Side Effects Of Psychotropic Medications Research Articles

Construction and validation of the My Medicines and Me Questionnaire for assessment of the self-reported side effects of psychotropic medication.

We aimed to construct and assess the psychometric properties of the My Medicines and Me Questionnaire (M3Q), a self-report side-effect questionnaire for mental health patients. Thirty individuals taking a psychotropic medication completed the M3Q side-effect checklist along with the Liverpool University Neuroleptic Side Effect Rating Scale. Thirty healthy comparison individuals also completed the M3Q checklist. Data were analyzed using factorial analysis. Psychometric evaluations including validity and reliability testing were carried out on the questionnaire's checklist. The original 54-item checklist of the M3Q was shortened to include only those items found to be significant in the factorial analysis. The revised 32-item checklist of the M3Q was found to be valid and reliable. The M3Q is a simple, valid and reliable questionnaire that can be used routinely in clinical practice for detecting bothersome side effects of a range of psychotropic medications. This will provide a platform for improved communication between the clinician and the patient.

Teaching Integrated Care.

This issue of Academic Psychiatry includes five articles [1–5] focusing on teaching tomorrow’s psychiatrists about integrated care, and the American Psychiatric Association’s Council on Medical Education and Lifelong Learning (CMELL) recently released its report on “Training Psychiatrists for Integrated Behavioral Health Care” [6]. Why is integrated care education important, and what do these reports tell us about how to teach this? Only 1 in 8 people in the USAwith a mental health disorder consults a psychiatrist [7]. Most people who seek care do so in primary care settings. In fact, for decades primary care has been recognized as the “de facto mental health system” [8]. Access to mental health specialty care is poor, and at least half of people referred do not follow up [9]. Integrated care models were designed to close this gap and provide access to mental health care for the maximum number of people. Behavioral health care can be integrated into primary care in a number of different ways, including co-location of a mental health provider or consultant within a primary care setting, telemental health, and collaborative care models, in which psychiatrists collaborate with primary care providers and behavioral health care managers to optimize the mental health of a clinic or care system. Collaborative care, especially for depression, has been shown in multiple studies and metaanalyses to improve access, outcomes, and costs of mental health care, thus accomplishing the “triple aim” of the US health care system [10, 11]. Given the effectiveness of such integrated care models and the increasing focus on patientcentered care, medical homes, and providing integrated behavioral and primary medical care under the Affordable Care Act, many psychiatrists will take on new roles as consultants, educators, and team leaders within interprofessional behavioral health teams working in primary care settings. Psychiatric education needs to prepare tomorrow’s psychiatrists for these roles. At the same time, patients within the mental health system, especially with chronic mental illnesses, have significantly earlier mortality than the general population, primarily due not to suicide but to chronic medical problems exacerbated or caused by low socioeconomic status, poor access to and adherence with primary medical care, and side effects of psychotropic medications [12]. In recent years, there has been increasing focus on the responsibility of psychiatrists to ensure adequate primary medical care for such patients, bringing with it the challenge of determining how psychiatry trainees should be prepared to do this. The reports in this issue focus on integrated care education across the spectrum, from medical students to psychiatry residents, subspecialty fellows, and psychiatrists in practice. The Dube and Verduin paper [1] and their CMELL report section [6] discuss integrated care education for medical students. Currently, medical student education in psychiatry seldom includes integrated care settings or experiences, although some schools provide elective integrated care experiences or longitudinal integrated clerkships that follow the same patients across different specialties and clinical services, which may or may not be integrated. The CMELL report [6] provides a number of recommendations regarding medical student exposure to effective integrated care services and psychiatrist role models, as well as education in interprofessional and interdisciplinary communication. Seeing psychiatrists working at the interface of primary care and mental health may also destigmatize psychiatry as a career choice for some students. * Deborah S. Cowley dcowley@u.wahington.edu

“They forget to actually listen”: the ‘dis-integrated’ physical health care experience of people with severe mental illness

