The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry E-Book

David M. Taylor

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: The Maudsley Prescribing Guidelines Series
• Sprache: Englisch

Seitenzahl: 1189

Veröffentlichungsjahr: 2020

Beschreibung

Learn to improve 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.

Leseprobe

Table of Contents

Cover

Title Page

Copyright Page

Preface

Abbreviations

Part 1: Cardiology

Chapter 1: Tachycardia

SINUS TACHYCARDIA

ATRIAL FIBRILLATION

SUPRAVENTRICULAR TACHYCARDIA

VENTRICULAR TACHYCARDIA

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 2: Bradycardia

DIAGNOSIS

MANAGEMENT AND WHEN TO REFER TO A SPECIALIST

References

Chapter 3: QT Interval Prolongation

PRESCRIBING QTC‐PROLONGING MEDICATION

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 4: Syncope

CAUSES OF SYNCOPE

SYNCOPE AND SERIOUS MENTAL ILLNESS

DIAGNOSTIC PRINCIPLES

DIAGNOSIS AND MANAGEMENT

References

Chapter 5: Hypertension

DIAGNOSTIC PRINCIPLES

DIAGNOSIS

MANAGEMENT

References

Chapter 6: Postural Hypotension

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 7: Peripheral Oedema

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 8: Myocarditis

DIAGNOSTIC PRINCIPLES

MANAGEMENT

CLOZAPINE‐INDUCED MYOCARDITIS

References

Chapter 9: Hypercholesterolaemia

DIAGNOSTIC PRINCIPLES

DIAGNOSTIC CRITERIA

MANAGEMENT

References

Chapter 10: Physical Activity

PHYSICAL ACTIVITY AND SERIOUS MENTAL ILLNESS

HOW MUCH PHYSICAL ACTIVITY AND EXERCISE SHOULD PEOPLE BE DOING?

PRACTICAL TIPS

MESSAGES TO INCLUDE IN DISCUSSIONS WITH PATIENTS

References

Part 2: Endocrinology

Chapter 11: Diabetes Mellitus

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 12: Thyroid Disease

HYPOTHYROIDISM

DIAGNOSTIC PRINCIPLES

MANAGEMENT

HYPERTHYROIDISM

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 13: Hyperprolactinaemia

DIAGNOSTIC PRINCIPLES

MANAGEMENT AND WHEN TO REFER TO A SPECIALIST

HYPERPROLACTINAEMIA AND OSTEOPOROSIS RISK IN SERIOUS MENTAL ILLNESS

HYPERPROLACTINAEMIA AND CANCER RISK

References

Chapter 14: Obesity

MONITORING

PREVENTION AND TREATMENT OF WEIGHT GAIN

References

Part 3: Haematology

Chapter 15: Anaemia

DIAGNOSTIC PRINCIPLES

MANAGEMENT AND REFERRAL PATHWAYS

References

Chapter 16: Neutropenia

DRUG‐INDUCED NEUTROPENIA AND AGRANULOCYTOSIS

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 17: Thrombocytopenia

DIAGNOSTIC PRINCIPLES

MANAGEMENT AND WHEN TO REFER

References

Chapter 18: Venous Thromboembolism and Anticoagulation

RISK FACTORS

PROPHYLAXIS

DIAGNOSIS

MANAGEMENT

References

Part 4: Gastroenterology

Chapter 19: Gastro‐oesophageal Reflux and Peptic Ulcer Disease

GASTRO‐OESOPHAGEAL REFLUX DISEASE

PEPTIC ULCER DISEASE

References

Chapter 20: Gastrointestinal Bleeding

DIAGNOSTIC PRINCIPLES

References

Chapter 21: Nausea and Vomiting

DIAGNOSTIC PRINCIPLES

MANAGEMENT [15]

References

Chapter 22: Dysphagia

CAUSES OF DYSPHAGIA IN THE GENERAL POPULATION

DIAGNOSTIC PRINCIPLES

MANAGEMENT

OESOPHAGEAL CANCER IN PSYCHIATRIC POPULATIONS

DYSPHAGIA IN THE ELDERLY

References

Chapter 23: Deranged Liver Function Tests

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 24: Alcohol and Physical Health

WHAT IS HARMFUL USE?

