The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry, by David M. Taylor, Fiona Gaughran, Toby Pillinger

THE MAUDSLEY GUIDELINES

Other books in the Maudsley Prescribing Guidelines series include:

The Maudsley Prescribing Guidelines in Psychiatry, 14th edition (coming in 2021) David M. Taylor, Thomas R.E. Barnes, Allan H. Young.

The Maudsley Guidelines on Advanced Prescribing in Psychosis Paul Morrison, David M. Taylor, Phillip McGuire.

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry

 

 

David M. Taylor BSc, MSc, PhD, FCMHP, FFRPS, FRPharmS, FRCP (Edin)

Director of Pharmacy and Pathology, Maudsley Hospital;
and Professor of Psychopharmacology, King’s College, London, UK

Fiona Gaughran MD, FRCP(I), FRCP (Lon), FRCP (Edin), FRCPsych, FHEA

Lead Consultant Psychiatrist, National Psychosis Service (Bethlem Royal Hospital);
Director of Research and Development, South London and Maudsley NHS Foundation Trust;
Reader in Psychopharmacology and Physical Health, King’s College, London, UK

Toby Pillinger MA (Oxon), BM BCh, MRCP, PhD

Academic Clinical Fellow, South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK

 

 

 

 

 

 

 

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For Aloysius, welcome to the world.

Preface

It is well documented that people with severe mental illness have elevated mortality rates compared with the general population, with physical health conditions the predominant cause. There are several potential mechanisms underlying this mortality gap. First, lifestyle factors such as poor diet, reduced exercise levels, and higher rates of smoking play a role. Second, psychiatric medications are associated with physical side effects, and can contribute to progressive impairment of multiple organ systems. Third, individuals with serious mental illness are less likely to present to a general practitioner or medical hospital with a physical complaint, thereby allowing conditions to progress without treatment. Fourth, when physical conditions are identified while under the care of psychiatric services, practitioners may lack the knowledge and confidence to act.

This, the first edition of The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry, aims to bridge the gap between psychiatric and physical health services which are usually geographically and organisationally separate. A key objective is to enhance the clinical confidence of psychiatric practitioners by providing these individuals with a practical and evidence‐based ‘toolkit’ with which to assess, investigate, and potentially initiate treatment for common physical health conditions seen in patients with serious mental illness. It is hoped that co‐working relationships between psychiatrists and general practitioners, physicians, and surgeons alike will be enhanced owing to improved quality of referrals. Furthermore, it is anticipated that the standard of clinical care delivered to patients with serious mental illness will improve by expediting appropriate investigation and management of physical comorbidity. Finally, we hope that the patient–practitioner relationship will be enhanced as psychiatric patients become aware that both body and mind are being considered as part of their holistic care.

The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry consists of 89 chapters, covering 14 different organ systems, alongside emergency presentations. Although The Guidelines are predominantly based on UK practice, we have made efforts to acknowledge the anticipated international readership, and as such have also included references to psychiatric and medical drugs not currently licensed in the UK. However, the reader should be aware that no guideline can take into account every drug available across the world, so omissions are inevitable.

This text may be seen as a sister volume to the The Maudsley Prescribing Guidelines in Psychiatry. Like that book, the The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry is the product of a group of local and international experts; we are indebted to the 125 individuals from across medicine, surgery, and psychiatry who have contributed. At present, the world’s attention is centred on the COVID‐19 pandemic and never has there been a greater need for clinicians from across specialties to work together for the greater good of patients. We hope that The Maudsley Practice Guidelines for Physical Health Conditions in Psychiatry will go some way to facilitate this, not only in the current climate but for years to come.

