[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Behavioral science](https://durgical.com/en/behavioral-science/) › [Somatic treatments and levels of care](https://durgical.com/en/behavioral-science/areas/care/) › Consultation-liaison psychiatry

# Consultation-liaison psychiatry

- Topic

Psychiatry inside the general hospital: helping medical and surgical teams with delirium, depression, capacity and other problems.

Updated Nov 13, 2026

## Key points

- Delirium is the most common reason for hospital psychiatric referral in published series and is often overlooked; the hyperactive form is often mistaken for psychosis.
- The first step is direct communication with the referring doctor to understand the real question, such as ‘can this patient refuse surgery?’.
- Depression in medically ill patients is common, affects the overall outcome and often presents as somatic distress.
- Decision-making capacity rests on four abilities: understanding, appreciation, reasoning and expressing a clear, consistent choice; the level needed rises with the stakes of the decision.
- Do not lean toward dissociative or conversion symptoms from the outset: underlying organic conditions are looked for first.
- Recommendations are communicated directly to the treating doctor, at least by phone, and the patient is followed up, at least within a week.

## What it is

Consultation-liaison psychiatry is the branch of psychiatry that works with patients admitted to general hospital wards and their teams. In consultation, the psychiatrist answers a specific question about one patient; in liaison, the psychiatrist works regularly with a team to improve care, train staff and prevent problems. In published series, delirium is the most common reason for referral, followed by substance use disorders; depression, anxiety, self-harm and physical symptoms without a clear medical explanation are also frequent.

## Step by step

- Talk directly with the referring doctor to understand how they see the case and what the real question is.
- Review the chart, the ongoing treatment and the nursing staff’s observations.
- Introduce yourself carefully: a psychiatric interview is often unexpected for the patient and relatives, so build rapport first.
- Assess mood, anxiety and substance use and, after any self-harm, suicidal intent.
- Examine attention and screen for delirium, the most common reason for referral.
- Write a short formulation: likely diagnosis, link with the medical illness, interactions with the ongoing treatment and immediate risk.
- Communicate the recommendations directly to the treating doctor, at least by phone, and follow up, at least within a week.

## Common referral questions and what to check first

| Referral question | Check first |
| --- | --- |
| [Confused or ‘psychotic’ patient](https://durgical.com/en/conditions/delirium/) | Attention, fluctuation, infection, hypoxia, metabolic causes, medicines: think delirium |
| [‘Depressed’ patient](https://durgical.com/en/conditions/major-depressive-disorder/) | Hypoactive delirium, and medical illness that can present as depression (such as pancreatic cancer); then screen for depression |
| Can the patient refuse treatment? | The four abilities of capacity: understanding, appreciation, reasoning and a clear choice |
| [Agitation days after admission](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/) | Alcohol or other substance withdrawal, delirium |
| [After a suicide attempt](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/) | Medical stabilisation first, then a detailed interview on suicidal intent |
| [Symptoms without a medical explanation](https://durgical.com/en/conditions/somatic-symptom-and-illness-anxiety-disorders/) | A complete medical review first, without leaning early toward a dissociative or conversion explanation |

## Clinical notes

- Depression in the medically ill often presents with somatic distress, and some medical illnesses present as depression, so both are looked for.
- The likely interaction of the needed psychiatric treatment with the ongoing medical treatment is part of the formulation.
- A symptom thought to be functional still needs evaluation for organic causes before that conclusion.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the difference between consultation and liaison?

Consultation answers a specific question about one patient; liaison is ongoing work with a team to improve care and train staff.

## What is the most common reason for hospital psychiatric referral?

Delirium, in published series; it is often overlooked or mislabelled as depression or psychosis.

## A surgical patient refuses an operation and the team asks for a psychiatric consultation. What is the real question?

Whether the patient has decision-making capacity: when someone declines recommended treatment, capacity becomes an essential consideration.

## A hospital patient becomes agitated and the team calls it psychosis. What should be looked for first?

Delirium: its hyperactive form is often mistaken for psychosis.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/behavioral-science/consultation-liaison-psychiatry/)

## Elsewhere in DurgiPedia

- [Decision-making capacity (competence) and how to assess it](https://durgical.com/en/medical-ethics/decision-making-capacity-and-how-to-assess-it/)
- [Refusing treatment, including blood transfusion](https://durgical.com/en/medical-ethics/refusing-treatment-including-blood-transfusion/)
- [Informed consent: elements and how to obtain it](https://durgical.com/en/medical-ethics/informed-consent-elements-and-how-to-obtain-it/)

## Connections

## Related 5

- [Psychological factors in physical illness](https://durgical.com/en/behavioral-science/psychological-factors-in-physical-illness/)
- [The reaction to illness: sick role, illness behavior and hospitalization](https://durgical.com/en/behavioral-science/the-reaction-to-illness-sick-role-illness-behavior-and-hospitalization/)
- [Assessing older adults in mental health](https://durgical.com/en/behavioral-science/assessing-older-adults-in-mental-health/)
- [Psychiatric emergencies: agitation, violence risk and the suicidal patient](https://durgical.com/en/behavioral-science/psychiatric-emergencies-agitation-violence-risk-and-the-suicidal-patient/)
- [Psychiatric symptoms caused by medical illness and drugs](https://durgical.com/en/behavioral-science/psychiatric-symptoms-caused-by-medical-illness-and-drugs/)

## Related conditions 6

- [Delirium](https://durgical.com/en/conditions/delirium/)
- [Somatic symptom and illness anxiety disorders](https://durgical.com/en/conditions/somatic-symptom-and-illness-anxiety-disorders/)
- [Major depressive disorder](https://durgical.com/en/conditions/major-depressive-disorder/)
- [Functional neurological symptom disorder (conversion disorder)](https://durgical.com/en/conditions/functional-neurological-symptom-disorder/)
- [Alcohol withdrawal and delirium tremens](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/)
- [Suicidal behaviour and suicide risk](https://durgical.com/en/conditions/suicidal-behaviour-and-suicide-risk/)

[← All of behavioral science](https://durgical.com/en/behavioral-science/)

Educational content on behavior and the clinical relationship; not a diagnostic or treatment guide and no substitute for assessment by a health professional. If you or someone near you is at risk, seek help now from an emergency service or a mental-health helpline.

Sources: [Assessment of Psychiatric Disorders in Consultation-Liaison Setting](https://pmc.ncbi.nlm.nih.gov/articles/PMC9122156/) (Indian Journal of Psychiatry, PubMed Central, 2022); [Medical Assessment of the Patient With Psychiatric Symptoms](https://www.msdmanuals.com/professional/psychiatric-disorders/approach-to-the-patient-with-psychiatric-symptoms/medical-assessment-of-the-patient-with-psychiatric-symptoms) (MSD Manual Professional Edition, 2024); [Delirium](https://www.msdmanuals.com/professional/neurologic-disorders/delirium-and-dementia/delirium) (MSD Manual Professional Edition, 2025); [A pragmatist’s guide to the assessment of decision-making capacity](https://pmc.ncbi.nlm.nih.gov/articles/PMC6430137/) (British Journal of Psychiatry, PubMed Central, 2019).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/behavioral-science/consultation-liaison-psychiatry/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/behavioral-science/consultation-liaison-psychiatry/