Consultation-Liaison Psychiatry: Mind, Body, and the Ward
Core concepts
Consultation-liaison psychiatry addresses psychiatric symptoms in medically ill patients: delirium, adjustment reactions, somatoform presentations, and the psychiatric effects of medical treatments. Know the principles of assessing capacity, managing agitation in the medically ill, and recognising drug interactions. Understand the biopsychosocial formulation in a hospital setting, and the distinction between medically unexplained symptoms and feigning or factitious disorder.
Traps
Questions test whether a symptom is attributable to a medical condition, a substance, or a primary psychiatric disorder. Avoid assuming that a physical symptom without clear pathology is psychiatric; investigate first. Capacity is decision-specific and time-specific, not a global judgement.
Worked example
A patient on the surgical ward becomes agitated and disoriented post-operatively. The rule of thumb: treat delirium first (identify cause, minimise deliriogenic drugs, use environmental measures), then consider psychiatric causes; avoid sedating without addressing the underlying precipitant.
Key points for revision
Capacity is decision-specific; document the reasoning.