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Textbook of Medical Psychiatry

Edited by Paul Summergrad, M.D., David A. Silbersweig, M.D., Philip R. Muskin, M.D., M.A., and John Querques, M.D.

  • ISBN 978-1-61537-080-1
  • Item #37080

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The Textbook of Medical Psychiatry was written for the wide range of clinicians who grapple with the diagnostic and treatment challenges inherent in this clinical reality: medical and psychiatric illnesses do not occur in isolation from one another. Because assessment in these cases may be challenging, the book addresses general medical conditions that directly cause psychiatric illness and the medical differential diagnosis of common psychiatric illnesses. In addition, the book describes how the presentation and treatment of both psychiatric and medical disorders are modified by the presence of comorbid conditions. The editors, who are at the forefront of the field, have assembled an outstanding group of contributors, all of whom share the objective of helping psychiatrists, internists, neurologists, trainees, and other health care providers recognize the medical issues facing patients with psychiatric symptoms, and vice versa. Proper assessment and treatment are dependent on the skillful application of this knowledge.

Written in down-to-earth, clinically grounded prose, this text

  • Provides a comprehensive exploration of approaches to the patient, including perspectives from internists and neurologists on dealing with diagnostic uncertainty and special chapters on the neurological examination, cognitive testing, neuroimaging, laboratory testing, and toxicological syndromes.
  • Presents a review of medical disorders that can directly or indirectly affect the clinical presentation and course of psychiatric disorders.
  • Presents a review of psychiatric disorders that can be caused by medical illnesses or affect the clinical presentation and course of medical disorders.
  • Includes chapters on pain, insomnia, and somatoform disorders, conditions that accompany many psychiatric and medical illnesses and that fall in the boundary between these practice settings.

In clinics and offices every day, physicians encounter patients whose presentations are atypical or whose symptoms are not responsive to usual care. When facing the challenges of accurately assessing complicated symptoms and managing the care of complex patients, clinicians often seek advice from colleagues whose perspectives and expertise they trust. The chapters in the Textbook of Medical Psychiatry can be consulted in much the same fashion, expanding clinicians' knowledge base and helping them to more effectively diagnose and care for their patients.


  • Contributors
  • Foreword
  • Introduction: The Importance of Medical–Psychiatric Illness
  • Part I: Approach to the Patient
  • Chapter 1. An Internist's Approach to the Neuropsychiatric Patient
  • Chapter 2. The Neurological Examination for Neuropsychiatric Assessment
  • Chapter 3. The Bedside Cognitive Examination in Medical Psychiatry
  • Chapter 4. Neuroimaging, Electroencephalography, and Lumbar Puncture in Medical Psychiatry
  • Chapter 5. Toxicological Exposures and Nutritional Deficiencies in the Psychiatric Patient
  • Part II: Psychiatric Considerations in Medical Disorders
  • Chapter 6. Cardiovascular Disease
  • Chapter 7. Endocrine Disorders and Their Psychiatric Manifestations
  • Chapter 8. Inflammatory Diseases and Their Psychiatric Manifestations
  • Chapter 9. Infectious Diseases and Their Psychiatric Manifestations
  • Chapter 10. Gastroenterological Disease in Patients With Psychiatric Disorders
  • Chapter 11. Renal Disease in Patients With Psychiatric Illness
  • Chapter 12. Neurological Conditions and Their Psychiatric Manifestations
  • Chapter 13. Cancer: Psychiatric Care of the Oncology Patient
  • Chapter 14. Dermatology: Psychiatric Considerations in the Medical Setting
  • Chapter 15. Women's Mental Health and Reproductive Psychiatry
  • Part III: Medical Considerations in Psychiatric Disorders
  • Chapter 16. Neurodevelopmental Disorders
  • Chapter 17. Psychotic Disorders Due to Medical Illnesses
  • Chapter 18. Catatonia in the Medically Ill Patient
  • Chapter 19. Mood Disorders Due to Medical Illnesses
  • Chapter 20. Anxiety and Related Disorders: Manifestations in the General Medical Setting
  • Chapter 21. Substance Use Disorders in the Medical Setting
  • Chapter 22. Neurocognitive Disorders
  • Part IV: Conditions and Syndromes at the Medical–Psychiatric Boundary
  • Chapter 23. Chronic Pain
  • Chapter 24. Insomnia
  • Chapter 25. Somatic Symptom and Related Disorders
  • Index


