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Faculty of Liaison Psychiatry – Royal College of Psychiatrists JISC UPDATE May and June 2014 Conversion disorders A London Liaison consultant asked whether there were any recent reliable studies on the prevalence of conversion disorders. Someone called Professor House responded. He and Hiroko Akagi did a review about a decade ago: Akagi H; House AO. The epidemiology of hysterical conversion. In Halligan P; Bass C; Marshall J, editors., Hysterical Conversion: clinical and theoretical perspectives. : Oxford University Press; 2001. p. 73-87. Akagi, H. and House, A. (2002) The clinical epidemiology of hysteria: vanishingly rare, or just vanishing? Psychological Medicine, 32 (2). 191 -194. ISSN 0033-2917 He said the exercise is not easy. “The big population-based epidemiology doesn’t use diagnostic criteria you’d want, and the studies that do include proper specialist assessment don’t usually give you a population denominator. So the best you can usually get is an administrative incidence from hospital practice.” The audit they did some time ago in Leeds suggests that the figures they found from the literature were similar to their own. Psychotherapy for somatoform disorders A 2014 paper was recommended to the Liaison group as helping make the case for psychotherapy as treatment for somatoform disorders. Psychotherapy and Somatoform disorders BJP 2014.pdf Further relevant recommendations were some recent work from Julian Stern at The Royal Free and a systematic review also by Abbass: Abbass et al Psychother Psychosom 2009;78:265–274 A discussion ensued about accessing psychodynamic therapies in Liaison Psychiatry. It can of great value to consult psychotherapy from time to time about difficult cases. For this clinician “the rationale wasn't just about evidence (although it is good to see it emerging) but about a sense that for certain presentations you just have to have a more dynamically-oriented approach to understand or respond to what's going on.” He argues that as well as offering a referral service, access to psychodynamic consultation time might be in the business case for any substantial liaison service. Antidepressant therapy and menorrhagia “Is there a recommended antidepressant/class for people with menorrhagia or other bleeding-related issues? I have a patient with significant menstrual issues and depression for whom I'm reluctant to prescribe an SSRI in view of increased bleeding tendency.” A transatlantic respondent in the know tells us that the literature contains very mixed findings as to whether there is an increased bleeding risk with SSRIs and if so, is it significant? He says there is more of a consensus if the patient also is taking other antiplatelet drugs like NSAIDs or clopidogrel; but he is unaware of any evidence that TCAs, mirtazapine, bupropion, or trazodone increase bleeding risk. Some TCAs of course are serotinergic, but the case reports of bleeding with them were explained by drug-induced thrombocytopenia. Most of the studies of bleeding with SSRIs focus on GI bleeding, perioperative bleeding, and stroke. Two recent references are a little closer to menorrhagia though reach opposite conclusions: Risk of vaginal bleeding and postpartum hemorrhage after use of antidepressants in pregnancy: a study from the Norwegian Mother and Child Cohort Study. Lupattelli et al, J Clin Psychopharmacol. 2014 Feb;34(1):143-8 Use of antidepressants near delivery and risk of postpartum hemorrhage: cohort study of low income women in the United States. Palmsten et al, BMJ. 2013 Aug 21;347:f4877. Jackie Gordon Worthing