PHYSICAL COMPLICATIONS OF ALCOHOL USE

APPROACH TO THE PATIENT WITH SUSPECTED ALCOHOL MISUSE

MANAGEMENT

References

Chapter 25: Unintentional Weight Loss

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 26: Dry Mouth

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 27: Hypersalivation

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 28: Constipation

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Part 5: Renal and Urology

Chapter 29: Urinary Retention

URINARY RETENTION AND SERIOUS MENTAL ILLNESS

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 30: Urinary Incontinence

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 31: Polyuria

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 32: Sodium Derangement

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 33: Potassium Derangement

HYPERKALAEMIA

HYPOKALAEMIA

References

Chapter 34: Chronic Kidney Disease

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Part 6: Sexual and Reproductive Health

Chapter 35: Sexual Dysfunction

ASSESSMENT OF A PATIENT WITH SEXUAL DYSFUNCTION

MANAGEMENT

References

Chapter 36: Contraception

CLINICAL APPROACH

CONTRACEPTIVE OPTIONS

ETHICAL AND LEGAL CONSIDERATIONS

WHEN TO REFER

SPECIAL CONSIDERATIONS IN PATIENTS WITH SERIOUS MENTAL ILLNESS

References

Chapter 37: Infertility

ADDRESSING INFERTILITY IN PSYCHIATRIC PRACTICE

ONWARD REFERRAL AND FURTHER TESTS FOR INFERTILITY

INFERTILITY TREATMENTS

References

Chapter 38: Sexually Transmitted Infection

HISTORY

STI TESTING IN PSYCHIATRY

DETERMINING URGENCY OF CLINICAL ACTION/REFERRAL

REFERRAL TO SEXUAL HEALTH SERVICES

References

Part 7: Infectious Diseases

Chapter 39: Pneumonia

PNEUMONIA AND SERIOUS MENTAL ILLNESS

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 40: Influenza

DIAGNOSTIC PRINCIPLES

MANAGEMENT

PREVENTING SPREAD OF INFLUENZA

References

Chapter 41: Urinary Tract Infection

URINARY TRACT INFECTION AND SERIOUS MENTAL ILLNESS

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 42: Gastroenteritis

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 43: Viral Hepatitis

HEPATITIS B

HEPATITIS C

References

Chapter 44: Tuberculosis

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 45: Human Immunodeficiency Virus

TESTING FOR HIV

HIV AND THE CENTRAL NERVOUS SYSTEM

ANTIRETROVIRAL THERAPY

References

Part 8: Respiratory

Chapter 46: Smoking Cessation

IDENTIFYING THOSE WHO WANT TO STOP SMOKING AND DEGREE OF NICOTINE DEPENDENCE

APPROACHES TO SMOKING CESSATION

References

Chapter 47: Chronic Obstructive Pulmonary Disease

COMMON CAUSES OF COPD IN THE GENERAL POPULATION AND PATIENTS WITH SERIOUS MENTAL ILLNESS

THE ASTHMA–COPD OVERLAP

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 48: Asthma

CAUSES IN THE GENERAL POPULATION AND PEOPLE WITH SERIOUS MENTAL ILLNESS

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 49: Obstructive Sleep Apnoea

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Part 9: Neurology

Chapter 50: Delirium

DIAGNOSTIC PRINCIPLES (SEE BOX 50.1)

MANAGEMENT

References

Chapter 51: Autoimmune Encephalitis

AUTOIMMUNE DISEASE MECHANISMS

CLINICAL APPROACH

MANAGEMENT

References

Chapter 52: Catatonia

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 53: Seizure Disorders

ACUTE SEIZURE

PSYCHIATRIC COMORBIDITY IN PEOPLE WITH EPILEPSY

PSYCHIATRIC SIDE EFFECTS OF ANTIEPILEPTIC DRUGS

PSYCHIATRIC DRUG THERAPY IN PEOPLE WITH EPILEPSY

PSYCHOGENIC NON‐EPILEPTIC SEIZURES

EPILEPSY SURGERY

EPILEPSY AND LEARNING DISABILITY

References

Chapter 54: Headache

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 55: Disorders of Sleep and Circadian Rhythm

DEFINITIONS OF COMMON SLEEP DISORDERS IN PSYCHIATRIC POPULATIONS

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 56: Extrapyramidal Side Effects

