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Consultation Liaison Psychiatry
Consultation Liaison Psychiatry
Liaison Psychiatry
u Consultation-liaison (C-L) psychiatry is the study, practice, and
teaching of the relation between medical and psychiatric disorders.
u In C-L psychiatry, psychiatrists serve as consultants to medical
colleagues (either another psychiatrist or, more commonly, a
nonpsychiatric physician) or to other mental health professionals
(psychologist, social worker, or psychiatric nurse).
u In addition, C-L psychiatrists consult regarding patients in medical or
surgical settings and provide follow-up psychiatric treatment as
needed.
u C-L psychiatry is associated with all the diagnostic, therapeutic,
research, and teaching services that psychiatrists perform in the
general hospital and serves as a bridge between psychiatry and
other specialties.
u In the medical wards of the hospital, C-L psychiatrists must play
many roles: skillful and brief interviewer, good psychiatrist and
psychotherapist, teacher, and knowledgeable physician who
understands the medical aspects of the case.
Diagnosis
u Suicide rates are higher in persons with medical illness than in those
without medical or surgical problems.
u High-risk factors for suicide are men over 45 years of age, no social
support, alcohol dependence, previous attempt, and
incapacitating or catastrophic medical illness, especially if
accompanied by severe pain.
u If suicide risk is present, the patient should be transferred to a
psychiatric unit or started on 24-hour nursing care.
Depression
u The C-L psychiatrist is often called in when the physician cannot find
evidence of medical or surgical disease to account for the patient's
symptoms.
u In these instances, several psychiatric conditions must be
considered, including conversion disorder, somatization disorder,
factitious disorders, and malingering.
u Glove and stocking anesthesia with autonomic nervous system
symptoms is seen in conversion disorder; multiple bodily complaints
are present in somatization disorder; the wish to be in the hospital
occurs in factitious disorder; and obvious secondary gain is
observed in patients who are malingering (e.g., compensation
cases).
C-L Psychiatry in Special Situations