Consultation Liaison Psychiatry

dan Penatalaksanaan Klien dengan Komorbid

OLEH:
NS. HERI SETIAWAN, M.KEP., SP., KEP.J
(CL NURSE)

RUMAH SAKIT JIWA PROF DR SOEROJO MAGELANG

LOGO
 Definition

sub-spesialisasi psikiatri yang

menggabungkan layanan klinis,
pembelajaran (teaching), dan
penelitian di antara psikiatri dan
pengobatan fisik (Lipowski,
1983)
 What is consultation-liaison
psychiatry?
 Liaison psychiatry, is the branch of psychiatry
that specialises in the interface between other
medical specialties and psychiatry
 The psychiatric team works as a "liaison" between
the medical team and the patient.
 Isu yang muncul meliputi kapasitas untuk
menyetujui pengobatan, konflik dengan tim
perawatan primer, dan persimpangan masalah
baik dalam kesehatan fisik maupun mental,
serta pasien yang mungkin melaporkan gejala
fisik sebagai akibat gangguan jiwa.
 CLP Services

Include:
 The physically ill who display co morbidity
 The somatosers,those who complain of somatic
symptoms suggestive of a physical illness, but
not supported by objective medical finding
 Those who either experience psychososial
problems related to physical illness or injury
 Those that suffer from some medical
complications of a psychiatric disorder such as
alcohol, drug abuse, or a suicide attemp

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 The ideal C-L team
(UK guidance for C-L services, 2014)

 Led by a consultant
liaison psychiatrist
 Specialist mental
health nurses
 Clinical psychologist
 Occupational
therapist
 Social workers
 What the psychiatric consultant must do to
perform an effective consultation?
(Goldman, Lee, Rudd: Ten commandments for effective
consultations. Arch Intern Med, 1983)

1. Determine the question:

the requesting physician
and the consultant can have
totally different impressions
of the reasons for which the
consultation was requested
(15%).
Clarifying the reason for the
consultation is not an easy
job sometimes.
How can the consultant clarify the reason
for consultation?

 Can ask for a written

referral note (put a
question to the
consultant)
 Can talk with the
referring physician,
nursing and other
staff before and after
consultation.
 Characteristics of the effective psychiatric
consultant:
2. Establishes the level of urgency.

i.e., emergency (immediate, that should be completed

within an hour time) or routine (that should be
completed within 24 hours).

Typical emergency situations:

1. Evaluation of a patient who expresses suicidal or
homicidal ideation.
2. Evaluation of a patient who is acutely psychotic or
agitated.
3. Evaluation of a patient with severe withdrawal
syndrome (delirium)
 Bodily Restraint

 To prevent serious harm to the person or another

person
 To administer treatment or medical treatment to
the person
Observations:
 Visual observation by RN or medical practisioner
(1:1 observation)
 15 minutes clinical review: persons safety;
dignity; changes in physical health; mental health
and risk
 Medical examination at leat every 4 hours
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 Non crisis intervention of CLP team

 Preventive intervention: behavior change

techniques
 Assisting patient to cope with medical
prosedures
 Assisting patient to better live with chronic pain
and chronic illness
 Liaison with community services for those
requiring treatment and support
 Education on psychiatric nursing: aggression
management

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 The ”formal” The Liaison
consultant psychiatrist

 Set up the Consultation

diagnose – physician centred
 Treat Liaison
 Act as a
– team centred
dispatcher

Member of the team

 Patterns of liaisons

Primary care Primary care

physician physician

Patient Consultant Patient Consultant

Traditional setting Consultation model
Primary care
physician

Patient Consultant
Consultation-Liaison model
Frame Work

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 INTERVENTIONS IN CLP

 Pharmacotherapy
 Review of patient’s existing medications
 Provision of advice on laboratory and
radiological investigations
 Psychotherapeutic interventions CBT, Brief
dynamic psychotherapy, supportive
psychotherapy
 Liaising with other members of the multi-
disciplinary team.
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