Towards Greater Integration with Other Medical Specialities

One of the major contributions of General Hospital Psychiatry Units (GHPU) has been the increased awareness among both psychiatrists and non-psychiatrist physicians regarding the importance of detecting and treating psychiatric disorders in the physically ill. The prevalence of psychiatric illness in both general medical inpatients and outpatients is significant (Guthrie, 1996). Emotional disturbances seen in association with physical disorders could either be psychological reactions to physical illness or physical manifestations of psychiatric illnesses. Both these groups of problems are commonly encountered in GHPUs. Both acute and chronic physical disorders may lead to psychological problems. Depressive disorders, anxiety disorders, adjustment disorders and sexual dysfunctions are commonly seen in association with physical disorders. The article in this issue of the journal on psychiatric aspects of Wilson's disease highlight this point. The diagnosis and management of these disorders require special skills. For example, the diagnosis of depressive disorder in a physically ill person on the basis of biological symptoms may be fallacious, because the physical illness itself may be the cause of physical symptoms like insomnia, loss of appetite and loss of weight. The diagnosis in such cases, has to rely therefore, more on the presence of symptoms like depressed mood, diurnal variation of mood, suicidal ideation, social withdrawal etc. Psychopharmacological agents like antidepressants and anxiolytics are, no doubt, useful in the reduction of psychological disorders in the physically ill. Howeve. pharmacological intervention has only limited value in the management of these conditions. So we have to depend more on psychological methods of treatment to help our patients adequately. For example, brief psychological interventions like counselling during the acute phase of illness were found to lower the level of anxiety and promote early return to work (Thompson and Meddis 1990) in patients who had myocardial infarction. Similarly Burton etal (1991) found that preoperative counselling could reduce the occurrence of post-operative anxiety and depression in women undergoing mastectomy. Psychological methods like progressive muscle relaxation, biofeedback problems and cognitive therapy are found to be effective in reducing emotional problems and improving compliance with treatment regimens even in chronic disorders like asthma, diabetes, hypertension etc.