By Stephen M. Raffle, M.D.

Most lay people, and for that matter quite a few physicians, don’t think about psychiatrists having expertise in other areas of medicine.

In my own practice, I was not only Assistant Clinical Professor of Psychiatry at UCSF Medical School but also Assistant Clinical Professor or Orthopedic Surgery albeit as a psychiatrist. There is considerable overlap in the different subspecialties and often the mental and physical converge in the same patient. From the beginning of my practice, I had an abiding interest in neurological processes and psychiatric dysfunction. One of my earliest consulting positions was to the Department of Neurological Rehabilitation at Herrick Hospital in Berkeley, California (5 years), and even after I stopped those consultations, I continued to treat brain damaged patients who suffered from concurrent psychiatric difficulties.

Both clinical experience and systematic investigations have shown that psychiatric problems can magnify or distort the presentation of neurological injury. For that reason, the evaluation of brain injury is best carried out by a team of experts, including a neurosurgeon or neurologist, neuropsychologist (for testing) and a psychiatrist who is adept at evaluating brain injuries and psychopathology.

Every other area of medicine has some psychological input. For example, the issue of depression and diabetes is of great concern since the depressed diabetic typically has excess cravings for carbohydrates and, in this particular illness, carbohydrates aggravate blood sugar levels and control. Also, depressed diabetics in particular, and depressed patients in general, have poorer medication compliance than non-depressed patients. It is not enough for a patient to be prescribed the proper medication if the patient does not take the medication as prescribed. With severe depressions, the patient often loses the will to live and intentionally stops taking the medication in order to die. Inasmuch as the depression is affecting the patient’s judgment, I question whether or not the patient is able to make an informed decision to stop taking his medication.

Continuing my considerations about diabetes and depression, it is worth emphasizing that severe depression is sometimes treated with low doses of atypical antipsychotic medications such as Zyprexa (Olanzapine). Usually in low doses, this medication does not cause Type II diabetes, it may in higher doses, but nevertheless the diabetes is a possible outcome whenever atypical antipsychotics are prescribed.

Neurosurgery

Neurology

Endocrinology

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