The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

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.

ABOUT THE AUTHOR

David M. Taylor, BSc, MSc, PhD, FCMHP, FFRPS, FRPharmS, FRCP (Edin), is Director of Pharmacy and Pathology at the Maudsley Hospital; Professor of Psychopharmacology at King’s College, London, UK.

Fiona Gaughran, MD, FRCP(I), FRCP (Lon), FRCP (Edin), FRCPsych, FHEA, is Director of Research and Development at South London and Maudsley NHS Foundation Trust, where she is Lead Consultant for the National Psychosis Service; Reader in Psychopharmacology and Physical Health at King’s College, London, UK.

Toby Pillinger, MA (Oxon), BM BCh, MRCP, PhD, is an Academic Clinical fellow at the Institute of Psychiatry, Psychology and Neuroscience, King’s College, London; South London and Maudsley NHS Foundation Trust, London, UK.

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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