Introduction: It is well established that people living with severe mental illness experience shortened average life expectancy resulting in up to 25-30 years of life lost. Despite evidence that indicates there are multiple contributing factors, clinicians commonly believe that the mortality gap is almost solely caused by side effects of psychotropic medication. Furthermore, there is a dearth of research regarding the physical health experience from the perspective of people who are living with severe mental illness. Understanding this experience will be essential if clinicians are to better integrate physical and mental health care for this population. Theory / Method: Semi-structured interviews were conducted with 32 people living with severe mental illness, and who were accessing care and support from public mental health services and / or non-government organizations. Data were thematically analyzed. Results: Overall, participants reported poor physical health that required considerable planning and effort to manage effectively. The mean age of participants was 44.5 years and over half (56%) reported major physical illness. Three overarching themes were identified: “the work of self care”, “the importance of being heard”, and “the importance of social support”. Discussion: Participants struggled to find the motivation for positive health behaviors and illness self-management; however, most were determined to take control of their physical and mental health concerns and become as independent as possible. Despite frequent problems of selfexpression and feelings of anxiety in health care settings, the quality and nature of relationships with health care practitioners was important to participants who valued being listened to and feeling that their concerns were validated. Likewise participants emphasized the role of their social network in terms of managing their mental and physical health. Conclusions: If healthcare practitioners are to improve the integration of physical and mental health care in the population with SMI, it is essential that respectful relationships form the basis of care provision. Second, in line with participants’ expressed desire for independence, promoting and supporting illness self-management is important. Third, individual tailored support particularly aimed at integrating and strengthening informal support networks is indicated. World Congress on Integrated Care 2014, Sydney, November 23-26, 2014. International Journal of Integrated Care – Volume 14, 8 December – URN:NBN:NL:UI:10-1-116603– http://www.ijic.org/ Lessons learned: Although the need for integrated care provision based on respectful relationships seems self-evident, the narratives of participants indicated that they struggled to find clinicians who would listen to them and who respond in ways that protected and promoted physical health. Additionally, although participants recognized the need to interact with a complex health care system, the biographical and social contexts in which they managed their health was not well integrated into care delivery processes. Limitations: Participants in this research needed to be sufficiently well to be able to provide informed consent. Therefore, research findings might not be transferable to those people with severe mental illness who are at different stages of their recovery journey. Future research: Further research is required to ascertain ways in which biographical and social contexts can be better integrated into physical and mental healthcare provision in Australia.

Using the FIELD Model to Prepare Social Work Students and Field Instructors on Sexuality and Intimacy for Persons with Psychiatric Disabilities

Though expression of sexuality is correlated with improved physiological, psychological, and social well-being, persons with psychiatric disabilities battle a myriad of forces preventing their full inclusion in this cherished domain of adult life. Powerful side effects of psychotropic medications are partly to blame for this complex problem. More troubling are providers that adopt silent or admonishing positions with clients struggling with issues of sexuality and intimacy. Despite an international embrace of the recovery framework in mental health systems of care, providers often behave in ways that do not support the sexuality and intimacy interests of their clients. Since social workers are the main providers of service for this population, they must lead in developing novel pedagogical techniques infusing social work curriculum with practice competencies for addressing sexuality and intimacy for persons with psychiatric disabilities. Furthermore, as field instructors are most influential in shaping practice habits of social work students, any effort at structural change must feasibly include them. This article delineates an adaptation of the Field Instructors Extending EBP Learning in Dyads (FIELD) Model, for the field instructor and social work student dyad. Utilizing motivational interviewing techniques, FIELD imparts sexuality and intimacy practice competencies for collaboration with persons living with psychiatric disabilities.

Lighting the darkness of addiction: can phototherapy enhance contingency-management-based treatment of substance-related and addictive disorders?

