Almost by tradition, the reason that a psychiatric consultation is requested is vague and imprecise. Requests can range from "depression" to " patient is being difficult" and sometimes this is because the consulting service is not completely sure why the consultation is to be called. Consultations are sometimes called because of an actual psychiatric problem and at other times because of feelings of countertransference by the treating team. There are several steps that are valuable to go through when approaching almost any consultation case, although most cases aren't a straightforward as the sequence would tend to suggest.
To help organize consultation data on an initial visit, its Initial Consultation Organization Worksheet that can be downloaded and printed. This sheet also includes the draw a clock test, which can be very helpful in assessing delirium.
Gathering data
Communicate
The first step for consultations receives is to begin a dialogue with the team member whose request to the consultation. This can provide valuable information in terms of the setting of the consultation and how the remainder of the information can be approached.
Chart
The next part of the initial step is to perform a complete review of the patients current and pertinent past medical records. In this position a psychiatric consultant is able to focus on details that may be overlooked by others. in particular, one should be alert for various neurobehavioral data from different disciplines that can be documented in the chart, such as the patient's level of awareness, ability to engage in different activities, and general functioning in terms of attention and memory.
Medication
It is important to create a detailed history of any medication prescriptions or changes that have occurred in the time leading up to admission. Even after a patient is hospitalized, it is important not only to have a list of medications that are prescribed or that have recently been changed, but also to know the actual amounts of prn medications a patient has received.
Laboratory tests
Laboratory test should be reviewed for all patients for whom a psychiatric consultation is requested. Although the reasons for this can be obvious in patients who are exhibiting potential delirium, laboratory abnormalities can also exert influence on other psychiatric symptoms as well. It is especially important to explore potential signs of infection, metabolic changes, and endocrine abnormalities. As a general rule, most patients seen by psychiatric consultation service should have thyroid function testing.
Mental Status Exam
The mental status exam is a vital part of the psychiatric assessment. It is explained in detail on the mental status exam page.