Psychiatry consult guide

Psychiatry consult guide

Jan 22, 2019 0
onthephones
Editor:  Grace Leo
Reviewed:  Malcolm Forbes

Contributor: Myles Gutkin

  • Patient’s name, age, UR, existing psychiatric diagnosis (if patient has one).
  • Why is the patient in hospital and what question or issue are you seeking help with? (I.e. do you want phone advice, do you need an urgent review, is it a diagnostic or management issue?)
  • Providing this information right at the beginning helps orientate the registrar and will help them hone in on specific information you present.
  • Report Mental Health Act Status: Is the patient scheduled, specialled, on a community treatment order or known to a psychiatrist?
  • Assess risk of harm to self or others. If patient is deteriorating rapidly, get help and consult early.
  • Perform basic MSE – are they currently co-operative, over-sedated, agitated, aggressive?
  • Context: What has happened, why has it led to hospitalisation? What is the primary condition being treated and the medical team’s current plan for investigations/prescription and length of stay?
  • Past psychiatric history and any provisional diagnosis.
    • If they have community psychiatry input?
    • What medications does the patient usually take? Are they taking these?
  • Current symptoms (e.g. depressed mood, expressing suicidal thoughts, hypomanic, manic, psychotic).
  • How the patient has been coping with their medical illness and have they been compliant with treatment?
  • Are they in obvious emotional pain or have an elevated likelihood of harm or poor treatment?
  • Risk of harm to self or others?
  • Any known triggers or associated factors?
  • What social supports does the patient have?
  • Medications: particularly psychotropics, opiates, benzodiazepines and steroids.
  • Substance use history including what substances are used and whether there are any signs of current intoxication or withdrawal.
  • Previous mental health assessments/correspondence from GP or private psychiatrist relating to existing mental illness.
  • MSE – a generic comment about behaviour may be most useful over the phone. For example: is the patient withdrawn/interactive/cooperative/uncooperative/aggressive/confused/threatening staff/needing to be specialled (one-on-one nursing care), brief cognitive assessment to screen for delirium (orientation to person, place and time, patient able to recite months of the year backwards).
  • Investigations where relevant:
    • Urine drug screen and urinalysis.
    • ECG: Psychotropic agents may prolong QT interval and lead to ventricular arrhythmias.
    • EUC: check for hyponatraemia caused by SSRI or renal injury.
    • FBC to check WCC or CRP if delirium suspected.
    • Serum levels for medication such as lithium, sodium valproate, clozapine.
  • How is the treating team coping with the patient?
  • Who suggested the referral – patient request or medical team?
  • Organising for an interpreter if the patient needs an interpreter.
  • Failing to identify alcohol or drug dependence or withdrawal.
  • Assuming that behavioural disturbance implies psychiatric illness in the presence of more likely causes.

Tags: #consult guide,#junior doctors,#Mental Health Act,#psychiatry,#requesting a consult

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