Liaison Psychiatry

Liaison psychiatry

3 September 2009

Introduction  

  

also known as consultative psychiatry or consultation-liaison psychiatry overlap with other distinct disciplines including psychosomatic medicine, health psychology and neuropsychiatry It is served by psychiatrist, nurses, psychologist and social worker provide consultation regarding medical or surgical settings and follow up psychiatric treatment It is also associated with diagnostic, therapeutic, research and teaching service (between psychiatrist and other specialities).

3 September 2009

Making a referral  What information to be given??   

Medical problem Reasons for referral Nature of the help required

3 September 2009

Common Consultation-Liaison Problems 

Suicide attempt or threat 



Depression  



Risk factor : men over 45, no social support, alcohol dependent, previous attempt, suicidal ideation Assess suicidal risk Check for history of substance abuse or depressant drugs (eg : propanolol, reserpine)

Agitation  

Related cognitive disorder, withdrawal from drugs Need to rule out toxic reaction to medication

3 September 2009

 Hallucination  

Common cause is delirium tremens Need to rule out brief psychotic disorder, schizophrenia, cognitive disorder

 Sleep disorder  

Common cause is pain Need to rule out ; Depression – early morning awakening, anxiety – difficulty in falling asleep

3 September 2009

 No organic basis symptom 

Need to rule out ; Conversion disorder – glove and stoking anaesthesia, Somatization disorder – multiple body complain, Factitious disorder – wish to be hospitalize

 Disorientation 

Assess metabolic status, neurologic finding, substance history

3 September 2009

Psychiatric aspects of physical disorder Cancer Surgical treatment Screening for physical disorder Genetic counseling 3 September 2009

Cancer 

Problems: 

Distress to patients, families or carers especially:• • • •



at diagnosis during treatment (surgery, radiotherapy/chemotherapy) financial & work worries about appearance

What can be done? 

discussion of information as patient required, practical and social support, encourage patients to talk about their worries

3 September 2009

Psychiatric consequences of cancer  Emotional reaction on diagnosis or

recurrence  Anxiety  Depression  Anticipatory of chemotherapy side effects  Neuropsychiatric syndromes (due to metastasis, paraneoplastic syndromes) 3 September 2009

Surgical treatment 

Consequences :    



Anxiety : before surgery Distress : after surgery Delirium (elderly) : after surgery changes to body appearance (mastectomy) or function (colostomy)

What can be done ? 



clear explanation of the operation, its consequences and plan for postoperative care (including effective treatment of pain) Provide written handouts since anxious patients do not remember all that they have been told

3 September 2009

Screening for physical disorder  Consequences  

Anxious – result of the screening procedure Distress

 Example :   

Hypertension Cancer DM

3 September 2009

Genetic counseling  Who are the persons involved?   

contemplating marriage or expecting a child Family history of hereditary disease previous abnormal pregnancy

 What can be done? 

help in taking well-informed decisions about family planning and treatment

3 September 2009

Psychiatric aspects of O&G Pregnancy Postpartum mental disorders Menstrual disorder

3 September 2009

Pregnancy  More common in women with a history of

previous psychiatric disorder  1st trimester: unwanted pregnancies associated with anxiety and depression  3rd trimester: fears about impending delivery or doubts about the normality of the fetus  Sometimes it can become worsen as more obstetric problem may arise due to irregular antenatal care visit 3 September 2009

Psychological problems in pregnancy     

Unwanted pregnancy Planned pregnancy – miscarriage/stillbirth Termination due to medical reason Hyperemesis gravidarum Pseudocyesis 



Believe as if she is pregnant (amenorrhea, abdominal distension and changes in early pregnancy)

Couvade syndrome 

Husband experience symptoms of pregnancy

3 September 2009

Postpartum mental disorder  Maternity ‘blues’ 

 

Brief episode of irritability, disorganized thinking, tearfullnes, lability of mood Peak on 3rd or 4th postpartum day No pharmacolgical treatment needed, just reassurerance

 Puerperal psychosis  Other puerperal depressive disorder 3 September 2009

Puerperal psychosis  



Typically 2-3 days after delivery or in the first/second postpartum weeks More frequent among:- primiparous women - single mother - those who suffered previous psychiatric disorder - those with family history of psychiatric disorder 3 types of psychosis are:- delirium (secondary to puerperal sepsis) - mood disorder - schizophrenia (mood disorder more common than schizophrenia)

3 September 2009



Assessment 







Treatment  



Determine whether mother concern about baby condition Delusional ideas either the child is malformed or imperfect and any attempt of killing her child Suicidal intent ECT Pharmacological – stop breast-feeding

Prognosis  

Recover fully Recurrence : puerperal depressive disorder

3 September 2009

Other puerperal depressive disorder   



Puerperal depression more common than puerperal psychoses Tiredness, irritability, anxiety, phobic symptoms more common than depressive mood Early detection is important, so that mother/infant relationship is well establish for cognitive and emotional development of infant Treatment : antidepressant

3 September 2009

Menstrual disorder Premenstrual syndrome Menopause

3 September 2009

Premenstrual syndrome 

 

Refers to psychological (anxiety, irritability, depression) and physical ( breast tenderness, abdominal discomfort, feeling of distension) symptoms few days before and end shortly after onset of menstrual period Physiological changes around menstruation may exacerbate psychological symptoms Treatment : 



Biological : progestrone, OCP, bromocriptine, psychotrophic drugs Psychosocial : cognitive behavioral therapy and psychological support

3 September 2009

Menopause  Physical symptoms (flushing, sweating, vaginal dryness, headache, dizziness) and

psychological

symptom (depression, anxiety)  Related with hormonal changes  Additional factors :   

Loneliness Alteration in relationship with husband Death of parents

3 September 2009