The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry:

Preface xxiii
List of Abbreviations xxv
Part 1 Cardiology 1
Chapter 1 Tachycardia 3
Guy Hindley, Eromona Whiskey, Nicholas Gall
Sinus tachycardia 3
Atrial fibrillation 4
Supraventricular tachycardia 4
Ventricular tachycardia 6
Diagnostic principles 6
Management 10
References 14
Chapter 2 Bradycardia 17
Eleanor Croft, Nicholas Gall
Diagnosis 19
Management and when to refer to a specialist 21
References 22
Chapter 3 QT Interval Prolongation 23
Guy Hindley, Nicholas Gall
Prescribing QTc-prolonging medication 27
Diagnostic principles 28
Management 29
References 32
Chapter 4 Syncope 35
Luke Vano, Nicholas Gall
Causes of syncope 35
Syncope and serious mental illness 36
Diagnostic principles 36
Diagnosis and management 38
References 39
Chapter 5 Hypertension 41
Luke Vano, Toby Pillinger, J. Kennedy Cruickshank
Diagnostic principles 43
Diagnosis 44
Management 45
References 48
Chapter 6 Postural Hypotension 51
Toby Pillinger, Ian Osborne, Thomas Ernst, J. Kennedy Cruickshank
Diagnostic principles 53
Management 54
References 58
Chapter 7 Peripheral Oedema 59
Thomas Whitehurst, Theresa McDonagh
Diagnostic principles 60
Management 66
References 67
Chapter 8 Myocarditis 71
Thomas Whitehurst, Theresa McDonagh
Diagnostic principles 71
Management 75
Clozapine-induced myocarditis 75
References 77
Chapter 9 Hypercholesterolaemia 79
Dipen Patel, Toby Pillinger, Narbeh Melikian
Diagnostic principles 80
Diagnostic criteria 81
Management 81
References 84
Chapter 10 Physical Activity 85
Garcia Ashdown-Franks, Brendon Stubbs
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
Yuya Mizuno, Toby Pillinger, Dan Siskind, Sophie Harris
Diagnostic principles 93
Management 97
References 102
Chapter 12 Thyroid Disease 105
Harriet Quigley, Jackie Gilbert
Hypothyroidism 105
Diagnostic principles 107
Management 110
Hyperthyroidism 111
Diagnostic principles 112
Management 113
References 114
Chapter 13 Hyperprolactinaemia 117
John Lally, Toby Pillinger, Olubanke Dzahini, Sophie Harris
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
Yuya Mizuno, Toby Pillinger, Dan Siskind, Ian Osborne, Kate Moffat, Donal O’Shea
Monitoring 127
Prevention and treatment of weight gain 129
References 134
Part 3 Haematology 137
Chapter 15 Anaemia 139
Sanjena Mithra, Aleksander Mijovic
Diagnostic principles 140
Management and referral pathways 143
References 145
Chapter 16 Neutropenia 147
John Lally, Toby Pillinger, Aleksander Mijovic
Drug-induced neutropenia and agranulocytosis 149
Diagnostic principles 150
Management 151
References 153
Chapter 17 Thrombocytopenia 155
Sanjena Mithra, Aleksander Mijovic
Diagnostic principles 156
Management and when to refer 158
References 158
Chapter 18 Venous Thromboembolism and Anticoagulation 159
Helen Doolittle, Lara Roberts, Roopen Arya
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
Luke Vano, Seema Varma, John O’Donohue
Gastro-oesophageal reflux disease 171
Peptic ulcer disease 176
References 178
Chapter 20 Gastrointestinal Bleeding 181
Douglas Corrigall, David Dewar
Diagnostic principles 183
Management 185
References 188
Chapter 21 Nausea and Vomiting 191
Mary Denholm, Matthew Cheetham
Diagnostic principles 193
Management 195
References 198
Chapter 22 Dysphagia 199
Mary Denholm, Jason Dunn
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
John Lally, Aisling Considine, Kosh Agarwal
Diagnostic principles 207
Management 212
References 213
Chapter 24 Alcohol and Physical Health 215
Musa Sami, Joseph Cooney, Michael Heneghan
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
Mary Denholm, John O’Donohue
Diagnostic principles 225
Management 227
References 227
Chapter 26 Dry Mouth 229
Enrico D’Ambrosio, Andrea Falsetti, Stephen Challacombe
Diagnostic principles 231
Management 231
References 232
Chapter 27 Hypersalivation 235
Enrico D’Ambrosio, Andrea Falsetti, Toby Pillinger, Stephen Challacombe
Diagnostic principles 235
Management 236
References 239
Chapter 28 Constipation 241
John Lally, Toby Pillinger, Kalliopi Vallianatou, Immo Weichert
