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Psychiatry3 > CONSULTATION LIASON > Flashcards

CONSULTATION LIASON Flashcards

1
Q

What is Consultation Liaison Psychiatry (CLP)?

A

The study, practice, and teaching of the relationship between medical and psychiatric disorders.

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2
Q

Who do psychiatrists in CLP serve as consultants to?

A
  • They serve as consultants to:
  • Medical colleagues: other psychiatrists, or other non-psychiatric specialists or primary care practitioners
  • Other mental health professionals: psychologists, social workers, psychiatric nurses, occupational
    therapists, etc
  • Non-medical professionals: in medico-legal cases
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3
Q

In what settings do psychiatrists in CLP assess and treat patients?

A

They asses and treat patients in non psychiatric wards (medical, surgical, etc), in collaboration with primary treating physicians

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4
Q

What is the role of Psychiatrists in CLP?

A
  1. serve as consultants
  2. asses and treat patients in non-psychiatric wards (medical, surgical, etc), in collaboration with primary
    treating physicians
  3. provide in-patient diagnostic and therapeutic programs for patients with medical and psychiatric co-morbidities
  4. provide out-patient maintenance and follow up treatment via variety of psychiatric and medical clinics
  5. conduct intense teaching, training and research in all academic levels and groups
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5
Q

In what kind of cases do CLP psychiatrists serve as consultants to non-medical professionals?

A

In medico-legal cases.

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6
Q

How do CLP psychiatrists assist in non-psychiatric wards?

A

They assess and treat patients in collaboration with primary treating physicians.

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7
Q

What type of programs do CLP psychiatrists provide for patients with medical and psychiatric co-morbidities?

A

In-patient diagnostic and therapeutic programs.

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8
Q

What academic activities do CLP psychiatrists engage in?

A

They conduct intense teaching, training, and research at all academic levels and groups.

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9
Q

What is involved in a bio-psycho-social-cultural assessment in CLP?

A

Conducting the assessment, creating a formulation, and implementing appropriate treatment in a general hospital context, including effective communication with the treatment team.

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10
Q

How does CLP address mental health in medical settings?

A

By assessing reactions to illness and differentiating between presentations of depression and anxiety.

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11
Q

What does CLP consider regarding the trajectories of illness?

A

They understand the combined trajectories of illness and developmental issues of individuals with mental health problems.

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12
Q

What emphasis is placed on neurocognitive disorders in CLP?

A

Emphases on assessing and managing delirium .

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13
Q

What disorders should CLP psychiatrists be able to assess and treat?

A

Somatic Symptom and related disorders.

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14
Q

What special populations have particular needs in CLP?

A

The young, the old, the indigenous,and those with intellectual disabilities, and others with psychiatric and psychosocial morbidity in medical settings.

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15
Q

What is the role of capacity assessments in CLP?

A

Conducting Capacity Assessments in clinical settings and assisting patients and clinicians in obtaining Informed Consent for relevant clinical investigations and treatment.

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16
Q

What are the categories of psychiatric differential diagnoses in the general hospital?

A
  • Psychiatric presentations of medical conditions
  • Psychiatric complications of medical conditions or treatments
  • Psychological reactions to medical conditions or treatments
  • Medical presentations of psychiatric conditions
  • Medical complications of psychiatric conditions or treatments
  • Comorbid medical and psychiatric conditions
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17
Q

What are the steps in the procedural approach to psychiatric consultation?

A
  1. Speak directly with the referring clinician.
  2. Review the current records and pertinent past records.
  3. Review the patient’s medications.
  4. Gather collateral data.
  5. Interview and examine the patient.
  6. Formulate diagnostic and therapeutic strategies.
  7. Write a note
  8. Speak directly with the referring clinician again.
  9. Provide periodic follow-up.
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18
Q

What are the key legal and ethical issues in Consultation Liaison Psychiatry (CLP)?

A
  1. Confidentiality
  2. Health Insurance Related Matters
  3. Treatment Consent and Refusal
  4. Advanced Directives and Substitute Decision Making
  5. Treatment Refusal and Involuntary Treatment
  6. Malpractice
  7. Parental Capacity
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19
Q

List exceptions to confidentiality in CLP?

A
  • Exceptions include public safety
  • welfare, duties to third parties
  • and duties to protect/inform.
20
Q

What is the principle of confidentiality in CLP?

A

Confidentiality is rooted in the Hippocratic oath, emphasizing:
* respect for the individual
* beneficence (doing good), and non-maleficence (avoiding harm).
* It is crucial for building trust but is not absolute; certain situations may require breaching confidentiality.

21
Q

What are exceptions to confidentiality?

