Table of Contents  
COMMENTARY
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 19-20  

Broadening horizons in psychiatry and respiratory medicine


Department of Psychiatry, Mahatma Gandhi Missions Medical College, Kamothe, Navi Mumbai, Maharashtra, India

Date of Web Publication14-Mar-2013

Correspondence Address:
Darpan Kaur
8/187, M.H.B., Om-Lamba Society, Opposite Bhakti-Dham Mandir, Sion-Chunabhatti, Mumbai, Maharashtra - 400 022
India
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How to cite this article:
Kaur D. Broadening horizons in psychiatry and respiratory medicine. Med J DY Patil Univ 2013;6:19-20

How to cite this URL:
Kaur D. Broadening horizons in psychiatry and respiratory medicine. Med J DY Patil Univ [serial online] 2013 [cited 2021 Sep 17];6:19-20. Available from: https://www.mjdrdypu.org/text.asp?2013/6/1/19/108628


  Introduction Top


Psychiatry as a discipline has significantly evolved from dealing with core psychiatric disorders to current day liaison consultation with other specialties. Patients with respiratory ailments can have co-existing psychiatric co-morbidities and psychological problems. Psychiatric patients can also have co-morbid diseases of respiratory system. Literature pertaining to the arena of psychiatry and respiratory system was reviewed and relevant studies were included.

Nosology of Medically Unexplained Symptoms

Functional symptoms in respiratory system include dyspnea, habit cough, laryngeal dysfunction, and hyperventilation. These symptoms are called somatic, functional, hysterical or psychogenic. The ICD 10 and DSM IV TR describe them under somatoform and dissociative disorders. [1]

Neurobiology of Psychogenic Dysnoea and Hyperventillatory Syndrome

Literature describes the role of neurotransmitters in panic disorder and hyperventilation. Existing studies also describe the modulation of airway responses to standard airway challenges with exercise, allergens, or pharmacological agents by psychological factors. Newer studies have are discovering physiological processes associated with psychologically induced airway responses, with vagal excitation and ventilatory influences being the most likely candidate pathways. [2]

Respiratory Diseases in Psychiatric Disorders

Respiratory diseases such as pneumonia and tuberculosis accounted for most deaths amongst patients with psychiatric disorders in the era of institutionalization. Despite deinstitutionalization, respiratory diseases are still continuing to be prevalent with a higher incidence of tuberculosis in patients with schizophrenia compared with the general population. Chronic obstructive pulmonary disease (COPD) has also emerged significantly among those with chronic psychiatric disorders. [3]

Psychiatric Comorbidity in Respiratory Disorders

Literature suggests that depression can occur during weaning from prolonged mechanical ventilation. Jubran et al, conducted a study on patients weaned from mechanical ventilation and found that depressive disorders were diagnosed in 42% of the patients. Patients with depressive disorders were more likely to experience weaning failure and death. They suggested that patients requiring mechanical ventilation were at increased risk of emotional stress. They concluded that emotional stress could negatively impact ventilator weaning and survival. [4]

Moussas et al, found a significantly higher rate of anxiety and depression in patients with bronchial asthma and COPD. They concluded that probable etiology could be the chronicity and severity of pulmonary disease. Early detection and management of psychiatric disorders may improve adaptation and quality of life of these patients. [5] Miedinger et al, found that quality of life was associated with psychological distress and psychiatric disorders in individuals with occupational asthma. [6] Felker et al, conducted a cross sectional survey on patients with COPD and associated psychiatric co-morbidity. They found that at each level of COPD severity, participants with mental disorders had worse health status and dyspnea. They concluded that independent of COPD severity, comorbid mental disorders were associated with worse health status and dyspnea. They suggest that further studies are needed to determine whether patients with comorbid mental disorders could have more significant improvement in physical symptoms and functioning if providers focus more on management of psychiatric conditions. [7]

Pharmacotherpaeutic Strategies for Psychogenic Dysnoea, Panic Disorder and Hyperventilation

American Psychiatric Association (APA) guidelines recommend selective serotoninreuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) as the best initial pharmacotherapy choice. Tricyclic antidepressants (TCA) are effective, however, their side effects limit their wider use. SSRIs, SNRIs, and TCAs are all preferable to benzodiazepines as monotherapies for patients with co-occurring depression or substance use disorders. The benefit of more rapid response to benzodiazepines must be reasonable weighed against the potential side effects of sedation and psychological dependence. [8]

Psychological Therapies for Psychogenic Dysnoea, Panic disorder and Hyperventilation

APA guidelines also discuss the role of various psychotherapies available for functional disorders. Cognitive Behavior Therapy and exposure therapy are recommended for these disorders. Evidence for the use of other psychodynamic psychotherapy approaches for panic disorder is described to be limited to case reports and experience of psychodynamic psychotherapy experts. [8]


  Conclusion Top


The existing literature highlights the significance of psychiatric co-morbidity in patients with respiratory diseases. Physicians should collaborate with mental health professions for early identification and management of patients with depressive and anxiety symptoms. Psychiatrist and allied mental health professionals need to be aware about respiratory diseases in patients with chronic psychiatric disorders for appropriate management. Evidence base points towards psychopharmacological and psychotherapeutic strategies for psychogenic dysnoea, panic disorder and hyperventilation. Further studies in the arena of consultation-liaison psychiatry and respiratory medicine are need.

 
  References Top

1.Escobar JI, Hoyos-Nervi C, Gara M. Medically unexplained physical symptoms in medical practice: A psychiatric perspective. Environ Health Perspect 2002;110:631-6.   Back to cited text no. 1
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2.Ritz T. Airway responsiveness to psychological processes in asthma and health. Front Physiol 2012;3:343.  Back to cited text no. 2
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3.DE Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011;10:52-77.  Back to cited text no. 3
    
4.Jubran A, Lawm G, Kelly J, Duffner LA, Gungor G, Collins EG, et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med 2010;36:828-35.  Back to cited text no. 4
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5.Moussas G, Tselebis A, Karkanias A, Stamouli D, Ilias I, Bratis D, et al. A comparative study of anxiety and depression in patients with bronchial asthma, chronic obstructive pulmonary disease and tuberculosis in a general hospital of chest diseases. Ann Gen Psychiatry 2008;7:7.  Back to cited text no. 5
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6.Miedinger D, Lavoie KL, L'Archeveque J, Ghezzo H, Malo JL. Identification of clinically significant psychological distress and psychiatric morbidity by examining quality of life in subjects with occupational asthma. Health Qual Life Outcomes 2011;9:76.  Back to cited text no. 6
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7.Felker B, Bush KR, Harel O, Shofer JB, Shores MM, Au DH. Added burden of mental disorders on health status among patients with chronic obstructive pulmonary disease. Prim Care Companion J Clin Psychiatry 2010;12 pii: PCC.09m00858. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2983456/ [Last accessed 2012 Dec 17].  Back to cited text no. 7
    
8.Treating panic disorders: A Quick Reference Guide. DOI: 10.1176/appi.books.9780890423912.154028, Available from: http://psychiatryonline.org/content.aspx?bookid=28§ionid=1663909 [Last accessed on 2012 Dec 17].  Back to cited text no. 8
    




 

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