Maladaptive patterns of substance use are serious social problems. Both pharmacological and nonpharmacological treatments are available, but nondrug options may be preferable because they avoid the expense and adverse side effects of psychotropic medication. Contingency management (CM) and nondrug social and recreational activities (NDSRAs) are based on operant conditioning principles and seek to decrease substance use by means of nondrug rewards. However, their efficacy may be hindered where brain reward circuitry is dysfunctional. Research shows that substance abuse biases neural reward systems in favor of drug-induced highs, while disrupting circadian-based rhythms. Circadian systems also have been found to influence human reward pathways. Possibly, a bidirectional relationship exists between circadian disturbance and substance abuse effects. If so, repair of abnormal circadian rhythms might help normalize reward response in substance abusers, with positive effects on CM or NDSRA treatment outcomes. Phototherapy has been effective in repairing circadian rhythms in persons with seasonal affective disorder and other chronobiological conditions. This article proposes that it similarly may repair circadian response in substance abusers, thereby normalizing brain reward systems. By doing so, it would enhance the efficacy of CM and NDSRA therapies and may also help prevent relapse. Given its low cost and ease of administration, phototherapy seems a promising avenue to pursue.

Adjustment of the UKU Side Effect Rating Scale for adults with intellectual disabilities. A pilot study

Purpose – Patients with intellectual disabilities (ID) and additional psychiatric disorders are often treated with psychotropic medication. However, examinations of side effects among these patients are scarce. The purpose of this pilot study is to examine the most frequently used side effect scale, UKU Side Effect Rating Scale (UKU-SERS), in this patient population. Design/methodology/approach – The aim of the present study is to explore whether the UKU-SERS is feasible for patients with ID. The UKU-SERS consists originally of 48 items, measuring side effects of psychotropic medication. In the study, UKU-SERS was used to score a group of 13 adults with ID admitted to a specialised inpatient psychiatric unit. First, an expert panel of seven psychiatrists and five psychiatric nurses independently evaluated the UKU-SERS and decided which items they considered possible to score after observation alone. Second, a total of 26 staff members, based on observation, scored the 13 patients on the ward. These results were used as the basis for recommending items from UKU-SERS to be used. Items scored differently by the two groups were examined more thoroughly. Findings – The expert panel and the ward staff agreed on 24 of the original 48 UKU-SERS items. The other 24 items were examined more thoroughly based on clinical meaningfulness. Consequently, 11 more items were included despite disagreement in the scorer groups. As expected, items that are based on observations seem more feasible than items based on the patients’ subjective experiences. Originality/value – The revised checklist comprises 35 items and seems applicable for further research and for use in clinical settings for this patient population. It is possible to observe important side effects using the UKU Side Effect Scale, but adjustment of the scale is desirable to make it more appropriate for the specific purpose and target group.

A review of self-report medication side effect questionnaires for mental health patients

Side effects of psychotropic medications are important determinants of adherence to treatment. Discussion between the patient and clinician facilitated through the use of a side effect self-report questionnaire (SRQ) could lead to improved communications and treatment adherence. The aim of this review was to 1) identify all currently available side effect SRQs used in the assessment of mental health patients׳ subjective experiences, 2) evaluate the characteristics of the studies and 3) assess the psychometric properties of each of the questionnaires. Eight electronic databases were searched for peer-reviewed published articles. Six side effect SRQs were identified. Two independent reviewers assessed the quality of the study designs and psychometric properties of the identified SRQs. All questionnaires consisted of closed questions relating to antipsychotic side effects and completion times ranged from 5 to 20min. Five questionnaires had undergone some form of psychometric testing, ranging from basic to comprehensive. There is a need in everyday clinical practice for a side effect communication tool applicable to all psychotropic medications, which allows the patient to express their subjective beliefs about their medications. This could provide an important contribution to the working relationship between patients and clinicians leading to informed decision-making and improved adherence.

