LIAISON
Liaison psychiatry, also known as consultation-liaison psychiatry (CLP) is the branch of psychiatry that specializes in the interface between general medicine and psychiatry, usually taking place in a hospital or medical setting.
The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Liaison psychiatry aims to bridge the gap between physical and mental healthcare.
Liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, psychological aspect and neuropsychiatry.
Liaison psychiatry usually provides a service to patients in a general medical hospital, either inpatients, outpatients or at the emergency department. Referrals are made when the treating medical team has questions about a patient's mental health, or how that patient's mental health is affecting his or her care and treatment.
Typical issues include:
- Patients with medical conditions that result in psychiatric or behavioral symptoms, such as acute confusions or delirium.
- Dealing with patients who have attempted suicide or self-harm.
- Supporting the management of patients with mental disorders who have been admitted for the treatment of medical problems.
- Assisting a patient in assessment of mental capacity to give consent to treatment.
- Patients who may report physical symptoms as a result of mental disorder or patients with medically unexplained physical symptoms.
- Patients who may not have a psychiatric disorder but are experiencing distress related to their medical problems.
- Assisting with the diagnosis, treatment and functional assessment of people with dementia including advice on discharge planning or the need for long- term care.
- Identify symptoms and make diagnosis as well as treatment plan for medical patient with any mental illness.
The requirement for liaison psychiatry is evident from the high prevalence of psychiatric disorders within the general hospital setting. In fact, the prevalence of psychiatric disorders amongst general hospitals patients is much higher than the general population. It has been reported that unless a specific liaison psychiatry service exists within the general hospital, a significant proportion of psychiatric co-morbidity remain undetected and untreated.
Effectiveness of liaison psychiatry:
- Reduce the lengths of stay in the hospital.
- Prevention of unnecessary readmission.
- Save costs for hospital management
Thus, all hospitals should have a liaison psychiatry service as standard care.
OBJECTIVES OF TRAINING
- Have a detailed knowledge of the interaction between psychiatric and physical illness
- Acquired specific clinical skills on interviewing liaison patient.
- Able to give opinion or guidance as to the most appropriate treatment to the patient.
- Able to function as a psychiatrist either as an integral member of the medical/surgical team or giving consultation opinion.
- Capable to have good communication with treatment team especially in gathering concern and difficulties of the main managing team.
- Able to set up a liaison psychiatric services in any general hospital setting.
BUILDING KNOWLEDGE-BASE
A detailed knowledge of the following ways in which physical and psychological factors interact is essential:
- Relationship between physical and psychiatric pathology.
- The psychological effects of physical illness.
- The psychological effects of physical effects of organic brain syndrome.
- The somatic presentation of psychiatric illness.
- Psychological aspect of cardiovascular illness.
- Psychological aspect of HIV Infections and AIDS.
- Psychological aspect of cancer patients.
- Psychological aspect of pregnancy and the puerperium.
- Psychological aspect of gastro intestinal tract disease.
- Physical or psychological conditions associated with self-destructive behavior, eg. self-poisoning and self-harm, anorexia nervosa and alcoholism.
- A detailed knowledge of the physical effects of psychotropic drugs and their interactions with other drugs.
- A working knowledge of psychological treatment such as cognitive- behavioral techniques and dynamics psychotherapy, applied to those with physical symptoms.