CLINICAL APPROACH

MANAGEMENT

References

Chapter 57: Tardive Dyskinesia

CLINICAL APPROACH

MANAGEMENT

References

Chapter 58: Tremor

CLINICAL APPROACH

MANAGEMENT

References

Part 10: Rheumatology and Musculoskeletal Health

Chapter 59: Low Back Pain

Diagnostic principles

MANAGEMENT

References

Chapter 60: Arthritis

CLINICAL APPROACH

MANAGEMENT

References

Part 11: Ophthalmology

Chapter 61: Eye Disease

CLINICAL APPROACH TO A PATIENT WITH VISUAL DISTURBANCE OR ORBITAL/PERIORBITAL DISORDERS

DISORDERS OF THE EYELIDS

DISORDERS OF THE CONJUNCTIVA

DISORDERS OF THE CORNEA

References

Part 12: Obstetrics and Gynaecology

Chapter 62: Pregnancy

THE PRE‐CONCEPTION PERIOD

DURING PREGNANCY

PSYCHIATRIC MEDICATION IN PREGNANCY

POSTPARTUM PSYCHOSIS

ELECTROCONVULSIVE THERAPY IN PREGNANCY

References

Chapter 63: Menopause

PHYSIOLOGY AND SYMPTOMS OF PERIMENOPAUSE

CLINICAL APPROACH

TREATMENT

References

Part 13: Dermatology

Chapter 64: General Dermatology

INFECTIOUS SKIN DISEASE

NON‐INFECTIOUS SKIN DISEASE

References

Chapter 65: Psychodermatology

PSYCHIATRIC DISORDERS WITH SKIN MANIFESTATIONS

PSYCHOPHYSIOLOGICAL CONDITIONS

SECONDARY PSYCHOLOGICAL DISORDERS

CUTANEOUS SENSORY DISORDERS

References

Part 14: Electroconvulsive Therapy

Chapter 66: Electroconvulsive Therapy

INDICATIONS AND CONTRAINDICATIONS

THE ECT PROCEDURE

PHYSIOLOGICAL EFFECTS OF ECT

PRE‐ECT ASSESSMENT

SAFETY OF ECT

ECT PRESCRIBING

GUIDANCE FOR THE DOCTOR ADMINISTERING ECT

SIDE EFFECTS OF ECT

SPECIAL PATIENT GROUPS

References

Part 15: Emergencies

Chapter 67: Chest Pain

DIAGNOSTIC PRINCIPLES

MANAGEMENT

INFORMATION TO PROVIDE IN A ‘CHEST PAIN’ REFERRAL TO MEDICAL SERVICES

References

Chapter 68: Acute Shortness of Breath

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 69: Acute Coronary Syndrome

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 70: Arrhythmia

TACHYCARDIA

BRADYCARDIA

Reference

Chapter 71: Hypertensive Crisis

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 72: Sepsis

WHEN TO THINK SEPSIS

SEPTIC SHOCK

MANAGEMENT

POST‐SEPSIS SYNDROME

References

Chapter 73: Acute Kidney Injury

CATEGORISATION OF ACUTE KIDNEY INJURY

DIAGNOSTIC PRINCIPLES

MANAGEMENT

PSYCHIATRIC MEDICATION AND ACUTE KIDNEY INJURY

References

Chapter 74: Diabetic Emergencies

HYPOGLYCAEMIA [1]

DIABETIC KETOACIDOSIS [2]

HYPEROSMOLAR HYPERGLYCAEMIC STATE [5]

References

Chapter 75: Acute Upper Gastrointestinal Bleeding

SIGNS OF ACUTE UPPER GASTROINTESTINAL BLEEDING

WAITING FOR TRANSFER

HANDING OVER TO THE ACUTE MEDICAL TEAM

Chapter 76: Status Epilepticus

Chapter 77: Anaphylaxis

MANAGEMENT

References

Chapter 78: Reduced Consciousness and Coma

CLINICAL APPROACH

References

Chapter 79: Thyroid Emergencies

HYPOTHYROID CRISIS/MYXOEDEMA COMA

HYPERTHYROID CRISIS/THYROID STORM

References

Chapter 80: Head Injury

CLINICAL APPROACH

TYPES OF INTRACRANIAL HAEMORRHAGE

References

Chapter 81: Acute Meningitis and Infective Encephalitis

MENINGITIS

INFECTIVE ENCEPHALITIS

References

Chapter 82: Stroke and Transient Ischaemic Attack

STROKE

DIAGNOSTIC PRINCIPLES

MANAGEMENT

TRANSIENT ISCHAEMIC ATTACK

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 83: Overdose

GENERAL PRINCIPLES [6]

INFORMATION GATHERING

EMERGENCY ASSESSMENT AND MANAGEMENT [6]

SPECIFIC SCENARIOS

MANAGEMENT OF A PERSON WHO REFUSES ADMISSION TO HOSPITAL AFTER AN OVERDOSE

References

Chapter 84: Acute Dystonia

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 85: Neuroleptic Malignant Syndrome