    Marcela Almeida, M.D.
    David Banayan, M.D., M.Sc., FRCPC
    Gaston C. Baslet, M.D.
    Scott R. Beach, M.D.
    Sheldon Benjamin, M.D.
    J. Michael Bostwick, M.D.
    Hannah E. Brown, M.D.
    Kara Brown, M.D.
    Michelle Burke Parish, Ph.D., M.A.
    Lily Chan, M.D.
    Charles De Mesa, D.O., M.P.H.
    Anna L. Dickerman, M.D.
    Karl Doghramji, M.D.
    Kevin M. Donnelly-Boylen, M.D.
    Saria El Haddad, M.D.
    Fernando Espi-Forcen, M.D., Ph.D.
    Carlos G. Fernandez-Robles, M.D., M.B.A.
    Barry S. Fogel, M.D.
    Oliver Freudenreich, M.D.
    Gregory L. Fricchione, M.D.
    Jane P. Gagliardi, M.D., M.H.S., FACP, DFAPA
    Rajesh T. Gandhi, M.D.
    Sean P. Glass, M.D.
    Rolando L. Gonzalez, M.D.
    Janna Gordon-Elliott, M.D.
    Sameera Guttikonda, M.D.
    Aaron Hauptman, M.D.
    Charles Hebert, M.D.
    Dilip V. Jeste, M.D.
    Hadine Joffe, M.D., M.Sc.
    Sharmin Khan, M.D.
    Joshua P. Klein, M.D., Ph.D.
    Margo D. Lauterbach, M.D.
    Jaswinder Legha, M.D., M.P.H.
    Sivan Mauer, M.D., M.S.
    Robert M. McCarron, D.O.
    Flannery Merideth, M.D.
    Leena Mittal, M.D.
    Shibani Mukerji, M.D., Ph.D.
    Philip R. Muskin, M.D., M.A.
    Ash Nadkarni, M.D.
    Margo Nathan, M.D.
    Charles B. Nemeroff, M.D., Ph.D.
    Kathryn Perticone, A.P.N., M.S.W.
    Mark Pollack, M.D.
    John Querques, M.D.
    Geoffrey S. Raynor, M.D.
    Joseph Rencic, M.D.
    Laura T. Safar, M.D.
    Deeb Salem, M.D.
    Peter A. Shapiro, M.D.
    Samata R. Sharma, M.D.
    Samir J. Sheth, M.D.
    David A. Silbersweig, M.D.
    Paul Summergrad, M.D.
    Joji Suzuki, M.D.
    Daniel Talmasov, M.D.
    Katherine Taylor, M.D.
    Ipsit V. Vahia, M.D.
    Lloyd Wasserman, M.D.
    Professor Sir Simon Wessely, M.A., B.M., B.Ch., M.Sc., M.D., FRCP, FRCPsych, FMedSci
    Mira Zein, M.D., M.P.H.

About the Authors

Paul Summergrad, M.D., is Dr. Frances S. Arkin Professor and Chairman of the Department of Psychiatry, and Professor of Psychiatry and Medicine, at Tufts University School of Medicine, as well as Psychiatrist-in-Chief of Tufts Medical Center, in Boston, Massachusetts.

David A. Silbersweig, M.D., is Stanley Cobb Professor of Psychiatry at Harvard Medical School and Chairman of the Department of Psychiatry, as well as Co-Director of the Center for the Neurosciences at Brigham and Women's Hospital in Boston, Massachusetts.

Philip R. Muskin, M.D., M.A., is Professor of Psychiatry and Senior Consultant in Consultation-Liaison Psychiatry at Columbia University Medical Center, in the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons in New York, New York.

John Querques, M.D., is Vice Chairman for Hospital Services in the Department of Psychiatry at Tufts Medical Center and Associate Professor of Psychiatry at Tufts University School of Medicine in Boston, Massachusetts.

A major tragedy of modern healthcare systems in many parts of the world is unnecessary dichotomy between mental and physical illnesses. Any clinician would recognise that these are interlinked and need to be considered in a coherent cogent manner in order to provide best services for the patients whether they have co-morbidities or not. Dr. Summergrad and colleagues are to be congratulated in developing the theme of medical psychiatry in linking physical and mental illnesses. The book is full of gems about medical conditions which cause psychiatric illnesses. It will be of great interest to clinicians at all levels and specialities. Highly recommended.—Dinesh Bhugra, CBE, PhD, MBBS, FRCP, FRCPE, FRCPsych, MA, MSc, MPhil; President, British Medical Association (2018-2019); President, World Psychiatric Association (2014-2017); President, Royal College of Psychiatrists (2008-2011)

The Textbook of Medical Psychiatry is designed to review the overlap of medical/neurologic and psychiatric illness and then to assist medical and psychiatric practitioners in the development of approaches to systematic assessment and intervention for these patients. The book is an important contribution to the literature since it defines the multiple components of psychiatric presentations and their potential and often real interactions/connections with co-existing medical and neurologic conditions. Inherent in this book is the implication that psychiatric presentations are intimately connected to many physical disorders that cannot be overlooked as patients are assessed and then assisted in the healing process.—Roger G. Kathol, M.D., President, Cartesian Solutions, Inc. and Adjunct Professor of Psychiatry, University of Minnesota

