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Taking a psychiatric history from a medical patient 

Taking a psychiatric history from a medical patient

Chapter:
Taking a psychiatric history from a medical patient
Author(s):

Eleanor Feldman

DOI:
10.1093/med/9780199204854.003.2602
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date: 23 April 2017

It is important to screen for mental health problems: they are common in general medical patients and failure to recognize and deal with them will often interfere with the management of the physical health of the patient.

Depression can kill, and if by screening you identify depression, you should ask about hopelessness and suicidal ideation (how to do this sensitively is discussed in Chapter 26.5.2). To be ill and in discomfort is generally to be unhappy: modified diagnostic criteria for depression are required in the medically ill, emphasis being placed on a predominantly negative thinking style that is pervasive.

Heavy alcohol use can cause insomnia and mood and anxiety disorders: incorrect advice and treatment will be given if the alcohol problem is missed.

Stress, anxiety, and depression can be the main reasons for physical symptoms, a process which is termed somatization. The patient’s suffering will increase if the doctor, having taken reasonable steps to exclude organic disease, fails to recognize the diagnosis and presses on with organizing more and more tests or specialist referrals, and much money will be wasted.

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