulsive therapy in patients with heart disease are noted.
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6/29/2006
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Psychiatric Issues in Infectious Diseases
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Many important psychiatric issues are related to infectious diseases. Neuropsychiatric symptoms are a prominent part of the presentation of many systemic and central nervous system (CNS) infections, and psychologic factors influence the course of infectious diseases. Rapid cultural and economic changes have led to epidemics of new diseases and previously isolated diseases, requiring physicians to expand their knowledge. Infections contribute to the pathogenesis of some psychiatric disorders, although how much weight should be given to attributions of psychopathology to infectious pathophysiology is controversial.
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4/27/2006
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Psychiatric Issues in Endocrinology
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Psychiatric symptoms and syndromes are common in patients with endocrine disorders. This column briefly reviews psychiatric issues in diabetes mellitus, hypoglycemia, thyroid disorders, parathyroid disorders, adrenal disorders, acromegaly, pheochromocytoma, hyperprolactinemia, polycystic ovary syndrome, and testosterone deficiency.
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3/29/2006
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Suicidality in the Medically Ill
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A common question facing psychiatrists and other clinicians caring for depressed medically ill patients is whether a patient is suicidal. Suicidal ideation in the medically ill is not uncommon, although completed suicide attempts are rare.
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3/25/2006
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Psychosis in the Medically Ill
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Psychosis profoundly impacts the medical care of patients with serious medical illness; patients with chronic psychosis are at increased risk for a number of general medical conditions. This article reviews psychosis, mania, and catatonia in the medically ill; both “primary” and “secondary” conditions, caused by a medical disease or drug, are discussed.
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3/19/2006
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Psychopharmacology in the Medically Ill
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Appropriate use of psychopharmacology in the medically ill requires careful consideration of how the underlying medical illness may affect pharmacokinetics, drug-drug interactions, and vulnerability to adverse drug effects.
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3/15/2006
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Legal Issues in the Interface of Medicine and Psychiatry
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Psychiatrists and physicians providing psychiatric care in medical settings regularly encounter difficult legal issues. This column reviews confidentiality and the Health Insurance Portability and Accountability Act (HIPAA), informed consent, competency, guardianship, substituted judgment, end-of-life decisions, advance directives, maternal “competency,” voluntary and involuntary treatment, American Medical Association discharges, and the use of physical restraints.
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3/14/2006
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