It is mandatory to care for psychiatric and psychological problems of patients and their families in the general hospital, such as psycho-oncology, by the experts in consultation of mental health. Psychiatric and psychological consultation in the general hospital has similar structure and function as in the general consultation activities in business administration. In the consultation process corresponding with social problem-solving process, the consultant carries out the comprehensive psychiatric and psychological assessment for patent’s problems and also for consultee’s problems, builds a hypothesis of problem formulation and its solutions, and makes a presentation of the hypothesis for consultee. After several revisions of hypothesis and decision-making, the consultant executes the solution for the identified case in collaborating with consultee and other medical staff. In this paper, the author describe the concept of the structure and function of psychiatric and psychological consultation and also the concept of comprehensive psychological and psychiatric assessment and social problem-solving technique, with focusing on the aspect of consultant’s skills.

Liaison psychiatry, also known as Psychological Medicine, is the medical specialty concerned with the care of patients who present with symptoms of both mental and physical health problems regardless of presumed cause. This specialization employs the bio-psychosocial model that addresses the inter-relationship between the physiology, psychology and sociology of human mental health. Liaison psychiatry services are designed to operate apart from traditional mental health settings, mostly in general hospital emergency departments and wards, and for medical and surgical outpatients. Models of service need to be amenable to local flexibility, and close working relationships between all key stakeholders will enable the best arrangements to be developed in each locality. A good liaison psychiatry service could and perhaps should pay for itself if it helps to reduce hospital attendance for those who self-harm and facilitates community support for those in distress. The service will be the least cost effective if it operates in isolation from other services and when it does not act as an agent of change.

Nurses who work in general hospitals with patients’ mental care needs are required functional capability to provide therapy and an environment that supports developmental growth that guarantees safety and security in everyday life of the patient. Because of their particular situation, however, nurses may be faced with a dilemma related to balancing patient needs with the physical risks associated with those needs, or may become emotionally involved with patients caused by their relationship with the patient. The psychiatric liaison nurse clarifies real needs of or relationship between patients in a nurse-patient relationship by grasping the meaning of stories told by both, and interpreting meaning of gap between the stories of both. This task corresponds to "drawing out hidden needs" and "identifying the problem" of a consultation process and is the most difficult task among all processes. In the present article, we focused on the consultation skill in this phase on our experiences.

Various mental health professionals such as psychiatrists or clinical psychologists are involved in consultation-liaison (CL) psychiatry in general hospitals. CL is performed based on psychiatric/psychological assessments. The role of clinical psychologists as members of a CL team includes comprehensive psychological assessment, psychotherapy for patients/families, advice for consultees, and adjusting negative relationships between medical staff and patients/families or among medical staff members themselves. Collaboration with consultees is essential in the CL service. In this review, some models of CL, including the “stepped care” model, which is considered to be useful in building collaborative relationships with consultees, are described. A case example of consultation adopting the cognitive behavior model, provided by a clinical psychologist, is presented.

Living donors of organ transplantation have been reported to experience various psychiatric and psychological problems. A regressive symbiotic relationship between donors and recipients leads to introjection and obtrusion in donors, rebirth fantasy, and rebound neglect. Ambivalent feelings about donor selection lead to feelings of persecution and isolation from family. In addition, donors sometimes exhibit physical, economic and social anxiety, and a depressive state from feelings of guilt toward the recipient. Further, it is necessary to somatic symptoms consider also be a hypochondriac complaints due to mental and psychological problems. These problems can be traced to problems that occur before donation; disclosing all feelings before donation helps prevent psychological problems that occur after donation. In order to cope with these problems, the perspective of surgeons who care for donors continuously before and after donation is very helpful.

Repeated drug overdose is a major risk factor for suicide. Data are lacking on the effect of psychiatric intervention on preventing repeated drug overdose. To investigate whether psychiatric intervention was associated with reduced readmission to emergency centers due to drug overdose. Using a Japanese national in-patient database, we identified patients who were first admitted to emergency centers for drug overdose in 2010–2012. We used propensity score matching for patient and hospital factors to compare readmission rates between intervention (patients undergoing psychosocial assessment) and unexposed groups. Of 29,564 eligible patients, 13,035 underwent psychiatric intervention. In the propensity-matched 7,938 pairs, 1,304 patients were readmitted because of drug overdose. Readmission rate was lower in the intervention than in the unexposed group (7.3% v. 9.1% respectively, p<0.001). Psychiatric intervention was associated with reduced readmission in patients who had taken a drug overdose.

We experienced a case with post-traumatic stress disorder (PTSD) presenting dissociative symptoms and comorbid hyperglycemic confusion revealed by an EEG. The patient was 24-year-old woman with mild intellectual disabilities on presentation, who came from an underprivileged background, and had been abused by her mother during childhood. She had diabetes mellitus from age 16 and became insulin-dependent. Since insulin injection reminded her of her childhood abuse and provoked dissociation, her blood glucose was poorly managed. Her physical and mental instability disrupted her life in her community as well as her relationship with the care supporters, precipitating admission to a general hospital. An EEG recording during an apparent dissociative state provoked by the sight of a needle showed predominantly delta waves with an irregular alpha rhythm, as is consistent with a slight mental disturbance due to comorbid hyperglycemic confusion. We successfully stabilized her blood glucose and concurrently improved her psychiatric symptoms using metformin in the expectation that she would cope with her PTSD symptoms better by taking oral diabetic medication. This case underscores the need to personalize therapy in cases involving collaboration between community and hospital care. Improvement of the patient’s prognosis and quality of life also requires comprehensive perspective on updated knowledge of common diseases on the part of the professionals, the patient’s capacity to cope, and the availability of social capital.