Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

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 xxiiiList of Abbreviations xxvPart 1 Cardiology 1Chapter 1 Tachycardia 3Guy Hindley, Eromona Whiskey, Nicholas GallSinus tachycardia 3Atrial fibrillation 4Supraventricular tachycardia 4Ventricular tachycardia 6Diagnostic principles 6Management 10References 14Chapter 2 Bradycardia 17Eleanor Croft, Nicholas GallDiagnosis 19Management and when to refer to a specialist 21References 22Chapter 3 QT Interval Prolongation 23Guy Hindley, Nicholas GallPrescribing QTc‐prolonging medication 27Diagnostic principles 28Management 29References 32Chapter 4 Syncope 35Luke Vano, Nicholas GallCauses of syncope 35Syncope and serious mental illness 36Diagnostic principles 36Diagnosis and management 38References 39Chapter 5 Hypertension 41Luke Vano, Toby Pillinger, J. Kennedy CruickshankDiagnostic principles 43Diagnosis 44Management 45References 48Chapter 6 Postural Hypotension 51Toby Pillinger, Ian Osborne, Thomas Ernst, J. Kennedy CruickshankDiagnostic principles 53Management 54References 58Chapter 7 Peripheral Oedema 59Thomas Whitehurst, Theresa McDonaghDiagnostic principles 60Management 66References 67Chapter 8 Myocarditis 71Thomas Whitehurst, Theresa McDonaghDiagnostic principles 71Management 75Clozapine‐induced myocarditis 75References 77Chapter 9 Hypercholesterolaemia 79Dipen Patel, Toby Pillinger, Narbeh MelikianDiagnostic principles 80Diagnostic criteria 81Management 81References 84Chapter 10 Physical Activity 85Garcia Ashdown-Franks, Brendon StubbsPhysical activity and serious mental illness 85How much physical activity and exercise should people be doing? 86Practical tips 87Messages to include in discussions with patients 87References 88Part 2 Endocrinology 91Chapter 11 Diabetes Mellitus 93Yuya Mizuno, Toby Pillinger, Dan Siskind, Sophie HarrisDiagnostic principles 93Management 97References 102Chapter 12 Thyroid Disease 105Harriet Quigley, Jackie GilbertHypothyroidism 105Diagnostic principles 107Management 110Hyperthyroidism 111Diagnostic principles 112Management 113References 114Chapter 13 Hyperprolactinaemia 117John Lally, Toby Pillinger, Olubanke Dzahini, Sophie HarrisDiagnostic principles 119Management and when to refer to a specialist 121Hyperprolactinaemia and osteoporosis risk in serious mental illness 122Hyperprolactinaemia and cancer risk 123References 123Chapter 14 Obesity 125Yuya Mizuno, Toby Pillinger, Dan Siskind, Ian Osborne, Kate Moffat, Donal O’SheaMonitoring 127Prevention and treatment of weight gain 129References 134Part 3 Haematology 137Chapter 15 Anaemia 139Sanjena Mithra, Aleksander MijovicDiagnostic principles 140Management and referral pathways 143References 145Chapter 16 Neutropenia 147John Lally, Toby Pillinger, Aleksander MijovicDrug‐induced neutropenia and agranulocytosis 149Diagnostic principles 150Management 151References 153Chapter 17 Thrombocytopenia 155Sanjena Mithra, Aleksander MijovicDiagnostic principles 156Management and when to refer 158References 158Chapter 18 Venous Thromboembolism and Anticoagulation 159Helen Doolittle, Lara Roberts, Roopen AryaRisk factors 159Prophylaxis 161Diagnosis 162Management 164References 168Part 4 Gastroenterology 169Chapter 19 Gastro‐oesophageal Reflux and Peptic Ulcer Disease 171Luke Vano, Seema Varma, John O’DonohueGastro‐oesophageal reflux disease 171Peptic ulcer disease 176References 178Chapter 20 Gastrointestinal Bleeding 181Douglas Corrigall, David DewarDiagnostic principles 183Management 185References 188Chapter 21 Nausea and Vomiting 191Mary Denholm, Matthew CheethamDiagnostic principles 193Management 195References 198Chapter 22 Dysphagia 199Mary Denholm, Jason DunnCauses of dysphagia in the general population 199Diagnostic principles 200Management 203Oesophageal cancer