Liaison Psychiatry

prof elham aljammas

APRIL2017
 Liaison psychiatry
Covers all aspect of psychiatry relavent to
general medicine it is concern with the
development of psychological factors in
diagnosis , management and prevention of
. illness
Many illness are now thought to have
psychological aetiology and the role of
psychological factors becoming clearer in
many conditions ( e.g. Coronary artery
disease )
- Diagnostic differences are often solved by a
thorough assessment of psychological
factors .
- Psychiatric methods and skills are useful both
in the management of chronic psychological
and psychiatric illness in general medical
setting .
- Prevention of illness often involves in change
as in behaviour (e.g. Stop smoking ,
drinking and taking exercise) an
appreciation of psychological factors
affecting these behaviour is useful .
- Psychiatric training is not necessary for
application of liaison psychiatry for example
self –poisoning used to be created as
psychiatric case but it is increasingly
accepted that many of these have no
psychiatric
The Role of general hospital staff
General hospital medical teams assess
and treat many of psychological and
social problems under their care ,
although all the member of the team
need to be able to manage these
problems psychiatrists and psychologist
may provide training and supervision
for medical and other members of staff
and care for the pts. Who require
specialist treatment .
Consultation and Liaison Psychiatry
Psychiatric services for general hospital are
widely referred to as consultation liaison
services .
In consultation work the psychiatrist is
available to give opinion on pts. referred
by physician and surgeons .
In liaison work the psychiatrist is a member
of medical or surgical team and offer advice
about the pt. care .
The aim of liaison
Is to increase the skills of other staff in
assessment and management of
psychological problems .
Consultation and liaison units vary in
their size and organization and others
by a team of psychiatrist nurses , social
workers and clinical psychiatrists some
liaison services have in pts. Leda for
pts. Who are both medically ill. and
psychologically disturbe .
The role of liaison psychiatrist
- To make links with other disciplines .
- To identify psychiatric disorder.
- To assess its relevance to any existing
organic disorder.
- To provide a management plan for the
individual in consultation with the
physicians and surgeons .
- To communicate with all staff so that this
plan can be executed ‫نجز‬-‫ او ا‬-‫م‬---‫ت‬
- Teaching
Common Reasons for referring to liaison
psychiatrist
- No organic cause for the physical
symptoms found .
- The symptoms continue despite treatment .
- Behavioural disturbance in the ward .
- Pt. Appear to be unable to manage at
home .
Psychiatric Emergency in general hospital
The successful management of psychiatric
emergency stress of the initial clinical
interview its aim as follow:-
1. To establish a good relationship with the pt.
2. To elicit information from pt. and other
information.
3. To observes pt. behaviour and mental state .
If the pt. Is violent it is essential to arrange for
help , physical contact should not be attempted
unless the pt. agree extrem caution is required .
Somatization Disorders
Problem caused by Somatization Excessive
use of health resources
-Moving from doctor to doctor or from
hospital to hospital
-Complain are not assured by positive finding.
-Hostility develops between patient and
doctor .
-Patients and doctors fail to appreciate the
importance of psychological factors in
developing symptomatology
Diagnosis of somatization disorder
- Somatization is a common
presentation of other psychiatric
disorder Depression is the most
common , Anxiety also present in this
way panic attack , Hyperventilation
syndrome can suggest physical illness .
Management of somatization disorder :

It is necessary to explain the following points

- The person attitude to the referral .
- The person reaction to previous treatment
- The attitude to his or her symptoms.
- What people actually do.
Somatization is an important concept for
All clinicians , 20% of attenders in primary care
there does not appear to be an organic basis for the
symptoms reported .
The essential nature of somatization is the
expression of psychological stress through bodily
symptoms .
Presentation :
people with somatization present to medical services
with physical complaints which the doctor is
unable to explain in organic terms either no
abnormality is found or minor abnormalities
which do not acount for the intesity of symptoms
A number of factors may be contribute
- 1.Social factors
In some cultures it is unacceptable to express
psychological distress , so physical
manifestations are more likely to express .
- 2. Environmental factors
early experience of your own and family
illness contribute to illness behaviour in
later like .
- 3. Personal factor
Principle of treatment of somatization disorder
-acknowledge that symptoms are true .
- Give pt. information about basic physiology
- Elicit from the person about his illness .
- Monitor health related through in the light of their
new knowledge .
- keep a written record of the activities which are
associated with the physical problems.
- Give instruction in relaxation techiques.
Patients who refuse to accept advice
about treatment .
if a pt. has mental illness that impair the
ability to give informed consent , it may be
appropriate to use legal power of
compulsory assessment and treatment .
The successful compulsory treatment of the
psychiatric disorder may result in the pt.
Giving informed consent for the treatment
of physical illness .