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Manual of Psychiatric Care for the Medically Ill

Antoinette Ambrosino Wyszynski, M.D., and Bernard Wyszynski, M.D.

  • ISBN 978-1-58562-688-5
  • Item #62688

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Manual of Psychiatric Care for the Medically Ill delivers a practical approach to accurate psychiatric diagnosis and treatment in the medical-surgical setting. The editors have updated the literature reviews of their widely used 1996 American Psychiatric Publishing publication A Case Approach to Medical-Psychiatric Practice and have added easy-to-use summaries, Web resources, checklists, flowcharts, and worksheets-all designed to facilitate and teach the process of psychiatric consultation. The appended study guide makes this book even more valuable as an educational tool.

Intended as a companion guide to comprehensive textbooks in psychosomatic medicine, this concise volume combines medication updates with how-to strategies for the psychiatric treatment of patients with cardiovascular, hepatic, renal, and pulmonary disease; gastrointestinal symptoms; delirium; HIV; hepatitis C; steroid-induced psychiatric syndromes; and organ transplantation. A special feature is the comprehensive chapter on the treatment of psychiatric illness in pregnancy. Each chapter summarizes the literature, emphasizing diagnostic and treatment considerations for patients with psychiatric symptoms and medical illnesses.

Representing the work of 24 contributors, this useful, highly informative volume features

  • Checklists, flowcharts, and worksheets that can be photocopied and brought to the patient's bedside for use during the clinical consultation. These templates help focus the information-gathering process, organize the data, and generate important documentation.
  • Standardized assessment instruments and questionnaires, such as the Michigan Alcohol Screening Test, Delirium Rating Scale-Revised-98, and HIV Dementia Scale, which assist in consultation and evaluation.
  • Summaries and charts of differential diagnoses to assist psychiatric consultation to medical patients, including Web addresses to access the latest information on a particular condition or treatment.
  • A study guide in case-question-answer format for selected chapters.

This volume also includes a how-to chapter on assessing decisional capacity, complete with a worksheet for gathering information and documenting informed consent. It also features practical reviews of psychotherapeutic issues, such as a primer for what to do when patients ask about spiritual issues. Concluding chapters present short, practical guides on addressing general psychological issues occurring in medical patients.

This proven manual—already being used to teach residents the core curriculum in Consultation-Liaison Psychiatry and On-Call Preparedness at Bellevue Hospital in New York City—will be welcomed by general psychiatrists, consultation-liaison and psychosomatic medicine fellows, residents, and medical students everywhere.


  • Contributors
  • Preface
  • Acknowledgments
  • Dedication
  • Chapter 1. The Delirious Patient
  • Chapter 2. The Patient With Hepatic Disease, Alcohol Dependence, and Altered Mental Status
  • Chapter 3. The Patient With Cardiovascular Disease
  • Chapter 4. The Patient With Kidney Disease
  • Chapter 5. The Patient With Pulmonary Disease
  • Chapter 6. The Patient With GI Symptoms and Psychiatric Distress
  • Chapter 7. The Obstetrics Patient
  • Chapter 8. The Patient Using Steroids
  • Chapter 9. The HIV-Infected Patient
  • Chapter 10. The Patient With Hepatitis C
  • Chapter 11. A Primer on Solid Organ Transplant Psychiatry
  • Chapter 12. Assessing Decisional Capacity and Informed Consent in Medical Patients: A Short, Practical Guide
  • Chapter 13. Psychological Issues in Medical Patients: Autonomy, Fatalism, and Adaptation to Illness
  • Chapter 14. When Patients Ask About the Spiritual: A Primer
  • Chapter 15. The Seriously Ill Patient: Physician Factors in the Doctor-Patient Relationship: A Short, Practical Guide
  • Chapter 16. Epilogue: The Physician as Comforter
  • Appendix 1: American Psychiatric Association Guidelines for Assessing the Delirious Patient: Checklist
  • Appendix 2: Worksheet for Organizing Medical Chart Information: The Initial Psychiatric Consultation
  • Appendix 3: Decision Tree for Psychiatric Differential Diagnosis of Medically Ill Patients
  • Appendix 4: VINDICTIVE MADS: Differential Diagnosis of Mental Status Changes
  • Appendix 5: A Short, Practical Guide to Treating Dementia-Related Behavioral Problems in the Medical Setting
  • Appendix 6: A Guide to Herbal Supplements in the Medical Setting
  • Appendix 7: Worksheet for Diagnosing and Comparing Serotonin Syndrome and Neuroleptic Malignant Syndrome
  • Appendix 8: Delirium Rating Scale-Revised-98
  • Appendix 9: The Confusion Assessment Method (CAM) Instrument
  • Appendix 10: Memorial Delirium Assessment Scale (MDAS)
  • Appendix 11: Risk Factors for Torsades de Pointes
  • Appendix 12: Guidelines for Adult Psychotropic Dosing in Renal Failure
  • Appendix 13: Commonly Used Drugs With Sedative-Hypnotic Properties
  • Appendix 14: Electroconvulsive Therapy in Medical Illness: Practice Guidelines of the American Psychiatric Association
  • Appendix 15: Diagnosing Depression in the Medically Ill
  • Appendix 16: Screening Worksheet for Bipolar Spectrum Disorders
  • Appendix 17: Neuropsychiatric Effects of Electrolyte and Acid-Base Imbalance
  • Appendix 18: Worksheet for Monitoring Patients Receiving Atypical Antipsychotics
  • Appendix 19: Case Vignettes and Study Guide
  • Index


