Team Approach Vital to Treating Patients with Mental Illness


A recent report about medication management for hospitalized patients with psychiatric comorbidities shows that collaboration between hospitalists and specialists is key to improving the care of these patients.

The paper, "Challenges in Pharmacologic Management of the Hospitalized Patient with Psychiatric Comorbidity," suggests that "when making complex psychopharmacologic decisions," hospitalists should collaborate with pharmacists and psychiatrists. The study aims to help hospitalists make informed decisions when considering whether to continue home psychotropic medication in medically ill patients.

Martha Ward, MD, assistant professor in the department of psychiatry and behavioral sciences at Emory University School of Medicine in Atlanta and lead author of the study, says hospitalists are rightly focused on the acute problem in front of them, and they sometimes do not have time to address chronic, nonemergent issues, such as a psychiatric comorbidity.

"It's a mindset," Dr. Ward says. "At times when you're focused minute to minute on an emergent issue, it can be difficult to look at the chronic issues that don't come to the forefront."

Dr. Ward says it's important for hospitalists to never "reflexively discontinue" medications for patients with mental illness. Instead, she suggests weighing the risks and benefits of how existing medications would interact with new treatments.

Working with pharmacists, psychiatrists, or even tapping online resources that provide information about drug interactions is a good first step, she adds. Otherwise, physicians risk introducing complicating factors, such as potential adverse events related to psychiatric decompensation or psychotropic drug withdrawal.

Over the long term, Dr. Ward says, hospitalists should be educated in psychiatry, starting in medical school and in residency. "I'm somewhat biased," adds Dr. Ward, who is trained in both internal medicine and psychiatry. "I think internal-medicine doctors could benefit greatly from additional training. I think that's one of the biggest deficiencies in our curriculum."

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