7 Old age psychiatry7.2 Principles of service provision
7.2.3 Liaison with medical specialists
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
A shared clinical question
Liaison brings psychiatric and medical assessment together when illness, treatment and behaviour affect each other. A psychiatric diagnosis does not explain away new physical symptoms. Keep investigating them.
A good referral question states what has changed, over what time course, the person's usual (baseline) function and the decision that needs psychiatric input.
Acute fluctuation in attention or alertness suggests delirium. It needs medical assessment, even when the person already has dementia or psychosis.
Specialty | Common shared problem |
|---|---|
Geriatric medicine | Delirium, falls, frailty, polypharmacy (many medicines at once) and discharge planning |
Neurology | Psychosis in Parkinson's disease, seizures, cognitive decline and abnormal movements |
Oncology and palliative care | Depression, delirium, distress, pain and treatment decisions |
Cardiology and renal medicine | Psychotropic side effects, drug interactions and altered drug clearance |
Ophthalmology and audiology | Loss of sight or hearing adding to hallucinations, isolation or apparent cognitive failure |
Agreeing responsibilities
Share information: the current medicines list and recent changes, relevant examination findings and results, and observations from carers or ward staff.
Build a shared formulation. Separate the direct effects of the disease, the effects of treatment and the person's emotional response. Several may be present at once.
Capacity is assessed for a specific proposed intervention. The treating team explains its benefits, risks and alternatives.
Agree treatment changes with the relevant specialist, especially when reducing dopaminergic medication or changing drugs with cardiac or renal effects.
For example, new visual hallucinations in Parkinson's disease call for a review of attention, infection, vision and medicines. Starting an antipsychotic before this review may worsen motor function or hide a delirium.
Continuity
Written advice says who will prescribe, monitor results, review the response and act if the person deteriorates.
Discharge planning covers unresolved medical and psychiatric problems, follow-up and the support needed to carry out the plan.
Communication with the person explains how the teams' recommendations fit together. Be open about uncertainty and say when the plan will be reviewed.