Links between sleep and body mass index in bipolar disorders: An exploratory study

Study objectivesObesity and excess bodyweight are highly prevalent in individuals with bipolar disorders (BD) and are associated with adverse consequences. Multiple factors may explain increased bodyweight in BD including side effects of psychotropic medications, and reduced physical activity. Research in the general population demonstrates that sleep disturbances may also contribute to metabolic burden. We present a cross-sectional study of the associations between body mass index (BMI) and sleep parameters in patients with BD as compared with healthy controls (HC). MethodsTwenty-six French outpatients with remitted BD and 29 HC with a similar BMI completed a 21-day study of sleep parameters using objective (actigraphy) and subjective (PSQI: Pittsburgh Sleep Quality Index) assessments. ResultsIn BD cases, but not in HC, higher BMI was significantly correlated with lower sleep efficiency (P=0.009) and with several other sleep parameters: shorter total sleep time (P=0.01), longer sleep onset latency (P=0.05), higher fragmentation index (P=0.008), higher inter-day variability (P=0.05) and higher PSQI total score (P=0.004). ConclusionsThe findings suggest a link between a high BMI and several sleep disturbances in BD, including lower sleep efficiency. Physiological mechanisms in BD cases may include an exaggeration of phenomena observed in non-clinical populations. However, larger scale studies are required to clarify the links between metabolic and sleep-wake cycle disturbances in BD.

Psychotropic-induced sexual dysfunction

Psychotropic-induced sexual dysfunction is a common and bothersome side effect of psychotropic medications. The majority of information available on the subject primarily pertains to antidepressants, but antipsychotics can also cause significant sexual dysfunction. The mechanisms behind these adverse events are thought to be primarily due to antidepressants' effects on serotonin and to antipsychotics' anti-dopaminergic activity. Sexual dysfunction can have many causes, not just psychotropic medication, therefore this article aims to examine the etiology of sexual dysfunction, as well as discuss differential diagnoses. Treatment for psychotropic-induced sexual dysfunction will be discussed, with more data available for the treatment of antidepressant-induced sexual dysfunction. The paucity of data for antipsychotic-induced sexual dysfunction does make it more difficult to treat.

Introduction to This Special Issue on Spirituality and Mental Health

This special edition of Issues of Mental Health Nursing focuses on spirituality and mental health and suggests that the topic warrants the attention of those who practice psychiatricmental health nursing. Religion and faith have often been seen as problematic in the field of psychiatry where concerns are expressed about religiosity, paranoid ideations, and delusions associated with religious figures that often distort reality. Obsessions and compulsions with religious overtones often make intervening with clients a difficult challenge for mental health professionals. Spiritualism brings images of voodoo, spirits, or dysfunctional thought processes that disrupt the problem solving ability of mental health clients. Guilt and shame associated with some religious doctrines have made recovery difficult for those with depressive illnesses or overly burdensome for others with addictions or other concerns. Hope is often mitigated by the reality of the limitations of current interventions, such as various talk therapies, and the side effects of psychotropic medications or electroconvulsive therapies. Spirituality seems to have made minimal foray into the field of mental health treatment. Members of the health care team have divergent and often conflicting opinions about the role of spirituality; additionally, religion and spirituality are often presented as one concept. Some team members willingly pray and are present with others,

Sleep disturbances in a clinical forensic psychiatric population

ObjectivePoor sleep is known to cause detrimental effects on the course of diverse psychiatric disorders and is a putative risk factor for hostility and aggression. Thus, sleep may be crucial in forensic psychiatric practice. However, little is known about the prevalence of sleep disturbances in these complex psychiatric patients. MethodsIn this study we investigated the presence of sleep disorders and subjective sleep quality using the Sleep Diagnosis List (SDL), the Pittsburgh Sleep Quality Index (PSQI), interviews addressing the causes of sleep complaints, and file information on sleep medications in 110 patients admitted to a forensic psychiatric hospital. ResultsAlmost 30% of the participants suffered from one or more sleep disorders, especially insomnia. An even larger proportion of the participants (49.1%) experienced poor sleep quality. Interestingly, patients with an antisocial personality disorder or traits were particularly dissatisfied with their sleep. The most common causes of sleep problems were suboptimal sleep hygiene, stress or ruminating, negative sleep conditioning, and side effects of psychotropic medication. Of the poor sleepers, 40.7% received a hypnotic drug. ConclusionDespite intensive clinical treatment, sleep problems are experienced by a large number of forensic psychiatric patients. It would be worthwhile to examine the effects of pharmacological and non-pharmacological sleep interventions on both psychiatric symptoms and reactive aggressive behavior in forensic patients.