Toby Pillinger

London, UK

September 2020

Abbreviations

ABPM
ambulatory blood pressure monitoring
ACE
angiotensin‐converting enzyme
ACOS
asthma–COPD overlap syndrome
ACS
acute coronary syndrome
ADH
antidiuretic hormone
ADR
adverse drug reaction
AE
autoimmune encephalitis
AED
antiepileptic drug
AF
atrial fibrillation
AFB
acid‐fast bacilli
AKI
acute kidney injury
ALP
alkaline phosphatase
ALT
alanine aminotransferase
ANC
absolute neutrophil count
ARB
angiotensin II receptor blocker
ART
antiretroviral therapy
ASPD
advanced sleep phase disorder
AST
aspartate aminotransferase
ATT
antitubercular treatment
AUR
acute urinary retention
BEN
benign ethnic neutropenia
BMI
body mass index
BNP
brain natriuretic peptide
BP
blood pressure
BPH
benign prostatic hyperplasia
CAP
community‐acquired pneumonia
CBT
cognitive‐behavioural therapy
CI
confidence interval
CIM
clozapine‐induced myocarditis
CKD
chronic kidney disease
CLD
chronic liver disease
CNS
central nervous system
COPD
chronic obstructive pulmonary disease
COVID‐19
coronavirus disease 2019
CPAP
continuous positive airway pressure
CRP
C‐reactive protein
CSF
cerebrospinal fluid
CT
computed tomography
CVD
cardiovascular disease
DAA
direct‐acting antiviral
DEXA
dual‐energy X‐ray absorptiometry
DI
diabetes insipidus
DKA
diabetic ketoacidosis
DRE
digital rectal examination
DSPD
delayed sleep phase disorder
DVT
deep vein thrombosis
ECT
electroconvulsive therapy
EDS
excessive daytime sleepiness
eGFR
estimated glomerular filtration rate
EPSE
extrapyramidal side effect
ESC
European Society of Cardiology
ESR
erythrocyte sedimentation rate
ESRF
end‐stage renal failure
FBC
full blood count
FDA
Food and Drug Administration
FEV1
forced expiratory volume in 1 s
FVC
forced vital capacity
GABA
gamma‐aminobutyric acid
GCS
Glasgow Coma Scale
GGT
gamma‐glutamyltransferase
GORD
gastro‐oesophageal reflux disease
HAD
HIV‐associated dementia
HAND
HIV‐associated neurocognitive disorders
HAP
hospital‐acquired pneumonia
HBPM
home blood pressure monitoring
HBV
hepatitis B virus
HCG
human chorionic gonadotrophin
HCV
hepatitis C virus
HDL
high‐density lipoprotein
HHS
hyperosmolar hyperglycaemic state
HMOD
hypertension‐mediated organ damage
HRT
hormone replacement therapy
HSV
herpes simplex virus
ICD
implantable cardioverter‐defibrillator
ICP
intracranial pressure
ICU
intensive care unit
IGRA
interferon gamma release assay
INR
international normalised ratio
IOP
intraocular pressure
IUD
intrauterine device
LARC
long‐acting reversible contraceptive
LBBB
left bundle branch block
LDL
low‐density lipoprotein
LFT
liver function test
LLQ
left lower quadrant
LMWH
low‐molecular‐weight heparin
LOS
lower oesophageal sphincter
LP
lumbar puncture
LUQ
left upper quadrant
LVH
left ventricular hypertrophy
MAOI
monoamine oxidase inhibitor
MCV
mean corpuscular volume
MDD
major depressive disorder
MOH
major obstetric haemorrhage
MRI
magnetic resonance imaging
MRSA
methicillin‐resistant Staphylococcus aureus
MSU
mid‐stream urine
NAFLD
non‐alcoholic fatty liver disease
NICE
National Institute for Health and Care Excellence
NMDA
N‐methyl‐D‐aspartate
NMS
neuroleptic malignant syndrome
NNRTI
non‐nucleoside reverse transcriptase inhibitor
NRT
nicotine replacement therapy
NSAID
non‐steroidal anti‐inflammatory drug
NSTEMI
non‐ST‐segment elevation myocardial infarction
OD
odds ratio
OGTT
oral glucose tolerance test
OIC
opioid‐induced constipation
OSA
obstructive sleep apnoea
PA
physical activity
PAMORA
peripherally acting μ‐opioid receptor antagonist
PCI
percutaneous coronary intervention
PCR
polymerase chain reaction
PE
pulmonary embolism
PEF
peak expiratory flow
PEFR
peak expiratory flow rate
PEP
post‐exposure prophylaxis
PHAP
psychiatric hospital‐acquired pneumonia
PID
pelvic inflammatory disease
PLMS
periodic limb movements in sleep
PLWHIV
people living with HIV
PNES
psychogenic non‐epileptic seizures
POI
premature ovarian insufficiency
PPI
proton‐pump inhibitor
PPS
psychogenic pseudosyncope
PUD
peptic ulcer disease
PwE
people with epilepsy
RAPD
relative afferent pupillary defect
RID
relative infant dose
RLS
restless leg syndrome
RR
relative risk
RUQ
right upper quadrant
SARS‐CoV‐2
severe acute respiratory syndrome coronavirus 2
SD
sexual dysfunction
SIADH
syndrome of inappropriate antidiuretic hormone secretion
SJS
Stevens–Johnson syndrome
SLE
systemic lupus erythematosus
SMI
serious mental illness
SNRI
serotonin/noradrenaline reuptake inhibitor
SPECT
single photon emission computed tomography
SSRI
selective serotonin reuptake inhibitor
STEMI
ST‐segment elevation myocardial infarction
STI
sexually transmitted infection
SVT
supraventricular tachycardia
TD
tardive dyskinesia
T2DM
type 2 diabetes mellitus
TEN
toxic epidermal necrolysis
TFT
thyroid function test
TIA
transient ischaemic attack
TIBC
total iron‐binding capacity
TLE
temporal lobe epilepsy
TLOC
transient loss of consciousness
TNF
tumour necrosis factor
TRH
thyrotropin releasing hormone
TSH
thyroid stimulating hormone
UA
unstable angina
ULN
upper limit of normal
UPSI
unprotected sexual intercourse
UTI
urinary tract infection
VGKC
voltage‐gated potassium channel
VT
ventricular tachycardia
VTE
venous thromboembolism
WHO
World Health Organization

Part 1
Cardiology