Front Matter

Contributors

Preface

Acknowledgments

PART I

Abnormal Vital Signs

1 Fever

Esther Ahn, M.D.

Katherine S. Lerner, M.D.

2 Hypertension

Philip Solomon, M.D.

Sean LaVine, M.D.

3 Hypotension and Orthostasis

Salonie Pereira, M.D.

4 Abnormal Heart Rate

Imran Karim, M.D.

Hai Xu, M.D.

Chukwuemeka Obi, M.D.

PART II

Common Somatic Symptoms

5 Headache

Marc L. Gordon, M.D., FAAN

Sassan Naderi, M.D.

6 Seizures

Sean T. Hwang, M.D.

Simona V. Proteasa, M.D.

7 Falls and Head Trauma

Marzena Gieniusz, M.D.

Gisele P. Wolf-Klein, M.D.

8 Syncope and Unresponsiveness

Deyun Yang, M.D., Ph.D.

Nancy Kwon, M.D.

9 Chest Pain

Fady Ibrahim, M.D.

Kyle C. Katona, M.D.

10 Shortness of Breath

Christopher Iamonaco, D.O.

Aleksandra Polonetskaya, M.D.

Linda M. Kurian, M.D.

Mityanand Ramnarine, M.D.

11 Edema

Farheen Hasan, M.D.

Salonie Pereira, M.D.

12 Obstructive Sleep Apnea

Annamaria Iakovou, M.D.

Margarita Oks, M.D.

Harly Greenberg, M.D.

13 Abdominal Pain and Heartburn

Priyanka Singh, M.D.

Manjula Dhayalan, M.D.

Karen Friedman, M.D.

14 Nausea and Vomiting

Manjula Dhayalan, M.D.

David Purow, M.D.

15 Bowel Habit Changes

Sanjay Sekar, M.D.

Karen Friedman, M.D.

16 Dysuria, Incontinence, and Urinary Retention

Semie Kang, M.D.

17 Changes in Visual Acuity, Red Eye, and Eye Pain

Amy Mastrangelo, M.D.

PART III

Abnormal Laboratory Findings

18 Glucose Dysregulation

Sushmitha Echt, M.D.

Nayla Idriss, M.D.

Rifka Schulman-Rosenbaum, M.D.

19 Electrolyte Abnormalities

Hitesh H. Shah, M.D.

Joji James, M.D.

Joseph Mattana, M.D.

20 Abnormal Thyroid Function

Aren Skolnick, D.O.

Rifka Schulman-Rosenbaum, M.D.

21 Abnormal Liver Function

Deyun Yang, M.D., Ph.D.

Tai-Ping Lee, M.D.

22 Acute Kidney Injury

Hitesh H. Shah, M.D.

Nupur N. Uppal, M.D.

PART IV

Major Adverse Effects of Psychotropic Drugs

23 QTc Prolongation and Torsades de Pointes

Charles L. Kast, M.D.

Mark Goldin, M.D.

24 Myocarditis and Cardiomyopathy

Alexander Makhnevich, M.D.

Adam Auerbach, M.D.

James Gabriels, M.D.

Zubair Hasan, M.D.

Omid Kohani, M.D., FACC

25 Neuroleptic Malignant Syndrome, Serotonin Syndrome, and Rhabdomyolysis

Chun Kit Hung, M.D.

Patrick W. Joasil, M.D.

Julia Fernandez, M.D.

Sandy Balwan, M.D., FACP

26 Neutropenia and Agranulocytosis

Rajvi Patel, M.D.

Sadia Riaz, M.D.

27 Venous Thromboembolism

Mark Goldin, M.D.

Jessica Cohen, M.D.

Peter Manu, M.D.

PART V

Interdisciplinary Interventions

28 Cardiopulmonary Emergencies

Courtney G. Kluger, M.D.

29 Agitation and Delirium

Katherine S. Lerner, M.D.

Courtney G. Kluger, M.D.

30 Adverse Events Associated With Electroconvulsive Therapy

Eugene Grudnikoff, M.D.

Peter Manu, M.D.

