Liason Psychiatry

Question 1

What is liason psychiatry?

Answer 1

Liaison Psychiatry is the sub-speciality of psychiatry who work at interface between physical and mental health problems; they provide psychiatric care to patients who are physcially unwell in A&E, medical and surgical wards in which their physical problems and mental healths are linked. They have expertise in the relationship between physical illness, psychological distress and social adversities.

Work with those in whom both physcial and mental health problems equal predominate. For example, wouldn’t look after someone who was diagnosed with diabetes 10yrs ago and is well controlled but now has depression also. But would look after someone with uncontrolled diabetes who developed end organ failure and then develop depression as a consequence of this.

Question 2

Discuss the link between mental & physical health

*NOTE: thinking about venn diagram of long term conditions & mental health problems

Answer 2

Question 3

State some roles of/things that liason psychiatrists do

Answer 3

• Conduct assessments on wards
• Therapeutic work with pts
• Liase with specialists, community psychiatry teams
• Education: students, doctors, trust etc…
• Participate in safeguarding

Question 4

State some common conditions that liason psychiatrists deal with

Answer 4

• Emergency assessements in suicide (in Leicester liason don’t see self-harm as they go to MH triage team)
• Dementia
• Delerium (Is it delerium or a psychiatric condition is common question)
• Depression
• Anxiety
• Medically unexplained symptoms
• Chronic disease
• Perinatal care
• Substance misuse

Question 5

What is meant by dual diagnosis?

Answer 5

· A dual diagnosis is when someone is experiencing mental illness and substance misuse issue

Question 6

For post-natal depression, discuss:

• Prevelance
• Peak time of presentation
• What it is
• Some risk factors
• Signs & symptoms
• What questionnaire can be used?
• Management

Answer 6

• 1 in 10 women, peak presentation at around 3/12 after birth
• Depression related to pregnancy/birth/having a child
• Risk factors (not exhaustive):
  
  • Previous psychiatric disorders
  • Low socioeconomic status
  • Lack of support/poor relationship
  • Stressful life events
  • Premature or complicated birth
• Presentation same as depression
• Edinburgh Postnatal Depression Scale
• Management similar to depression:
  
  • Mild: self-help, additional support, follow up
  • Moderate: CBT or/and antidepressants e.g. SSRIs
  • Severe: CBT, antidepressants e.g. SSRIs, consider admission to mother & baby unit

*Sertraline & paroxetine are SSRIs of choice

Question 7

State some self-help methods for PND

Answer 7

• Balanced healthy diet
• Sleep when baby does
• Talk to family & friends
• Join support groups
• Regular steady exercise
• Try to relax & not put pressure on yourself
• Make an effort to see other people/don’t be isolated
• Accept help

Question 8

For puerperal psychosis, discuss:

• Prevelance
• Peak onset
• What it is
• Signs & symptoms
• Risk factors
• Management

Answer 8

• 1 in 1000
• 2-3 weeks after birth
• Psychosis in days or weeks following birth of baby
• Signs & symptoms include those of psychosis e.g. delusions, hallucinations, thought disorderand others such as depression, mania, confusion
• Risk factors: FH of PP, mother has bipolar or schizophrenia, PH of PP, traumatic or premature birth
• Management:
  
  • Urgent assessment & input from specialist
  • Admission to mother & baby unit
  • Medications (antipsychotics, mood stabilisers, sometimes antidepressants)
  • ECT
  • Support from community perinatal mental health services upon discharge