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OVERVIEW

EMOTIONAL AND BEHAVIORAL SYMPTOMS ACCOMPANY and may exacerbate many chronic diseases, and thus, almost every practitioner will at some point encounter patients with psychiatric comorbidities. This chapter aims to provide a framework for approaching the psychiatric patient. Diagnosing and treatment calls for first viewing the patient as a human with psychiatric symptoms. Some extra precautions for protecting the patient and oneself may be needed, such as obtaining information on safety precautions or reliability as a historian, but many of these should already be part of good clinical practice for any patient.

Some keys to working successfully with psychiatric patients involve:

  • Having a fundamental knowledge of a patient's psychiatric condition to help assess treatment compliance, safety issues, and potential barriers to treatment.

  • Knowing the psychiatrist's treatment plan, and being able to anticipate a patient's mental progress over time.

  • Working in unison with the psychiatric team (and preventing patients from engaging in “team-splitting”).

  • Protecting oneself mentally to avoid burnout.

  • Remaining open-minded to increase chances of finding overlooked diagnoses.

  • Being aware of psychiatric medication side effects such as weight change, orthostatic hypotension, movement disorders, confusion, irritability, fatigue, anxiety, or increased fall risk.

  • Helping find organic causes for psychiatric symptoms by reviewing labs, screening for infections, and so on.

  • Helping diagnose movement disorders, which may represent primary medical conditions or medication side effects.

  • Using exercise and physical movement to help break a downward cycle.

  • Reducing unnecessary systemic medication usage, especially for pain management, and helping prevent substance abuse.

  • Recognizing physical maladies as clues to undiagnosed mental disorders.

EPIDEMIOLOGY

Mental illness accounts for more disability in the developed world than any other health condition. In the United States, a fourth of adults annually report having mental illness meeting Diagnostic and Statistical Manual of Mental Disorders-IV criteria.

Psychiatric conditions often lead to a host of patient stressors: family, finance, and work are often adversely affected. Often, the patient suffering from psychiatric illness is afflicted with poor health habits, diet, lack of self-care, and inability to perform activities of daily living (ADL). In extreme cases, an individual may have also sustained musculoskeletal injury from dangerous behaviors. A paranoid patient might not even cooperate with therapists, a depressed individual may lack motivation to follow a home exercise program, an Alzheimer's patient may not comprehend instructions, or a schizophrenic may halt amidst gait training on account of hallucinations. It is no wonder that prior caregivers may have given up on attempts to mobilize a patient, leading to a downward spiral involving inactivity, deconditioning, frailty, and even obesity. In such cases, a progressive physical reconditioning program emphasizing functional training and self-care may help turn things around.

Adding to the toll of mental illness is its often-early onset: in the United States, three-fourths of all lifetime cases start by age 24 years.1 By age 75, about half the population has had some psychiatric condition.1 Table ...

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