31 Alcohol and Substance Use Disorders

Jessy Warner-Cohen, Ph.D.

Warren D. Zysman, LCSW

Kenneth Harris Jr., M.D.

Corey Karlin-Zysman, M.D., FHM, FACP

32 Adolescent Medicine Topics for the Mental Health Practitioner

Marigold Castillo, M.D.

Ronald Feinstein, M.D.

Martin Fisher, M.D.

33 Geriatric Medicine Topics for the Mental Health Practitioner

Liron Sinvani, M.D.

Gisele P. Wolf-Klein, M.D.

Index

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Site Director, Division of Hospital Medicine, Northwell Health Department of Medicine, North Shore University Hospital, Manhasset, New York

Assistant Professor of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Medical Director, Sandra Atlas Bass Heart Hospital at North Shore University Hospital, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Associate Chair, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Adolescent Medicine, Northwell Health Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Fellow, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Endocrinology, Diabetes and Metabolism Fellowship Program, Long Island Jewish Medical Center, New Hyde Park, New York

Professor of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Adolescent Medicine, Northwell Health Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Professor of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Chief, Division of Adolescent Medicine, Northwell Health Department of Pediatrics Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York

Associate Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Vice Chair for Education, Department of Medicine; Program Director, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, North Shore University Hospital, Manhasset, New York

Resident, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Geriatric Medicine and Palliative Care, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director of Clinical Trials, Department of Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Professor of Neurology and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Chief of Neurology, Zucker Hillside Hospital, Glen Oaks, New York

Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Chief, Division of Pulmonary Medicine, Critical Care and Sleep Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Department of Psychiatry, NYC Health + Hospitals/Elmhurst Hospital, Queens, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Associate Professor of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Program Director, Epilepsy Fellowship, North Shore University Hospital, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Pulmonary Medicine, Critical Care and Sleep Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Site Director, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Fellow, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Nephrology Fellowship Program, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Assistant Site Director, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Associate Medical Director, Long Island Jewish Medical Center at Northwell Health, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Associate Chief, Division of Hospital Medicine North Shore University Hospital at Northwell Health, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Site Director, Division of Hospital Medicine, Northwell Health Department of Medicine, North Shore University Hospital, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Attending Physician, Cardiovascular Diseases, Bayside, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Chief, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Associate Professor of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Vice Chair, Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Associate Chief, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Associate Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director of Education and Training, Division of Hepatology, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, North Shore University Hospital at Northwell Health, Manhasset, New York

Professor of Medicine and Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director of Medical Services South Oaks Hospital, Amityville, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Professor of Medicine, Frank H. Netter MD School of Medicine at Quinnipiac University; Chair of Medicine and Internal Medicine Residency Program Director, St. Vincent’s Medical Center, Bridgeport, Connecticut

Attending Physician, Brookhaven Memorial Medical Center, Patchogue, New York

Resident, Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Pulmonary Medicine, Critical Care and Sleep Medicine, Northwell Health Department of Medicine, Lenox Hill Greenwich Village Office at Northwell Health, New York, New York

Fellow, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Hematology/Oncology Fellowship Program, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Fellow, Epilepsy Program, North Shore University Hospital, Manhasset, New York

Chief, Medicine/Gastroenterology, Huntington Hospital, Northwell Health, Huntington, New York

Attending Physician, Department of Emergency Medicine, Citrus Memorial Health System Inverness, Inverness, Florida

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hematology/Oncology, North Shore University Hospital at Northwell Health, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director of Inpatient Diabetes, Division of Endocrinology, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Fellowship Program Director, Division of Nephrology, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Associate Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director of Research, Division of Hospital Medicine, Northwell Health Department of Medicine, North Shore University Hospital at Northwell Health, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Director, Division of Endocrinology, Northwell Health Department of Medicine, Center for Transgender Care, Great Neck, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, North Shore University Hospital, Manhasset, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Nephrology, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Psychiatry and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Health Psychologist, Long Island Jewish Medical Center at Northwell Health, New Hyde Park, New York

Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Geriatric Medicine and Palliative Care, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Resident, Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Internal Medicine Residency Program, Long Island Jewish Medical Center, New Hyde Park, New York

