|Year : 2021 | Volume
| Issue : 2 | Page : 164-165
Handbook of consultation liaison psychiatry in India, first edition
Inpatient Rehabilitation Unit, Kingsway Hospital, Derbyshire Healthcare Foundation Trust, Derby, United Kingdom
|Date of Submission||07-Aug-2021|
|Date of Acceptance||04-Sep-2021|
|Date of Web Publication||02-Feb-2022|
Inpatient Rehabilitation Unit, Kingsway Hospital, Derbyshire Healthcare Foundation Trust, Derby
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dua D. Handbook of consultation liaison psychiatry in India, first edition. J Mental Health Hum Behav 2021;26:164-5
Editors: Prof. R. K. Chadda, Prof. Mamta Sood, and Dr. Siddharth Sarkar
In India, provision of mental health services ranges from private outpatient, general hospital outpatient and inpatient units, to exclusive mental hospitals. The division between services from mental and physical illness remains prominent despite the presence of general hospital psychiatry units (GHPUs). Over the last few decades, integration of the two, with a focus on holistic care, is gaining grounds. Consultation–liaison psychiatry (CLP) is a subspecialty of psychiatry which is integral to this approach.
CLP takes its roots from psychosomatic medicine. It essentially involves the care of patients with mental health problems while seeking help for physical health issues. At the same time, an important focus lies in educating and communicating with a physician/surgeon to improve patient outcome. It also helps in better acceptance of mental health interventions and reducing stigma associated with psychiatric disorders.
Although the majority of the psychiatry training in India is done in the GHPUs, there is lack of focus on the CLP. Hence, there is a need to improve the focus on the CLP and improve the resource material related to CLP.
Handbook of Consultation Liaison Psychiatry, edited by Prof. R. K. Chadda, Prof. Mamta Sood, and Dr. Siddharth Sarkar, is an excellent resource for anyone to learn about clinical practice in the CL setting. The book consists of 14 chapters contributed by experts with extensive experience in the area.
The handbook provides an excellent resource for trainees as well as qualified psychiatrists to make use of the same in their day-to-day practice. As the focus lies on clinical application, the chapters are focused on the clinical issues, one is likely to encounter in their day-to-day practice. The authors of each chapter have meticulously researched the topic, with evidence-based recommendations. A list of references is provided at the end of each chapter for those who want to further their understanding into the topic.
In the foreword to the book written by Prof. Randeep Guleria, Director, AIIMS, New Delhi, he accurately describes how the handbook is useful not just to psychiatrists but also doctors from any specialty. Reading this book will be helpful in honing the skills of any doctor to deal with common clinical scenarios such as dealing with an agitated or suicidal patient, stress in the hospital, patients with terminal illnesses, and improving communications with patients and colleagues.
In the first chapter, the authors have highlighted the way CLP is practiced in India and compared it with its evolution in the West. The authors have elaborated on the functions of CLP as well as the models practiced. The authors also write about the challenges and what can be done in the future to overcome these challenges, by adopting an integrative approach.
The second chapter focuses on the challenges faced in the practice of CLP in a low-resource setting. The authors have suggested innovations to improve on the mental health gap, which include improving awareness, increasing collaboration, and promoting specialized training.
In the third chapter titled, “Communication with the nonpsychiatrist clinician: Evolving a common language,” the authors have done a remarkable job in highlighting the importance of communication. Communication gaps are seen in various settings, including while making referrals for mental health issues. The authors have stressed upon the importance of using simple language, limiting the use of abbreviations and specialty specific jargon, and formal and informal meeting to aid communication with doctors from other specialties to provide integrated care to patients. These steps are also beneficial in improving workplace relationships and reducing stigma.
Chapters 4 and 5 deal with the management of agitated and suicidal patients, respectively. These chapters serve as a detailed overview of the causes, epidemiology, and management of these clinical scenarios. As these are encountered fairly frequently, it is an important skill which all clinicians should develop to manage emergencies. The authors provide simplified algorithmic, evidence-based approach which can be employed to manage patients presenting with agitation and suicidal behavior.
In Chapter 6, the authors cover the enigmatic area of medically unexplained symptoms. Assessment, management, and models have been described in depth to empower clinicians to skillfully treat patients presenting with such symptoms.
Another area which warrants focus in the hospital is stress. Stress is prevalent in hospitalized patients as well as anyone seeking help for any kind of physical problems. A bidirectional relationship is often found between medical disorders and stress. In Chapter 7, the authors highlight the high prevalence of stress in medical settings as well as the impact it has on outcome of medical disorders. This is frequently seen in the context of chronic medical disorders.
The next chapter deals with mental health problems in persons with chronic medical disorders. The authors describe common physical illnesses such as diabetes mellitus, cardiovascular diseases, and cancer which have an impact on mental health. In addition, they provide a detailed guide on assessment and management of these patients, keeping in mind the overlapping physical symptoms which can contribute to diagnostic dilemmas. Physicians can be trained to recognize stress and psychological reactions, make appropriate referrals which can help in improving overall outcome of patients. The authors emphasize the impact of psychotropic medications on the underlying medical illness, in addition to the weight of psychosocial interventions.
The subsequent chapters deal with special groups and their care. These include the pediatric age group and end-of-life care. It is important to develop specialized services for these groups to individualize care to improve outcomes, as highlighted in Chapters 9 and 10. Another group which needs specialized care is patients waiting to undergo organ transplant or those who have undergone organ transplantation. This group has high vulnerability to mental health problems, which has a significant impact on the outcomes. Chapter 12 is dedicated to issues in transplant surgery. Chapter 13 covers an important area of addiction psychiatry in the context of the CL setting. It is an area with tremendous potential as a significant proportion of referrals are for substance use disorders when patients are admitted for medical problems. Clinicians have limited skills and resources to deal with patients in withdrawal state or intoxication, leading to poor management and increased risks. Trained CL psychiatrists have the necessary skills to adequately manage these patients in the time of crisis and also formulate a plan for the future.
Chapter 11 covers the area of CLP in the community setting. It is now understood that CL psychiatrist plays an important role in primary care. However, due to limitation of resources, the same has not come into practice. The authors have described the various models which can be brought into practice in India. Telepsychiatry serves as essential role in this regard and as immense potential for expansion.
Overall, the handbook serves as an all-inclusive guide for any psychiatrist. Its scope stretches beyond the CLP unit at a tertiary care GHPU and extends from primary to specialized care. The editors have done a remarkable job in selecting appropriate topics which are encountered in daily practice.
I hope we see regular updates after this first edition, to serve as essential reading for all psychiatry trainees in India.
Financial support and sponsorship