Second-year child and adolescent psychiatry fellow Zargham Abbas, MD, likens consult-liaison psychiatry to detective work, where the psychiatrist collaborates with a team of multidisciplinary clinicians to uncover clues about what’s going on with a patient—typically someone with complex medical challenges—and develop a diagnosis and treatment plan.
It’s one of the subspecialties Abbas is most drawn to, and Duke’s consult-liaison (CL) psychiatry services made it a top fellowship option for him as he wrapped up his residency at the University of Missouri–Kansas City. “There are only a handful of [child and adolescent psychiatry fellowship] programs in the country that have really strong pediatric consult-liaison experiences, and Duke is one of them,” Abbas recalled.
“There are only a handful of [child and adolescent psychiatry fellowship] programs in the country that have really strong pediatric consult-liaison experiences, and Duke is one of them.”
— Zargham Abbas, MD
CL psychiatrists care for patients struggling with both mental health and medical conditions, such as individuals with an eating disorder that has led to physical health problems, or people with a chronic disease who suffer from depression. They conduct psychiatric evaluations, make diagnoses, help manage patient medications, and provide referrals to other services, often liaising with other members of the patient’s care team to ensure a comprehensive and integrated approach. Duke Health offers pediatric psychiatry CL services on hospital floors, in the emergency department, and in an outpatient clinic.
Child and adolescent psychiatry fellows participate in a required six-month inpatient and emergency department (ED) CL rotation during their first year of fellowship and have the option to pursue an outpatient CL elective in their second year. Abbas has embraced both opportunities and was appointed this year as CL chief fellow.
Inpatient & ED Consult-Liaison
On inpatient units and in the ED at Duke University Hospital, the primary team caring for a patient may request a pediatric psychiatry consult when the patient presents with mental health concerns. “We’re there to answer any questions the teams might have,” said Emmalie Stay, MD, an attending pediatric CL psychiatrist. “The questions can really vary. They might be more straightforward, like, ‘We’re concerned that the patient may be experiencing some depression or anxiety and we’d like a more formal evaluation.’ Sometime the patient may be having difficulty adjusting to their illness. And sometimes the question might be a little bit more complex. Our role is to help them sort all of that out.”
During his inpatient CL rotation, Abbas found the variety and complexity of the cases fascinating and rewarding. “We saw cases of infant delirium, which is treated by psychiatrists at Duke. That’s not the case in most of the children’s hospitals in the country, so that was a unique experience,” he recalled. “We also treated children with bipolar disorder, early onset psychosis, and catatonia.”
In the outpatient clinic, the CL team, led by assistant professor Amanda Kimberg, MD, focuses on managing patients’ medication and coordinating care with other medical providers and staff at the child’s school. The bulk of their patients include children with cancer, eating disorders, chronic conditions such as lupus, or autoimmune brain disease—a neurologic condition that causes acute psychiatric symptoms. Pediatric neurology, pediatric rheumatology, and pediatric cardiology are among the most common specialties with whom the outpatient CL team collaborates.
“For example, Zargham has a patient who has ADHD and is also in heart failure,” said Kimberg, “and he’s able to think through the risks and benefits of treating the patient’s ADHD in collaboration with their cardiologist, and make that decision together.”
Kimberg, who also serves as the associate director for the child and adolescent psychiatry fellowship, noted that the fellowship’s CL rotations offer some rare yet valuable development opportunities for learners. “In general, kids are relatively healthy, so being able to have a concentrated experience of working with sick kids who have psychiatric needs, and thinking about how their psychiatric medications may interact with their medical diagnoses—while having support and supervision—is pretty unique,” she reflected.
Taking on a Leadership Role
As CL chief fellow, a role he assumed this year, Abbas helps oversee a diverse cadre of learners on the inpatient and ED CL service, including first-year child and adolescent psychiatry fellows; residents in psychiatry, pediatrics, neurology, and family medicine; and medical students. He orients learners to the service, gives them ongoing support and guidance, and plans and facilitates weekly professional development sessions.
In these sessions, the learners and attending psychiatrists gather to discuss a journal article relevant to their work, collaborate on a complex case, or hear a guest speaker. Recently, they hosted providers from palliative care, pediatric neurology, and the psychology team. Abbas helps coordinate similar weekly discussions and case conferences with the outpatient CL team, which includes Kimberg, medical instructor Aishwarya Rajagopalan, DO, MHS, and nurse practitioner Kari Overstreet.
“There’s still so much to learn about CL. And at the same time, I really enjoy looking at the articles in terms of what I can give to back to the learners, especially our medical students, because it’s the time that they’re deciding what specialty area they want to pursue.”
— Zargham Abbas, MD
Abbas thoroughly enjoys both planning and engaging in these educational opportunities: “There’s still so much to learn about CL. And at the same time, I really enjoy looking at the articles in terms of what I can give to back to the learners, especially our medical students, because it’s the time that they’re deciding what specialty area they want to pursue.”
Looking to the Future
As he considers his career options, Abbas is most attracted to CL and inpatient psychiatry. “For CL psychiatry, I enjoy navigating the intersection of medicine and psychiatry and integrating a biopsychosocial model within a framework of an interdisciplinary team,” he said. With inpatient work, he’s drawn to caring for patients with highly acute needs, as well as “the opportunity to rapidly adjust medications while closely monitoring patients for any adverse events, and collaborating with a multidisciplinary team to improve patients’ overall prognosis.”
Either way, he’s well-positioned for success. Stay and Kimberg describe Abbas as compassionate, thorough, organized, proactive, and fearless. “On consults, it’s very unpredictable. You never know what you’re going to walk into,” Stay reflected. “Whatever comes his way, Zargham does what he can to learn about the case and to do his best with the patient and their family—and he really isn’t afraid to just step in and go for it.”