Liaison psychiatry

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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.

Contents

Scope

Liaison psychiatry usually provides a service to patients in a general medical hospital, either inpatients, outpatients or attenders 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:

The psychiatric team liaises with many other services, including the treating medical team, other mental health services, social services, and community services. There is increasing interest on extending liaison psychiatry to primary care, for the management of long-term medical conditions such as diabetes mellitus. [1]

Effectiveness of liaison psychiatry

Consultation-liaison psychiatry helps improve patients' coping mechanisms, treatment adherence, school/work re-integration and quality of life. An evaluation of the Rapid Assessment, Interface and Discharge (RAID) model of liaison psychiatry—employed at City Hospital, Birmingham—estimated that the service saved between 43 and 64 beds per day through reduced lengths of stay and prevention of readmission. [2] In 2011 the Centre for Mental Health published an economic evaluation of the service, estimating savings of around £3.5 million. This was followed in 2012 by the publication of a report recommending that every NHS hospital should have a liaison psychiatry service as standard. [3]

History

The history of liaison psychiatry is partly a history of psychiatry and medicine. Galen was highly influential for over 1500 years in medicine particularly advocating the use of experimentation to advance knowledge. The polymath physician Avicenna produced many insights into medicine but only became influential in Western medicine when William Harvey's elucidation of the circulatory system forced a re-evaluation of Galen's work. The French philosopher René Descartes began the dualistic debate on the division between mind and body. Johann Christian August Heinroth is credited with the origination of the term psychosomatic illness. At the beginning of the 19th century Johann Christian Reil created the term psychiatry whilst the polymath Benjamin Rush wrote Diseases of the Mind. The philosopher Spinoza's concept of conatus, Mesmer's development of hypnosis together with Charcot's refinement of this technique influenced Sigmund Freud whose development of psychoanalytic theory was to have a profound impact on the development of liaison psychiatry. Under the guidance of Alan Gregg, psychoanalysis impacted on hospital medicine through figures such as Franz Alexander, Stanley Cobb and Felix Deutsch.

Edward Billings first coined the term liaison psychiatry. The publishing of two texts A Handbook of Elementary Psychobiology and Psychiatry, by Billings, and Psychosomatic Medicine, by Edward Weiss and O. Spurgeon English, outlined the theoretical foundations for the developing field. George L. Engel was involved in the development of liaison psychiatry and coined the term biopsychosocial model which overcame divisions created by Cartesian mind-body dualism and was to have wider repercussions on psychiatric practice. [4]

United Kingdom

The Faculty of Liaison Psychiatry was established within the Royal College of Psychiatrists in 1997. The European Association for Consultation Liaison Psychiatry and Psychosomatics also produced a set of guidelines for training in Liaison Psychiatry. [5] The American Psychiatric Association formally recognized C-L psychiatry as a subspecialty in 2004, with its own sub-specialty board exam. The profession debated about the best term for this specialty, finally settling on "Psychosomatic Medicine".

A survey for NHS England in 2015 found 133 out of 179 A&E departments could not deliver the minimum core standard for 24/7 liaison psychiatry. 11 hospitals had no liaison psychiatry service, and only 35 delivered at or above the minimum standards. Collectively there was a shortage of 1,270 trained nurses and 230 trained consultants. [6]

Related Research Articles

A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians and evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.

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Psychosomatic medicine is an interdisciplinary medical field exploring the relationships among social, psychological, behavioral factors on bodily processes and quality of life in humans and animals.

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<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

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Telepsychiatry or telemental health refers to the use of telecommunications technology to deliver psychiatric care remotely for people with mental health conditions. It is a branch of telemedicine.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

<span class="mw-page-title-main">Psychology in the medieval Islamic world</span> Historical Islamic psychological studies

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George Libman Engel was an American internist and psychiatrist. He spent most of his career at the University of Rochester Medical Center in Rochester, New York. He is best known for his formulation of the biopsychosocial model, a general theory of illness and healing.

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Donald S. Kornfeld is an American psychiatrist best known for his work on psychiatric issues associated with medical practice. This subspecialty is known as Consultation-Liaison Psychiatry or Psychosomatic Medicine.

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The following outline is provided as an overview of and topical guide to psychiatry:

Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.

References

  1. Bolton, Jim (2012). "Liaison psychiatry and the management of long-term conditions and medically unexplained symptoms" (PDF). Royal College of Psychiatrists’ Faculty of Liaison Psychiatry. Royal College of Psychiatrists. Archived from the original (PDF) on March 13, 2013. Retrieved February 1, 2022.
  2. Tadros, George; Salama, Rafik A; Kingston, Paul; Mustafa, Nageen; Johnson, Eliza; Pannell, Rachel; Hashmi, Mahnaz (2013). "Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model". Psychiatric Bulletin. doi: 10.1192/pb.bp.111.037366 .
  3. "A liaison psychiatry service in every hospital can save the NHS millions and improve lives". Centre for Mental Health. Archived from the original on March 12, 2013. Retrieved February 1, 2022.
  4. "The Biopsychosocial Model Approach" (PDF). Rochester University. Rochester University. Retrieved 18 April 2019.
  5. "EACLPP Training Guidelines". EACLPP.org. Retrieved 2008-07-05.
  6. Lintern, Shaun (2015-11-04). "Majority of A&E departments fail liaison psychiatry standards". Health Service Journal. Retrieved 2024-01-07.