August 2011  << Back  

  Can't open the PDF? Click here for help.



Psychosomatic Medicine. An Introduction to Consultation-Liaison Psychiatry

Richard  Balon, MD

Wayne State University, Detroit, MI, USA

Edited by James J. Amos and Robert G. Robinson. New York, NY: Cambridge University Press; 2010; ISBN 978-0-521-10665-8; pp 275; $60 (paperback).

The everyday interaction between psychiatry and the rest of medicine usually occurs in the area of consultation-liaison psychiatry, also called, for better or worse, psychosomatic medicine. As the authors of this volume point out, numerous good, mostly large books on psychosomatic medicine have been published since the American Board of Psychiatry and Neurology recognized psychosomatic medicine as a subspecialty of psychiatry. These textbooks frequently are trying to be the definitive texts or reference books. What is missing, according to the authors of this volume, is an introductory, portable text for novices or learners in this area, such as junior faculty, fellows, residents, and medical students. The primary goal of putting together this relatively small book was to fill this gap.

The book consists of 28 chapters written by 42 mostly North American contributors. These chapters cover almost all areas of consultation-liaison psychiatry, starting with general themes such as the consultation process; assessing capacity in the medically ill; encountering a difficult patient; assessing suicide risk; assessing and managing the violent patient; evaluating and managing delirium; and reviewing psychopharmacology in the medically ill. The book then moves to disease or condition specific areas such as management of somatoform disorders, managing factitious disorder and malingering, agitation in patients with dementia, depression and heart disease, management of post-stroke depression, psychiatric aspects of Parkinson’s disease, managing depression in traumatic brain injury, managing psychiatric aspects of seizure disorders, distress and depression in cancer care, depression in patients with hepatitis C, psychiatric aspects of AIDS, managing depression in renal failure, management of psychiatric syndromes due to endocrine and metabolic diseases, management of alcohol withdrawal and other selected substance withdrawal issues, managing depression in pregnancy, psychiatric aspects of organ transplantation, and preoperative psychiatric evaluation for bariatric surgery. The final 4 chapters deal with general issues, such as psychiatric care at the end of life (hospice and palliative medicine), demoralization in the medical setting, psychotherapy for the hospitalized medically ill, and children’s reactions and consequences of illness and hospitalization and transition of care from the pediatric to the adult setting.

The chapters are mostly well written, informative, and cover topics sufficiently. They usually start with a typical consult in the area they cover. Many contain interesting facts. I will mention some of them for illustration. The chapter on the consultation process makes several important points, such as communication is the most crucial element of the consultation process (communication among all parties involved!), a routine consult should be completed within 24 hours, the consultation notes should be simple and devoid of “psycho-speak,” and one is allowed to obtain information from care providers whom the patient has seen previously, as part of care coordination (this is allowed under Health Insurance Portability and Accountability Act regulations). The chapter describes in detail what the consult should look like and what interventions could/should be. The chapter on capacity assessment makes an important point about distinguishing capacity and competency. The discussion of assessing and managing the violent patient emphasizes the importance of paying attention to one’s body language (eg, crossed arms or arms behind one’s back can seem threatening). The discussion on somatoform disorders mentions anniversary reactions may be the underlying dynamic for some conversion symptoms. The chapter on Parkinson’s disease notes low testosterone may exacerbate Parkinson’s disease-related apathy and actually is the only chapter in this book that discusses sexual functioning of patients inflicted with any disease. The review of depression in cancer care mentions paroxetine should not be used in patients treated with tamoxifen, as it diminishes tamoxifen’s active metabolite levels. Interestingly, the chapter on hepatitis C argues against the common practice of prophylactic use of antidepressants in patients treated with interferon-alfa, because evidence to support antidepressant use to minimize psychiatric side effects of interferon is lacking. On the other hand, this chapter advocates the use of stimulants in interferon-induced fatigue. The chapter on children’s reactions includes a useful table on psychotropic medications with FDA-approved uses in children and adolescents.

Some chapters present data without any critical reflection that could be useful to novices or less experienced readers. For instance, the chapter on suicide assessment mentions medical inpatients tend to commit suicide by jumping from heights, in contrast to patients on psychiatric units who tend to hang themselves, and in contrast to community-based persons, who tend to shoot themselves (p 52). It would be useful to note these modes of suicide reflect the opportunity in the environment—medical units usually are on the upper floors of hospitals and windows may be easier to open and guns are not permitted in hospitals. The chapter on AIDS has too many tables.

I mentioned the book covers almost all areas of psychosomatic medicine. Among topics I miss are sexual disorders and dysfunctions and eating disorders (obesity is covered in the chapter on psychiatric syndromes due to endocrine and metabolic disease, but anorexia, bulimia, and binging are not covered). The chapter on factitious disorder and malingering presents a “poem” about Münchausen syndrome but misses anything on Münchausen syndrome by proxy. The chapter on depression in pregnancy could have been expanded to management of other mental disorders in pregnancy.

No book is perfect. The flaws of this volume are fairly minor and could be taken care of in the next edition, if there is one. The book fulfills its goal of being an introductory, yet informative and useful text for novices in the field and learners such as residents, fellows, and students. These individuals definitely will benefit from using it and should buy it. They will note the authors also realized another of their goals—they limited the length of each chapter in order to “make this the kind of book that the clinician can carry in her (sic) pocket.” I checked; it will fit into the pocket of your lab coat.