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CL Psy

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Consultation-

Liaison Psychiatry
• Consultation-liaison (C-L) psychiatry as a subspecialty has
been defined as the area of clinical psychiatry that
encompasses clinical, teaching and research activities of
psychiatrists and allied mental health professionals in the
non-psychiatric divisions of a general hospital.
• Consultation” refers to the provision of
expert opinion about the diagnosis and
advice on management regarding a patient's
mental state and behavior at the request of
another health professional.
• Liaison refers to linking up of groups for the
purpose of effective collaboration
• consultation encompass three interlocked
foci i.e., the patient, the consultee, and the
therapeutic team

• Hence for consultation to be most effective


the consultant psychiatrist need to have
personal contact with both the patient
(including his family) and those taking care
of him.
• Prior to 1930, mental health services in this country
were confined to the mental hospitals.

• The C-L Psychiatry as a subspecialty started in


1930s with the establishment of general hospital
psychiatric units (GHPUs). Dr Girindra Shekhar at
R. G. Kar Medical College and Hospital, Calcutta
started the first GHPU in 1933
• In 2003, C-L Psychiatry was given the
accredited subspecialty status in the field of
psychiatry under the name “Psychosomatic
Medicine” in United States
Various models of psychiatric consultation
patient oriented approach

• patient is the primary focus of the consultant's


interest. It not only includes diagnostic interview
and assessment of the patient but also includes a
psychodynamic evaluation of the patient's
personality and reaction to illness.
crisis-oriented approach

• involves a rapid assessment of patient's problem


and coping styles and immediate therapeutic
intervention to address the problem
consultee-oriented approach

• the motive of the consultee and his related


difficulties and expectations are the major focus
situation oriented approach

• focuses on the interpersonal interactions of


all the members of the clinical team involved
in the care of the patient for whom
consultation had been sought are taken into
consideration

• It is to understand the patient's behavior and


the consultee's concern about it.
consultation model
liaison model
Bridge model
• bridge model basically involves the teaching role of a C-L psychiatrist for the
primary care physicians
Hybrid model
Autonomous psychiatric
model
• autonomous psychiatric model the C-L psychiatrist
is not affiliated to any department but is hired by
primary care services
Functions
• Functions of CL psychiatrist can be divided
• clinical work,

• teaching,

• administration

• clinical research
• In India the C-L services are mostly in the
line with the consultation model, in which on
receiving a referral from the
physician/surgeon, a psychiatrist evaluates
the patient and psychiatric inputs are
provided.
• Establishing psychiatric signs and symptoms
• establishing the relationship of psychological morbidity and
physical illnes

• documentation of history from the medico-legal point of view

• confidentiality issues

• providing psychotherapeutic interventions and


psychopharmacological intervention wherever required.
• In all cases, an effort is made to communicate with the
primary physician about the psychological morbidity, its
relationship with physical illness and treatment of the
same.

• In all cases the C-L Psychiatry team regularly also


communicates with the other staff of the hospital
involved in the patient care (e.g. nursing staff).

• The family members are also informed about the


psychological morbidity and in cases, which require
intensive psychiatric management; patient and family are
advised to follow-up in the psychiatry outpatient
• C-L Psychiatry has brought forward the
concept of psychiatric sequelae of medical
disorders

• contribution of psychiatric manifestations to


the etiology, course and outcome of various
medical illnesses. There have been
landmark studies in diabetes, HIV/AIDS,
coronary artery disease, cancer, and stroke.
• The liaison with neurologist has led to identification
of various psychiatric manifestations of
Parkinsonism and psychiatric symptoms in epilepsy
• C-L psychiatrists are not only required for pre- and
post-operative evaluation of the recipient and
potential donors

• but they are also required to deal with a situation in


which a potential donor, related to the patient, is
reluctant to give up an organ but is unable to tell
their family.
• Other important contribution of C-L
Psychiatry to practice of whole medicine as
an attempt to preserve

• humanism in medicine

• direction provided to communication skills


of physicians
• preservation of medical ethics in difficult
situations
Future aspects
• we can not see patients of psychiatric
disorders and those with physical illnesses in
isolation and there is a need to focus on both
the aspects

• Hence, integrated approach, which focuses


on both the aspects, i.e., psychological
aspects of physical illnesses and physical
comorbidity and its impact on psychiatric
disorders, is important.
• C-L Psychiatry as a subspecialty should be
looked as an important component of
child psychiatry, geriatric psychiatry and
community psychiatry training
• Psychiatry resident should at least have 3-4
months of training exclusively focusing on the
C-L Psychiatry.

• Besides the resident undergoing training in


psychiatry, trainee doctors undergoing
residency in other medical and surgical
specialties can also be targeted,
• Centers with well-established C-L services can
start fellowships programmes of 6 months to 1 year
to provide training to interested candidates

• focus on holding regular continuing medical


education (CMEs) programmes on various aspects
of C-L Psychiatry by IPS
• Many of the patients seen in C-L
Psychiatry services also don’t fit into clear
diagnostic categories as described by the
current nosological systems.

• Hence there is need to develop diagnostic


models which can fit the symptomatology of
various disorders in the C-L Psychiatry set
up.
• In future, with emerging research and role of
epigenetic in various psychiatric and physical
illnesses

• new clinical challenges are going to emerge


which will further enhance the role of a
psychiatrist who is well equipped to deal with
psychological issues in medically ill subjects and has
better understanding of the comorbidity.
• Hence there is a need to improve CL
psychiatry to provide best and optimal
care to the patients and provide best
education to the trainees.

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