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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The May 2013 update sees updates to chapters focusing on Respiratory Medicine and Haematology.

Respiratory Medicine updates include substantial updates to key chapters and new material on a wide range of topics including: new bronchoscopic techniques for early detection of lung cancer, specific causes of effusion and pleural disease, and chronic obstructive pulmonary disease.

Haematology updates include extensive revisions of key chapters on chronic myeloid leukaemia, aplastic anaemia and bone marrow failure disorders, and blood transfusion, with new information on a wide range of matters.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2010
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

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

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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