Consultation-Liaison Psychiatry

Many geriatric psychiatry cases are initially encountered in the general hospital or emergency room, where the psychiatric services rendered are accomplished by the consultation-liaison psychiatry (formerly psychosomatic medicine) service. As such, the areas of responsibility of consultation-liaison psychiatrists and geriatric psychiatrists overlap significantly. Specific areas of clinical expertise that are priorities for consultation-liaison psychiatrists include determinations of decisional capacity, evaluation and management of neurocognitive disorders, and assessment and management of catatonia, neuroleptic malignant syndrome, serotonin syndrome, and the toxicity states associated with CNS-active medications. The psychotherapeutic role of the consultation-liaison psychiatrist is commingled with the medical management role. Patients in the hospital, particularly geriatric patients, are at risk for many psychiatric syndromes (including depressive disorders and posttraumatic stress disorder) that are directly referable to the disruptive and traumatic experiences of medical/surgical illness, traumatic injury, and existential matters of disability and death. Consultation-liaison psychiatry, therefore, is an integrative subspecialty of psychiatry that occupies a crucial place “between” psychiatry and the numerous other medical specialists working with hospitalized patients. The authors highlight some important roles for consultation-liaison psychiatrists and present two complex cases to illustrate the framework of consultation-liaison psychiatry and various illness-specific psychiatric interventions.