Reasons for referral and consultation liaison psychiatry diagnoses

AbstractObjectives:Focused management strategies, including effective distribution of available resources is dependent on ongoing analysis of referral type in any liaison psychiatry consultation service. This survey sought to measure rate of diagnoses in an Irish liaison psychiatry consultation service, and compare the results with other similar services.Method:A survey of referral reasons and diagnoses was performed on all patients presenting to a Dublin based inpatient liaison psychiatry consultation service over two six month periods. The results were subsequently compared with other similar international studies.Results:Commonest referral reasons were for depressive disorders, while commonest diagnoses included alcohol related disorders, depressive disorders, and delirium, with notably higher rates of alcohol related disorders than in other similar international studies.Conclusions:This study provides valuable information for referral reasons and diagnoses present in an Irish liaison psychiatry consultation service. The differences noted between diagnoses in our study and other international studies, as well as some of the difficulties in establishing these diagnoses, are discussed.

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Diagnostic Agreement between Physicians and a Consultation–Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020749 ◽

2021 ◽

Vol 18 (2) ◽

pp. 749

Author(s):

Mattia Marchi ◽

Federica Maria Magarini ◽

Giorgio Mattei ◽

Luca Pingani ◽

Maria Moscara ◽

...

Keyword(s):

General Hospital ◽

Depressive Disorders ◽

Psychiatric Morbidity ◽

Clinical Signs ◽

Kappa Statistics ◽

Comorbid Depression ◽

Liaison Psychiatry ◽

Consultation Liaison Psychiatry ◽

Psychiatric Conditions ◽

Diagnostic Concordance

Consultation–liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000–2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

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Consultation liaison psychiatry in Talavera's hospital during the year 2014

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1417 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S394-S394

Author(s):

M. Palomo Monge ◽

D.C. Sandra ◽

A.L. Maria Fernanda ◽

G.M. David ◽

T.G. Maria Fernanda ◽

...

Keyword(s):

Internal Medicine ◽

Psychiatric Disorders ◽

Descriptive Study ◽

Liaison Psychiatry ◽

Consultation Service ◽

Cross Sectional ◽

Consultation Liaison Psychiatry ◽

Competing Interest

IntroductionAnalyze the number of interdepartmental consultations carried out at Department of Psychiatry, Hospital Nuestra Señora del Prado from other areas of hospitalization during 2014.ObjectivesThe goal is to evaluate the prevalence of psychiatric disorders in patients who are hospitalized for other reasons, and which services are needed the most.MethodsRetrospective cross-sectional descriptive study. A record of consultations carried out by the psychiatry service in 2014 was collected. The data were analyzed according to the origin of the consultation service, the month when it was performed and the sex of the patient. The monthly percentage of interconsultations and the percentage represented by each interconsultation service were calculated. They classified according to sex.ResultsIn 2014, 211 interconsultations were carried out, 104 men and 86 women. Surgery 16, 11%, pneumology 13, 74%, internal medicine 12, 32%, traumatology 8, 06%, digestive 7, 11%), I.C.U. 6, 64%, cardiology 6, 16%, hematology 5, 69%, oncology 5, 21%, pediatrics 4, 27%, gynecology 2, 84%, emergency 1, 90%, palliative1, 90%, endocrinology 1, 42%, urology 1, 42, nephrology 0, 95%, E.N.T. 0, 95%, obstetrics 0, 47%, dermatology 0%, ophthalmology 0%, rheumatology 0%. January 12, 8%, February 13%, March 9, 5%, April 6, 2%, May 5, 7%, June 8, 1%, July 6, 2%, August 4, 3%, September 8, 1%, October 12%, November 7, 6%, December 6, 2%.ConclusionsMost of the interconsultations were carried out in January, February and October. However, August was the least busy month. The busiest service was the Surgery service, followed by the Pneumology and Internal Medicine one. There were no interconsultations of the Ophthalmology, Rheumatology and Dermatology services. The consults were in demand mainly by men rather than women.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Implementation of the CLiP database