Combined or co-occurring medical and psychiatric illnesses are critically important in both general and specialty medical care. Through case examples, developing a differential diagnosis and clinical reasoning, and reviewing the evidence-based approaches for management and treatment, this textbook will be the standard in the field. Drs. Summergrad, Silbersweig, Muskin, Querques and colleagues from general and subspecialty medical and psychiatric disciplines, have provided clinicians with an incredibly thorough, well-organized, clearly written and useful textbook. It is a major and significant contribution that is very much needed and appreciated.—Michelle B. Riba, MD, MS, DFAPA, FACLP; Professor, Department of Psychiatry, University of Michigan; Director, Consultation-Liaison Fellowship; Director, PsychOncology Program, University of Michigan Rogel Cancer Center; Associate Director, University of Michigan Comprehensive Depression Center

Psychiatry became a separate medical specialty two centuries ago, but never strayed very far from its roots. It's impossible to be a competent doctor without knowing a great deal of psychiatry—or to be a competent psychiatrist without being a really good doctor. Medical illness can mimic or cause all sorts of psychiatric problems and vice-versa. The first step in every differential diagnosis in psychiatry must be to rule out medical illness. A substantial minority of patients in general medical practice present with emotional problems. And the bulk of psych meds—80 percent—are prescribed not by psychiatrists, but by primary care docs. Sadly, patients with combined medical and psychiatric problems are often neglected by, and get the worst care from, both specialties. This vital book beautifully bridges this yawning gap. It will enrich the practice of medical doctors from all the specialties and of mental health workers from all the disciplines. I think it should become required reading for all medical students. It has my highest recommendation.—Allen Frances, M.D., Professor & Chair Emeritus, Department of Psychiatry, Duke University; Chair, DSM-IV Task Force; Author, Saving Normal

Although the etymology of psychiatrist is physician of the soul, the psychiatrist is first and foremost physician. To be fully informed and conversant in the psychiatric manifestations of medical illness, to have at the ready knowledge of the way medical disease can mimic psychiatric disorder and to be expert in how derangements of thought, emotion and behavior can be signals of medical disorder are essential to being a psychiatrist. Moreover the need for this expertise is surging with the growing demand for care of psychiatric symptoms and disorders and the increasing reliance on behavioral health integration into primary healthcare settings to meet this need. This volume delivers the content to meet this need with authority and breadth and will prepare and support colleagues at the forefront of this expanding collaborative interface for our field.—Jerrold F. Rosenbaum, M.D., Chief of Psychiatry, Massachusetts General Hospital; Stanley Cobb Professor of Psychiatry, Harvard Medical School

Afflictions of the body can lead to disruptions in mental health. This is a foundation of integrative medicine and a person-centred approach in health care. Syphilis may be the classic historical trope for this observation, but the reality is that there are countless more medical conditions which have psychiatric significance and every psychiatrist must be fully equipped with this knowledge to enhance the effectiveness of our efforts to achieve an accurate understanding of the aetiology of the syndromes we encounter in our clinical practice. This volume offers an exemplary guide to this critically important interface; it is comprehensive, packed with clinically relevant guidance, and beautifully presented. Highly recommended for any psychiatrist who believes that the mind and body are inseparable.—Vikram Patel

Finally, a resource that lucidly describes medical diseases that cause psychiatric symptoms, and psychiatric diseases that cause physical ailments. The discussion of the overlap between these is the best I have read and will serve as a resource for psychiatrists, neurologists, and generalists for some time to come. It is a credit to the authors and the profession that this book is coming out now.—Dr. Allan H. Ropper, M.D., Professor of Neurology Harvard Medical School, Executive vice chair, Department of neurology Brigham, and Women's Hospital, Author of How the Brain Lost its Mind: Sex, Hysteria, and the Riddle of Mental Illness

Textbook of Medical Psychiatry is a handsomely written, scholarly and informative description of the overlap between psychiatric and other medical conditions, differential diagnosis and treatment approaches. Challenging the mind/brain duality, this book provides the scaffolding for addressing the myriad presentations that a clinician might encounter to determine whether the patient is evincing psychiatric symptoms that are a treatment side effect, a response to an illness, a complication of the accompanying medical condition or primarily psychiatric. Divided into four sections, it contains a section describing the clinical approaches leveraged by psychiatrists, internists and neurologists to generate robust differential diagnoses. A second section describes common co-occurring psychiatric symptoms among medical or neurological conditions and a third focuses on major psychiatric diagnostic categories with chapters that are erudite treatises on topics ranging from Neurocognitive Disorders to Neurodevelopmental Disorders. A final section covers pain, sleep and somatoform conditions. The utility of this engaging book is enhanced by a panoply of excellent tables such as Selected Neuropsychiatric Complications of Agents Used in Cancer Treatment and Cytochrome P450 Isoenzymes: Some Effects on Cardiac and Psychotropic Agents. Textbook of Medical Psychiatry is a must-read book for the trainee and seasoned clinician alike.—Maria A. Oquendo, M.D., Ph.D.

This book makes itself essential for efficiently learning information pertinent to patients with specific comorbidities. The in-depth yet specifically relevant content skillfully captures the needs of both a clinical and academic audience. Many books are relevant from either one perspective or the other; however, this book manages to bring them together seamlessly, both educating and making an argument for doing away with the remaining rift between psychiatry and medicine.—Hannah EH Williams, M.D., Doody's Book Reviews

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