Diagnostic principles 243
Management 244
References 249
Part 5 Renal and Urology 251
Chapter 29 Urinary Retention 253
Atheeshaan Arumuham, Vimoshan Arumuham
Urinary retention and serious mental illness 253
Diagnostic principles 254
Management 256
References 256
Chapter 30 Urinary Incontinence 259
Atheeshaan Arumuham, Vimoshan Arumuham
Diagnostic principles 261
Management 262
References 264
Chapter 31 Polyuria 267
Atheeshaan Arumuham, Toby Pillinger, Benjamin Whitelaw
Diagnostic principles 268
Management 269
References 271
Chapter 32 Sodium Derangement 273
Atheeshaan Arumuham, Peter Conlon
Diagnostic principles 274
Management 276
References 277
Chapter 33 Potassium Derangement 279
Ellis Onwordi, Peter Conlon
Hyperkalaemia 279
Hypokalaemia 282
References 285
Chapter 34 Chronic Kidney Disease 287
Ellis Onwordi, Toby Pillinger, Anne Connolly, Peter Conlon
Diagnostic principles 289
Management 291
References 295
Part 6 Sexual and Reproductive Health 297
Chapter 35 Sexual Dysfunction 299
Rudiger Pittrof
Assessment of a patient with sexual dysfunction 299
Management 301
References 304
Chapter 36 Contraception 307
Neha Pathak, Usha Kumar
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
Rudiger Pittrof
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
Harriet Le Voir, Rudiger Pittrof
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
Emma McGuire, Loren Bailey, Peter Saunders, Meera Chand
Pneumonia and serious mental illness 329
Diagnostic principles 329
Management 332
References 335
Chapter 40 Influenza 337
Anna Riddell, Eithne MacMahon
Diagnostic principles 338
Management 339
Preventing spread of influenza 341
References 342
Chapter 41 Urinary Tract Infection 343
Sian Cooper, Conor Maguire
Urinary tract infection and serious mental illness 344
Diagnostic principles 344
Management 347
References 350
Chapter 42 Gastroenteritis 351
Maria Krutikov, Luke Snell
Diagnostic principles 351
Management 354
References 356
Chapter 43 Viral Hepatitis 357
Klara Doherty, Aisling Considine, Kosh Agarwal
Hepatitis B 357
Hepatitis C 361
References 364
Chapter 44 Tuberculosis 365
Sakib Rokadiya, Adrian R. Martineau
Diagnostic principles 366
Management 369
References 371
Chapter 45 Human Immunodeficiency Virus 373
Rebecca Marcus, Jessica Gaddie, Toby Pillinger, Ben Spencer, Kalliopi Vallianatou, Rudiger Pittrof
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
Harriet Quigley, Mary Yates, John Moxham
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
Mary Docherty, Jenny Docherty, Peter Saunders
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
Mary Docherty, Jenny Docherty, Peter Saunders
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
Nicholas Meyer, Hugh Selsick, Kai Lee
Diagnostic principles 414
Management 415
References 416
Part 9 Neurology 419
Chapter 50 Delirium 421
Luke Jelen, Sean Cross
Diagnostic principles 421
Management 426
References 429
Chapter 51 Autoimmune Encephalitis 431
Adam Al-Diwani, Julia Thompson, Sarosh Irani
Autoimmune disease mechanisms 431
Clinical approach 432
Management 437
References 439
Chapter 52 Catatonia 441
Jonathan P. Rogers, Ali Amad
Diagnostic principles 442
Management 444
References 448
Chapter 53 Seizure Disorders 451
Emanuele F. Osimo, Brian Sweeney
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
Ines Carreira Figueiredo, Nazia Karsan, Peter Goadsby
Diagnostic principles 463
Management 466
References 468
Chapter 55 Disorders of Sleep and Circadian Rhythm 471
Nicholas Meyer, Hugh Selsick
Definitions of common sleep disorders in psychiatric populations 471
Diagnostic principles 474
Management 476
References 477
Chapter 56 Extrapyramidal Side Effects 479
Graham Blackman, R. John Dobbs, Sylvia Dobbs
Clinical approach 480
Management 482
References 483
Chapter 57 Tardive Dyskinesia 485
Graham Blackman, Toby Pillinger, R. John Dobbs, Sylvia Dobbs
Clinical approach 486
Management 487
References 489
Chapter 58 Tremor 491
Graham Blackman, R. John Dobbs, Sylvia Dobbs
Clinical approach 491
Management 494
References 496
Part 10 Rheumatology and Musculoskeletal Health 497