    Salvatore V. Ambrosino, M.D.
    Khleber Chapman Attwell, M.D., M.P.H.
    Leonard Barkin, M.D.
    Brian D. Bronson, M.D.
    Bryan Bruno, M.D.
    Linda Chuang, M.D.
    Nancy Forman, M.D.
    Miriam Friedlander, M.D.
    Carol F. Garfein, M.D.
    Stanley Grossman, M.D.
    Ceri Hadda, M.D.
    Silvia Hafliger, M.D.
    Shari I. Lusskin, M.D.
    Victor B. Rodack, M.D.
    Bruce Rubinstein, M.D.
    Manuel Santos, M.D.
    Victor Schwartz, M.D.
    Melanie Schwarz, M.D.
    Manuel Santos, M.D.
    Elyse D. Weiner, M.D.
    Antoinette Ambrosino Wyszynski, M.D.
    Bernard Wyszynski, M.D.
    Patrick Ying, MD
    Van Yu, M.D.

About the Authors

Antoinette Ambrosino Wyszynski, M.D., is a graduate of New York University School of Medicine in New York City. She completed her residency in psychiatry at Bellevue-N.Y.U. Medical Centers, and was a Fellow at Memorial Sloan-Kettering Cancer Center. She divides her time between treating medically ill outpatients suffering psychiatric disorders and teaching psychosomatic medicine in the N.Y.U.-Bellevue residency program. Dr. Wyszynski is also on the Faculty of The Psychoanalytic Institute at N.Y.U. Medical Center.

Bernard Wyszynski, M.D., is a graduate of the University of Pennsylvania School of Medicine. He completed his residencies in neurology and in psychiatry at Mt. Sinai Hospital in New York City. He is currently Inpatient Director and Unit Chief, Inpatient Psychiatry, at Montefiore Hospital and Medical Center, Bronx, New York. He teaches neuropsychiatry to medical students and psychiatric residents at Albert Einstein College of Medicine.

They are co-authors of A Case Approach to Medical-Psychiatric Practice (APPI, 1996)

This is a remarkable book that must be in the libraries of all psychiatrists. Its use of clinical vignettes illuminates comprehensive discussions of commonly seen situations in patients with medical and psychiatric disorders. Its practical yet scholarly approach will be invaluable to clinicians in all stages of training and practice!—Thomas N. Wise, M.D., Editor-in-Chief, Psychosomatics

The Manual of Psychiatric Care for the Medically Ill, like its predecessor A Case Approach to Medical-Psychiatric Practice, combines at-the-bedside utility with illustrative case examples, practice guidelines, and citation of the key literature. The Wyszynskis and their colleagues have achieved their aims of brevity and practicality. Every chapter is a string of clinical pearls, concise, up-to-date, and clinically relevant.—James L. Levenson, M.D., Chair, C-L Psychiatry/Vice-Chair, Psychiatry, Medical College of Virginia/Virginia Commonwealth University

This manual, which covers the major comorbid psychiatric disorders of the common medical illnesses, is a gem—it uses algorithms, tables, and short cuts to get to the heart of the problems quickly. I love the chapter on delirium, which is particularly pithy and succinct. The book will be a hit with psychiatrists in managing their patients with medical illnesses, and with medical students. Physicians increasingly deal with patients with chronic illnesses in our aging population. Psychiatric disorders are common and complicate care. This book is a guide that will be widely used.—Jimmie C. Holland, M.D., Prof, Dept of Psychiatry, Weill Med Coll Cornell Univ; Wayne Chapman Chair Psychiatric Oncology; Attending Psychiatrist, Psychiatry & Beh Sci, Mem Sloan Kettering Cancer Ctr

This Manual by Wyszynski and Wyszynski does what it promises to do. It gives the busy psychiatrist working in the medical-surgical setting a wealth of practical information invaluable for state-of-the-science care of important conditions at the bedside. It is an outstanding contribution to the medical psychiatry literature.—Gregory Fricchione, M.D., Associate Chief of Psychiatry, Massachusetts General Hospital, Associate Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts

Psychiatrists are increasingly being called upon to act in the role of physician and healer in medically ill patients. Most training programs have not adequately prepared residents for this responsibility. This volume successfully addresses the need. It is practical, useful, and in addition contains wisdom as well as solid clinical advice.—Robert Cancro, M.D., Med.D.Sc., Lucius N. Littauer Professor of Psychiatry and Chairman of the Department, New York University School of Medicine, New York

This is a good book. . . . You can find your way around. The logical structure, with largely predictable and systematic coverage of different systems, is an advantage both for psychiatrists with limited medical knowledge and for physicians with little mental health experience.—British Journal of Psychiatry, 12/1/2005

The Wyszynskis have done it again! The Manual of Psychiatric Care for the Medically Ill is a practical, concise, case-based approach to the medicine-psychiatry interface-a fitting update to their highly regarded 1996 manual A Case Approach to Medical-Psychiatric Practice.Journal of Clinical Psychiatry, 12/1/2005

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