Liaison psychiatry
Encyclopedia
Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry
that specialises in the interface between medicine
and psychiatry, usually taking place in a hospital or medical setting. Liaison psychiatry has areas of overlap with other distinct disciplines including psychosomatic medicine, health psychology
and neuropsychiatry
. The role of the consultation-liaison psychiatrist is to see patients currently admitted as general medical inpatients at the request of the treating medical or surgical consultant or team. This is known as a 'consult' and constitutes the consultation facet of the role.
of a patient to consent to treatment, attempting to settle conflicts between patients with the primary care team, and the intersection of problems in both physical and mental health, as well as patients who may report physical symptoms as a result of a mental disorder, and assessing patients for
abnormal illness behaviour. Delirium
is commonly diagnosed and treated by psychiatrists. Finally, patients who have attempted suicide
and subsequently admitted for medical treatment are generally treated by this field.
In some hospitals, the Consultation-liaison psychiatry team also covers psychiatric presentations to the Emergency Department, while in others doctors from the psychiatric unit will cover this area.
was highly influential for over 1500 years in medicine particularly advocating the use of experimentation to advance knowledge. The polymath physician Avicenna
produced many insights into medicine but only became influential in Western medicine when William Harvey
's elucidation of the circulatory system forced a re-evaluation of Galen
's work. The French philosopher René Descartes
began the dualistic debate on the division between mind and body. Johann Christian August Heinroth
is credited with the origination of the term psychosomatic illness. At the beginning of the 19th century Johann Christian Reil
created the term psychiatry whilst the polymath Benjamin Rush
wrote Diseases of the Mind. The philosopher Spinoza's concept of conation
, Mesmer's development of hypnosis
together with Charcot
's refinement of this technique influenced Sigmund Freud
whose development of psychoanalytic theory
was to have a profound impact on the development of liaison psychiatry. Under the guidance of Alan Gregg, psychoanalysis impacted on hospital medicine through figures such as Franz Alexander
, Stanley Cobb
and Felix Deutsch.
Edward Billings first coined the term "liaison psychiatry." The publishing of two texts A Handbook of Elementary Psychobiology and Psychiatry, by Billings, and Psychosomatic Medicine, by Edward Weiss and O Spurgeon English, outlined the theoretical foundations for the developing field. George L. Engel is considered to have been one of the most important figures in the development of liaison psychiatry and coined the term "Biopsychosocial Model" which overcame divisions created by Cartesian Dualism and was to have wider repercussions on psychiatric practice.
In the United Kingdom
, the Faculty of Liaison Psychiatry was established within the Royal College of Psychiatrists
in 1997. The European Association for Consultation Liaison Psychiatry and Psychosomatics also produced a set of guidelines for training in Liaison Psychiatry. The American Psychiatric Association
formally recognized C-L psychiatry as a subspecialty in 2004, with its own sub-specialty board exam. The profession debated about the best term for this specialty, finally settling on "Psychosomatic Medicine".
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
that specialises in the interface between medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and psychiatry, usually taking place in a hospital or medical setting. Liaison psychiatry has areas of overlap with other distinct disciplines including psychosomatic medicine, health psychology
Health psychology
Health psychology is concerned with understanding how biological, psychological, environmental, and cultural factors are involved in physical health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behavior change in public health promotion,...
and neuropsychiatry
Neuropsychiatry
Neuropsychiatry is the branch of medicine dealing with mental disorders attributable to diseases of the nervous system. It preceded the current disciplines of psychiatry and neurology, in as much as psychiatrists and neurologists had a common training....
. The role of the consultation-liaison psychiatrist is to see patients currently admitted as general medical inpatients at the request of the treating medical or surgical consultant or team. This is known as a 'consult' and constitutes the consultation facet of the role.
Scope
"Consults" occur when the primary care team has questions about a patient's mental health, or how that patient's mental health is affecting his or her care and treatment. The psychiatric team works as a "liaison" between the medical team and the patient. Issues that arise include assessing the capacityCapacity (law)
The capacity of both natural and legal persons determines whether they may make binding amendments to their rights, duties and obligations, such as getting married or merging, entering into contracts, making gifts, or writing a valid will...
of a patient to consent to treatment, attempting to settle conflicts between patients with the primary care team, and the intersection of problems in both physical and mental health, as well as patients who may report physical symptoms as a result of a mental disorder, and assessing patients for
abnormal illness behaviour. Delirium
Delirium
Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...
is commonly diagnosed and treated by psychiatrists. Finally, patients who have attempted suicide
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...
and subsequently admitted for medical treatment are generally treated by this field.
In some hospitals, the Consultation-liaison psychiatry team also covers psychiatric presentations to the Emergency Department, while in others doctors from the psychiatric unit will cover this area.
