Transcript CONSULTATION-LIAISON PSYCHIATRY: AN AUSTRALIAN

CONSULTATION-LIAISON
PSYCHIATRY: AN AUSTRALIAN
EXPERIENCE.
BY
DR HENRY AGHANWA,
MBBS, FWACP, FRANZCP
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Consultant Psychiatrist
Toowoomba Base Hospital
Toowoomba, Queensland Australia
Senior Lecturer (Psychiatry)
Rural Division, School of Medicine
University of Queensland
Toowoomba Queensland Australia
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DEFINITIONS
Consultation-Liaison Psychiatry is defined as
consultation to and collaboration with the
non-psychiatric specialist in the management
of a patient with a primary physical condition
complicated by psychiatric comorbidity in the
general hospital setting or any other health
facility
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Consultation Psychiatry
• The provision of assessment and intervention
to a patient with primary medical condition
who has developed a psychiatric complication.
• It is reactive
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Liaison Psychiatry
• The is the conduction of an exploration with
the intent of carrying out a mediatory role
between a patient with primary physical
condition and the treating team.
• It is proactive
• It helps to improve the interpersonal
relationship between the treatment team and
the patient
• It prevents the development of a full-fledged
psychopathology or prevents the deterioration
of the primary physical condition.
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Synonyms
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Consultation-Liaison Psychiatry
Psychosomatic Medicine
General Hospital Psychiatry
Medical/surgical Psychiatry
De facto Psychiatry
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The areas of activities
• Mainly inpatient settings
• Some outpatient settings
The settings include the medical, surgical, and
obstetric units, ICU, coronary care unit, burnt
unit, renal unit, oncology unit, palliative unit.
Paediatric unit- for the child & adolescent
psychiatrist.
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Settings cont’d
• The outpatient units include general and
medical speciality clinics (renal unit and ANC)
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Areas of interest within CLP
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Psychooncology
Psychonephrology
Psychosomatic Obstetrics and Gynaecology
CLP of Cardiology and Gastroenterology
General CLP
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Theoretical Basis
• CLP was originally based on psychosomatic
medicine which was the body of theoretical
information put together by psychoanalysis.
• CLP has been described as the clinical pendant
of psychosomatic medicine
• Biopsychosocial is emphasized
• Adolf Meyer’s psychobiological approach was
the starting point of CLP in the USA where its
practice began
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Scope of the CLP service
Psychiatric assessment and intervention in the
non-psychiatric speciality context
Assessment of capacity/competence to accept
or refuse treatment of a general medical
condition
Education of non-psychiatric team on mental
health
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Scope cont’d
Collaboration with non-psychiatric specialists in
research at the interface between physical
and psychological medicine
Provision of support to the non-psychiatric
specialists in the management of psychiatric
condition in the general medical context.
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Conditions commonly encountered
• Anxiety related conditions such as generalized
anxiety disorder
• Affective Disorders such as depressive episode
• Psychotic disorders (e.g. acute and transient
psychotic disorder)
• Cognitive disorders (e.g. Delirium, Dementia)
• Addiction disorders
• Somatoform disorders (somatization disorder)
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Conditions commonly encountered
cont’d
• Adjustment Disorders
• Personality Disorders
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INTERVENTIONS IN CLP
• Pharmacotherapy
• Review of patient’s existing medications
• Provision of advice on laboratory and
radiological investigations
• Psychotherapeutic interventions CBT, IPT, Brief
dynamic psychotherapy, supportive
psychotherapy
• Liaising with other members of the multidisciplinary team.
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Models of CLP
• Consultative model
• Joint endaevour model
• Outpost model
In practice services are often adapted to local
situations or developed to serve the peculiar
needs of a situation. No two services are
identical
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Staff Composition
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A psychiatrist
A nurse
Psychologist
Social Worker
Psychiatry registrar
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Challenges
• The use of psychopharmalogical agents in the
presence of compromised physical status
• The possibility of an interaction between
medications for physical and those of mental
illness.
• The tendency of some non-psychiatric specialists
to reject the mentally ill patient due to stigma
• Determining when to evoke the guardianship
administration or the mental health act
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• Determining when to transfer the mentally
disruptive patient from the non-psychiatric
unit to the psychiatric facility
• Working with two clients—the referring
specialist, and the referred patient.
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Emerging Issues
• The reluctance of the health insurance to fund
mental treatment for a physically unwell
person.
• The confusion between CL as a sub-speciality
and as a process.
• The ongoing debate on who funds the CLP?
the general hospital or the psychiatric service?
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Training in CLP
• In a 5-year postgraduate program in psychiatry
leading to the award of the Fellowship, a 6
month rotation in CLP is mandatory. However,
any interested registrar can spend an
additional period of 6 months as a part of his
advanced training. Doing this will enable the
registrar to obtain a certificate in advanced
training in addition to the fellowship.
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References
J A. Bourgeois, D M. Hilty, M E. Servis and R E.
Hales. Consultation-Liaison Psychiatry
Advantages for Healthcare Systems
Dis Manage Health Outcomes 2005; 13 (2): 93106 REVIEW ARTICLE 1173-8790
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Aghanwa HS, Morakinyo O, Aina OF.
Consultation-liaison psychiatry in a general
research? J Psychosom Res 1995; 39: 247-50
hospital setting in West Africa. East Afr Med J
1996; 73: 133-6
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Aghanwa HS.
Consultation-liaison Psychiatry in the main
general hospital in Fiji-Islands. Pacific Health
Dialog (Asia- Pacific) 2002; 9(1): 21-28.
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