Managing General Medical Inpatients with Psychiatric Illness, with Sejal Shah, MD

Comorbid psychiatric illness is common among hospitalized patients, underscoring the importance of ensuring clinicians are equipped to both recognize and treat individuals with acute psychiatric diagnoses in the inpatient setting.

In a session at the 2024 American College of Physicians (ACP) Internal Medicine meeting in Boston, Sejal Shah, MD, chief of the division of medical psychiatry and associate vice chair of clinical consultation services at Brigham and Women’s Hospital, highlighted key considerations for managing general medical inpatients with psychiatric illness, emphasizing the importance of treating patients in a “nonjudgmental” manner.

“[These patients] often experience bias and judgment related to mental illness in the rest of their lives, so when they're admitted, being treated in a way that is equitable and in a nonjudgmental way is the number one principle to keep in mind, and then really just being able to recognize that they're experiencing not only medical illness, but also psychiatric illness,” Shah explained in an interview with HCPLive.

Specifically, her session at ACP focused on depression, demoralization, anxiety, somatic symptom disorder, psychotic disorders, and substance use disorder. During her discussion of mood disorders and depression, Shah emphasized the importance of considering suicidality and identifying potential safety issues for patients experiencing psychiatric illness. Although she noted patients with psychiatric illness are more likely to be the victims of violence rather than perpetrating violence, she also mentioned the management of agitation in these patients given its prevalence in the general inpatient setting.

Looking ahead to ensuring safe transition and placement at discharge, Shah explained how this process varies based on location and the availability of mental health resources in the local community, saying “If a patient is experiencing mental illness, it is not unlikely that they will experience an exacerbation after an acute medical hospitalization… helping the patient help the clinician identify what resources would be helpful in the community to be able to continue caring for them more holistically and making sure that their mental illness is cared for is kind of the most important.”

Shah has no relevant disclosures.