in psychiatric populations 203Dysphagia in the elderly 204References 204Chapter 23 Deranged Liver Function Tests 207John Lally, Aisling Considine, Kosh AgarwalDiagnostic principles 207Management 212References 213Chapter 24 Alcohol and Physical Health 215Musa Sami, Joseph Cooney, Michael HeneghanWhat is harmful use? 215Physical complications of alcohol use 216Approach to the patient with suspected alcohol misuse 217Management 220References 222Chapter 25 Unintentional Weight Loss 223Mary Denholm, John O’DonohueDiagnostic principles 225Management 227References 227Chapter 26 Dry Mouth 229Enrico D’Ambrosio, Andrea Falsetti, Stephen ChallacombeDiagnostic principles 231Management 231References 232Chapter 27 Hypersalivation 235Enrico D’Ambrosio, Andrea Falsetti, Toby Pillinger, Stephen ChallacombeDiagnostic principles 235Management 236References 239Chapter 28 Constipation 241John Lally, Toby Pillinger, Kalliopi Vallianatou, Immo WeichertDiagnostic principles 243Management 244References 249Part 5 Renal and Urology 251Chapter 29 Urinary Retention 253Atheeshaan Arumuham, Vimoshan ArumuhamUrinary retention and serious mental illness 253Diagnostic principles 254Management 256References 256Chapter 30 Urinary Incontinence 259Atheeshaan Arumuham, Vimoshan ArumuhamDiagnostic principles 261Management 262References 264Chapter 31 Polyuria 267Atheeshaan Arumuham, Toby Pillinger, Benjamin WhitelawDiagnostic principles 268Management 269References 271Chapter 32 Sodium Derangement 273Atheeshaan Arumuham, Peter ConlonDiagnostic principles 274Management 276References 277Chapter 33 Potassium Derangement 279Ellis Onwordi, Peter ConlonHyperkalaemia 279Hypokalaemia 282References 285Chapter 34 Chronic Kidney Disease 287Ellis Onwordi, Toby Pillinger, Anne Connolly, Peter ConlonDiagnostic principles 289Management 291References 295Part 6 Sexual and Reproductive Health 297Chapter 35 Sexual Dysfunction 299Rudiger PittrofAssessment of a patient with sexual dysfunction 299Management 301References 304Chapter 36 Contraception 307Neha Pathak, Usha KumarClinical approach 308Contraceptive options 308Ethical and legal considerations 312When to refer 313Special considerations in patients with serious mental illness 313References 314Chapter 37 Infertility 317Rudiger PittrofAddressing infertility in psychiatric practice 317Onward referral and further tests for infertility 318Infertility treatments 318References 318Chapter 38 Sexually Transmitted Infection 319Harriet Le Voir, Rudiger PittrofHistory 319STI testing in psychiatry 320Determining urgency of clinical action/referral 321Referral to sexual health services 322References 324Part 7 Infectious Diseases 325Chapter 39 Pneumonia 327Emma McGuire, Loren Bailey, Peter Saunders, Meera ChandPneumonia and serious mental illness 329Diagnostic principles 329Management 332References 335Chapter 40 Influenza 337Anna Riddell, Eithne MacMahonDiagnostic principles 338Management 339Preventing spread of influenza 341References 342Chapter 41 Urinary Tract Infection 343Sian Cooper, Conor MaguireUrinary tract infection and serious mental illness 344Diagnostic principles 344Management 347References 350Chapter 42 Gastroenteritis 351Maria Krutikov, Luke SnellDiagnostic principles 351Management 354References 356Chapter 43 Viral Hepatitis 357Klara Doherty, Aisling Considine, Kosh AgarwalHepatitis B 357Hepatitis C 361References 364Chapter 44 Tuberculosis 365Sakib Rokadiya, Adrian R. MartineauDiagnostic principles 366Management 369References 371Chapter 45 Human Immunodeficiency Virus 373Rebecca Marcus, Jessica Gaddie, Toby Pillinger, Ben Spencer, Kalliopi Vallianatou, Rudiger PittrofTesting for HIV 374HIV and the central nervous system 374Antiretroviral therapy 375References 380Part 8 Respiratory 383Chapter 46 Smoking Cessation 385Harriet Quigley, Mary Yates, John