History
The history of liaison psychiatry is partly a history of psychiatry and medicine. GalenGalen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
was highly influential for over 1500 years in medicine particularly advocating the use of experimentation to advance knowledge. The polymath physician Avicenna
Avicenna
Abū ʿAlī al-Ḥusayn ibn ʿAbd Allāh ibn Sīnā , commonly known as Ibn Sīnā or by his Latinized name Avicenna, was a Persian polymath, who wrote almost 450 treatises on a wide range of subjects, of which around 240 have survived...
produced many insights into medicine but only became influential in Western medicine when William Harvey
William Harvey
William Harvey was an English physician who was the first person to describe completely and in detail the systemic circulation and properties of blood being pumped to the body by the heart...
's elucidation of the circulatory system forced a re-evaluation of Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
's work. The French philosopher René Descartes
René Descartes
René Descartes ; was a French philosopher and writer who spent most of his adult life in the Dutch Republic. He has been dubbed the 'Father of Modern Philosophy', and much subsequent Western philosophy is a response to his writings, which are studied closely to this day...
began the dualistic debate on the division between mind and body. Johann Christian August Heinroth
Johann Christian August Heinroth
Johann Christian August Heinroth was a German physician born in Leipzig.He initially studied medicine in Leipzig, later continuing his education in Vienna under Johann Peter Frank . After briefly studying theology in Erlangen, he returned to Leipzig, where in 1805 he obtained his medical doctorate...
is credited with the origination of the term psychosomatic illness. At the beginning of the 19th century Johann Christian Reil
Johann Christian Reil
Johann Christian Reil was a German physician, physiologist, anatomist and psychiatrist. He coined the term psychiatry or, in German, Psychiatrie in 1808....
created the term psychiatry whilst the polymath Benjamin Rush
Benjamin Rush
Benjamin Rush was a Founding Father of the United States. Rush lived in the state of Pennsylvania and was a physician, writer, educator, humanitarian and a Christian Universalist, as well as the founder of Dickinson College in Carlisle, Pennsylvania....
wrote Diseases of the Mind. The philosopher Spinoza's concept of conation
Conation
Conation is a term that stems from the Latin conatus, meaning any natural tendency, impulse, striving, or directed effort. It is one of three parts of the mind, along with the affective and cognitive...
, Mesmer's development of hypnosis
Hypnosis
Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination."It is a mental state or imaginative role-enactment . It is usually induced by a procedure known as a hypnotic induction, which is commonly composed of a long series of preliminary...
together with Charcot
Jean-Martin Charcot
Jean-Martin Charcot was a French neurologist and professor of anatomical pathology. He is known as "the founder of modern neurology" and is "associated with at least 15 medical eponyms", including Charcot-Marie-Tooth disease and amyotrophic lateral sclerosis...
's refinement of this technique influenced Sigmund Freud
Sigmund Freud
Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...
whose development of psychoanalytic theory
Psychoanalytic theory
Psychoanalytic theory refers to the definition and dynamics of personality development which underlie and guide psychoanalytic and psychodynamic psychotherapy. First laid out by Sigmund Freud, psychoanalytic theory has undergone many refinements since his work...
was to have a profound impact on the development of liaison psychiatry. Under the guidance of Alan Gregg, psychoanalysis impacted on hospital medicine through figures such as Franz Alexander
Franz Alexander
Franz Gabriel Alexander was a Hungarian-American psychoanalyst and physician, who is considered one of the founders of psychosomatic medicine and psychoanalytic criminology.- Life :...
, Stanley Cobb
Stanley Cobb
-External links:* can be found at The Center for the History of Medicine at the Countway Library, Harvard Medical School....
and Felix Deutsch.
Edward Billings first coined the term "liaison psychiatry." The publishing of two texts A Handbook of Elementary Psychobiology and Psychiatry, by Billings, and Psychosomatic Medicine, by Edward Weiss and O Spurgeon English, outlined the theoretical foundations for the developing field. George L. Engel is considered to have been one of the most important figures in the development of liaison psychiatry and coined the term "Biopsychosocial Model" which overcame divisions created by Cartesian Dualism and was to have wider repercussions on psychiatric practice.
In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
, the Faculty of Liaison Psychiatry was established within the Royal College of Psychiatrists
Royal College of Psychiatrists
The Royal College of Psychiatrists is the main professional organisation of psychiatrists in the United Kingdom responsible for representing psychiatrists, psychiatric research and providing public information about mental health problems...
in 1997. The European Association for Consultation Liaison Psychiatry and Psychosomatics also produced a set of guidelines for training in Liaison Psychiatry. The American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
formally recognized C-L psychiatry as a subspecialty in 2004, with its own sub-specialty board exam. The profession debated about the best term for this specialty, finally settling on "Psychosomatic Medicine".