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Consultation psychiatrists are skilled clinicians and expert liaisons in the general hospital setting. Clear communication improves the process of the consultation as well as the result, by ensuring accurate, timely, and helpful interventions. The first steps in the consultation process include the institutional and personal organization, consulting individual, patient, consult question and acuteness of the consult. Medications can be the cause and cure formyriad psychiatric issues. Identifying unnecessary and/or psychiatrically offensive medications is a significant part of consultation psychiatry. Anticholinergic medications, benzodiazepines, and narcotics are particularly deliriogenic in the medically ill or debilitated. Interventions other than medications can be helpful as well, including reorienting and reassuring the patient as needed, providing necessary assistive devices (including hearing aids and eyeglasses), using interpretive services when needed, explaining procedures and communicating clearly with the patient, and having family meetings.
Patients with hepatitis C viral infection (HCV) have higher rates of baseline psychiatric disorders. Screening for HCV must be considered for patients in psychiatric practice, particularly when risk factors exist, and in older, less educated males with substance use histories. Close collaboration with a psychiatrist is recommended for patients with co-morbid psychiatric history. Many clinicians advocate prophylactic antidepressants for patients with a history of severe depression or previous depression with interferon (IFN) therapy. The primary treatment for IFN-induced depression is traditional antidepressant therapy; however, a number of adjuvant medications have been utilized to assist with symptomatic relief. Mania may emerge with IFN therapy, during discontinuation of IFN, and with the addition of antidepressants during the treatment course. Once the causes of IFN-induced depression and neuropsychiatric symptoms are better elucidated, a cocktail of adjuvant medications may be developed to minimize side effects.
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