Bedside PSYCHIATRY
Bedside PSYCHIATRY
Arabinda N Chowdhury MBBS MD FAMS PhD FAMS FRCPsych PhD (Soc Anthropology) DSc Psychoanalyst
Consultant Psychiatrist Leicestershire Partnership NHS Trust, UK
Edited by The Publication Subcommittee Indian Psychiatric Society
PK Singh (Chairperson)
Shahul Ameen (Co-Chairperson)
Naresh Nebhinani (Convenor)
Jaypee Brothers Medical Publishers (P) Ltd.
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Bedside Psychiatry
First Edition: 2019
9789352709854
Printed at
Since its birth Indian Psychiatric Society has remained committed to and proactive in imparting knowledge of psychiatry to the medical undergraduates, postgraduates and working professionals. In recent times, this role has been augmented.
Our CMEs, Conferences and respectably indexed Journal, the Indian Journal of Psychiatry have often made historic contributions. For last few years, our Publication Committee has been actively working on bringing out quality books suitable for Indian subcontinent. Two such books, already published, have been received very well.
The present volume, Bedside Psychiatry, has been uniquely designed for all medical graduates who are being trained in Psychiatry. Its approach is practical, covering almost all areas of psychiatric interview and examination. Going through it, one can see that this book is much more than just another a clinical handbook. It contains brief information about all psychiatric disorders. To us it appears as a mini Textbook of Psychiatry. The author and Professor Arabinda N Chowdhury, an accomplished academician and clinician, who has worked in India and abroad in important positions. This book embodies not only the available knowledge but also his personal clinical experience. We thank Professor Arabinda N Chowdhury for writing this book for Indian Psychiatric Society. This is the first time that Indian Psychiatric Society has undertaken publication of a book written independently by an author, which is getting published under its auspices. However, it has been editorially reviewed by our Publication Committee.
We congratulate and put on record our sincere thanks to our Publication Committee headed by Professor PK Singh. Professor PK Singh, Drs Shahul Ameen and Naresh Nebhinani have devoted lot of their time in editing this book to enhance its clarity and usefulness.
The Indian Psychiatric Society is grateful to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. for their help and support for quality production. We especially acknowledge the contribution of Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and Prerna Bajaj (Development Editor).
Ajit V Bhide President | Mrugesh Vaishnav President Elect | Vinay Kumar Hon General Secretary |
I am honored to provide this foreword. Dr Arabinda N Chowdhury joined the NHS as a Consultant Psychiatrist in 2006. Prior to that, he was Professor and Head, Department of Psychiatry, Institute of Postgraduate Medical Education and Research, and Superintendent of Institute of Psychiatry, Kolkata, West Bengal, India.
Dr Arabinda N Chowdhury has written chapters in books on cultural competency, done several international projects, and is the person who has published the most articles on a culture-bound syndrome ‘Koro’. He has extensive experience in running and establishing services in psychiatry.
Despite all his achievements, he is one of the most humble person I have met to date. As part of his passion and self-commitment to create psychiatrists of the highest caliber, he has worked extensively on this book, which is a great resource of knowledge and a pleasure to read. It assimilates information from several aspects. One who reads it will be able to develop both an extensive knowledge and skills base in psychiatry; while also learning the importance of listening and being a caring doctor who is understanding and sensitive to the person who seeks their help. What usually takes psychiatrists years to learn has been summarized proficiently in a book less than 200 pages. This is a treasure for psychiatrists in training and gives the experienced psychiatrists a great way to refresh their knowledge and skills.
In ‘Bedside Psychiatry’, Dr Arabinda N Chowdhury skillfully draws together the key elements needed to successfully implement the art and science of clinical assessment of a patient. He begins with an introduction to the interview itself with reference to goals, process, and the key components of the physician-patient relationship. Chapter 2: History—is a guide to taking a comprehensive and thorough history. Chapter 3: Examination—emphasizes the importance of physical, central nervous system, and Mental State Examination (MSE) in a psychiatric evaluation.
The chapter on Mental State Examination, as you would expect, gets particular attention. Chapter 3 concentrates on the traditional Mental State Examination including clarification and explanation of phenomenology. Chapter 4 consists of Diagnostic Formulation, Risk Assessments, Mental Capacity Assessment and Treatment Planning, Safeguarding, and Safe Prescribing. Appendices (Appendix 1 to 38) provide additional useful clinical reference material.
I hope Arabinda N you enjoy this book as much as I have and will highly recommend it.
Fabida Noushad
Consultant Psychiatrist in Assertive Outreach Team and Pave Team
Deputy Clinical Director, Adult Mental Health Services
Leicestershire Partnership NHS Trust and Royal College Regional Advisor for Leicestershire
Northamptonshire and Rutland
OSL House, East Link, Meridian
Leicestershire, LE19 1XU, UK
Preview
Greetings and welcome to all the readers who are glancing through the page of this unique and extraordinary book. This is for the first time that the Publication Committee of Indian Psychiatric Society (IPS) has undertaken the task of publishing a book written independently by one of our own colleagues and a member of the IPS fraternity. This book is being published by the leading medical publication house of the country M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India. Being a first-time event, there was no precedence. Therefore, a completely new strategy and mechanism had to be evolved to set a trend for the future. It was decided, with the approval of the Executive Council of the IPS, that all such books, which are written independently by various authors on their own but are intended to be published under IPS banner, shall be subjected to an editorial review by a committee set up by the Publication Committee. In the case of Professor Arabinda N Chowdhury's book, for practical reasons, this task was done by the Publication Committee itself.