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 86: Serotonin Syndrome

DIAGNOSTIC PRINCIPLES

MANAGEMENT

References

Chapter 87: Emergencies in Obstetrics and Gynaecology

MATERNAL COLLAPSE

PRE‐ECLAMPSIA

MAJOR OBSTETRIC HAEMORRHAGE

AMNIOTIC FLUID EMBOLISM

ECTOPIC PREGNANCY

MISCARRIAGE

HYPEREMESIS GRAVIDARUM

OVARIAN CYST ACCIDENTS

PELVIC INFLAMMATORY DISEASE

References

Chapter 88: The Acute Abdomen

HISTORY

CAUSES OF THE ACUTE ABDOMEN BASED ON PAIN LOCATION

EXAMINATION

INVESTIGATIONS

ONWARD REFERRAL

References

Chapter 89: The ABCDE Approach

FIRST STEPS

AIRWAY (A)

BREATHING (B)

CIRCULATION (C)

DISABILITY (D)

EXPOSURE (E)

References

Index

End User License Agreement

List of Tables

Chapter 1

Table 1.1 Differential diagnosis of tachycardia according to the length of th...

Table 1.2 CHA

2

DS

2

VASc score to assess risk of thromboembolic event in atrial ...

Table 1.3 HAS‐BLED score determines risk of major bleeding for people with at...

Chapter 2

Table 2.1 Causes of bradycardia in the general and psychiatric population.

Chapter 3

Table 3.1 Effects of psychotropic medication on QTc [17].

Table 3.2 The management of acquired QTc prolongation [17,37,44].

Chapter 6

Table 6.1 Common causes of postural hypotension in the general and psychiatri...

Table 6.2 Approximate relative hypotensive severity of antidepressants.

Table 6.3 Approximate relative hypotensive severity of antipsychotics.

Chapter 7

Table 7.1 Common causes of oedema in the general and psychiatric population.

Chapter 8

Table 8.1 Causes of myocarditis in the general population and special conside...

Chapter 11

Table 11.1 Risks, benefits and evidence base for diabetes treatments in serio...

Chapter 12

Table 12.1 Primary and secondary causes of hypothyroidism and hyperthyroidism...

Table 12.2 Common signs and symptoms of hypothyroidism and hyperthyroidism.

Table 12.3 Medications that cause hypothyroidism and hyperthyroidism.

Table 12.4 Biochemical findings in hypothyroidism and hyperthyroidism.

Chapter 13

Table 13.1 Relative risk of hyperprolactinaemia with different antipsychotics...

Chapter 14

Table 14.1 Monitoring protocol for weight gain, metabolic disturbance, and ca...

Table 14.2 Pharmacological interventions to counteract weight gain.

Chapter 15

Table 15.1 Causes of anaemia in the general and psychiatric patient populatio...

Table 15.2 Haematological tests in the work‐up of anaemia.

Chapter 17

Table 17.1 Causes of isolated thrombocytopenia.

Chapter 18

Table 18.1 Revised Wells Score for suspected deep vein thrombosis (DVT) [9].

Table 18.2 Wells Score for suspected pulmonary embolus (PE) [11].

Table 18.3 Anticoagulants for use in long‐term treatment of DVT/PE and preven...

Chapter 19

Table 19.1 Common causes of GORD in the general and psychiatric patient popul...

Chapter 20

Table 20.1 Blatchford score for GI bleeds.

Chapter 21

Table 21.1 Commonly prescribed anti‐emetics.

Chapter 24

Table 24.1 Moderate alcohol dependence: example of fixed‐dose chlordiazepoxid...

Table 24.2 Severe alcohol dependence: example of fixed‐dose chlordiazepoxide ...

Chapter 27

Table 27.1 Drug treatments for hypersalivation.

Chapter 30

Table 30.1 Types of urinary incontinence.

Chapter 31

Table 31.1 Causes of polyuria.

Chapter 32

Table 32.1 Common causes of hyponatraemia and hypernatraemia.

Chapter 34

Table 34.1 Stages of chronic kidney disease based on glomerular filtration ra...

Table 34.2 Special considerations when prescribing antidepressants, antipsych...

Chapter 36

Table 36.1 Contraception options.

Table 36.2 Specific considerations regarding contraception in people with ser...

Chapter 38

Table 38.1 Symptoms of sexually transmitted infections.

Table 38.2 Typical treatment regimens for sexually transmitted infections.

Chapter 39

Table 39.1 Recommended investigations for pneumonia in patients being managed...

Table 39.2 CURB‐65 scoring for severity of community‐acquired pneumonia [27].

Table 39.3 Guidelines on management of CAP by severity, in the UK general pop...

Chapter 40

Table 40.1 Pharmacological treatment and prophylaxis of influenza in adults.

