Consultation/Liaison Psychiatry During Covid-19

Robert Frierson,University Of Louisville

doi:10.18297/jri/vol5/iss1/33

Robert Frierson, University Of Louisville

Open Access

https://doi.org/10.18297/jri/vol5/iss1/33

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Abstract

Consultation/liaison psychiatrists care for people with co-existing medical and psychologic difficulties. The coronavirus pandemic is stressful for patients and their psychiatric caregivers. Patients have lost support systems and harbor fears about exposing family to the virus. COVID-19 sometimes exacerbates previous psychiatric conditions, while diminishing intimacy with physicians. Everyone is oversaturated with COVID-19-related news focusing on rising concerns about the illness and about jobs, school, and housing insecurities. The psychiatrist maintains a hospital presence despite fear of contracting the disease. Challenges include addressing staff morale, evidencing empathy despite telecommunication devices, and treating anxiety, depression, sleep phobias, post intubation flashbacks, COVID-19-induced cognitive disorders, and/or drug and alcohol addiction or withdrawal. They also provide support to patients who otherwise would die alone. The consultant must value small clinical successes, debrief beleaguered colleagues, offer support to hospital staff, and deliver psychotherapies to bolster patient comfort and autonomy. They prescribe pharmacotherapies that address psychiatric concerns without adversely affecting medical conditions. To decrease professional burnout from COVID-19-related issues, psychiatrists should attend to self-care and precautions designed to maintain the safety of their family.

Highlights

Consultation/liaison (C/L) psychiatry is a subspecialty that focuses on treating people with mental health disorders that co-exist with medical conditions.[1, 2] As part of patient evaluations, the C/L psychiatrist relates to and contends with the issues of others beside the patient: physicians, nurses, family, visitors, and patient roommates.[3]
Patients are often unaware that a psychiatric consultation has been requested; they may wonder whether their doctor questions their state of mind
The responsibilities of the C/L psychiatrist include evaluations after a suicide attempt or for suspected suicidal ideation or plans; they manage psychiatric sequelae resulting from medical conditions, provide care for pre-existing mental disorders, assess decisional capacity, and treat substance abuse, including withdrawal states

Summary

Introduction

Consultation/liaison (C/L) psychiatry is a subspecialty that focuses on treating people with mental health disorders that co-exist with medical conditions.[1, 2] As part of patient evaluations, the C/L psychiatrist relates to and contends with the issues of others beside the patient: physicians, nurses, family, visitors, and patient roommates.[3]. The COVID-19 pandemic has created many economic, psychosocial and mental health difficulties for those affected and for anyone who employs protective measures such as social isolation, quarantine, and/or widespread lockdowns.[5, 6] This pandemic has had discomforting implications for the psychosocial well-being of patients and medical caregivers. When PPE is limited, supplies must be prioritized to those most directly involved in close patient contact, but if scarcity is less of an issue, having the psychiatrist at the bedside lets other clinicians know: “we are all in this together.” They serve as good examples to other healthcare workers of the importance of personal care and that it can be done safely.

Helplessness and loss of control

Conclusion