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Psychiatric Consultations
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How do you prefer to be contacted? Email is usually quite a bit quicker. Phone Email Where are you in the process? What is a Psychiatric Consultation? TABLE 1. Required skills for the evaluation and treatment of patients with psychiatric disorders in the general medical setting -------------------------------------------------------------------------------- 1.Ability to take a medical-psychiatric history 2.Ability to recognize and categorize symptoms 3.Ability to assess neurological dysfunction 4.Ability to assess the risk of suicide 5.Ability to assess medication effects and drug–drug interactions 6.Ability to know when to order and how to interpret psychological testing 7.Ability to assess interpersonal and family issues 8.Ability to recognize and manage hospital stressors 9.Ability to place the course of hospitalization and treatment in perspective 10.Ability to formulate multiaxial diagnoses 11.Ability to perform psychotherapy 12.Ability to prescribe and manage psychopharmacological agents 13.Ability to assess and manage agitation 14.Ability to assess and manage pain 15.Ability to administer drug detoxification protocols 16.Ability to make medicolegal determinations 17.Ability to apply ethical decisions 18.Ability to apply systems theory and resolve conflicts 19.Ability to initiate transfers to a psychiatry service 20.Ability to assist with disposition planning TABLE 2. Problems that commonly lead to requests for psychiatric consultation in the medical/surgical setting -------------------------------------------------------------------------------- 1.Acute stress reactions 2.Aggression or impulsivity 3.Agitation 4.AIDS or HIV infection 5.Alcohol and drug abuse (including withdrawal states) 6.Anxiety or panic 7.Assessment of psychiatric history 8.Burn sequelae 9.Change of mental status 10.Child abuse 11.Coping with illness 12.Death, dying, and bereavement 13.Delirium 14.Dementia 15.Depression 16.Determination of capacity and other forensic issues 17.Eating disorders 18.Electroconvulsive therapy 19.Ethical issues 20.Factitious disorders 21.Family problems 22.Geriatric abuse 23.Hypnosis 24.Malingering 25.Pain 26.Pediatric psychiatric illness 27.Personality disorders 28.Posttraumatic stress disorder 29.Pregnancy-related care 30.Psychiatric care in the intensive care unit 31.Psychiatric manifestations of medical and neurological illness 32.Psychological factors affecting medical illness 33.Psychological and neuropsychological testing 34.Psycho-oncology 35.Psychopharmacology of the medically ill 36.Psychosis 37.Restraints 38.Sexual abuse 39.Sleep disorders 40.Somatoform disorders 41.Suicide 42.Terminal illness 43.Transplantation issues Guideline When the consultee asks for a psychiatric consultation, the consultant should establish the urgency of the consultation (i.e., emergency or routine—within 24 hours). Commonly, requests for psychiatric consultation fall into several general categories: 1.Evaluation of a patient with suspected psychiatric disorder, a psychiatric history, or use of psychotropic medications. The evaluation aims to properly assess the underlying psychiatric syndrome and to mitigate its effect on the medical/surgical condition. 2.Evaluation of a patient who is acutely agitated. The evaluation should carefully review the medical and psychiatric reasons for agitation (e.g., psychosis, intoxication, withdrawal, dementia, delirium) and should delineate possible etiologies (e.g., toxic metabolic disturbances, cardiopulmonary, endocrine, neurologic disorders). 3.Evaluation of a patient who expresses suicidal or homicidal ideation. Any patient who voices such ideation should be evaluated by a psychiatric consultant. In situations where the consultant is not immediately available, appropriate precautions should be recommended by the consultant (e.g., placing the patient under constant observation until the psychiatrist arrives at the bedside). 4.Evaluation of a patient who wishes to die, including one who requests hastened death, physician-assisted suicide, or euthanasia. No presumption should be made that such requests are "rational" until a complete evaluation has been performed. 5.Evaluation of a patient who is at high risk for psychiatric problems by virtue of serious medical illness. In some circumstances (e.g., organ transplantation), a medical or surgical service or protocol may require psychiatric evaluation of all patients. Psychiatric consultation in specific settings has proven valuable and should be encouraged. 6.Evaluation of a patient who requests to see a psychiatrist. Any patient who requests to speak with a psychiatrist should be evaluated only after the physician responsible for the patient's care has been contacted about the case. 7.Evaluation of a patient in an emergency situation. In emergencies, a consultation may be requested by any health professional involved with the care of the patient (subject to the rules of procedure of the institution). The patient should be prevented from harming him- or herself or others (constant observation) until the consultant arrives. 8.Evaluation of a patient with a medicolegal situation (e.g., where there is a question of a patient's capacity to consent to or refuse medical treatment). 9.Evaluation of a patient with known or suspected substance abuse.