Clinicians working in general hospitals can expect to see the full spectrum of psychiatric and psychological presentations, ranging from time-limited distress through to highly disturbed behaviour caused by serious mental or medical illness. The general hospital is a particularly challenging environment in which to diagnose and treat mental illness, both in terms of the types of disorders that present and the nature of the hospital environment itself.

In this chapter, I will focus on a number of disorders that commonly present in an acute manner to the general hospital, including medically unexplained emergencies and presentations for which the presence of physical disorder is a complicating factor in terms of aetiology or management.

Behavioural disturbance in the general hospital

A request for assessment of an acutely disturbed patient, such as the one shown in case study 1, is among the most common reasons for referral to a liaison psychiatry team (Bronheim et al, 1998). A recent survey of general hospital wards in Leeds found that the prevalence of disturbed behaviour, as identified by senior nursing staff, was 4% and that the management of this behaviour consumed a disproportionately high amount of nursing time (Kannabiran et al, 2008).

Psychiatric staff are generally familiar with the challenges that patients with disturbed behaviour present in the psychiatric setting, but managing such challenges in the general hospital environment can be difficult. General hospital staff are far less likely to be familiar with disturbed behaviour and can find such presentations highly anxiety provoking.