Chapter 41

Table 41.1 Recommended investigations for UTI in patients being managed in th...

Table 41.2 Determining likelihood of urinary tract infection based on urinaly...

Table 41.3 Common antibiotic regimens for uncomplicated urinary tract infecti...

Chapter 42

Table 42.1 Common causes of gastroenteritis.

Table 42.2 Clinical features of dehydration.

Table 42.3 Examples of antibiotic treatments for bacterial gastroenteritis ac...

Chapter 43

Table 43.1 Interpretation of hepatitis B serology.

Table 43.2 HBV vaccine schedules.

Chapter 44

Table 44.1 Common antituberculous agents and effects on psychiatric symptoms ...

Table 44.2 Common major and minor side effects of the most common antitubercu...

Chapter 45

Table 45.1 Antiretrovirals: classes, examples, and mechanisms of action.

Table 45.2 Potential psychotropic–antiretroviral therapy interactions.

Chapter 46

Table 46.1 Prescribing guidelines for psychiatric drugs during smoking cessat...

Table 46.2 Fagerström test for nicotine dependence.

Table 46.3 Nicotine withdrawal symptoms

Table 46.4 Nicotine replacement therapy preparations and dose.

Chapter 47

Table 47.1 Causes of COPD in the general population [13] and in those living ...

Table 47.2 Additional investigations that may be requested in patients with C...

Table 47.3 Recommended primary care follow‐up in patients with COPD. Frequenc...

Table 47.4 Stepped inhaled pharmacological treatment of COPD [19].

Table 47.5 Oral therapies for COPD [19].

Chapter 48

Table 48.1 Stepped pharmacological treatment of asthma [20].

Table 48.2 Features of acute and life‐threatening asthma.

Chapter 49

Table 49.1 Common causes and exacerbating factors for OSA in the general and ...

Chapter 50

Table 50.1 Common risk factors for delirium in general and psychiatric patien...

Table 50.2 Common precipitating factors for delirium in general and psychiatr...

Table 50.3 Anticholinergic effect on cognition (AEC): medications commonly us...

Chapter 51

Table 51.1 Main clinical and paraclinical abnormalities in NMDAR and LGI1 ant...

Table 51.2 Immunotherapies used in treatment of autoimmune encephalitis.

Chapter 52

Table 52.1 Additional investigations for particular indications.

Table 52.2 Lorazepam challenge protocols.

Chapter 54

Table 54.1 Tension‐type headache, migraine and cluster headache syndromes [13...

Table 54.2 Specific neuroimaging recommendations in patients with headaches [...

Table 54.3 Pharmacological treatment of the most common types of headache.

Chapter 55

Table 55.1 Prevalence and common causes of sleep disorders in the general and...

Chapter 60

Table 60.1 Common types of arthritis in adults, underlying pathoaetiology, ty...

Chapter 62

Table 62.1 Medical complaints associated with pregnancy or that may pose grea...

Table 62.2 Risks and considerations in the perinatal prescription of antidepr...

Chapter 64

Table 64.1 Frequently reported cutaneous adverse drug reactions to commonly p...

Chapter 67

Table 67.1 Causes of chest pain in the general population presenting to prima...

Chapter 69

Table 69.1 Clinical, ECG, and biochemical features of unstable angina, non‐ST...

Chapter 72

Table 72.1 The Quick Sequential Organ Failure Assessment (qSOFA) score: a sco...

Table 72.2 The NEWS2 scoring system [8].

Table 72.3 ABCDE assessment of patient with suspected sepsis, and associated ...

Chapter 73

Table 73.1 Simplified version of the Kidney Disease: Improving Global Outcome...

Chapter 78

Table 78.1 Glasgow Coma Scale [1].

Chapter 80

Table 80.1 Glasgow Coma Scale [7].

Chapter 81

Table 81.1 Main infectious causes of encephalitis listed in order of frequenc...

Chapter 82

Table 82.1 Adapted TOAST classification: subtypes of acute ischaemic stroke.

Chapter 83

Table 83.1 Specific antidotes for opioid and paracetamol overdose.

Chapter 87

Table 87.1 Adaptations to resuscitation techniques in the context of pregnanc...

List of Illustrations

Chapter 2

Figure 2.1 Sinus bradycardia, rate 50 bpm, as measured from lead II of the E...

Chapter 5

Figure 5.1 Criteria for diagnosis of hypertension. ABPM, ambulatory blood pr...

Figure 5.2 National Institute for Health and Care Excellence (NICE) algorith...

Chapter 7

Figure 7.1 Algorithmic diagnostic approach to peripheral oedema.