A
  • circumstances involving Public Safety and Welfare, where harm to others may occur
  • Duties to Third Parties, which may require disclosure to protect individuals.
  • Duties to Protect/Inform, where a clinician must act to prevent imminent harm.
22
Q

What matters are related to health insurance in CLP?

A

Health Insurance Related Matters->involve understanding coverage and the implications of insurance on treatment decisions, which can affect patient care and access to necessary services.

23
Q

What is involved in treatment consent and refusal?

A

Treatment consent requires Capacity Assessments

24
Q

Why are Capacity assessments used ?

A
  • to ensure patients understand their treatment options and implications.
  • They can then make informed consent and knowledgeable decisions about their care.
25
Q

What are exceptions to informed consent?

A
  • Emergency exception
  • Waiver exception
  • Therapeutic privilege exception
26
Q

What are advanced directives?

A

Advanced directives are legal documents that outline a patient’s preferences for treatment in case they lose capacity

27
Q

What is substitute decision making?

A

Substitute decision making involves appointing someone to make healthcare decisions on behalf of an incapacitated individual, ensuring their wishes are respected

28
Q

What is malpractice in the context of CLP?

A

Malpractice refers to professional negligence where a clinician’s actions fall below the standard of care, resulting in harm to the patient

29
Q

What does parental capacity refer to?

A

Parental Capacity involves assessing a parent’s ability to make informed decisions regarding their child’s welfare and treatment, ensuring that the child’s best interests are prioritized in healthcare decisions.

30
Q

What does “Level of consciousness” include in the mental status examination?

A

Alert, drowsy, somnolent, stuporous, comatose; fluctuations.

31
Q

which emergency condition is characterised by fluctuation in level of consciousness

A

Delirium

32
Q

What does “Appearance and behavior” assess in the mental status examination?

A
  • Overall appearance, grooming, hygiene
  • Cooperation, eye contact, psychomotor agitation or retardation
  • Abnormal movements: tics, tremors, chorea, posturing
33
Q

What does “Attention” assess in the mental status examination?

A

Vigilance, concentration, ability to focus, and sensory neglect.

34
Q

What does “Orientation and memory” assess in the mental status examination?

A

Orientation to person, place, time, situation; recent, remote, and immediate recall.

35
Q

What does “Language” assess in the mental status examination?

A
  • Speech: rate, volume, fluency, prosody
  • Comprehension and naming ability
  • Abnormalities including aphasia, dysarthria, agraphia, alexia, clanging, neologisms, echolalia
36
Q

What does “Constructional ability” assess in the mental status examination?

A
  • Clock drawing to assess neglect, executive function, and planning
  • Drawing of a cube or intersecting pentagons to assess parietal ”function”
37
Q

What does “mood and affect” assess in the mental status examination?

A
  • Mood: subjective sustained emotion,how the patient is feeling
  • Affect: observed emotion—quality, range, appropriateness
38
Q

What does “form and content of thought” assess in the mental status examination?

A
  • Rate of flow
  • Form: it would be linear, circumstantial, tangential, disorganized, blocked
  • Content: delusions, paranoia, ideas of reference, suicidal or homicidal ideation
39
Q

What does “perception” assess in the mental status examination?

A
  • Auditory, visual, gustatory, tactile, and olfactory hallucinations
40
Q

What does “Judgment and insight “ assess in the mental status examination?

A
  • Understanding of illness and consequences of specific treatments offered
  • Reasoning
  • Illogical versus logical; ability to make consistent decisions
41
Q

what are some of Psychiatric Symptoms in Medical Settings?

A
  • Delirium and dementia
  • Depression and anxiety disorders
  • Psychosis, mania, and catatonia
  • Aggression and violence
  • Suicidality and substance-related disorders
42
Q

What are some common defense mechanisms used in response to illness?

A

Common defense mechanisms include rationalization, regression, denial, optimism, pessimism, and others

43
Q

What emotional responses might patients experience due to medical illness?

A

Emotional responses to medical illness can include anger, anxiety, fear, sadness, guilt, and shame.

44
Q

What are adaptive behavioral responses to illness?

A

Adaptive responses include seeking support, altruism, reevaluating life priorities, and becoming an expert on the illness.

45
Q

What are maladaptive behavioral responses to illness?

A

Maladaptive responses include non-adherence to treatment, refusal of care, and discharging against medical advice

46
Q

what are some defense mechanisms that can form of psychological responses to illness.

A

rationalization, regression, denial, optimism, pessimism

47
Q

List the various approaches used to treat psychiatric conditions.

A
  • PHARMACOLOGY
  • PSYCHOTHERAPY
  • ELECTROCONVULSIVE THERAPY
  • BRAIN STIMULATION THERAPIES
  • PALLIATIVE CARE

Psychiatry3 (7 decks)

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