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-08-2018-0199 ◽

2019 ◽

Vol 33 (1) ◽

pp. 27-35

Author(s):

Kenneth Ken Siong Lee ◽

Umi Adzlin Silim

Keyword(s):

Depressive Disorders ◽

Management Plan ◽

Care Plan ◽

Liaison Psychiatry ◽

Content Type ◽

Audit Data ◽

Common Diagnosis ◽

Consultation Liaison Psychiatry ◽

Working Day ◽

Audit Standards

Purpose The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services. Design/methodology/approach All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan. Findings The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan. Originality/value Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

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Prescription Patterns of Antidepressants in Consultation-Liaison Psychiatry - a 10 Year-Observational Study (1988-1997)

European Psychiatry ◽

10.1016/s0924-9338(09)70863-6 ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

A. Diefenbacher

Keyword(s):

Observational Study ◽

Selective Serotonin Reuptake Inhibitors ◽

Depressive Disorders ◽

Tertiary Care ◽

Liaison Psychiatry ◽

The Us ◽

Consultation Liaison Psychiatry ◽

Major Depressive Disorders ◽

Changes Over Time

Few long term studies have reported observations of changes over time with consultation-liaison (C-L) populations. This is a longitudinal observational study of a tertiary care psychiatric C-L- service over a ten-year-period (1988 - 1997) using a standardized computerized clinical database to examine 4429 consecutive referrals. Sociodemographic variables, relative consultation rates, reasons for referral, and psychiatric diagnoses, apart from a shift from adjustment disorders with depressed mood to major depressive disorders within the depressive syndrome group, did not demonstrate significant changes during the study period. Changes occurred in the pattern of C-L-psychiatric recommendations, e.g., in the prescription of antidepressants where tricyclic antidepressants were replaced by newer agents such as the selective serotonin reuptake inhibitors (SSRI), beginning with the introduction of fluoxetine to the US-american market in 1988. Due to a decrease in length of stay (LOS) over the ten year observation period the correlation of lagtime (the time from admission to the hospital until referral to C-L psychiatry) and LOS decreased from very strong to moderate.

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Delusional parasitosis on the psychiatric consultation service – a longitudinal perspective: Case study

BJPsych Open ◽

10.1192/bjpo.bp.116.004358 ◽

2017 ◽

Vol 3 (3) ◽

pp. 154-158 ◽

Cited By ~ 2

Author(s):

Adam Trenton ◽

Neha Pansare ◽

Anthony Tobia ◽

Viwek Bisen ◽

Kenneth R. Kaufman

Keyword(s):

Case Report ◽

Hospital Admission ◽

Psychiatric Treatment ◽

Kidney Injury ◽

Liaison Psychiatry ◽

Unique Case ◽

Consultation Service ◽

Delusional Parasitosis ◽

Consultation Liaison Psychiatry

BackgroundDelusional parasitosis is infrequently seen in hospital-based consultation–liaison psychiatry.AimsAlthough there are many publications on delusional parasitosis, this report reviews a unique case that was diagnosed during a hospital admission and treated over the next 36 months.MethodCase report and literature review.ResultsThis case report describes a 65-year-old man who was diagnosed with delusional parasitosis during a hospital admission for congestive heart failure and acute kidney injury. A longitudinal description of the patient's condition during the hospital stay and in the 36 months following discharge, during which time he was treated by a consultation psychiatrist, is provided.ConclusionsIn discussing the treatment of a challenging presentation, this case demonstrates the opportunity for consultation psychiatrists to initiate care in patients who might not otherwise seek psychiatric services. Patients with somatic delusions represent one group of patients who are unlikely to independently seek psychiatric treatment.