Chapter 11

Figure 11.1 Approach to management of type 2 diabetes mellitus (T2DM) in pat...

Chapter 14

Figure 14.1 Waist circumference measurement sites for men and women based on...

Figure 14.2 Flowchart to manage weight gain in patients with severe mental i...

Figure 14.3 Propensity of 18 antipsychotics to induce weight gain in the acu...

Chapter 15

Figure 15.1 An algorithmic approach to anaemia.

Chapter 18

Figure 18.1 Investigation of suspected deep vein thrombosis (DVT). CRP, C‐re...

Figure 18.2 Investigation of suspected pulmonary embolus (PE). ECG, electroc...

Chapter 27

Figure 27.1 Suggested treatment algorithm for clozapine‐induced hypersalivat...

Chapter 28

Figure 28.1 The Bristol Stool Form Scale.

Figure 28.2 Management algorithm for clozapine‐related constipation.

Chapter 30

Figure 30.1 Suggested management of clozapine‐induced nocturnal enuresis.

Chapter 35

Figure 35.1 Approximate rates of sexual dysfunction with psychiatric drugs a...

Chapter 43

Figure 43.1 Hepatitis C testing algorithm. *Note that previous infection and...

Chapter 52

Figure 52.1 Treatment algorithm for catatonia.

Chapter 56

Figure 56.1 Suggested treatment algorithm for antipsychotic‐induced akathisi...

Chapter 57

Figure 57.1 Algorithmic approach to management of antipsychotic‐induced tard...

Chapter 69

Figure 69.1 A clinical approach to a patient with suspected cardiac ischaemi...

Figure 69.2 Anterolateral myocardial ischaemia as demonstrated by ST‐segment...

Figure 69.3 Anterolateral ST‐elevation myocardial infarction (STEMI).

Chapter 70

Figure 70.1 Emergency approach to the unresponsive patient.

Figure 70.2 Adult tachycardia (with pulse) algorithm.

Figure 70.3 Adult bradycardia algorithm.

Chapter 72

Figure 72.1 Sepsis screening and treatment.

Chapter 77

Figure 77.1 Management of anaphylaxis in adults.

Chapter 78

Figure 78.1 Algorithm for approach to a patient with reduced level of consci...

Chapter 80

Figure 80.1 An algorithm for determining need for CT imaging post head injur...

Figure 80.2 Types of intracranial haemorrhage.

Chapter 83

Figure 83.1 Ascending dosing of naloxone for opioid overdose in adults. Pati...

Chapter 88

Figure 88.1 Differential diagnoses of abdominal pain based on its location....

Chapter 89

Figure 89.1 Adult Advanced Life Support algorithm. The algorithm is reproduc...

Guide

Cover

Table of Contents

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THE MAUDSLEY GUIDELINES

Other books in the Maudsley Prescribing Guidelines series include:

The Maudsley Prescribing Guidelines in Psychiatry, 14th edition (coming in 2021) David M. Taylor, Thomas R.E. Barnes, Allan H. Young.

The Maudsley Guidelines on Advanced Prescribing in Psychosis Paul Morrison, David M. Taylor, Phillip McGuire.

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

David M. Taylor BSc, MSc, PhD, FCMHP, FFRPS, FRPharmS, FRCP (Edin)

Director of Pharmacy and Pathology, Maudsley Hospital; and Professor of Psychopharmacology, King’s College, London, UK

Fiona Gaughran MD, FRCP(I), FRCP (Lon), FRCP (Edin), FRCPsych, FHEA

Lead Consultant Psychiatrist, National Psychosis Service (Bethlem Royal Hospital);Director of Research and Development, South London and Maudsley NHS Foundation Trust;Reader in Psychopharmacology and Physical Health, King’s College, London, UK

Toby Pillinger MA (Oxon), BM BCh, MRCP, PhD

Academic Clinical Fellow, South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK

This edition first published 2021© 2021 John Wiley & Sons Ltd

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Library of Congress Cataloging‐in‐Publication Data

Names: David M. Taylor, 1963– editor. | Gaughran, Fiona, editor. | Pillinger, Toby, editor.Title: The Maudsley practice guidelines for physical health conditions in psychiatry / [edited by] David M. Taylor, Fiona Gaughran, Toby Pillinger.Description: Hoboken, NJ : John Wiley & Sons, Inc., 2021. | Includes index.Identifiers: LCCN 2020025468 (print) | LCCN 2020025469 (ebook) | ISBN 9781119554202 (paperback) | ISBN 9781119554219 (adobe pdf) | ISBN 9781119554240 (epub)Subjects: MESH: Mental Disorders–complications | Patient Care–methods | Diagnostic Techniques and Procedures | Referral and Consultation | Evidence‐Based Practice | Practice GuidelineClassification: LCC RC454 (print) | LCC RC454 (ebook) | NLM WM 140 | DDC 616.89–dc23LC record available at https://lccn.loc.gov/2020025468LC ebook record available at https://lccn.loc.gov/2020025469

Cover Design: WileyCover Image: © SciePro/Shutterstock

For Aloysius, welcome to the world.

