A psychiatry outpatient consultation-liaison clinic. Experience at the Cleveland Clinic Foundation.

This report describes the patients seen during the first 3 months of operation of a psychiatry outpatient consultation-liaison (C-L) clinic. A total of 113 patients were seen. For 8% of the appointments made, patients did not show up; the cancellation rate was 3.8%. Depression, anxiety, stress, and somatic symptoms were the most common reasons for referral, while the most common diagnoses made were major depression, adjustment disorder, and panic disorder. Practitioners in the fields of internal medicine, primary care, and psychology made the majority of the referrals. Patient satisfaction as expressed in a written survey was high. The results showed that an outpatient C-L clinic can be an effective way to access and treat medicine, surgery, and psychology outpatients in a big hospital setting.

Paraneoplastic limbic encephalopathy.

Paraneoplastic limbic encephalopathy (PLE) is a remote, nonmetastatic complication of carcinoma. Neuropsychiatric symptoms consists of cognitive, affective, and behavioral changes that can predate the diagnosis of carcinoma by as much as 6 years. The most striking feature is the development of an amnestic syndrome without generalized intellectual decline. We report a case of PLE, including neuropsychological test results, and review the features of similar cases in the literature. The postulated causes and clinical implications of PLE are discussed.

The brain and the immune system: a psychosomatic network.

The central nervous system (CNS) and the immune system, communicating through the neuroendocrine system, are closely involved in the individual's adaptation to the environment. The data from basic science research and clinical observations are overviewed, and more recent studies are summarized. As changes in immune function may mediate the effects of psychosocial factors in psychosomatic disorders, it is important for all biopsychosocially oriented physicians to understand the network that connects the central nervous and immune systems.

The anticardiolipin syndrome.

Anticardiolipin antibodies delineate a recently defined syndrome characterized by venous and arterial thrombosis, thrombocytopenia and recurrent fetal loss, usually in the setting of autoimmune disease. A recently standardized enzyme immunoassay for this antibody is becoming widely available. Treatment is controversial and includes prednisone and aspirin in pregnant patients. Anticoagulation therapy has been recommended for thrombosis. The roles of plasmapheresis and cytotoxic agents have not yet been defined.

Neuroleptic malignant syndrome.

Neuroleptic malignant syndrome may occur in patients taking neuroleptics and other psychotropic drugs. The syndrome is characterized by hyperthermia, muscular rigidity, altered consciousness and autonomic instability. Cerebrospinal fluid examination is normal. Treatment includes intensive supportive measures and the use of dantrolene or bromocriptine, or both.

Ophthalmologic effects of psychotropic medications.

This article reviews the effects of psychotropic medications on the eye. Although some of these effects have been known for years, they have been largely ignored by psychiatrists. The ophthalmologic effects of antidepressants, neuroleptics, benzodiazepines, carbamazepine, and lithium in therapeutic doses and overdose are reviewed and their implications discussed. Recommendations are made for appropriate monitoring, treatment, and ophthalmologic referral of patients on these medications.