Assistant Professor of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell; Attending Physician, Division of Hospital Medicine, Northwell Health Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York

Chief Operating Officer/Executive Vice President, True Care Treatment Centers, Las Vegas, Nevada

Accelerated aging, poverty, substandard medical care, social neglect and withdrawal, unhealthy lifestyle, and complications of psychiatric treatments are major contributors to the substantial morbidity of patients with severe mental illnesses. Medical deteriorations are many times unexpected and severe and can have major adverse consequences for psychiatric patients, as they may lead to life-threatening complications if they are not rapidly diagnosed and treated. Their evaluation is particularly difficult in the context of psychotic disorders, developmental abnormalities, or dementia with behavioral disturbance, because patients with these disorders are often vague or silent about physical suffering, and in the setting of stand-alone psychiatric hospitals, which lack access to consulting specialists, advanced imaging, and short laboratory turnaround time.

The first edition of this handbook was published in 2006. Now in its third edition, the book is designed to provide a cognitive framework and knowledge base for dealing with the medical pathology of psychiatric patients. For each of the symptoms, signs, and laboratory abnormalities described in the text, we tried to enable frontline clinicians to answer five important questions, presented here in the order in which we ask them in our own practice:

The book starts with the challenge of abnormal vital signs (e.g., fever, orthostatic hypotension) and of symptoms frequently voiced by psychiatric patients (e.g., headache, seizures, falls, chest pain, nausea), after which we discuss common laboratory abnormalities in this population (e.g., decreased thyroid-stimulating hormone level, increased transaminase levels, hyponatremia). We then present the major medical complications of psychotropic drugs (e.g., torsades de pointes, myocarditis, neutropenia and agranulocytosis). In the final section we provide a detailed discussion of issues requiring interdisciplinary interventions in collaboration with neurologists and anesthesiologists, or with addiction medicine, adolescent medicine, and geriatric medicine specialists. The chapters include clinical vignettes, the main features of clinical presentation and differential diagnosis, the risk stratification for major complications, an evidence-based approach to the management in the psychiatric setting, key points, and suggested readings.

The third edition of Handbook of Medicine in Psychiatry has been thoroughly updated and streamlined to 33 chapters that describe a commonsense approach to realities confronting clinicians who work in today’s busy inpatient and outpatient psychiatric settings. As we are inviting you to read it, we hope you will keep in mind that our work is not intended to replace standard textbooks and other reputable print and electronic sources of clinical guidelines for the practice of internal medicine. Instead, our intention is to offer help for accurate decision making in the conditions of uncertainty created by potentially major medical deteriorations of the vulnerable patients under your care.

Peter Manu, M.D.

Corey Karlin-Zysman, M.D., FHM, FACP

Eugene Grudnikoff, M.D.

This book owes its existence to the dedication, talent, and hard work of a large group of faculty, subspecialty fellows, and residents from Northwell Health’s Long Island Jewish Medical Center, New Hyde Park; Cohen Children’s Medical Center, New Hyde Park; and North Shore University Hospital, Manhasset, New York—the principal teaching units of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. We extend our deep appreciation to all for sharing their clinical experiences, knowledge, insight, and discernment.

We acknowledge with gratitude Laura W. Roberts, M.D., and John McDuffie, as well as their wonderful editorial and production teams at American Psychiatric Association Publishing, for great suggestions in shaping the content of the book and its graphic presentation. They insisted on accuracy, brevity, and clarity and helped us deliver a text with these features to our readers.

We are also indebted to Rhonda Kaplowitz and Donna Vasic from the support staff of the Division of Hospital Medicine and Hospital Administration at Long Island Jewish Medical Center for their tireless assistance as we worked to improve the scientific quality and practical value of the volume.

Finally, we praise those whose understanding of the concentration, attention, and time required for the editing of this volume was most important and sustaining to us—our families: Lisa, Matthew, Michael, Daniel, and Kathryn Manu; Warren, Elliott, and Reese Zysman; and Abigail Hughes and Samuel Hughes-Grudnikoff.