PSYCHIATRIC ASPECT OF ORTHOPAEDICS

Volume 8 Issue 1 January, 2018

Consultation Liaison Psychiatry : ORTHOPEDICS

A high index of suspicion for the presence of psychiatric disorders is important in treating the orthopedic patient with multiple trauma, chronic disease, factitious disorder or suspected malingering or who fails to improve with recognized treatment. Recognition of a psychiatric problem should be part of preoperative planning in orthopedic practice, and a formal psychiatric referral for diagnosis and treatment should be made for patient with significant psychiatric involvement. When associated psychiatric disease is diagnosed and controlled before orthopedic treatment commences, patient is more likely to comply with treatment regimen, which may lead to better results. There are special circumstances where in consent from significant others taken while treating like persons with Intellectual Developmental Delay (IDD), severe mental illness and there are conditions where delirium will be precipitated by orthopedic procedures like hyponatremia among others.

There exist limit data regarding the frequency of psychiatric illness in patients who sustain orthopedic polytrauma. Depression and anxiety disorder appears to be very common in orthopedic patients; both social circumstances and nature of bone pathology are associated with such conditions. Patients with co morbid psychiatric illness who are admitted to hospitals are at increased risk of inpatient adverse events and post hospitalization care leading to longer hospital stays, higher risk of suboptimal outcomes and increased resource utilization and a common cause of disability.
Psychiatric co morbidity with concurrent antipsychotic and antidepressant use are known risk factors for extremity fractures, postulated to be a result of decreased bone mineral density.

Orthopedic surgeon play pivotal role in changing the care of orthopedic patients from a biomedical to a biopsychosocial pattern. There is need to identify surgeons attitude and practice of identifying, screening and referral of patients with psychological illness to address psychosocial issues. Additionally identification of potential barriers to and reason for referral to psychosocial treatment needs to be done.