Definition and Overview
A psychiatry consultation is an appointment with a psychiatrist to obtain his medical opinion on a specific case. Psychiatrists are physicians who specialize in diagnosing and treating mental health disorders. They provide two types of consultations – a patient consultation and liaison psychiatric consultation.
In a psychiatric consultation, the doctor evaluates a patient’s psychiatric condition, taking into consideration various psychological, biological, and social factors. In a liaison consultation, a general practitioner or attending physician consults with a psychiatrist with regards to the treatment and management of patients suffering from medical conditions. This consultation links general medicine and psychiatry.
At the end of the consultation, the psychiatrist will provide a diagnosis followed by treatment recommendations. Seeking this type of consultation protects patients from the serious risks caused by a compromised mental state.
Who Should Undergo and Expected Results
A psychiatry consultation can benefit patients who are suffering from:
- Mental problems
- Chronic diseases
- Risk factors of mental illness
Patients with mental problems
For patients suffering from mental problems, seeking a psychiatric consultation is the first step towards receiving the treatment they need. It is beneficial for patients suffering from or showing signs of mental health illnesses, some examples of which include:
- Bipolar disorder
- Mood or anxiety disorders
- Attention deficit hyperactivity disorder (ADHD)
- Borderline personality disorder
- Dissociative disorders
- Eating disorders
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
At the end of a psychiatric evaluation, the patient or his family will be given a differential diagnosis, treatment recommendations, and practical advice on how to (a) manage the patient’s symptoms and (b) deal with the patient’s condition in the long run.
The differential diagnosis will give patients and their families an insight as to the possible sources of the problem, which could be due to biological, psychological, or social factors.
Biological causes may include:
- Inherited condition
- Poor nutrition
- Physical illness
Psychological causes may include:
- Childhood experience
Social causes may include:
- Relationship problems
- Cultural issues
Patients with chronic diseases
Chronic medical conditions such as heart disease and diabetes, among others, can significantly affect the lives of patients who may suffer from a vulnerable mental state as a result of their condition. Thus, they can also benefit from a consultation with a psychiatrist, usually as part of their treatment plan. The consultation is typically requested or facilitated by their attending physician.
These patients are most at risk of suffering from anxiety, depression, and in severe cases, suicidal attempts. Thus, incorporating psychiatric care in their treatment plans is highly important. At the end of the liaison consultation, the psychiatrist can provide treatment recommendations that can be performed alongside the patient’s existing medical care plan.
The rise of liaison psychiatry is backed by studies that show how people suffering from medical and surgical health conditions also suffer from psychiatric disorders in one form or another.
Patients at risk of mental illness
People who are at risk of mental illness should also undergo a psychiatry consultation to monitor their condition and assess their risk factors, which include:
- Having a family history of mental illness
- Stressful life events, such as death, divorce, medical condition, or financial problem
- Traumatic experiences
- Trauma or injury to the head causing brain damage
- Use of recreational drugs
- Frequent alcohol consumption
- Child abuse
How the Procedure is Done?
A psychiatric consultation takes around 45 minutes to an hour and usually takes place in the psychiatrist’s clinic or office. Upon arriving at the office or clinic, patients may be asked to fill up a patient survey, which will help familiarize the psychiatrist with the case at hand and provide him all the information he needs.
A consultation with a psychiatrist typically involves:
- Evaluation of the patient’s medical and psychiatric history
- Assessment of previous mental records
- Assessment of the patient’s family history of psychiatric illness
- Assessment of the patient’s history of substance abuse
- Discussion of the patient’s symptoms
- Discussion of possible causes of the mental problem or the patient’s social history
- Discussion and evaluation of previous treatments, medications, and hospitalizations
- Formulation of a treatment plan
- Prescription of medications, if necessary
If the psychiatrist needs more information, he can request for:
- Psychological evaluation
- Physical exam
- Lab tests
Treatment plans may involve:
- Medications, such as antidepressants, anti-anxiety medications, mood stabilizers, and antipsychotic medications
- Brain stimulation
- Residential treatment
- Support group
The psychiatrist may also prescribe some lifestyle changes, such as:
- Quitting smoking
- Avoiding alcohol and illegal drug consumption
- Proper diet
Since proper care and management of psychiatric problems require the participation of family members or primary care providers, the patient should be accompanied by a concerned companion during the consultation.
After the consultation, the patient is not obliged to push through with the proposed treatment and is free to seek a second opinion from a different psychiatrist. If, however, he decides to push through with the recommended treatment plan, the psychiatrist will schedule follow-up appointments that are spaced about 2 to 3 weeks apart. These follow-up appointments will last for only around 30 minutes and will mainly involve monitoring the patient’s symptoms and his response to medications so that changes may be made, such as adjusting the dosage of medications, when necessary. Once the patient’s condition begins to improve, the appointments may be reduced to just once every 1-3 months.
Possible Risks and Complications
There are no risks involved in a psychiatry consultation. In fact, it can help protect a person who is suffering from a mental or a medical condition from the risks and possible complications of psychiatric disorders. These include:
- Decreased enthusiasm in life
- Social isolation
- Problems with relationships and families
- Health problems
- Substance abuse
- Work-related or school-related problems
- Financial problems
- Legal problems
- Harm to others such as homicide
- Self-harm such as suicide
These complications can affect the patient in various degrees of severity. If left untreated, they can lead to an irreversible deterioration of the patient’s condition. Thus, before these complications arise, it is best to consult a psychiatrist.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.
Bui E, Pollack MH, Kinrys G, Delong H, Vasconcelos e Sa D, Simon NM. The pharmacotherapy of anxiety disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 41.