Psychiatry Consultation Liaison Service
The NIMH PCLS is a multidisciplinary team that provides psychiatric and psychological consultations for patients enrolled in clinical protocols at the NIH CC, a 200-bed hospital with inpatient, outpatient, and day-hospital facilities, serving 18 different NIH Institutes/Centers at the Bethesda, Maryland campus. The PCLS team includes psychiatrists, a psychologist, social worker and consultation liaison fellows. PCLS consultants provide routine and emergency psychiatry consultations in adult and pediatric patients participating in clinical research at the NIH CC. In addition to direct care, the PCLS provides liaison services to medical teams through its expertise in the management of complex health conditions in a research setting. PCLS consultants also play an integral role in the provision of education, training and outreach in the CC and other non-clinical constituent groups on the larger NIH-campus.
The consult service conducts approximately 450 consults a year; eighty percent of patients seen are adults, 20% are pediatric. In addition to evaluating and managing psychiatric conditions affecting research patients, the team also provides consultation on neuropsychiatric toxicities secondary to experimental therapeutics, and medication interactions. The PCLS team is often asked to address questions that impact on the feasibility of clinical research through the conduct of capacity assessments or baseline mental status and neuropsychiatric evaluations. Other consult questions relate to improving communications between patient and research teams and advising on end-of-life decision-making. In addition to providing direct short-term pharmacologic and psychotherapeutic interventions to patients, members of the PCLS team offer expertise to medical teams through formal educational outreach and participation in rounds as well as in multidisciplinary case conferences. In the case of psychiatric crises, the PCLS intervenes to assess danger to self or others, the need for a petition for psychiatric evaluation or for non-voluntary commitment to an outside hospital.
The PCLS provides excellent educational opportunities for short and long-term trainee rotators at the NIH CC. Fourth-year medical students can apply to complete a 4-week elective with the PCLS. Other NIMH trainees, such as Intramural Research Training Award (IRTA) recipients, visiting students, residents or fellows, may arrange to participate in PCLS weekly case review and clinical walk-rounds on a time-limited basis in order to learn about the interplay between psychiatric conditions and other medical illnesses. Faculty and trainees from the NIH Bioethics Department are regular participants in rounds as are behavioral health nursing staff and other allied disciplines. NIMH Clinical Fellows and Attendings are assigned rotating on-call responsibilities and are available 24/7 to all research subjects enrolled in clinical trials across the CC for psychiatric emergencies. On-call physicians participate in PCLS Friday clinical walk-rounds to effectively transition the care of active patients during weekends and holidays.
Maryland Pao, M.D.
Haniya Raza, D.O.
Joyce Chung, M.D.
Lisa Horowitz, Ph.D., M.P.H.
Deborah Snyder, M.S.W.