The Rapid Evolution of Consultation-Liaison Psychiatry

SPECIAL REPORT: CONSULTATION-LIAISON PSYCHIATRY

This month, Psychiatric Times features a Special Report on consultation-liaison psychiatry. Twenty years ago, consultation-liaison psychiatry (then officially called psychosomatic medicine) was given official subspecialty status by the American Board of Psychiatry and Neurology, with the first subspecialty examinations offered in 2005. In 2018, the name consultation-liaison psychiatry was officially adopted.¹

The hyphenated title of our subspecialty reflects 2 different and complementary functions of consultation-liaison psychiatry in patient care. Consultation refers to a clinical service offered “directly through consultation with patients,” as is the case with all medical consultants. Liaison refers to clinical services accomplished as “members of interdisciplinary teams by communicating and collaborating with medical and surgical colleagues (ie, liaison services) to optimize patient care.” This emphasizes that liaison functions are to collaborate with and guide other clinicians to facilitate these other clinicians’ care for their patients.²

In consultation-liaison psychiatry, the focus of care is the patient with other medical illness(es), in whom the comorbid psychiatric illness often complicates the management of the primary illness. As such, consultation-liaison psychiatrists work collaboratively with other physicians (and multidisciplinary health professionals) to manage other medical illnesses and psychiatric comorbid illnesses simultaneously. Although the historical foundation of consultation-liaison psychiatry was in the medical center, outpatient consultation-liaison psychiatry practice in settings of high psychiatric comorbidity (eg, HIV, organ transplant, oncology) is becoming more common and is complementary to inpatient consultation-liaison services.

Because of the specific focus on the interface of general medical and psychiatric illness, consultation-liaison clinical service development and scholarship focus substantially on research of other medical illnesses with clinically significant psychiatric comorbidity as well as the development of service models to modernize and enhance the provision of psychiatric services in the general medical setting. The articles included in this Special Report illustrate both goals and offer a contemporary perspective on consultation-liaison psychiatry practice.

A major area of consultation-liaison psychiatry scholarship is the study of psychiatric illnesses commonly encountered in acute medical settings, such as delirium, major neurocognitive disorder, traumatic brain injury, catatonia, neuroleptic malignant syndrome, and serotonin syndrome. In “Catatonia: Where We Are and What’s Next,” Mark A. Oldham, MD; and Jo E. Wilson, MD, PhD, MPH, provide a timely review of this fascinating condition. Although catatonia has been in the clinical literature since the late 1800s, the exact description of its clinical phenomenology, diagnostic criteria, and approaches to clinical management are in continuous evolution. Because catatonia often (but, importantly, not always) presents in the context of another psychiatric illness, management of catatonia must be accomplished in a thoughtful and integrative manner. Catatonia management includes a thorough diagnostic evaluation and often complex psychopharmacology, requiring electroconvulsive therapy for treatment-refractory cases.

The other article in this Special Report describes the recent evolution in the practice of consultation-liaison psychiatry itself, in the context of other medical care. In “Anticipating Care: Proactive Consultation-Liaison Psychiatry,” Sofia Matta, MD; and Patrick Triplett, MD, describe and illustrate the proactive consultation-liaison psychiatry model as applied to the general hospital. Rather than the historically grounded reactive model, where the admitting physician team must decide which patients need psychiatric consultation, the proactive model includes data review for patients with a high risk for psychiatric comorbidity (which may not necessarily have been evident at acute presentation) and then preemptively engages with the admitting physician team to see such patients earlier in the hospitalization. This model requires sophisticated use of data analytics to identify candidate patients. Two major benefits of this model are earlier consultant engagement in care and collaborative engagement in important areas such as placement, discharge planning, and aftercare.

Finally, taking the proactive approach to a higher level, in the CME article “Racing Toward the Fire: Proactive Consultation-Liaison Psychiatry in Critical Care,” Melissa P. Bui, MD, illustrates the application of the proactive model to the critical care unit. The further subspecialization of consultation-liaison psychiatry to critical care psychiatry includes a cohort of consultation-liaison psychiatrists who work exclusively in intensive care units and other arenas of critical care. Having a cohort of critical care psychiatrists as integral members of intensive care unit teams offers greater collegial collaboration and access to psychiatric expertise in the management of substance intoxication/withdrawal, delirium, and catatonia.

Consultation-liaison psychiatry is in a period of rapid evolution, both in terms of illness understanding and management as well as the development of increasingly sophisticated models of integrated care delivery. We hope that this sample of contemporary consultation-liaison psychiatry is helpful and illuminating to our colleagues.

Dr Bourgeois is vice chair of hospital psychiatry services at University of California, Davis Health in Sacramento.

References

1. Lee HB. Journal of the Academy of Consultation-Liaison Psychiatry: a new chapter. J Acad Consult Liaison Psychiatry. 2021;62(1):1-2.

2. What is consultation-liaison psychiatry? Academy of Consultation-Liaison Psychiatry. Accessed February 16, 2026. https://clpsychiatry.org/about-aclp/whatis-clp/