Many geriatric psychiatry cases are initially encountered in the general hospital or emergency room, where the psychiatric services rendered are accomplished by the psychosomatic medicine consultation service. As such, the areas of responsibility of psychosomatic medicine psychiatrists and geriatric psychiatrists overlap significantly. Specific areas of clinical expertise that are priorities for psychosomatic medicine psychiatrists include determinations of decisional capacity, evaluation and management of neurocognitive disorders, and assessment and management of catatonia, neuroleptic malignant syndrome, serotonin syndrome, and the toxicity states associated with centrally acting medications. The psychotherapeutic role of the psychosomatic medicine psychiatrist is coequal with the medical management role. Patients in the hospital, particularly geriatric patients, are at risk for many psychiatric syndromes (including depressive disorders and posttraumatic stress disorder) that are directly referable to the disruptive and traumatic experiences of medical/surgical illness, traumatic injury, and existential matters of disability and death. Psychosomatic medicine, therefore, is an integrative subspecialty of psychiatry that occupies a crucial place “between” psychiatry and numerous other medical specialists working with hospitalized patients. The authors highlight some important roles for psychosomatic medicine psychiatrists and present two complex cases to illustrate the framework of psychosomatic medicine and various, illness-specific psychiatric interventions.
Consult-liaison Psychosomatic medicine Interface Assessment Decisional capacity Medical/surgical illness Delirium Catatonia Toxicity Holistic Biopsychosocial Trauma-informed Communication
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