Liaison_psychiatry

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Liaison psychiatry

Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between medicine and psychiatry, usually taking place in a hospital or medical setting. Liaison psychiatry has areas of overlap with other distinct disciplines including psychosomatic medicine, health psychology and neuropsychiatry. The role of the consultation-liaison psychiatrist is to see patients currently admitted as general medical inpatients at the request of the treating medical or surgical consultant or team. This is known as a 'consult' and constitutes the consultation facet of the role.

Scope of Liaison Psychiatry

"Consults" occur when the primary care team has questions about a patient's mental health, or how that patient's mental health is affecting his or her care and treatment. The psychiatric team works as a "liaison" between the medical team and the patient. Issues that arise include assessing the capacity of a patient to consent to treatment, attempting to settle conflicts between patients with the primary care team, and the intersection of problems in both physical and mental health, as well as patients who may report physical symptoms as a result of a mental disorder, and assessing patietns for abnormal illness behaviour. Delirium is commonly diagnosed and treated by psychiatrists. Finally, patients who have attempted suicide and subsequently admitted for medical treatment are generally treated by this field.

In some hospitals, the Consultation-liaison psychiatry team also covers psychiatric presentations to the Emergency Department, while in others doctors from the psychiatric unit will cover this area.

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 Rene 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 conation, 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 is considered to have been one of the most important figures in the development of liaison psychiatry and coined the term "Biopsychosocial Model" which overcame divisions created by Cartesian Dualism and was to have wider repercussions on psychiatric practice.

In the 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. 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".