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Consultation–Liaison Psychiatry is a centuries-old field of medical practice and research that bridges the biological, psychological, and social domains of psychiatric and medical illnesses. Since 2003, it has been recognized by the American Board of Medical Subspecialties as the psychiatric subspecialty Psychosomatic Medicine, based upon its historical nomenclature. The practice of Consultation Psychiatry usually occurs within general hospital settings. The standard consultation is performed at the request of the primary clinician, and is a neutral collaboration with colleagues and patients in nonpsychiatric settings. Interview techniques in consultations may be open-ended for an individual patient's diagnostic evaluation or structured to screen for psychiatric disorders in a general population. Often a combination of both techniques is utilized. A central role of the consultation psychiatrist is to educate colleagues and patients about the psychiatric presentations or complications of medical illness and about illness behavior. Liaison Psychiatry expands the role of the psychiatrist to facilitate comprehensive treatment approaches within a system of care and to enhance communication among disciplines and across divisions in health care systems. The liaison psychiatrist is often a member of a multidisciplinary care team, performing psychiatric screenings, for example in organ transplant surgery or oncology, when the risks of psychiatric comorbidity are expected to be higher.
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History of Psychosomatic Medicine and Consultation–Liaison Psychiatry
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History of Psychosomatic Medicine
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In the United States, the historical roots of psychiatry in the general hospital are found in the 1751 charter of the Pennsylvania Hospital, which provided for the care of “persons distempered in mind and deprived of rational faculties.” At that time, outpatient psychiatric clinics both in the Philadelphia Hospital and New York's Bellevue Hospital were developed. Reports from these early centers contain themes emphasizing the significant rates of psychiatric disorders in medically ill patients, and the need to integrate services.
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In the modern era, the scientific approach to the relationship between psychiatric disorders and medical illness began with early studies in psychosomatic medicine which examined the relationship between psychological and medical disorders. Psychosomatic medicine as an area of research began with psychoanalytic studies of the mind–body relationship. Beginning in 1900, Sigmund Freud, as a young neurologist, described conversion hysteria as psychological symptoms imbued with deep psychic meaning, which manifested as or converted to somatic (physical) illness. In 1910, Sandor Ferenczi related conversion symptoms to the autonomic nervous system. In 1934, Franz Alexander proposed that ‘psychosomatic symptoms' were due to prolonged autonomic system arousal linked to repressed psychic conflict. Psychosomatic medicine advanced in the 1940s and 1950s with psychophysiological studies such as those by Hans Selye who described the human stress response in relation to adrenocortical hormones. Sociocultural researchers Thomas Holmes and Richard Rahe in 1975 linked disease likelihood to the severity and number of stressful life events, and further expanded the psychosomatic medicine framework. Zbigniew Lipowski in 1970 and George Engel in 1977 utilized systems theory to examine environmental influences on the mind–body–culture paradigm. All ...