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