American Psychiatric Publishing Textbook of Psychosomatic Medicine


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The American Psychiatric Publishing
Textbook of Psychosomatic Medicine

Editorial Board

William Breitbart, M.D. Chief, Psychiatry Service, Department of Psychiatry and Behavioral Sciences, and Attending Psychiatrist, Pain and Palliative Care Service, Department of Neurology, Memorial Sloan-Kettering Cancer Center; Professor of Psychiatry, Department of Psychiatry, Weill Medical College of Cornell University, New York, New York
Francis Creed, M.D., F.R.C.P., F.R.C.Psych., F.Med.Sci. Professor of Psychological Medicine, University of Manchester, United Kingdom; Honorary Consultant Psychiatrist, Manchester Mental Health and Social Care Trust
Joel Dimsdale, M.D. Professor of Psychiatry, University of California, San Diego, San Diego, California
Giovanni A. Fava, M.D. Professor of Clinical Psychology, University of Bologna, Bologna, Italy; Clinical Professor of Psychiatry, State University of New York at Buffalo, Buffalo, New York; Editorin-Chief, Psychotherapy and Psychosomatics
Donna B. Greenberg, M.D. Psychiatrist, Massachusetts General Hospital; Associate Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts
Wayne Katon, M.D. Professor, Vice-Chair, and Director of Division of Health Services and Psychiatric Epidemiology, University of Washington Medical School, Seattle, Washington
Antonio Lobo, M.D., Ph.D. Professor and Chairman, Department of Medicine and Psychiatry, Universidad de Zaragoza; and Chief, Psychosomatics and Consultation-Liaison Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
Constantine G. Lyketsos, M.D., M.H.S. Professor of Psychiatry and Behavioral Sciences and Director, Division of Geriatric Psychiatry and Neuropsychiatry, The Johns Hopkins Hospital, Baltimore, Maryland
Luis Ruiz-Flores, M.D. Professor and Head of Psychiatry, National University of Mexico, Mexico City; President, Mexican Psychiatric Association, 1998–1999

Teresa A. Rummans, M.D. Professor of Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota
Peter A. Shapiro, M.D. Associate Professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons; Associate Director, Consultation-Liaison Psychiatry Service; Director, Transplantation Psychiatry Service, Columbia University Medical Center, New York–Presbyterian Hospital, New York, New York
Michael C. Sharpe, M.A., M.D., F.R.C.P., M.R.C.Psych. Professor of Psychological Medicine and Symptoms Research, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh, United Kingdom
Graeme C. Smith, M.D. Professor of Psychological Medicine, Monash University, Clayton, Australia
Theodore A. Stern, M.D. Chief, The Avery D. Weisman, M.D., Psychiatry Consultation Service, Massachusetts General Hospital; Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts
Donna E. Stewart, M.D., F.R.C.P.C. Professor and Chair of Women’s Health, University of Toronto, University Health Network Women’s Health Program, Toronto, Ontario, Canada
Paula T. Trzepacz, M.D. Medical Director, U.S. Neurosciences, Lilly Research Laboratories; Clinical Professor of Psychiatry, University of Mississippi Medical School, Jackson, Mississippi; Adjunct Professor of Psychiatry, Tufts University School of Medicine, Boston, Massachusetts
Thomas N. Wise, M.D. Chairman, Department of Psychiatry, Inova Fairfax Hospital, Falls Church, Virginia; Professor and Vice Chair, Department of Psychiatry, Georgetown University, Washington, D.C.

The American Psychiatric Publishing
Textbook of Psychosomatic Medicine
Edited by
James L. Levenson, M.D.
Chair, Consultation-Liaison Psychiatry, and Vice-Chair, Psychiatry Professor of Psychiatry, Medicine, and Surgery Virginia Commonwealth University Richmond, Virginia
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 general psychiatric 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, specific situations 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 authors and 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 5 4 3 2 1 First Edition
Typeset in Adobe’s Janson Text and Frutiger 55 Roman
American Psychiatric Publishing, Inc. 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org
Library of Congress Cataloging-in-Publication Data The American Psychiatric Publishing textbook of psychosomatic medicine / edited by James L. Levenson.—1st ed.
p. ; cm. Includes bibliographical references and index. ISBN 1-58562-127-7 (hardcover : alk. paper) 1. Medicine, Psychosomatic. I. Title: Textbook of psychosomatic medicine. II. Levenson, James L. III. American Psychiatric Publishing. [DNLM: 1. Psychophysiologic Disorders. 2. Psychosomatic Medicine—methods. WM 90 A512 2005] RC49.A417 2005 616.08—dc22
2004050259
British Library Cataloguing in Publication Data A CIP record is available from the British Library.

Alan Stoudemire, M.D. Professor of Psychiatry and Behavioral Sciences Director of Medical Student Education in Psychiatry
Emory University School of Medicine
This book is dedicated to the memory of Alan Stoudemire (1951–2000), a brilliant clinician, true scholar, prolific writer, and dedicated teacher and mentor. His contributions profoundly transformed our field. He was and remains an inspiration to others, in and outside our profession, for he lived life fully with passion and principle. He transcended his own illnesses with rare strength of spirit, deepening his compassion for and commitment to the medically ill, even while his own life was tragically abbreviated. Those of us who knew him well will forever miss his warmth, wit, and heartfelt friendship.1
1See also Thompson T: “A Tribute to Alan Stoudemire, M.D.: 1951–2000.” Psychosomatics 42:1–4, 2001.

