Consultation-Liaison Psychiatry and Emergency Psychiatry
Consultation-liaison
Assess psychiatric symptoms in medical illness: delirium, depression in chronic disease, anxiety, somatoform presentations, self-harm, and capacity. Understand the biopsychosocial formulation in medically ill patients, drug interactions, and the effect of physical illness on mental state.
Emergency psychiatry
Risk assessment (suicide, self-harm, violence, vulnerability), acute agitation management (de-escalation first, then pharmacological), acute psychosis, acute intoxication and withdrawal, and the violent or absconding patient. Always consider medical causes of agitation (hypoglycaemia, hypoxia, head injury, sepsis, anticholinergic toxicity).
Traps
Attributing agitation to psychiatric illness without excluding physical causes; over-sedation; missing delirium in older patients; ignoring collateral information; failing to document risk and safety plans.
Worked rule of thumb
In any emergency presentation with new agitation or confusion, check glucose, oxygen saturation, temperature and neurological status before psychiatric formulation. De-escalation and environmental measures precede medication.