Libro Psicosomática

Clinical Manual of
Psychosomatic Medicine
A Guide to
Consultation-Liaison Psychiatry

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Clinical Manual of
Psychosomatic Medicine
A Guide to
Consultation-Liaison Psychiatry

Michael G. Wise, M.D.
Clinical Professor of Psychiatry
University of California, Davis
Adjunct Professor of Psychiatry
Uniformed Services University of the Health SciencesF. Edward Hébert School of Medicine
Bethesda, Maryland

James R. Rundell, M.D.
Professor of Psychiatry
Uniformed Services University of the Health Sciences
F. Edward Hébert School of Medicine
Bethesda, Maryland

Washington, DC
London, England

Note: The authors have worked to ensure that all information in this book is accurate
at the time of publication and consistent with generalpsychiatric and medical standards,
and that information concerning drug dosages, schedules, and routes of administration
is accurate at the time of publication and consistent with standards set by the U.S.
Food and Drug Administration and the general medical community. As medical
research and practice continue to advance, however, therapeutic standards may change.
Moreover, specificsituations may require a specific therapeutic response not included
in this book. For these reasons and because human and mechanical errors sometimes
occur, we recommend that readers follow the advice of physicians directly involved in
their care or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views and
opinions of the individual authorsand do not necessarily represent the policies and
opinions of APPI or the American Psychiatric Association.
Copyright © 2005 American Psychiatric Publishing, Inc.
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
09 08 07 06 05
54321
First Edition
Typeset in AGaramond and Formata.
American Psychiatric Publishing, Inc.
1000 Wilson Boulevard
Arlington,VA 22209-3901
www.appi.org
Library of Congress Cataloging-in-Publication Data
Wise, Michael G., 1944–
Clinical manual of psychosomatic medicine : a guide to consultation-liaison
psychiatry / by Michael G. Wise, James R. Rundell.—1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-201-X (alk. paper)
1. Consultation-liaison psychiatry. 2. Medicine, Psychosomatic.[DNLM: 1. Psychophysiologic Disorders—diagnosis. 2. Psychophysiologic
Disorders—therapy. 3. Diagnosis, Differential. 4. Mental Disorders—diagnosis.
5. Mental Disorders—Therapy. 6. Psychology, Medical—methods. 7. Psychotherapy—
methods. 8. Referral and Consultation. WM 90 M813c 2005] I. Rundell, James R.,
1957– II. Title.
RC455.2.C65W568 2005
616.89′14—dc22
2004026969
British LibraryCataloguing in Publication Data
A CIP record is available from the British Library.

Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

1

Effective Psychiatric Consultation in a
Changing Health Care Environment. . . . . . . . . . . 1
History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cost-Effectiveness of PsychiatricConsultation. . . . . . . . . 2
Approach to the Consultation . . . . . . . . . . . . . . . . . . . . . . 3
Consultation or Liaison Psychiatry?. . . . . . . . . . . . . . . . . . 6
Outpatient Psychosomatic Medicine . . . . . . . . . . . . . . . . 6
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Additional Readings . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 9

2

Mental Status Examination and
Other Tests of Brain Function. . . . . . . . . . . . . . . 11
Mental Status Examination . . . . . . . . . . . . . . . . . . . . . . .13
Screening Mental Status Examinations. . . . . . . . . . . . . .17
Other Useful Tests of Cognitive Function . . . . . . . . . . . .19
Tests of Executive Function . . . . . . . . . . . . . . . . ....