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Contents
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
Stephen C. Scheiber, M.D.
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
James L. Levenson, M.D.
PART I
General Principles in Evaluation and Management
1 Psychiatric Assessment and Consultation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Felicia A. Smith, M.D., John Querques, M.D., James L. Levenson, M.D., and Theodore A. Stern, M.D.
2 Neuropsychological and Psychological Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . .15
Wendy A. Law, Ph.D., Robert L. Mapou, Ph.D., Jack Spector, Ph.D., and Gary G. Kay, Ph.D.
3 Legal Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Robert I. Simon, M.D., Barbara A. Schindler, M.D., and James L. Levenson, M.D.
4 Ethical Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Donald L. Rosenstein, M.D., and Franklin G. Miller, Ph.D.
5 Psychological Responses to Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67
Mark S. Groves, M.D., and Philip R. Muskin, M.D.
PART II
Symptoms and Disorders
6 Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91
Paula T. Trzepacz, M.D., and David J. Meagher, M.D., M.R.C.Psych., M.Sc.
7 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
Antonio Lobo, M.D., Ph.D., and Pedro Saz, M.D., Ph.D.
8 Aggression and Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Chiadi U. Onyike, M.D., M.H.S., and Constantine G. Lyketsos, M.D., M.H.S.

9 Depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Gary M. Rodin, M.D., F.R.C.P.C., Robert P. Nolan, Ph.D., R.Psych., and Mark R. Katz, M.D., F.R.C.P.C.
10 Suicidality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
John Michael Bostwick, M.D., and James L. Levenson, M.D.
11 Mania, Catatonia, and Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Prakash S. Masand, M.D., Eric J. Christopher, M.D., Greg L. Clary, M.D., Rajnish Mago, M.D., James L. Levenson, M.D., and Ashwin A. Patkar, M.D.
12 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Steven A. Epstein, M.D., and Daniel Hicks, M.D.
13 Somatization and Somatoform Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Susan E. Abbey, M.D., F.R.C.P.C.
14 Deception Syndromes: Factitious Disorders and Malingering . . . . . . . . . . . . . . . . . 297
Charles V. Ford, M.D.
15 Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Michael J. Devlin, M.D., Joel P. Jahraus, M.D., and Ilyse J. Dobrow, B.A.
16 Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Lois E. Krahn, M.D., and Jarrett W. Richardson, M.D.
17 Sexual Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
George R. Brown, M.D., and Richard C. Haaser, M.D.
18 Substance-Related Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
John E. Franklin Jr., M.D., M.Sc., James L. Levenson, M.D., and Elinore F. McCance-Katz, M.D., Ph.D.
PART III
Specialties and Subspecialties
19 Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423
Peter A. Shapiro, M.D.
20 Lung Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Kathy Coffman, M.D., and James L. Levenson, M.D.
21 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465
Francis Creed, M.D., F.R.C.P.C., F.R.C.Psych., F.Med.Sci., and Kevin W. Olden, M.D.
22 Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Lewis M. Cohen, M.D., Norman B. Levy, M.D., Edward G. Tessier, Pharm.D., M.P.H., and Michael J. Germain, M.D.

23 Endocrine and Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .495
Ann Goebel-Fabbri, Ph.D., Gail Musen, Ph.D., Caitlin R. Sparks, B.A., Judy A. Greene, M.D., James L. Levenson, M.D., and Alan M. Jacobson, M.D.
24 Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .517
Mary Jane Massie, M.D., and Donna B. Greenberg, M.D.
25 Rheumatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .535
Chris Dickens, M.B.B.S., Ph.D., James L. Levenson, M.D., and Wendy Cohen, M.D.
26 Chronic Fatigue and Fibromyalgia Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .555
Michael C. Sharpe, M.A., M.D., F.R.C.P., M.R.C.Psych., and Patrick G. O’Malley, M.D., M.P.H.
27 Infectious Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .577
James L. Levenson, M.D., and Robert K. Schneider, M.D.
28 HIV/AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .599
Niccolo D. Della Penna, M.D., and Glenn J. Treisman, M.D., Ph.D.
29 Dermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .629
Lesley M. Arnold, M.D.
30 Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .647
Pauline S. Powers, M.D., and Carlos A. Santana, M.D.
31 Organ Transplantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .675
Andrea F. DiMartini, M.D., Mary Amanda Dew, Ph.D., and Paula T. Trzepacz, M.D.
32 Neurology and Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .701
Alan J. Carson, M.Phil., M.D., M.R.C.Psych., Adam Zeman, M.A., D.M., M.R.C.P., Lynn Myles, B.Sc., M.D., F.R.C.S.Ed., and Michael C. Sharpe, M.A., M.D., F.R.C.P., M.R.C.Psych.
33 Obstetrics and Gynecology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .733
Nada L. Stotland, M.D., M.P.H., Donna E. Stewart, M.D., F.R.C.P.C., Sarah E. Munce, B.Sc., and Danielle E. Rolfe, B.P.H.E.
34 Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .761
Brenda Bursch, Ph.D., and Margaret Stuber, M.D.
35 Physical Medicine and Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .787
Jesse R. Fann, M.D., M.P.H., Richard Kennedy, M.D., and Charles H. Bombardier, Ph.D.
36 Pain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .827
Michael R. Clark, M.D., M.P.H., and Maciej P. Chodynicki, M.D.

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American Psychiatric Publishing Textbook of Psychosomatic Medicine