MoxhamIdentifying those who want to stop smoking and degree of nicotine dependence 385Approaches to smoking cessation 387References 392Chapter 47 Chronic Obstructive Pulmonary Disease 395Mary Docherty, Jenny Docherty, Peter SaundersCommon causes of COPD in the general population and patients with serious mental illness 395The asthma–COPD overlap 396Diagnostic principles 397Management 400References 403Chapter 48 Asthma 405Mary Docherty, Jenny Docherty, Peter SaundersCauses in the general population and people with serious mental illness 405Diagnostic principles 406Management 409References 412Chapter 49 Obstructive Sleep Apnoea 413Nicholas Meyer, Hugh Selsick, Kai LeeDiagnostic principles 414Management 415References 416Part 9 Neurology 419Chapter 50 Delirium 421Luke Jelen, Sean CrossDiagnostic principles 421Management 426References 429Chapter 51 Autoimmune Encephalitis 431Adam Al-Diwani, Julia Thompson, Sarosh IraniAutoimmune disease mechanisms 431Clinical approach 432Management 437References 439Chapter 52 Catatonia 441Jonathan P. Rogers, Ali AmadDiagnostic principles 442Management 444References 448Chapter 53 Seizure Disorders 451Emanuele F. Osimo, Brian SweeneyAcute seizure 452Psychiatric comorbidity in people with epilepsy 455Psychiatric side effects of antiepileptic drugs 457Psychiatric drug therapy in people with epilepsy 457Psychogenic non‐epileptic seizures 458Epilepsy surgery 459Epilepsy and learning disability 459References 459Chapter 54 Headache 461Ines Carreira Figueiredo, Nazia Karsan, Peter GoadsbyDiagnostic principles 463Management 466References 468Chapter 55 Disorders of Sleep and Circadian Rhythm 471Nicholas Meyer, Hugh SelsickDefinitions of common sleep disorders in psychiatric populations 471Diagnostic principles 474Management 476References 477Chapter 56 Extrapyramidal Side Effects 479Graham Blackman, R. John Dobbs, Sylvia DobbsClinical approach 480Management 482References 483Chapter 57 Tardive Dyskinesia 485Graham Blackman, Toby Pillinger, R. John Dobbs, Sylvia DobbsClinical approach 486Management 487References 489Chapter 58 Tremor 491Graham Blackman, R. John Dobbs, Sylvia DobbsClinical approach 491Management 494References 496Part 10 Rheumatology and Musculoskeletal Health 497Chapter 59 Low Back Pain 499Jennifer Ireland, Matthew CheethamDiagnostic principles 500Management 502References 503Chapter 60 Arthritis 505Sarah Griffin, Joseph Nathan, Richard CampbellClinical approach 510Management 512References 512Part 11 Ophthalmology 515Chapter 61 Eye Disease 517Ernest Iakovlev, Radwan AlmousaClinical approach to a patient with visual disturbance or orbital/periorbital disorders 517Disorders of the eyelids 522Disorders of the conjunctiva 526Disorders of the cornea 529References 533Part 12 Obstetrics and Gynaecology 535Chapter 62 Pregnancy 537Katherine Beck, Ruth Cochrane, Louise M. HowardThe pre‐conception period 538During pregnancy 539Psychiatric medication in pregnancy 543Postpartum psychosis 547Electroconvulsive therapy in pregnancy 547References 548Chapter 63 Menopause 551Deirdre LundyPhysiology and symptoms of perimenopause 551Clinical approach 552Treatment 553References 556Part 13 Dermatology 559Chapter 64 General Dermatology 561Jonathan Kentley, Ruth Taylor, Anthony BewleyInfectious skin disease 561Non‐infectious skin disease 564References 566Chapter 65 Psychodermatology 569Jonathan Kentley, Ruth Taylor, Anthony BewleyPsychiatric disorders with skin manifestations 569Psychophysiological conditions 571Secondary psychological disorders 571Cutaneous sensory disorders 572References 572Part 14 Electroconvulsive Therapy 573Chapter 66 Electroconvulsive Therapy 575James Kelly, Mariese Cooper, Mario JuruenaIndications and contraindications 575The ECT procedure 576Physiological effects of ECT 576Pre‐ECT assessment 578Safety of