Preface

It is well documented that people with severe mental illness have elevated mortality rates compared with the general population, with physical health conditions the predominant cause. There are several potential mechanisms underlying this mortality gap. First, lifestyle factors such as poor diet, reduced exercise levels, and higher rates of smoking play a role. Second, psychiatric medications are associated with physical side effects, and can contribute to progressive impairment of multiple organ systems. Third, individuals with serious mental illness are less likely to present to a general practitioner or medical hospital with a physical complaint, thereby allowing conditions to progress without treatment. Fourth, when physical conditions are identified while under the care of psychiatric services, practitioners may lack the knowledge and confidence to act.

This, the first edition of The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry, aims to bridge the gap between psychiatric and physical health services which are usually geographically and organisationally separate. A key objective is to enhance the clinical confidence of psychiatric practitioners by providing these individuals with a practical and evidence‐based ‘toolkit’ with which to assess, investigate, and potentially initiate treatment for common physical health conditions seen in patients with serious mental illness. It is hoped that co‐working relationships between psychiatrists and general practitioners, physicians, and surgeons alike will be enhanced owing to improved quality of referrals. Furthermore, it is anticipated that the standard of clinical care delivered to patients with serious mental illness will improve by expediting appropriate investigation and management of physical comorbidity. Finally, we hope that the patient–practitioner relationship will be enhanced as psychiatric patients become aware that both body and mind are being considered as part of their holistic care.

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry consists of 89 chapters, covering 14 different organ systems, alongside emergency presentations. Although The Guidelines are predominantly based on UK practice, we have made efforts to acknowledge the anticipated international readership, and as such have also included references to psychiatric and medical drugs not currently licensed in the UK. However, the reader should be aware that no guideline can take into account every drug available across the world, so omissions are inevitable.

This text may be seen as a sister volume to the The Maudsley Prescribing Guidelines in Psychiatry. Like that book, the The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry is the product of a group of local and international experts; we are indebted to the 125 individuals from across medicine, surgery, and psychiatry who have contributed. At present, the world’s attention is centred on the COVID‐19 pandemic and never has there been a greater need for clinicians from across specialties to work together for the greater good of patients. We hope that The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry will go some way to facilitate this, not only in the current climate but for years to come.

