Psychiatry

• Hospital-based psychiatry is psychiatric care delivered to medically-admitted patients in the hospital.
• Consult liaison psychiatry, often referred to as CL psychiatry, has a broader scope of practice than hospital-based psychiatry and includes collaboration with the patients’ primary teams.
• Altered mental status (AMS) is an acute change in a patient’s mentation, which may include arousal level, thought process, and orientation.
• Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry, is the branch of psychiatry that specialises in the interface between general medicine/pediatrics 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.
• Consultation-liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology, and neuropsychiatry.
• Deterioration of intellectual functioning in clear consciousness, due to brain disease, can lead to conditions such as Alzheimer dementia, Vascular dementia, Dementia with Lewy bodies, Frontotemporal dementia, Huntington disease, and others.
• Decisional Capacity is the ability to provide informed consent for a medical decision.
• The Appelbaum Criteria for Decisional Capacity assessment include the ability to communicate a choice, understand the relevant information, appreciate the situation and its consequences, and reason rationally.
• The threshold for self-determination correlates with the risk of the decision, for example, a lower threshold for a patient in the ED consenting to receive a medication to relieve their pain and a higher threshold for leaving the hospital against medical advice when currently septic and in need of emergent antibiotics and surgery.
• “Competence” is a legal status; “capacity” is a medical status.
• Hospital-based psychiatry, often called consult liaison psychiatry, is psychiatric care delivered to medically-admitted patients, in collaboration with the primary team.
• Altered mental status (AMS) is an acute change in a patient’s mentation, including arousal level, thought process, and orientation.
• Possible causes of AMS include Delirium, Psychosis, Catatonia, Dementia, and Decisional capacity can be assessed by the Appelbaum criteria: ability to communicate a choice, understand the relevant information, appreciate the situation and its consequences, and reason rationally.
• Consultation-liaison psychiatrists often work in primary care and outpatient specialty clinics (such as diabetes or women's clinics) and have key roles in developing population-based collaborative care models for the over 10 million patients with comorbid chronic illness.
• The workflow for hospital-based psychiatry involves speaking directly with the referring clinician, reviewing the current records and pertinent past records, reviewing the patient’s medications, gathering collateral data, interviewing and examining the patient, formulating diagnostic and therapeutic strategies, writing a note, and providing periodic follow-up.
• The workflow for consult liaison psychiatry involves clarifying the question, reviewing the current records and pertinent past records, reviewing the patient’s medications, gathering collateral data, building a broad differential diagnosis, interviewing and examining the patient, formulating diagnostic and therapeutic strategies, writing a note, and providing periodic follow-up.
• Psychiatric presentations of medical conditions include psychiatric complications of medical conditions or treatments, psychological reactions to medical conditions or treatments, and medical presentations of psychiatric conditions.
• Medical complications of psychiatric conditions or treatments include comorbid medical and psychiatric conditions.
• Differential diagnosis categories for hospital-based psychiatry include psychiatric conditions, medical conditions, and emergent hospital-based psychiatric concerns.
• Workflow for hospital-based psychiatry involves speaking directly with the referring clinician, clarifying the question, reviewing the current records and pertinent past records, reviewing the patient’s medications, gathering collateral data, building a broad differential diagnosis, interviewing and examining the patient, formulating diagnostic and therapeutic strategies, writing a note, and providing periodic follow-up.
• Emergent hospital-based psychiatric concerns include delirium, catatonia, post-partum psychosis, decision capacity, mania, and suicidality.
• Delirium is a serious change in mental abilities that results in confused thinking and a lack of awareness of someone's surroundings.
• Delirium usually comes on fast, within hours or a few days, and can often be traced to one or more factors such as a severe or long illness, imbalance in the body, certain medicines, infection, surgery, or alcohol or drug use or withdrawal.
• Symptoms of delirium are sometimes confused with symptoms of dementia and health care providers may rely on input from a family member or caregiver to diagnose the disorder.
• Catatonia is a disorder that disrupts how your brain works, disrupting how a person processes and reacts to the world around them.
• People with catatonia often don’t react to things happening nearby or may react in ways that seem unusual.
• Impaired communication, unusual movements or lack of movement, and behavior abnormalities are the most striking features of this condition.
• There are 12 officially accepted symptoms of catatonia, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM - 5).
• Catatonia is a syndrome of motor signs presenting with disordered affect, thought, and behavior.
• Subtypes of catatonia include catatonic withdrawal and catatonic excitement.
• The diagnosis of catatonia is made using the Bush-Francis Catatonia Rating Scale.
• Catatonia usually occurs in the context of primary psychotic disorders such as schizophrenia and schizoaffective disorder, mood disorders like MDD and bipolar disorder, and medical conditions.
• Treatment recommendations for catatonia include benzodiazepines, higher doses and more frequently than otherwise would prescribe, slow taper off after resolution, and electroconvulsive therapy (ECT).
• Medical management for catatonia may include IV fluids and nutrition support if the patient has not been eating or drinking.
• Consultation-liaison psychiatry involves the treatment of patients with complicated medical or surgical conditions who are suffering emotionally.
• Examples of patients treated in consultation-liaison psychiatry include treatment of delirium tremens in an elderly woman with unsuspected alcohol dependence who just received coronary artery bypass surgery, consultation to an outpatient HIV/AIDS clinic to help manage psychotropic medications for a patient about to begin a new antiretroviral regimen, and inpatient consultation to the Oncology Service for a depressed middle-aged man with newly diagnosed, widespread pancreatic cancer.
• Consultation-liaison psychiatry provides the opportunity to work more closely with medical and surgical colleagues than is typically the case for most psychiatrists.
• Consultation-liaison psychiatry is a great way to make a big difference in the lives of patients with complicated medical or surgical conditions who are suffering emotionally.
• Delirium is a waxing and waning neuropsychiatric disorder that disrupts cognition, including thought process, language, and comprehension, and circadian rhythm.