Integrating psychological care into general medical practice

ABC p 1567

It is becoming increasingly clear that we can improve medical care by paying more attention to psychological aspects of medical assessment and treatment. The study and practice of such factors is often called psychological medicine. Although the development of specialist consultation-liaison psychiatry (liaison psychiatry in the United Kingdom) and health psychology contribute to psychological medicine, the task is much wider and has major implications for the organisation and practice of care. The ABC on psychological medicine that starts this week (p 1567) aims to explain some of those implications.

Disorders that are traditionally, and perhaps misleadingly, termed psychiatric are highly prevalent in medical populations. At least 25-30% of general medical patients have coexisting depressive, anxiety, somatoform, or alcohol misuse disorders.1 Several factors account for the co-occurrence of medical and psychiatric disorders. First, a medical disorder can occasionally be a cause of the psychiatric disorder (for example, hypothyroidism as a biological cause of depression). Second, cardiovascular diseases, neurological disorders, cancer, diabetes, and many other medical diseases increase the risk of depression and other psychiatric disorders. Such so called comorbidity is common, but its causal linkage with psychological conditions remains poorly understood. A third factor is coincidence—common conditions such as hypertension and depression may coexist in the …