Toby Pillinger

London, UK

September 2020

Abbreviations

ABPM

ambulatory blood pressure monitoring

ACE

angiotensin‐converting enzyme

ACOS

asthma–COPD overlap syndrome

ACS

acute coronary syndrome

ADH

antidiuretic hormone

ADR

adverse drug reaction

AE

autoimmune encephalitis

AED

antiepileptic drug

AF

atrial fibrillation

AFB

acid‐fast bacilli

AKI

acute kidney injury

ALP

alkaline phosphatase

ALT

alanine aminotransferase

ANC

absolute neutrophil count

ARB

angiotensin II receptor blocker

ART

antiretroviral therapy

ASPD

advanced sleep phase disorder

AST

aspartate aminotransferase

ATT

antitubercular treatment

AUR

acute urinary retention

BEN

benign ethnic neutropenia

BMI

body mass index

BNP

brain natriuretic peptide

BP

blood pressure

BPH

benign prostatic hyperplasia

CAP

community‐acquired pneumonia

CBT

cognitive‐behavioural therapy

CI

confidence interval

CIM

clozapine‐induced myocarditis

CKD

chronic kidney disease

CLD

chronic liver disease

CNS

central nervous system

COPD

chronic obstructive pulmonary disease

COVID‐19

coronavirus disease 2019

CPAP

continuous positive airway pressure

CRP

C‐reactive protein

CSF

cerebrospinal fluid

CT

computed tomography

CVD

cardiovascular disease

DAA

direct‐acting antiviral

DEXA

dual‐energy X‐ray absorptiometry

DI

diabetes insipidus

DKA

diabetic ketoacidosis

DRE

digital rectal examination

DSPD

delayed sleep phase disorder

DVT

deep vein thrombosis

ECT

electroconvulsive therapy

EDS

excessive daytime sleepiness

eGFR

estimated glomerular filtration rate

EPSE

extrapyramidal side effect

ESC

European Society of Cardiology

ESR

erythrocyte sedimentation rate

ESRF

end‐stage renal failure

FBC

full blood count

FDA

Food and Drug Administration

FEV

1

forced expiratory volume in 1 s

FVC

forced vital capacity

GABA

gamma‐aminobutyric acid

GCS

Glasgow Coma Scale

GGT

gamma‐glutamyltransferase

GORD

gastro‐oesophageal reflux disease

HAD

HIV‐associated dementia

HAND

HIV‐associated neurocognitive disorders

HAP

hospital‐acquired pneumonia

HBPM

home blood pressure monitoring

HBV

hepatitis B virus

HCG

human chorionic gonadotrophin

HCV

hepatitis C virus

HDL

high‐density lipoprotein

HHS

hyperosmolar hyperglycaemic state

HMOD

hypertension‐mediated organ damage

HRT

hormone replacement therapy

HSV

herpes simplex virus

ICD

implantable cardioverter‐defibrillator

ICP

intracranial pressure

ICU

intensive care unit

IGRA

interferon gamma release assay

INR

international normalised ratio

IOP

intraocular pressure

IUD

intrauterine device

LARC

long‐acting reversible contraceptive

LBBB

left bundle branch block

LDL

low‐density lipoprotein

LFT

liver function test

LLQ

left lower quadrant

LMWH

low‐molecular‐weight heparin

LOS

lower oesophageal sphincter

LP

lumbar puncture

LUQ

left upper quadrant

LVH

left ventricular hypertrophy

MAOI

monoamine oxidase inhibitor

MCV

mean corpuscular volume

MDD

major depressive disorder

MOH

major obstetric haemorrhage

MRI

magnetic resonance imaging

MRSA

methicillin‐resistant

Staphylococcus aureus

MSU

mid‐stream urine

NAFLD

non‐alcoholic fatty liver disease

NICE

National Institute for Health and Care Excellence

NMDA

N

‐methyl‐

D

‐aspartate

NMS

neuroleptic malignant syndrome

NNRTI

non‐nucleoside reverse transcriptase inhibitor

NRT

nicotine replacement therapy

NSAID

non‐steroidal anti‐inflammatory drug

NSTEMI

non‐ST‐segment elevation myocardial infarction

OD

odds ratio

OGTT

oral glucose tolerance test

OIC

opioid‐induced constipation

OSA

obstructive sleep apnoea

PA

physical activity

PAMORA

peripherally acting μ‐opioid receptor antagonist

PCI

percutaneous coronary intervention

PCR

polymerase chain reaction

PE

pulmonary embolism

PEF

peak expiratory flow

PEFR

peak expiratory flow rate

PEP

post‐exposure prophylaxis

PHAP

psychiatric hospital‐acquired pneumonia

PID

pelvic inflammatory disease

PLMS

periodic limb movements in sleep

PLWHIV

people living with HIV

PNES

psychogenic non‐epileptic seizures

POI

premature ovarian insufficiency

PPI

proton‐pump inhibitor

PPS

psychogenic pseudosyncope

PUD

peptic ulcer disease

PwE

people with epilepsy

RAPD

relative afferent pupillary defect

RID

relative infant dose

RLS

restless leg syndrome

RR

relative risk

RUQ

right upper quadrant

SARS‐CoV‐2

severe acute respiratory syndrome coronavirus 2

SD

sexual dysfunction

SIADH

syndrome of inappropriate antidiuretic hormone secretion

SJS

Stevens–Johnson syndrome

SLE

systemic lupus erythematosus

SMI

serious mental illness

SNRI

serotonin/noradrenaline reuptake inhibitor

SPECT

single photon emission computed tomography

SSRI

selective serotonin reuptake inhibitor

STEMI

ST‐segment elevation myocardial infarction

STI

sexually transmitted infection

SVT

supraventricular tachycardia

TD

tardive dyskinesia

T2DM

type 2 diabetes mellitus

TEN

toxic epidermal necrolysis

TFT

thyroid function test

TIA

transient ischaemic attack

TIBC

total iron‐binding capacity

TLE

temporal lobe epilepsy

TLOC

transient loss of consciousness

TNF

tumour necrosis factor

TRH

thyrotropin releasing hormone

TSH

thyroid stimulating hormone

UA

unstable angina

ULN

upper limit of normal

UPSI

unprotected sexual intercourse

UTI

urinary tract infection

VGKC

voltage‐gated potassium channel

VT

ventricular tachycardia

VTE

venous thromboembolism

WHO

World Health Organization

Part 1Cardiology