0
1

Clinical consultations are evaluations requested by other physicians or health care professionals, patients, families, or others for the purpose of assisting in the diagnosis, treatment, or management of an individual with a suspected mental disorder or behavioral problem. These evaluations may be comprehensive or may be focused on a relatively narrow question, such as the preferred medication for treatment of a known mental disorder in a patient with a particular general medical condition. Psychiatric evaluations for consultative purposes use the same data sources as general evaluations. Consideration is given to information from the referring source on the specific problem leading to the consultation, the referring source's aims for the consultation, information that the psychiatrist may be able to obtain regarding the patient's relationship with the primary clinician, and the resources and constraints of those currently treating the patient. Also, in the case of a consultation regarding a mental or behavioral problem in a patient with a general medical illness, information about that illness, its treatment, and its prognosis is relevant. The patient should be informed that the purpose of the consultation is to advise the party who requested it. Permission to report findings to others, including family, needs to be clarified with the patient and other concerned parties before the evaluation begins.

The aim of the consultative psychiatric evaluation is to provide clear and specific answers to the questions posed by the party requesting the consultation (36, 37). For example, the psychiatrist may be asked to determine the patient's capacity to give consent for treatment decisions. On other occasions, the psychiatrist may be asked to assess a particular sign, symptom, or syndrome; provide a diagnosis; and recommend evaluation, treatment, or disposition at a level of specificity appropriate to the needs of the treating clinician.

In the course of the evaluation, the consultant may also identify a diagnostic or therapeutic issue that was not raised in the request for consultation but that is of concern to the patient or of relevance to treatment outcome. For example, treatment adherence may be affected by personality and countertransference issues that compromise the patient's therapeutic alliance with the referring clinician. If any conflicts between the patient and the primary clinician do emerge as an issue, positive resolution of them should be encouraged in a manner that respects the patient's relationship with the primary clinician.

If agreed to by the patient, discussion of findings and recommendations with the family or involved persons can assist with appropriate follow-up and adherence with recommendations.

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 1.  >
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 3.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 1.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 2.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 4.  >
Psychiatric News
PubMed Articles
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation