Consultation-Liaison and Emergency Psychiatry: Risk and Medical Complexity
This domain emphasizes safety, medical comorbidity, and rapid decision-making. In the emergency setting, assess suicide risk, violence risk, agitation, and capacity. Know the difference between danger to self, danger to others, and grave disability as commitment criteria, and understand that these are legal standards varying by jurisdiction. Delirium is the most common psychiatric emergency in medically ill patients; identify and treat the underlying cause. Catatonia is a medical emergency responsive to benzodiazepines and ECT.
Traps
- Attributing agitation in a medically ill patient to a primary psychiatric disorder.
- Missing serotonin syndrome, NMS, or anticholinergic toxicity.
- Confusing decisional capacity with competence, which is a legal determination.
- Overlooking withdrawal states (alcohol, benzodiazepine) as causes of seizures and delirium.
Rule of thumb
In any emergency vignette, sequence: safety first, then medical rule-out, then psychiatric formulation, then disposition. Worked example: an agitated patient with fever, rigidity, and elevated CK after starting an antipsychotic-stop the agent, treat supportively, and consider dantrolene or bromocriptine for NMS; do not simply add a sedative.