1. CONSULTATION-LIAISON PSYCHIATRY: AN AUSTRALIAN EXPERIENCE.BY
DR HENRY AGHANWA,
MBBS, FWACP, FRANZCP

2. Consultant Psychiatrist Toowoomba Base Hospital Toowoomba, Queensland Australia Senior Lecturer (Psychiatry) Rural Division, School of Medicine University of Queensland Toowoomba Queensland Australia

3. DEFINITIONS
Consultation-Liaison Psychiatry is defined as consultation to and collaboration with the non-psychiatric specialist in the management of a patient with a primary physical condition complicated by psychiatric comorbidity in the general hospital setting or any other health facility

4. Consultation Psychiatry
The provision of assessment and intervention to a patient with primary medical condition who has developed a psychiatric complication.
It is reactive

5. Liaison Psychiatry
The is the conduction of an exploration with the intent of carrying out a mediatory role between a patient with primary physical condition and the treating team.
It is proactive
It helps to improve the interpersonal relationship between the treatment team and the patient
It prevents the development of a full-fledged psychopathology or prevents the deterioration of the primary physical condition.

6. Synonyms Consultation-Liaison Psychiatry Psychosomatic Medicine
General Hospital Psychiatry
Medical/surgical Psychiatry
De facto Psychiatry

7. The areas of activities
Mainly inpatient settings
Some outpatient settings
The settings include the medical, surgical, and obstetric units, ICU, coronary care unit, burnt unit, renal unit, oncology unit, palliative unit.
Paediatric unit- for the child & adolescent psychiatrist.

8. Settings cont’d
The outpatient units include general and medical speciality clinics (renal unit and ANC)

9. Areas of interest within CLP
Psychooncology
Psychonephrology
Psychosomatic Obstetrics and Gynaecology
CLP of Cardiology and Gastroenterology
General CLP

10. Theoretical Basis
CLP was originally based on psychosomatic medicine which was the body of theoretical information put together by psychoanalysis.
CLP has been described as the clinical pendant of psychosomatic medicine
Biopsychosocial is emphasized
Adolf Meyer’s psychobiological approach was the starting point of CLP in the USA where its practice began

11. Scope of the CLP service
Psychiatric assessment and intervention in the non-psychiatric speciality context Assessment of capacity/competence to accept or refuse treatment of a general medical condition Education of non-psychiatric team on mental health

12. Scope cont’d
Collaboration with non-psychiatric specialists in research at the interface between physical and psychological medicine
Provision of support to the non-psychiatric specialists in the management of psychiatric condition in the general medical context.

13. Conditions commonly encountered
Anxiety related conditions such as generalized anxiety disorder
Affective Disorders such as depressive episode
Psychotic disorders (e.g. acute and transient psychotic disorder)
Cognitive disorders (e.g. Delirium, Dementia)
Addiction disorders
Somatoform disorders (somatization disorder)

14. Conditions commonly encountered cont’d
Adjustment Disorders
Personality Disorders

15. INTERVENTIONS IN CLP Pharmacotherapy
Review of patient’s existing medications
Provision of advice on laboratory and radiological investigations
Psychotherapeutic interventions CBT, IPT, Brief dynamic psychotherapy, supportive psychotherapy
Liaising with other members of the multi-disciplinary team.

16. Models of CLP Consultative model Joint endaevour model Outpost model
In practice services are often adapted to local situations or developed to serve the peculiar needs of a situation. No two services are identical

17. Staff Composition A psychiatrist A nurse Psychologist Social Worker
Psychiatry registrar

18. Special Skills of a CL psychiatrist
Understanding the interaction between psychotropic and non-psychotropic medications
Understanding the interaction between psychotropic medications and compromised medical (physical) state.
Skills in communication with other specialists
Knowledge of the overall medical settings

19. Challenges
The use of psychopharmalogical agents in the presence of compromised physical status
The possibility of an interaction between medications for physical and those of mental illness.
The tendency of some non-psychiatric specialists to reject the mentally ill patient due to stigma
Determining when to evoke the guardianship administration or the mental health act

20. Determining when to transfer the mentally disruptive patient from the non-psychiatric unit to the psychiatric facility
Working with two clients—the referring specialist, and the referred patient.

21. Emerging Issues
The reluctance of the health insurance to fund mental treatment for a physically unwell person.
The confusion between CL as a sub-speciality and as a process.
The ongoing debate on who funds the CLP? the general hospital or the psychiatric service?

22. Training in CLP
In a 5-year postgraduate program in psychiatry leading to the award of the Fellowship, a 6 month rotation in CLP is mandatory. However, any interested registrar can spend an additional period of 6 months as a part of his advanced training. Doing this will enable the registrar to obtain a certificate in advanced training in addition to the fellowship.

23. References
J A. Bourgeois, D M. Hilty, M E. Servis and R E. Hales. Consultation-Liaison Psychiatry
Advantages for Healthcare Systems
Dis Manage Health Outcomes 2005; 13 (2): REVIEW ARTICLE

24. Aghanwa HS, Morakinyo O, Aina OF
Aghanwa HS, Morakinyo O, Aina OF. Consultation-liaison psychiatry in a general research? J Psychosom Res 1995; 39:
hospital setting in West Africa. East Afr Med J 1996; 73: 133-6

25. Aghanwa HS.
Consultation-liaison Psychiatry in the main
general hospital in Fiji-Islands. Pacific Health
Dialog (Asia- Pacific) 2002; 9(1):