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Challenging Consultations

Challenging Consultations

Madeleine Becker, MD, FAPMMadeleine Becker, MD, FAPM


Psychosomatic medicine, or medical psychiatry—also known as consultation-liaison (CL) psychiatry—specializes in the diagnosis and treatment of psychiatric disorders and psychiatric manifestations of complex medical illness.1 CL psychiatrists treat a challenging and diverse patient population both in the general hospital setting and in the outpatient setting. They specialize in the care of patients with comorbid psychiatric and medical illnesses, as well as patients whose psychiatric illness is a direct consequence of a primary medical condition.

Psychosomatic medicine psychiatrists also have expertise in managing psychiatric effects of medical treatments and medications. Their roles include consulting to the patient’s primary medical team, serving as a liaison between the psychiatry service and the primary medical service, and treating patients’ psychiatric disorders while active medical care is being provided.2 Consultation psychiatrists have the unique ability to do this work while navigating the logistics of managing psychiatric treatment of sometimes very complex patients in the general hospital setting.

The Psychiatric Times Special Report on psychosomatic medicine that was published in the March and April issues—the last article in that series appears on page 32 of this issue—includes articles on the management of some of the more challenging consultations seen in the general medical hospital. Topics in neuropsychiatry, oncology, and pediatrics were selected not only to illustrate interesting and challenging issues but also to represent the diversity of the field of psychosomatic medicine.

Drs. Abbasi and TsungWai3 discuss psychogenic non-epileptic seizures (PNES). They review the history, epidemiology, diagnosis, and treatment of PNES. The authors provide an interesting look into the diagnosis with a discussion of the significance non-epileptic seizures hold in the context of a patient’s medical illness, and they suggest ways of communicating with patients who have this disorder.

Drs. Wilson, Denysenko, and Francis4 discuss catatonia, its diagnosis, incidence, and possible etiologies as well as its relationship to delirium. They present the broad and often confusing differential diagnosis for catatonia as well as treatment strategies.

Also included is an article on the role of psychiatric care for patients living with cancer. Drs. Pozo-Kaderman and Pirl5 address some of the varied psychiatric issues that the consultant must take into account when caring for these patients. They discuss the importance of coordination of care, management of medications (including attention to pain control), and the involvement of a supportive care team.


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