It is my pleasure to introduce this book, Bedside Psychiatry, to a very wide readership, which certainly will receive great acceptance because of its everyday utility. This book is essentially an updated and improvised version of his previously published book, Psychiatric Interview. The name change was affected with a view to make it more representative of the broad range of contents included in the book. This book is a distillate of Professor Chowdhury's lifetime experience with psychiatric patients and also the psychiatry trainees to whom the book has justifiably been dedicated. This book certainly has a personal touch of the author in the sense that many aspects of the major headings of mental state examination and management plan have a nonconventional dimension added to it. The process of editorial review by the Publication Committee has not made any significant changes in the finer organization or the actual contents of the book. They have respected the author's jurisdiction over these areas. The Publication Committee has limited itself to the general organization of the book, smoothening of corners at places, enhancing consistency, and ensuring flow of the book.
Bedside Psychiatry brings it much closer to the mainstream disciplines of modern medicine. The inclusion of certain amount of theoretical information as appendix, which is of immediate relevance to the clinician, also adds to the value of the book. Bedside psychiatry includes skills of collecting most relevant and valid piece of information from patients and their attendants, further supplementing this information by systematic and insightful physical and mental state assessment, and then making a diagnostic formulation, undertaking required biomedical investigations, and psychometric evaluation leading to a management plan; furthermore, how to implement this plan with due care and expertise.
It has been our pleasure and also privilege to be associated with this task and thereby gain insight and experience in return. We express our most sincere good wishes for wider circulation, acceptance, and readership of this book. We pray that may the publication of this book trigger the arrival of many more even higher quality books from our most talented psychiatric fraternity of Indian Psychiatric Society (IPS).
Long live IPS.
PK Singh
Professor and Head
Department of Psychiatry
Patna Medical College and Hospital
Patna, Bihar, India
Shahul Ameen
Consultant Psychiatrist
St Thomas Hospital
Changanacherry, Kerala, India
Naresh Nebhinani
Associate Professor
Department of Psychiatry
All India Institute of Medical Sciences
Jodhpur, Rajasthan, India
Preface
The psychiatric interview and mental state examination are the key elements of clinical psychiatry. Psychiatric trainees should have an easy-to-use interview and examination format, keeping all the relevant information on mental symptomatology in their mind. This is a brief compilation of all the relevant information usually needed for day-to-day psychiatric evaluation in adult psychiatry. This compilation helps the trainees to get all the important issues relating to examination and treatment planning along with their duties and obligation in a comprehensive manner and helps them to equip with some running clinical oral questions as well. Alongside with the practical clinical examination procedure, the relevant theoretical issues are provided in the ‘Appendix’ to offer a comprehensive insight about the clinical items.
I am deeply thankful to Dr Fabida Noushad for writing the ‘Foreword’ for this book. I am expressing my thanks to Dr Rajesh Jacob, Dr John Burke, and Dr M Chawala, all were former consultant psychiatrists of Northamptonshire Healthcare NHS Foundation Trust, for their critical review of the primary draft. I am obligated to my wife Dr Shyamali Chowdhury and daughter Dr Monali Chowdhury for their generous allowance of sufficient academic time during the initial phase of the writing.
I am very thankful to all my past postgraduate students, who over the years, helped me to learn and particularly to Drs KD Sen, Piyal Sen, VG Jhanwar, Amit Bhattacharya, Saikat Basu, S Bhakta, Arabinda Brahma, Sayanti Ghosh, and research coordinator Dr Sohini Banerjee from India. I am also grateful for what I imbibed from my colleagues in the UK, including Dr Anand Madasamy and trainees Shiva Margani, Fabian Motsi, and J Butler. I take the opportunity to express my sincere thanks to three of my colleagues who always supported me in my work: Professor Manoj Bhattacharrya, Former Dean, University College of Medicine, Calcutta University, Kolkata; Professor Makhanlal Saha, Department of Surgery, IPGME and R, Kolkata; and Dr Ajoy Chakraborty, DHS, Government of West Bengal. I must thank Dr Sayanti Ghosh, now Associate Professor of Psychiatry, NRS Medical College in Kolkata, Dr Sohini Banerjee, Assistant Epidemiologist, Care, Bihar, for stringently reviewing of the present draft with suggestions. I am also grateful to Dr Nilanjana Ray, Consultant Pediatrician, London North West University Hospitals NHS Trust, and Dr Samrat Sen Gupta, Consultant Psychiatrist, Broadmoor Hospital, Berkshire, for reviewing the draft and Chandana Chatterjee and Medha Dube for their help in the copy editing of the draft. Lastly, I would like to express my deep gratitude and sincere thanks to the Publication Committee of IPS for their kindness to publish this book. I feel honored by their acceptance, valuable suggestions, and compliments. My special thanks to Professor PK Singh, Chairperson, Publication Committee, for his continued support, constructive suggestion and critical comments on the design and content of the book. I am also thankful to two of our junior colleagues, Drs Shahul Ameen and Dr Naresh Nebhinani who very carefully reviewed the draft with their suggestion.
If this compilation benefits our adult mental health trainees, then this attempt would have been worthwhile.
Arabinda N Chowdhury