Table 1-.

Approach to an Inpatient Psychiatric Consult for a HSCT Patient

Step	Explanation
Preparation	Obtain detailed medical history, stage in transplantation, hospital course and complications from the primary HSCT team Review the electronic medical records including both pertinent inpatient and outpatient medical records Review social work records Review any psychiatric records (including for prior psychiatric history and psychiatric medications) if available Review chemotherapeutic regimens used in the conditioning stage and/or radiation Review inpatient medications Inquire about behavioral issues and deficits in engagement with care from inpatient nursing team Review laboratory results Review brain imaging results
Patient Interview	Obtain a comprehensive history of both physical and psychiatric symptoms Inquire about pain symptoms Determine psychiatric history including prior psychiatric treatment and medications Conduct a safety assessment Gather social history including the nature of social supports, religion and spirituality factors Conduct mental status exam including a comprehensive cognitive screening instrument, e.g., MoCA53
Differential Diagnoses	Consider common medical etiologies of neuropsychiatric symptoms e.g., rare infections [including from viruses (Herpes viruses like Human Herpes Virus 6, Epstein Barr viruses), parasites (toxoplasmosis), fungus (mucormycosis)], thyroid disease, and nutritional deficiencies in addition to psychiatric diagnoses Explore potential symptoms related to existential distress Elicit difficulty coping and adjustment issues that do not necessarily qualify for an adjustment disorder
Treatment/Interventions	Pharmacological interventions including psychiatric medications Non-pharmacological interventions e.g., cognitive behavioral therapy Spiritual care services Social work support
Considerations for liaison with care team	Awareness of the complex nature of the inpatient care team including medical house staff who may rotate quite often over the course of a transplant admission Familiarity with primary HSCT team who would likely follow patient over the course of the transplant for continuity Familiarity with inpatient social workers who follow patients closely