Book review: Managing the side effects of psychotropic medication

Book review: Managing the side effects of psychotropic medication

The health benefits and challenges of exercise training in persons living with schizophrenia: a pilot study.

Background: In addition to the hallmark cognitive and functional impairments mounting evidence indicates that schizophrenia is also associated with an increased risk for the development of secondary complications, in particular cardio-metabolic disease. This is thought to be the result of various factors including physical inactivity and the metabolic side effects of psychotropic medications. Therefore, non-pharmacological approaches to improving brain health, physical health, and overall well-being have been promoted increasingly. Methods: We report on the health-related physical fitness (body composition, blood pressure, heart rate, and aerobic fitness) and lipid profile of persons living with schizophrenia and effective means to address the challenges of exercise training in this population. Results: There was a markedly increased risk for cardio-metabolic disease in 13 persons living with schizophrenia (Age = 31 ± 7 years) including low aerobic fitness (76% ± 34% of predicted), reduced HDL (60% of cohort), elevated resting heart rate (80% of cohort), hypertension (40% of cohort), overweight and obesity (69% of cohort), and abdominal obesity (54% of cohort). Individualized exercise prescription (3 times/week) was well tolerated, with no incidence of adverse exercise-related events. The exercise adherence rate was 81% ± 21% (Range 48%–100%), and 69% of the participants were able to complete the entire exercise training program. Exercise training resulted in clinically important changes in physical activity, aerobic fitness, exercise tolerance, blood pressure, and body composition. Conclusion: Persons living with schizophrenia appear to be at an increased risk for cardio-metabolic disease. An individualized exercise program has shown early promise for the treatment of schizophrenia and the various cognitive, functional, and physiological impairments that ultimately affect health and well-being.

Managing the Side Effects of Psychotropic Medications

Managing the Side Effects of Psychotropic Medications

An exploratory study of the factors associated with medication nonadherence among youth in adult mental health facilities in Ontario, Canada

Although the issue of medication nonadherence among children and youth appears to be high, there is a paucity of research examining associated factors related to medication nonadherence among youth with mental health difficulties. Using logistic regression, this exploratory study sought to examine specific factors associated with medication nonadherence among youth with mental health needs in Ontario, Canada. Data on 3681 youth between the ages of 12–18 years old were obtained from the Resident Assessment Instrument for Mental Health (RAI-MH). Medication nonadherence was observed among 24.6% of the study population. Multivariate results showed that youth who experienced side effects of psychotropic medication were more than 3 times more likely to have failed to adhere to their medication. Other significant factors contributing to medication nonadherence include age, having multiple psychiatric admissions, limited insight into mental health, and having a disturbed/dysfunctional relationship with immediate family members. Tobacco use, cannabis use, depressive symptoms, and positive symptoms were also associated with medication nonadherence. Our data highlights some of the factors associated with medication nonadherence among youth with mental health needs. Physicians, clinicians and mental health care providers need to consider these factors, particularly when planning for discharge.

Management of Psychotropic Medication Side Effects in Children and Adolescents

This article is a review of several of the most concerning side effects of psychotropic medications in children and adolescents. An emphasis is placed on review of the prevalence, presentation, monitoring, and evidence-based management of these side effects.

