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Psychosomatic Medicine/Consultation-Liaison Psychiatry in Late Life

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Geriatric Psychiatry

Abstract

Many geriatric psychiatry cases are initially encountered in the general hospital or emergency room, where the psychiatric services rendered are accomplished by the psychosomatic medicine consultation service. As such, the areas of responsibility of psychosomatic medicine psychiatrists and geriatric psychiatrists overlap significantly. Specific areas of clinical expertise that are priorities for psychosomatic medicine psychiatrists include determinations of decisional capacity, evaluation and management of neurocognitive disorders, and assessment and management of catatonia, neuroleptic malignant syndrome, serotonin syndrome, and the toxicity states associated with centrally acting medications. The psychotherapeutic role of the psychosomatic medicine psychiatrist is coequal with the medical management role. Patients in the hospital, particularly geriatric patients, are at risk for many psychiatric syndromes (including depressive disorders and posttraumatic stress disorder) that are directly referable to the disruptive and traumatic experiences of medical/surgical illness, traumatic injury, and existential matters of disability and death. Psychosomatic medicine, therefore, is an integrative subspecialty of psychiatry that occupies a crucial place “between” psychiatry and numerous other medical specialists working with hospitalized patients. The authors highlight some important roles for psychosomatic medicine psychiatrists and present two complex cases to illustrate the framework of psychosomatic medicine and various, illness-specific psychiatric interventions.

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References

  1. Appelbaum P, Grisso T. Assessing patients’ capacities to consent to treatment. New Engl J Med. 1988;319:1635–8.

    Article  CAS  PubMed  Google Scholar 

  2. Taylor MA, Fink M. Catatonia in psychiatric classification: a home of its own. Am J Psychiatry. 2003;160:1233–41.

    Article  PubMed  Google Scholar 

  3. Caroff SN, Mann SC, Francis A, Fricchione GL. Catatonia: from psychopathology to neurobiology. Washington, DC: American Psychiatric Publishing, Inc; 2004.

    Google Scholar 

  4. Kahlbaum KL. Catatonia: the tension insanity (1874). Baltimore: Johns Hopkins University Press; 1973. Translated by Levij Y, Pridon T.

    Google Scholar 

  5. Carroll BT. Kahlbaum’s catatonia revisited. Psychiatry Clin Neurosci. 2001;55:431–6.

    Article  CAS  PubMed  Google Scholar 

  6. Bush G, Fink M, Petrides G, Dowling F, Francis A, Catatonia I. Rating scale and standardized examination. Acta Psychiatr Scand. 1996;93:129–36.

    Article  CAS  PubMed  Google Scholar 

  7. Pfuhlmann B, Stober G. The different conceptions of catatonia: historical overview and critical discussion. Eur Arch Psychiatry Clin Neurosci. 2001;251(Suppl 1):I4–7.

    Article  PubMed  Google Scholar 

  8. Joyston-Bechal MP. The clinical features and outcome of stupor. Br J Psychiatry. 1966;112:967–81.

    Article  CAS  PubMed  Google Scholar 

  9. Fink M. Rediscovering catatonia: the biography of a treatable syndrome. Acta Psychiatr Scand. 2013;127(Suppl 441):1–47.

    Article  Google Scholar 

  10. Diagnostic and Statistical Manual of Mental Disorders. 5th Edition. Arlington: American Psychiatric Association; 2013.

    Google Scholar 

  11. Azzam PN, Gopalan P. Prototypes of catatonia: diagnostic and therapeutic challenges in the general hospital. Psychosomatics. 2013;54:88–93.

    Article  PubMed  Google Scholar 

  12. Kaelle J, Abujam A, Ediriweera H, Macfarlane MD. Prevalence and symptomatology of catatonia in elderly patients referred to a consultation-liaison service. Australas Psychiatry. 2016;24:164–7. https://doi.org/10.1177/1039856215604998.

    Article  PubMed  Google Scholar 

  13. Saddawi-Konefka D, Berg SM, Nejad SH, Bittner EA. Catatonia in the ICU: an important and underdiagnosed cause of altered mental status. A case series and review of the literature. Crit Care Med. 2013;42:e234–1. https://doi.org/10.1097/CCM.0000000000000053.

