Gustavo C Medeiros1, Susan Turkel2, Katherine Brownlowe3, Thomas Cummings4, Davin Quinn5, Durga Roy6. 1. Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD. Electronic address: gcmedeiros@live.com. 2. Keck School of Medicine of University of Southern California, Departments of Psychiatry and Pediatrics, Children's Hospital, Los Angeles, CA. 3. Division of Neurobehavioral Health at the Ohio State University Wexner Medical Center, Columbus, OH. 4. Department of Psychiatry, Georgetown University Hospital and School of Medicine, Washington, DC. 5. Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM. 6. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Abstract
BACKGROUND: The management of psychiatric disorders in neurological diseases (PDND) creates special challenges that cannot be adequately addressed by either psychiatry or neurology alone. However, the literature on clinician-friendly recommendations on how to coordinate neurological and psychiatric care is limited. OBJECTIVE: This narrative review will provide practical instructions on how to efficiently integrate psychiatric and neurological care in inpatient management of PDND. METHODS: We reviewed articles published as recently as January, 2021 in five electronic databases. We included articles that assessed human care, focused on adults, and examined how to better coordinate care between different medical specialties, particularly, between psychiatry and neurology. RESULTS: Eighty-four manuscripts were included in this review, of which 23 (27%) discussed general principles of well-coordinated care of PDND in inpatient settings (first part of this review), and 61 (73%) were used to provide recommendations in specific neurological diseases (second part of this review). CONCLUSIONS: General principles of well-coordinated care of PDND include recommendations for both the primary team (usually neurology) and the consulting team (psychiatry). Primary teams should delineate a specific question, establish roles, and follow up on the recommendations of the consulting team. Consultants should do their independent assessment, be organized and specific in their recommendations, and anticipate potential problems. One of the most important aspect to develop well-coordinated care is the establishment of clear, frank and, preferably oral, communication between the teams. Practical difficulties in the management of PDND include pharmacodynamic and pharmacokinetic interactions as well as mutual dependency between psychiatry and neurology.
BACKGROUND: The management of psychiatric disorders in neurological diseases (PDND) creates special challenges that cannot be adequately addressed by either psychiatry or neurology alone. However, the literature on clinician-friendly recommendations on how to coordinate neurological and psychiatric care is limited. OBJECTIVE: This narrative review will provide practical instructions on how to efficiently integrate psychiatric and neurological care in inpatient management of PDND. METHODS: We reviewed articles published as recently as January, 2021 in five electronic databases. We included articles that assessed human care, focused on adults, and examined how to better coordinate care between different medical specialties, particularly, between psychiatry and neurology. RESULTS: Eighty-four manuscripts were included in this review, of which 23 (27%) discussed general principles of well-coordinated care of PDND in inpatient settings (first part of this review), and 61 (73%) were used to provide recommendations in specific neurological diseases (second part of this review). CONCLUSIONS: General principles of well-coordinated care of PDND include recommendations for both the primary team (usually neurology) and the consulting team (psychiatry). Primary teams should delineate a specific question, establish roles, and follow up on the recommendations of the consulting team. Consultants should do their independent assessment, be organized and specific in their recommendations, and anticipate potential problems. One of the most important aspect to develop well-coordinated care is the establishment of clear, frank and, preferably oral, communication between the teams. Practical difficulties in the management of PDND include pharmacodynamic and pharmacokinetic interactions as well as mutual dependency between psychiatry and neurology.