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Interconsulta psiquiátrica: fatores de encaminhamento para a terapia ocupacional em saúde mental / Consultation-liaison psychiatry: factors referral from occupational therapy in mental health

Revista Interinstitucional Brasileira de Terapia Ocupacional - REVISBRATO ◽

10.47222/2526-3544.rbto12711 ◽

2018 ◽

Vol 2 (1) ◽

pp. 109-125

Author(s):

Solange Aparecida Tedesco ◽

Vanessa Albuquerque Citero ◽

Luiz Antonio Nogueira Martins

Keyword(s):

Mental Health ◽

Occupational Therapy ◽

Referral And Consultation ◽

Cross Sectional Study ◽

Liaison Psychiatry ◽

Cross Sectional ◽

Referral Decisions ◽

Guidance Intervention ◽

Consultation Liaison Psychiatry ◽

Therapy Attendance

Introdução: As intervenções em terapia ocupacional associadas com serviços de interconsulta psiquiátrica não são usuais, embora contribuam para a redução do estresse do paciente e facilitem a continuidade dos cuidados. Objetivo: Identificar o perfil demográfico, clínico e psiquiátrico dos pacientes assistidos por um interconsultor psiquiatra e encaminhados a um terapeuta ocupacional de saúde mental, e os respectivos motivos. Métodos: Estudo transversal descritivo eu comparou 139 pacientes avaliados em um serviço de interconsulta psiquiátrica que foram encaminhados para o atendimento de terapia ocupacional em saúde mental com os 561 pacientes do mesmo serviço de interconsulta que não foram encaminhados. Realizou-se um modelo de analise de regressão logística no qual a variável dependente foi o fator encaminhamento para a terapia ocupacional e as demais variáveis sóciodemográficas, clinicas, psiquiátricas e ocupacionais foram avaliadas como possíveis variáveis preditoras (método backward). Resultados: Os pacientes que se aposentaram por incapacidade, com maior número de consultas anteriormente ao encaminhamento, hospitalizados em unidades de diálise, hematologia, ginecologia e clínica cirúrgica eram mais propensos a serem encaminhados à terapia ocupacional. A redução da probabilidade de encaminhamento foi associada ao aumento da idade e à presença de sintomas de psicose, confusão mental ou agressividade. Conclusão: Os pacientes encaminhados por interconsultores psiquiatras, para a terapia ocupacional em saúde mental, integravam um subgrupo com características que contribuíam com a previsão de decisões de encaminhamento. Esses pacientes apresentaram dificuldades em lidar com a doença, maior vulnerabilidade pessoal e uma série de comportamentos e atitudes de preocupação e angústia em relação a sua doença ou hospitalização que os conduziria a situações de ruptura e estresse. Abstract Background: Interventions in occupational therapy in combination with consultation-liaison psychiatry services are uncommon, although they contribute to patient's reduction of stress, and facilitate the continuity of care. Objective: To identify the demographic, clinical and psychiatric profile of patients seen by a consultation-liaison psychiatrist and referred to a mental health occupational therapist and the reasons for referral. Methods: This is a cross-sectional study which compared 139 patients under evaluation in a consultation-liaison psychiatry service and who were referral to a mental health occupational therapy attendance with 561 patients also under consultation-liaison psychiatry but not referred to occupational therapy. It was developed a logistic regression analysis in which the dependent variable was the referral to occupational therapy and the sociodemographic, clinical, psychiatric and occupational variables were predictors (backward methods). Results: Patients retired on disability, with a high number of consultations before referral, hospitalized in dialysis, hematology, gynecology and plastic surgery units, and those whose attending staff received guidance intervention were more likely to be referred to occupational therapy. Reduced likelihood for referral was associated with with higher age and presence of symptoms of psychosis/confusion or aggression. Conclusion: Patients referred by consultation-liaison psychiatrists to a mental health occupational therapy comprised a subgroup with characteristics that contribute to the prediction of referral decisions. These patients showed difficulties in dealing with the disease, personal vulnerability, and a series of behaviors and attitudes regarding their disease that may lead to rupture episodes.Keywords: General hospital; Mental health; Occupational therapy; Referral and consultation.

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