    Article  Google Scholar 

  14. Grover S, Ghosh A, Ghormode D. Do patients of delirium have catatonic features? An exploratory study. Psychiatry Clin Neurosci. 2014;68:644–51.

    Article  PubMed  Google Scholar 

  15. Jaimes-Albornoz W, Serra-Mestres J. Prevalence and clinical correlations of catatonia in older adults referred to a liaison psychiatry service in a general hospital. Gen Hosp Psych. 2013;35:512–6.

    Article  Google Scholar 

  16. Cottencin O, Warembourg F, de Chouly de Lenclave MB, Lucas B, Vaiva G, Goudemand M, Thomas P. Catatonia and consultation-liaison psychiatry study of 12 cases. Prog Neuro-Psychopharmacol Biol Psychiatry. 2007;31:1170–6.

    Article  Google Scholar 

  17. Oldham MA, Lee HB. Catatonia vis-à-vis delirium: the significance of recognizing catatonia in altered mental status. Gen Hosp Psych. 2015;37:554–9.

    Article  Google Scholar 

  18. Dessens FM, van Paassen J, van Westerloo DJ, van der Wee NJ, van Vliet IM, van Noorden MS. Electroconvulsive therapy in the intensive care unit for the treatment of catatonia: a case series and review of the literature. Gen Hosp Psych. 2016;38:37–41.

    Article  Google Scholar 

  19. Espinola-Nadurille M, Ramirez-Bermudez J, Fricchione GL, Ojeda-Lopez MC, Perez-Gonzalez AF, Aguilar-Venegas LC. Catatonia in neurologic and psychiatric patients at a tertiary neurological center. J Neuropsychiatry Clin Neurosci. 2016;28:124–30. https://doi.org/10.1176/appi.neuropsych.15090218.

    Article  PubMed  Google Scholar 

  20. Clinebell K, Azzam PN, Gopalan P, Haskett R. Guidelines for preventing common medical complications of catatonia: case report and literature review. J Clin Psychiatry. 2014;75:644–51.

    Article  PubMed  Google Scholar 

  21. Mahli GS, Tanious M, Das P, Berk M. The science and practice of lithium therapy. Aus N Z J Psychiatry. 2012;46:192–211. https://doi.org/10.1177/0004867412437346.

    Article  Google Scholar 

  22. Okusa M, Crystal LJT. Clinical manifestations and management of acute lithium intoxication. Am J Med. 1994;97:383–9.

    Article  CAS  PubMed  Google Scholar 

  23. Baird-Gunning J, Lea-Henry T, Hoegberg LCG, Gosselin S, Roberts DM. Lithium poisoning. J Intensiv Care Med. 2016; 1–15. https://doi.org/10.1177/0885066616651582.

  24. Chen K-P, Shen WW, Lu M-L. Implication serum concentration monitoring in patients with lithium intoxication. Psychiatry Clin Neurosci. 2004;58:25–9.

    Article  CAS  PubMed  Google Scholar 

  25. Adityanjee MKR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005;28:38–49.

    Article  CAS  PubMed  Google Scholar 

  26. Murakami K, Sugimoto T, Nishida N, Kobayashi Y, Kuhara T, Matsumoto I. Abnormal metabolism of carnitine and valproate in a case of acute encephalopathy during chronic valproate therapy. Brain and Development. 1992;14:178–81.

    Article  CAS  PubMed  Google Scholar 

  27. Oechsner M, Steen C, Stürenburg HJ, Kohlschütter A. Hyperammonemic encephalopathy after initiation of valproate therapy in unrecognized ornithine transcarbamoylase deficiency. J Neurol Neurosurg Psychiatry. 1998;64:680–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Brusilow SW. Hyperammonemic encephalopathy. Medicine. 2002;81:240–9.

    Article  PubMed  Google Scholar 

  29. Zaret BS, Beckner RR, Marini AM, Wagle W, Passarelli C. Sodium valproate-induced hyperammonemia without clinical hepatic dysfunction. Neurology. 1982;32:206–8.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to James A. Bourgeois OD, MD .

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Bourgeois, J.A., Giroux, C. (2018). Psychosomatic Medicine/Consultation-Liaison Psychiatry in Late Life. In: Hategan, A., Bourgeois, J., Hirsch, C., Giroux, C. (eds) Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-67555-8_26

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  • DOI: https://doi.org/10.1007/978-3-319-67555-8_26

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