The Use of the Wii Fit in Forensic Mental Health: Exercise for People at Risk of Obesity

Introduction: Side effects of psychotropic medication often lead to rapid weight gain, having detrimental effects on forensic mental health patients' health, wellbeing, occupational performance and quality of life. Virtual reality technology could provide novel environments and motivating forums for exercise, which are otherwise unavailable to patients in such secure settings. This exploratory study aimed to evaluate the use of the Nintendo Wii Fit in changing engagement in physical activity for patients at risk of obesity at a secure hospital. Method: Two participants used a Wii Fit for 8 weeks in individual or group sessions. A mixed methods approach was taken, because participants' use of the Wii Fit was compared with their attitudes towards it (reported during interviews) and their daily physical activity levels (measured using an accelerometer). Researcher field notes were also used to gather contextual data. Findings: Participants played Wii Fit up to four times a week in sessions ranging from 7 to 127 minutes. When using the Wii Fit, participants increased their overall time spent actively moving their bodies in physical activity, as measured by the accelerometer. Using the Wii Fit also changed participants' attitudes towards exercise as they realised that it could be ‘fun’ and ‘challenging’, especially if staff members also participated. Conclusion: The Wii Fit encouraged patients to attempt physical activities and to learn about their bodily response to exercise. It provided a meaningful occupational intervention in a secure setting and demonstrated a potential use of the technology in mental health settings.

Need for Sleep Clinics in Psychiatric Practice

Sleep medicine is a rapidly developing specialty. Detection and treatment of sleep disorders is on the rise with changing lifestyles and more awareness. Sleep disturbances are increasingly commonly encountered in psychiatric practice compared with the general population. Sleep disturbances can be secondary to the psychiatric illness or might manifest as a side effect of psychotropic medications. However, they are frequently neglected or may be misdiagnosed as a primary psychiatric disorder and treated wrongly. Psychological disturbances such as depression can also occur due to primary sleep disorders. Comorbidity of sleep disorder and psychiatric disorder can affect treatment, course of both the disorders and ultimately affect the quality of life of the patients. Specialized sleep clinics are now a part of many specialties,such as pulmonary medicine. These clinics require specific standards with respect to staff and infrastructure; in addition, they necessitate effective liaison between multiple specialties. Development of sleep clinics in psychiatry would help in better detection, assessment, and treatment of sleep disturbances in psychiatric patients as well as those with primary sleep disturbances with secondary psychological distress. Sleep clinics would also help in understanding the complex relation between sleep and psychiatric disorders through research and would help in developing more effective management techniques.

Disability support workers’ knowledge and education needs about psychotropic medication

Accessible summary The staff who are paid to support people with an intellectual disability in Australia are called disability support workers. As part of their job, disability support workers give out medications when the doctor says to. Some of these medications are used to help people with disability to calm down when they are angry. Often, these medications are not for treating any illness. These medications can sometimes make people feel very ill. In the past, the staff who used to give out these medications were nurses, but nurses do not do this job anymore. This study asked disability support workers what they think they need to know about the medications they give out. Most of the disability support workers said they needed to know more about these medications if they were to keep people safe, and it would also help them to talk to the doctors about what these medications are for when they go to appointments with people with a disability. SummaryDisability support workers are the predominant workforce employed to support people with an intellectual disability in Australia. Many support workers are required to assist people they support to take psychotropic medications in the form of chemical restraint. Support workers in Australia receive limited education and training in this area and as a result may miss important information about effects of medication on the people they support. In this study, we asked support workers about their education and training needs around chemical restraint. Our results showed that while the majority of support workers feel they are provided with good support from their co‐workers and supervisors, they feel they need more specific information regarding the side effects of psychotropic medication and its alternatives. Finding ways to support the support workers is crucial if we are to minimise the use of chemical restraint and provide best support possible to people with disabilities.

