prof elham aljammas APRIL2017 Liaison Psychiatry prof elham aljammas APRIL2017

Liaison psychiatry Covers all aspect of psychiatry relavent to general medicine it is concern with the development of psychological factors in diagnosis , management and prevention of illness . Many illness are now thought to have psychological aetiology and the role of psychological factors becoming clearer in many conditions ( e.g. Coronary artery disease )

- Diagnostic differences are often solved by a thorough assessment of psychological factors . - Psychiatric methods and skills are useful both in the management of chronic psychological and psychiatric illness in general medical setting . - Prevention of illness often involves in change as in behaviour (e.g. Stop smoking , drinking and taking exercise) an appreciation of psychological factors affecting these behaviour is useful .

- Psychiatric training is not necessary for application of liaison psychiatry for example self –poisoning used to be created as psychiatric case but it is increasingly accepted that many of these have no psychiatric

The Role of general hospital staff General hospital medical teams assess and treat many of psychological and social problems under their care , although all the member of the team need to be able to manage these problems psychiatrists and psychologist may provide training and supervision for medical and other members of staff and care for the pts. Who require specialist treatment .

Consultation and Liaison Psychiatry Psychiatric services for general hospital are widely referred to as consultation liaison services . In consultation work the psychiatrist is available to give opinion on pts. referred by physician and surgeons . In liaison work the psychiatrist is a member of medical or surgical team and offer advice about the pt. care .

The aim of liaison Is to increase the skills of other staff in assessment and management of psychological problems . Consultation and liaison units vary in their size and organization and others by a team of psychiatrist nurses , social workers and clinical psychiatrists some liaison services have in pts. Leda for pts. Who are both medically ill. and psychologically disturbe .

The role of liaison psychiatrist To make links with other disciplines . To identify psychiatric disorder. To assess its relevance to any existing organic disorder. To provide a management plan for the individual in consultation with the physicians and surgeons . To communicate with all staff so that this plan can be executed تم او انجز Teaching

Common Reasons for referring to liaison psychiatrist - No organic cause for the physical symptoms found . - The symptoms continue despite treatment . Behavioural disturbance in the ward . Pt. Appear to be unable to manage at home .

Psychiatric Emergency in general hospital The successful management of psychiatric emergency stress of the initial clinical interview its aim as follow:- To establish a good relationship with the pt. To elicit information from pt. and other information. To observes pt. behaviour and mental state . If the pt. Is violent it is essential to arrange for help , physical contact should not be attempted unless the pt. agree extrem caution is required .

Somatization Disorders Problem caused by Somatization Excessive use of health resources Moving from doctor to doctor or from hospital to hospital Complain are not assured by positive finding. Hostility develops between patient and doctor . Patients and doctors fail to appreciate the importance of psychological factors in developing symptomatology

Diagnosis of somatization disorder - Somatization is a common presentation of other psychiatric disorder Depression is the most common , Anxiety also present in this way panic attack , Hyperventilation syndrome can suggest physical illness .

Management of somatization disorder : It is necessary to explain the following points - The person attitude to the referral . The person reaction to previous treatment The attitude to his or her symptoms. What people actually do.

Somatization is an important concept for All clinicians , 20% of attenders in primary care there does not appear to be an organic basis for the symptoms reported . The essential nature of somatization is the expression of psychological stress through bodily symptoms . Presentation : people with somatization present to medical services with physical complaints which the doctor is unable to explain in organic terms either no abnormality is found or minor abnormalities which do not acount for the intesity of symptoms

A number of factors may be contribute 1.Social factors In some cultures it is unacceptable to express psychological distress , so physical manifestations are more likely to express . 2. Environmental factors early experience of your own and family illness contribute to illness behaviour in later like . - 3. Personal factor

Principle of treatment of somatization disorder -acknowledge that symptoms are true . Give pt. information about basic physiology Elicit from the person about his illness . Monitor health related through in the light of their new knowledge . keep a written record of the activities which are associated with the physical problems. Give instruction in relaxation techiques.

Patients who refuse to accept advice about treatment . if a pt. has mental illness that impair the ability to give informed consent , it may be appropriate to use legal power of compulsory assessment and treatment . The successful compulsory treatment of the psychiatric disorder may result in the pt. Giving informed consent for the treatment of physical illness .