Psychiatry: disorder groups
Consultation-liaison (psychosomatic) psychiatry
Consultation-liaison psychiatry is psychiatry practised in the general hospital, for patients whose physical and mental health problems interact. Psychiatrists assess delirium, self-harm, depression in medical illness and capacity, and advise medical and surgical teams.
Depth by stage, Pre-U → Consultant (details)
What is it?
Many people in hospital for physical illness also have mental health problems: confusion, depression after a heart attack or stroke, anxiety about surgery, alcohol withdrawal, or overdose. Some physical symptoms have psychological causes, and some psychiatric symptoms have physical causes.
Consultation-liaison (C-L) psychiatrists, also called liaison or psychosomatic psychiatrists, see these patients on medical and surgical wards and in the emergency department, and train other staff to recognise and manage mental health problems.
In Malaysia, most general hospital psychiatric departments provide a referral (consultation) service to other wards, and C-L psychiatry is one of the recognised subspecialty areas.
Why does a psychiatrist need it?
Liaison work is a daily part of psychiatry in Malaysian hospitals. Psychiatrists need to understand medical illness and drugs, assess capacity to consent or refuse treatment, manage self-harm safely, recognise delirium and organic causes, and communicate clearly with colleagues in other specialties.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalNot expected
- ClinicalAwareAware that psychiatry provides a referral service to other wards.
- HousemanshipUnderstandsMakes appropriate psychiatric referrals and manages simple mental health needs on wards.
- Medical officerAppliesSees ward referrals and emergency cases, presenting to the specialist.
- Psych traineeMasters / TeachesIndependently assesses complex referrals, capacity and risk; examined in Part II and MRCPsych.
- Specialist / consultantMasters / TeachesLeads the liaison service; C-L subspecialists set up specialist pathways.
What are the key topics?
Common referrals
- Delirium and confusion
- Self-harm and overdose
- Depression and anxiety in medical illness (cancer, heart disease, stroke, diabetes, HIV)
- Alcohol and drug withdrawal
- Functional and somatic symptoms
- Psychiatric patients with medical problems
- Refusal of treatment and capacity questions
Knowledge needed
- Psychiatric presentations of medical illness (thyroid, adrenal, autoimmune encephalitis, brain tumours)
- Drug interactions and prescribing in liver, kidney and heart disease
- Psychological reactions to illness and coping
- Pain and psychiatry
- Psycho-oncology and palliative care
- Psychiatric aspects of organ transplantation and ICU
Skills
- Rapid focused assessments in busy wards
- Capacity assessment and documentation
- Clear written advice to referring teams
- Teaching ward staff
- Working within the multidisciplinary team
How is it learned and assessed?
- Housemanship (seeing referrals from the other side)
- MO and trainee liaison rotations
- MMed Part II; MRCPsych Paper B and CASC (e.g. capacity assessment station)
- Subspecialty fellowship for C-L psychiatry
Typical textbooks and resources
- Handbook of Liaison Psychiatry — Cambridge University Press
- Lishman's Organic Psychiatry — Wiley-Blackwell
- The Maudsley Prescribing Guidelines in Psychiatry — Wiley (prescribing in physical illness)
- Oxford Handbook of Psychiatry — Oxford University Press
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Why would a psychiatrist see a patient in a medical ward?
Because mental and physical health interact. A psychiatrist may be asked to assess confusion, low mood after illness, an overdose, alcohol withdrawal or whether a patient can make a decision about treatment.
What is a capacity assessment?
A check of whether a person can understand, remember and weigh information about a decision and communicate a choice. Psychiatrists are often asked to help when capacity is in doubt.