Clinical Manual of Psychopharmacology in the Medically Ill

Back to table of contents Previous article Next article Book ReviewsFull AccessClinical Manual of Psychopharmacology in the Medically IllDavid Gitlin, M.D.David GitlinSearch for more papers by this author, M.D.Published Online:1 Apr 2011https://doi.org/10.1176/ps.62.4.pss6204_0437AboutSectionsView articlePDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleClinical Manual of Psychopharmacology in the Medically IllFerrandoStephen J., M.D., LevensonJames L., M.D., and OwenJames A., Ph.D.; Washington, D.C., American Psychiatric Publishing, Inc., 2010, 640 pages, $75Over the past 20 to 30 years, there has been a massive proliferation in the pharmacologic armamentarium for virtually all medical and surgical illnesses. Although medical schools have stepped up training in pharmacology, most physicians are increasingly overwhelmed by the knowledge base necessary to keep track of all the medications available. Psychiatrists manage to develop expertise in the appropriate use of psychotropic medications to treat psychiatric illnesses but struggle to keep current with the pharmacotherapy of most medical and surgical conditions. Likewise, internists and surgeons are proficient in the use of pharmacotherapies in their own specialties but often lack essential knowledge about the use of psychotropic medications. And for all providers, understanding of the potential for interactions between the several classes of drugs is often beyond reach.Entering the fray is the Clinical Manual of Psychopharmacology in the Medically Ill, a text that aims to provide a single reference for both general physicians and psychiatrists. To the credit of the editors, the book comes quite close to hitting its mark.The text is divided into two main sections. The first is focused on general principles of psychopharmacology, which provide a context for understanding psychotropic medication issues in medical populations. The first two chapters on drug-versus-drug interactions and severe drug reactions are well organized but can be found in many other general psychiatry texts. For hospital-based physicians, the chapter on alternate routes of drug administration is useful and informative, providing some options for the complicated issue of patients unable to take oral medications because of medical circumstances.The second section is organized around organ systems. These chapters discuss common medical illnesses of each particular organ that may have neuropsychiatric sequelae or in which psychotropic treatments may play some role, adverse psychiatric effects of the typical medications used to treat those illnesses, the impact of psychotropic medications on the organ system under discussion, and finally a detailed review of medical-psychotropic drug interactions particular to that organ. Each chapter provides a series of easily referenced, organized tables of the relevant medications used for the organ system and drug-drug interactions. All chapters end with a summary of key clinical points, most of which are somewhat too general to be of significant value.Several of the chapters are especially beneficial to providers considering the complex interactions of a specific illness and its impact on the psychotropic treatment of patients. The chapter on gastrointestinal (GI) disorders, for example, discusses common disorders such as esophageal reflux and the potential indications for psychotropics, GI disorders on the interface of psychiatry (such as irritable bowel syndrome), GI side effects of psychotropic medications, and several important interactions. Special attention is given to patients with hepatic insufficiency, the pharmacologic impact of gastric bypass surgery, and antidepressant treatment issues with interferon-alpha hepatitis C treatment. The chapters on neurologic and endocrine disorders are equally superb. There is also an excellent discussion in the cardiology chapter on sudden death and QT prolongation due to psychotropic medications. Conversely, some of the chapters are a bit limited in the discussion of organ-specific illnesses, particularly the chapter on rheumatologic disorders.General psychiatrists who frequently treat patients with comorbid medical disorders will find this book to be a terrific reference and useful review. Primary care providers will also find this to be a helpful volume to keep at hand, especially for patients with chronic psychiatric disorders and new-onset general medical illnesses. Last, for those of us who are consultation-liaison and psychosomatic medicine psychiatrists, the editors have created an indispensable textbook.Dr. Gitlin is director of medical psychiatry at Brigham and Women's-Faulkner Hospitals, Boston.The reviewer reports no competing interests. FiguresReferencesCited byDetailsCited ByNone Volume 62Issue 4 April 2011Pages 437-438 Metrics PDF download History Published online 1 April 2011 Published in print 1 April 2011