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8/12/2019 C-L Psychiatry or clinical liaison psychiatry
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CONSULTATION-LIAISON
PSYCHIATRY
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Consultation-Liaison Psychiatry
•
It is the study, practice andteaching of the relation
between medical and
psychiatric disorders.
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C-L Psychiatrists
• serve as consultants to medicalcolleagues (either another psychiatrist or,more commonly, a nonpsychiatric
physician) or• to other mental health professionals
(psychologist, social worker, or psychiatricnurse)
• consult regarding patients in medical orsurgical settings and provide follow-uppsychiatric treatment as needed
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Roles of a C-L Psychiatrist
• skillful and brief interviewer
• good psychiatrist and psychotherapist
• teacher
• knowledgeable physician who
understands the medical aspects of the
case
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C-L Psychiatry
• Associated with all the diagnostic,
therapeutic, research and teaching
services that psychiatrists perform in thegeneral hospital and serves as a bridge
between psychiatry and other specialties.
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SCOPE
• 1. Understand the impact of medical illness andthe system in which it is treated and how thisaffects the presentation, experience, and impactof psychiatric and psychosocial morbidity.
• 2. Conduct a biopsychosocioculturalassessment, create a formulation and implementappropriate treatment in the context of thegeneral hospital including effectivecommunication with the rest of the treatmentteam.
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•
3. Assess reactions to illness, anddifferentiate the presentation of depression
and anxiety in the medical setting.
• 4. Understand the trajectories of illness
and the developmental issues of the
person with mental health problems and
mental illness.
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• 7.Understand the particular needs ofspecial populations with psychiatric andpsychosocial morbidity in the medicalsettings, including the young, the old, theindigenous, and those with intellectualdisabilities.
• 8. Assess and manage acute and
emergency presentations of psychiatricmorbidity in the general medical setting.
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C-L Psychiatrists
• Treat psychiatric problems in medical
patients.
• Commonly treated problems: anxiety,
sleep disorders, disorientation, often as a
result of delirium.
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• Recommend specific medications
• Identify and organize the patient's social cupportsystems
• Address the immediate problem through short-term, dynamic psychotherapy
• Develop a plan to deal with the petient's socialor occupational problems
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COMMON CONSULTATION-
LIAISON PROBLEMS
• 1. SUICIDE ATTEMPT OR THREAT
• 2. DEPRESSION
• 3. AGITATION
• 4. HALLUCINATIONS
• 5. SLEEP DISORDER
• 6. CONFUSION
• 7. NONCOMPLIANCE OR REFUSAL TOCONSENT TO PROCEDURE
• 8. NO ORGANIC BASIS FOR SYMPTOMS
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PROBLEMS IN HOSPITALIZED
MEDICAL PATIENTS• Resistance to treatment for medical
complications of substance abuse
• Chronic psychiatric illness in a patient admittedfor other reasons
•
Medical complications of psycotropic agents
• Medical complications of a suicide attempt
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PATIENTS AT RISK
• Patients with AIDS
• Patients undergoing renal dialysis
• Patients undergoing surgery
• Patients treated in the ICU
• Transplantation issues
• Psychooncology