ECT 579ECT prescribing 579Guidance for the doctor administering ECT 579Side effects of ECT 580Special patient groups 581References 581Part 15 Emergencies 583Chapter 67 Chest Pain 585Luke Vano, Immo WeichertDiagnostic principles 586Management 590Information to provide in a ‘chest pain’ referral to medical services 591References 591Chapter 68 Acute Shortness of Breath 593Martin Osugo, Toby Pillinger, Vivek SrivastavaDiagnostic principles 593Management 595References 596Chapter 69 Acute Coronary Syndrome 597Laura O’Sullivan, Narbeh MelikianDiagnostic principles 598Management 602References 603Chapter 70 Arrhythmia 605Martin Osugo, Nicholas GallTachycardia 605Bradycardia 605Reference 608Chapter 71 Hypertensive Crisis 609Luke Vano, J. Kennedy CruickshankDiagnostic principles 609Management 610References 611Chapter 72 Sepsis 613Laura O’Sullivan, Immo WeichertWhen to think sepsis 613Septic shock 614Management 614Post‐sepsis syndrome 615References 616Chapter 73 Acute Kidney Injury 617Phillipa Brothwood, Toby Pillinger, Anne Connolly, Peter ConlonCategorisation of acute kidney injury 617Diagnostic principles 620Management 622Psychiatric medication and acute kidney injury 622References 623Chapter 74 Diabetic Emergencies 625Toby Pillinger, Yuya Mizuno, Sophie HarrisHypoglycaemia 625Diabetic ketoacidosis 626Hyperosmolar hyperglycaemic state 627References 627Chapter 75 Acute Upper Gastrointestinal Bleeding 629Douglas Corrigall, David DewarSigns of acute upper gastrointestinal bleeding 629Waiting for transfer 629Handing over to the acute medical team 630Chapter 76 Status Epilepticus 631Emanuele F. Osimo, Brian SweeneyChapter 77 Anaphylaxis 633James Kelly, Immo WeichertManagement 633References 636Chapter 78 Reduced Consciousness and Coma 637James Kelly, Immo WeichertClinical approach 637References 640Chapter 79 Thyroid Emergencies 641Harriet Quigley, Jackie GilbertHypothyroid crisis/myxoedema coma 641Hyperthyroid crisis/thyroid storm 642References 643Chapter 80 Head Injury 645Susie Bradwell, Sophie Williams, Joanna MansonClinical approach 645Types of intracranial haemorrhage 649References 650Chapter 81 Acute Meningitis and Infective Encephalitis 651Hina Khan, Brian SweeneyMeningitis 651Infective encephalitis 653References 655Chapter 82 Stroke and Transient Ischaemic Attack 657Toby Pillinger, James TeoStroke 657Diagnostic principles 658Management 659Transient Ischaemic Attack 660Diagnostic principles 660Management 661References 661Chapter 83 Overdose 663Stephen Kaar, Immo WeichertGeneral principles 663Information gathering 664Emergency assessment and management 664Specific scenarios 667Management of a person who refuses admission to hospital after an overdose 670References 670Chapter 84 Acute Dystonia 673Jonathan P. Rogers, R. John Dobbs, Sylvia DobbsDiagnostic principles 673Management 675References 677Chapter 85 Neuroleptic Malignant Syndrome 679Robert A. McCutcheon, James Kelly, Toby PillingerDiagnostic principles 679Management 680References 681Chapter 86 Serotonin Syndrome 683Robert A. McCutcheon, James Kelly, Toby PillingerDiagnostic principles 683Management 684References 685Chapter 87 Emergencies in Obstetrics and Gynaecology 687Hanine Fourie, Ruth CochraneMaternal collapse 689Pre‐eclampsia 689Major obstetric haemorrhage 691Amniotic fluid embolism 691Ectopic pregnancy 691Miscarriage 693Hyperemesis gravidarum 694Ovarian cyst accidents 695Pelvic inflammatory disease 697References 697Chapter 88 The Acute Abdomen 699Sophie Williams, Joanna MansonHistory 699Causes of the acute abdomen based on pain location 702Examination 705Investigations 706Onward referral 706References 707Chapter 89 The ABCDE Approach 709Toby Pillinger, Immo WeichertFirst steps 709Airway (A) 711Breathing (B) 711Circulation (C) 711Disability (D) 711Exposure (E) 712References 712Index 713