Chapter 59 Low Back Pain 499
Jennifer Ireland, Matthew Cheetham
Diagnostic principles 500
Management 502
References 503
Chapter 60 Arthritis 505
Sarah Griffin, Joseph Nathan, Richard Campbell
Clinical approach 510
Management 512
References 512
Part 11 Ophthalmology 515
Chapter 61 Eye Disease 517
Ernest Iakovlev, Radwan Almousa
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
Katherine Beck, Ruth Cochrane, Louise M. Howard
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
Deirdre Lundy
Physiology and symptoms of perimenopause 551
Clinical approach 552
Treatment 553
References 556
Part 13 Dermatology 559
Chapter 64 General Dermatology 561
Jonathan Kentley, Ruth Taylor, Anthony Bewley
Infectious skin disease 561
Non-infectious skin disease 564
References 566
Chapter 65 Psychodermatology 569
Jonathan Kentley, Ruth Taylor, Anthony Bewley
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
James Kelly, Mariese Cooper, Mario Juruena
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
Luke Vano, Immo Weichert
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
Martin Osugo, Toby Pillinger, Vivek Srivastava
Diagnostic principles 593
Management 595
References 596
Chapter 69 Acute Coronary Syndrome 597
Laura O’Sullivan, Narbeh Melikian
Diagnostic principles 598
Management 602
References 603
Chapter 70 Arrhythmia 605
Martin Osugo, Nicholas Gall
Tachycardia 605
Bradycardia 605
Reference 608
Chapter 71 Hypertensive Crisis 609
Luke Vano, J. Kennedy Cruickshank
Diagnostic principles 609
Management 610
References 611
Chapter 72 Sepsis 613
Laura O’Sullivan, Immo Weichert
When to think sepsis 613
Septic shock 614
Management 614
Post-sepsis syndrome 615
References 616
Chapter 73 Acute Kidney Injury 617
Phillipa Brothwood, Toby Pillinger, Anne Connolly, Peter Conlon
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
Toby Pillinger, Yuya Mizuno, Sophie Harris
Hypoglycaemia 625
Diabetic ketoacidosis 626
Hyperosmolar hyperglycaemic state 627
References 627
Chapter 75 Acute Upper Gastrointestinal Bleeding 629
Douglas Corrigall, David Dewar
Signs of acute upper gastrointestinal bleeding 629
Waiting for transfer 629
Handing over to the acute medical team 630
Chapter 76 Status Epilepticus 631
Emanuele F. Osimo, Brian Sweeney
Chapter 77 Anaphylaxis 633
James Kelly, Immo Weichert
Management 633
References 636
Chapter 78 Reduced Consciousness and Coma 637
James Kelly, Immo Weichert
Clinical approach 637
References 640
Chapter 79 Thyroid Emergencies 641
Harriet Quigley, Jackie Gilbert
Hypothyroid crisis/myxoedema coma 641
Hyperthyroid crisis/thyroid storm 642
References 643
Chapter 80 Head Injury 645
Susie Bradwell, Sophie Williams, Joanna Manson
Clinical approach 645
Types of intracranial haemorrhage 649
References 650
Chapter 81 Acute Meningitis and Infective Encephalitis 651
Hina Khan, Brian Sweeney
Meningitis 651
Infective encephalitis 653
References 655
Chapter 82 Stroke and Transient Ischaemic Attack 657
Toby Pillinger, James Teo
Stroke 657
Diagnostic principles 658
Management 659
Transient Ischaemic Attack 660
Diagnostic principles 660
Management 661
References 661
Chapter 83 Overdose 663
Stephen Kaar, Immo Weichert
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
Jonathan P. Rogers, R. John Dobbs, Sylvia Dobbs
Diagnostic principles 673
Management 675
References 677
Chapter 85 Neuroleptic Malignant Syndrome 679
Robert A. McCutcheon, James Kelly, Toby Pillinger
Diagnostic principles 679
Management 680
References 681
Chapter 86 Serotonin Syndrome 683
Robert A. McCutcheon, James Kelly, Toby Pillinger
Diagnostic principles 683
Management 684
References 685
Chapter 87 Emergencies in Obstetrics and Gynaecology 687
Hanine Fourie, Ruth Cochrane
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
Sophie Williams, Joanna Manson
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
Toby Pillinger, Immo Weichert
First steps 709
Airway (A) 711
Breathing (B) 711
Circulation (C) 711
Disability (D) 711
Exposure (E) 712
References 712
Index 713

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