Psychiatric Consultations
Profile
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If you have answered these questions, then you need to answer questions relevant to your professional goals.
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What is a Psychiatric Consultation?
TABLE 1. Required skills for the evaluation and treatment of patients with psychiatric disorders in the general medical setting
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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
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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.
