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25.1 The eye in general medicine 6399 Tasanee Braithwaite, Richard W.J. Lee, and Peng T. Khaw ESSENTIALS The integrity of ocular anatomy and physiology, the function of the visual system, and the perception of vision, our most prized sense, are intimately conn...

26.1 General introduction 6445 Michael Sharpe ESSENTIALS All physicians experience situations in which they need the know- ledge, skills, and attitudes commonly thought of as belonging to psychiatry. This section of the book aims to help physicians to ac- quir...

26.2 The psychiatric assessment of the medical patient 6447 Jane Walker, Roger Smyth, and Michael Sharpe ESSENTIALS Medically ill patients often have psychiatric illness. Physicians can and should detect and diagnose these illnesses during their standard medic...

26.3 Common psychiatric presentations in medical patients 6454 26.3.1 Confusion 6454 Bart Sheehan and Thomas Jackson CONTENTS 26.3.1 Confusion  6454 Bart Sheehan and Thomas Jackson 26.3.2 Self-​harm  6457 Kate E.A. Saunders and Keith Hawton 26.3.3 Medically...

26.3.2 Self- harm 6457 Kate E.A. Saunders and Keith Hawton 26.3.2  Self-harm 6457 26.3.2  Self-​harm Kate E.A. Saunders and Keith Hawton ESSENTIALS Self-​harm is one of the commonest reasons people present to hos- pital emergency departments and the most frequ...

26.3.3 Medically unexplained symptoms 6460 Michael Sharpe section 26  Psychiatric and drug-related disorders 6460 Elderly patients Self-​harm in older patients, while much less common than in younger people, is often of high suicidal intent and carries a high ...

26.3.4 Low mood 6462 Jane Walker section 26  Psychiatric and drug-related disorders 6462 Physical examination Even if symptoms are suspected to be medically unexplained, it is useful to physically examine the patient. This may not only reveal unsuspected clini...

26.4 Psychiatric treatments in the medically ill 6465 26.4.1 Psychopharmacology in medical practice 6465 Philip J. Cowen CONTENTS 26.4.1 Psychopharmacology in medical practice  6465 Philip J. Cowen 26.4.2 Psychological treatments  6470 Michael Sharpe and Sim...

26.4.2 Psychological treatments 6470 Michael Sharpe and Simon Wessely section 26  Psychiatric and drug-related disorders 6470 should not be given with any agent likely to potentiate its depressant effect on the white cell count such as carbamazepine, co-​trimo...

26.5 Specific psychiatric disorders 6475 26.5.1 Delirium 6475 Bart Sheehan CONTENTS 26.5.1 Delirium   6475 Bart Sheehan 26.5.2 Dementia   6478 Bart Sheehan 26.5.3 Organic psychoses   6482 Curtis McKnight and Jason Caplan 26.5.4 Alcohol misuse   6486 Jonath...

26.5.10 Eating disorders 6509 Christopher G. Fairburn 26.5.10  Eating disorders 6509 development of PTSD. The natural course of PTSD is to reduce slowly over time; half of PTSD sufferers will no longer fulfil the full criteria two years after onset, but a thir...

26.5.11 Schizophrenia 6513 Stephen M. Lawrie 26.5.11  Schizophrenia 6513 Anorexia nervosa The course of anorexia nervosa varies greatly. In the early months and years it may be self-​limiting; it may require some form of inter- vention; it may evolve into buli...

26.5.12 Somatic symptom and related disorders 6517 Michael Sharpe 26.5.12  Somatic symptom and related disorders 6517 26.5.12  Somatic symptom and related disorders Michael Sharpe ESSENTIALS Somatic symptom disorder is a diagnosis for patients who have marked ...

26.5.13 Personality disorders 6520 Iain Jordan SECTION 26  Psychiatric and drug-related disorders 6520 Psychological treatment The most widely used psychological treatments for SSD are behav- ioural or cognitive behavioural therapy (CBT). These therapies aim t...

26.5.2 Dementia 6478 Bart Sheehan SECTION 26  Psychiatric and drug-related disorders 6478 26.5.2  Dementia Bart Sheehan ESSENTIALS Dementia is a clinical syndrome, not a specific disease. It is character- ized by impairment of mental functions leading to memor...

26.5.3 Organic psychoses 6482 Curtis McKnight and Jason Caplan SECTION 26  Psychiatric and drug-related disorders 6482 26.5.3  Organic psychoses Curtis McKnight and Jason Caplan ESSENTIALS A psychosis is a syndrome characterized by delusions and hallu- cinatio...

26.5.4 Alcohol misuse 6486 Jonathan Wood SECTION 26  Psychiatric and drug-related disorders 6486 Treponema pallidum infection have been increasing. Given this re- surgence, some recommend that patients with new onset psychosis should be screened. The human imm...

26.5.5 Substance misuse 6490 Stephen Potts SECTION 26  Psychiatric and drug-related disorders 6490 Disulfiram (Antabuse) is a commonly used drug, but is only mod- erately effective. It works by inhibiting aldehyde dehydrogenase, which prevents the metabolism o...