Handbook of Liaison Psychiatry
Geoffrey Lloyd, Elspeth Guthrie
Cambridge University Press, May 24, 2007 - Medical
Liaison psychiatry, the recognition and management of psychiatric problems in the general medical setting, is an essential component of many doctors' work. Depression, anxiety and somatization disorders occur in about 50% of cases presented to primary care physicians. The Handbook of Liaison Psychiatry was first published in 2007 and is a comprehensive reference book for this fast-growing subspecialty. A team of experts in the field cover the full range of issues, from establishing a service and outlining the commonest problems encountered in general hospitals and primary care, to assessment and treatment guidelines, working with specific units within the hospital setting, disaster planning and legal-ethical considerations. It will be essential reading for doctors and other professionals concerned with the psychological health of patients in acute general hospitals and in primary care.
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Contains the usual egregious and very harmful misrepresentations (on the so-called 'functional somatic syndromes') that are the stock in trade of Prof. Simon Wessely. If this chapter is deleted in future printings or all of the misrepresentations rectified (it would be much more practical to throw this chapter out and start from scratch), I would be very happy to change my review to five stars. Please contact me if you are willing to discuss this. Thank you very much.
From the Book pp.125-148:
"Chapter: Functional somatic syndromes
Definition and Terminology
The functional somatic syndromes refer to a number of related syndromes that have been characterised by the reporting of somatic symptoms and resultant disability rather than on the evidence of underlying conventional disease pathology....all however share the feature of a disconnection between subjective symptomatology and objective biomedical pathology.
Chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia have been more extensively researched than most other FSS which has led to specific pathophysiological mechanisms being advanced for each. Nevertheless...it remains the case that the similarities between the different FSS are sufficiently striking for there to be a compelling case for considering them together (Barksy & Borus, 1999; Wessely et al, 1999).
The standard (medical) diagnostic criteria for FSS usually require specific symptoms to be present, whereas psychiatric classification (under the somatoform disorders) emphasises the number of symptoms.
Patients with FSS have been rated as one of the three most common types of patients that are ‘difficult to help’ (Sharpe 1994)....The tendency of those with FSS to turn to alternative medicines for treatment is likely to be ...because alternative remedies often endorse the FSS patient’s own physical illness attributions (Moss‐Morris et al 2003).
At present, chronic fatigue syndrome is the functional somatic syndrome for which there is most evidence that beliefs about the illness may impact on the course of the illness itself. Patients with chronic fatigue syndrome are more likely to make physical illness attributions (rather than normalising or psychologising attributions) for a selection of common symptoms compared to controls (Butler et al 2001) and are more likely to believe their illness will be chronic...
These beliefs and attitudes about symptoms may act as a mechanism that then guides the patient to adopt avoidant behaviours....In fact, it is a change to beliefs about avoidance...that predicts good outcome from cognitive behavioural therapy in chronic fatigue syndrome (Deale et al 1998), highlighting the need for more research into the way illness attributions maintain ill‐health.
Several of the functional somatic syndromes, including chronic fatigue syndrome, GWS (Gulf War Syndrome) and repetitive strain injury have gained public credibility in spite of widespread medical scepticism as to their very existence. This phenomenon has been attributed to changes within society, including the erosion of the physician’s traditional role...Patient support groups...may have some negative consequences, for example, membership of a chronic fatigue syndrome support group has been associated with poorer prognosis (Bentall et al 2002, Sharpe et al 1992).
The financial ‘reward’ to be gained from disability payments or litigation has been argued as playing a role in the maintenance of ill health in those suffering from functional somatic syndromes...For example being in receipt of sickness benefit has been shown to be a poor prognostic sign in chronic fatigue syndrome (Bentall et al 2002, Cope et al 1994).
Psychosocial treatments such as cognitive behavioural therapy have been shown to be beneficial in a range of somatoform disorders...including the most researched functional somatic syndromes (i.e. chronic fatigue syndrome, irritable bowel syndrome and fibromyalgia).
Figure 281 Mean scores on the short form SF36 for
prevalence and clinical
+ Social withdrawal
Maximal severity of depression and
Table 291 cont
Table 337 Benzodiazepines and related drugs
Box 361 Advice for family doctors on the management of
mean+one 285 14
Baez et al 1998