Concordance with Recommendations in a Consultation-Liaison Psychiatry Service

1991 ◽  
Vol 25 (2) ◽  
pp. 243-254 ◽  
Author(s):  
Louise N. Seward ◽  
Graeme C. Smith ◽  
Geoffrey W. Stuart
Keyword(s):  
Mental Disorder ◽  
Affective Disorder ◽  
General Hospital ◽  
Psychotropic Drug ◽  
Psychotropic Drugs ◽  
Discharge Summary ◽  
Psychiatric History ◽  
Liaison Psychiatry ◽  
Organic Mental Disorder ◽  
Consultation Liaison Psychiatry

We studied the concordance of physicians with the recommendations of psychiatric consultants in a sample of 270 consultations in a 400-bed general hospital. Of the patients about whom a consultation was sought, 37% had a past psychiatric history, and 67% were on psychotropic drugs. Twelve percent had Organic Mental Disorder, 35% Affective Disorder, and for 24% no DSM-Ill diagnosis could be made. The psychiatrist made psychotropic drug recommendations in 62%, and the physicians' concordance with this recommendation was 86%. The physician's discharge summary included a diagnosis which concorded with the psychiatrist's diagnosis in 53% of files. The psychiatrist recommended further investigations in only 5.2% of files.

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

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.

Mental Disorders and the Use of Psychotropic Drugs in an 85-Year-Old Urban Population

1993 ◽  
Vol 5 (1) ◽  
pp. 33-48 ◽  
Author(s):  
Ingmar Skoog ◽  
Lars Nilsson ◽  
Sten Landahl ◽  
Bertil Steen
Keyword(s):  
Drug Therapy ◽  
Mental Disorders ◽  
Anxiety Disorders ◽  
Mental Disorder ◽  
Psychotropic Drug ◽  
Psychotropic Drugs ◽  
Urban Population ◽  
Depressive Disorders ◽  
Psychotic Disorders ◽  
Antidepressant Drug

The prevalence of mental disorders was studied in a representative sample of 85-year-old living in Gothenburg, Sweden, (n=494). All subjects were examined by a psychiatrist, whose diagnoses were defined according to the DSM-III-R criteria. In the sample, the prevalence of dementia was 29.8%, and of any other mental disorder was 24.3%. Psychotic disorders were present in 4.7%, depressive disorders in 12.6%, and anxiety disorders in 10.5%. Anxiety disorders were more common in women than in men. Of all subjects, 42.5% used a psychotropic drug (men 30.1%, women 47.6%, p<0.001), 34.2% used anxiolytic-sedatives, 14.0% used antidepressants, and 5.7% used neuroleptics. Women used significantly more anxiolytic-sedatives and antidepressants than did men. Of those with no mental disorders, 29.1% used a psychotropic drug. Although the prescription of psychotropic drugs was high, only one fifth of those with depressive disorders received antidepressant drug therapy and one tenth of those with psychotic disorders received neuroleptics.

scholarly journals Pattern of psychiatric morbidity among referred inpatients in a tertiary care hospital of Bangladesh

2020 ◽  
Vol 31 (2) ◽  
pp. 38-42
Author(s):  
Nasim Jahan ◽  
Mohammad Muntasir Maruf ◽  
Sharmin Kauser ◽  
Mekhala Sarkar ◽  
Md Masud Rana Sarker ◽  
...  
Keyword(s):  
General Hospital ◽  
Tertiary Care ◽  
Psychiatric Morbidity ◽  
Care Hospital ◽  
Psychiatric Consultation ◽  
Liaison Psychiatry ◽  
Major Depressive ◽  
Consultation Liaison Psychiatry ◽  
The Mean ◽  
Inpatient Units

There is a dearth of studies related to consultation-liaison psychiatry in Bangladesh. The psychiatric referral rates in this country are very low, considering the higher rates of psychiatric morbidity in patients who attend various departments of a general hospital. This was a descriptive study consisting of all the cases referred for psychiatric consultation from inpatient units of various departments of BIRDEM General Hospital, Dhaka from July 2017 to June 2018. Patients of any age and of either gender were included. A total of 673 patients (1.97% of total admission) were referred from different departments of the hospital for psychiatric consultation within the study period. Majority of the respondents were female. The mean age of the respondents was 59.47 (±1.98) years. Among the referred, Generalized anxiety disorder (GAD) was the diagnosis in 24.96%, followed by Major depressive disorder (MDD) in 9.95% cases. Referral from the department of Medicine and allied was 92.86 %, followed by department of Surgery and allied (6.38%) & department of Obstetrics and Gynaecology (0.74%). Frequency of referral was the lowest in the months of November to January. There is a need to encourage multi-disciplinary interaction in the management of patients who attend general hospitals, so as to better identify the psychiatric morbidity. Bang J Psychiatry December 2017; 31(2): 38-42

scholarly journals Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Yousaf Iqbal ◽  
Majid Ali Al Abdulla ◽  
Sultan Albrahim ◽  
Javed Latoo ◽  
Rajeev Kumar ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Psychiatric Morbidity ◽  
Physical Symptoms ◽  
Service Planning ◽  
Psychiatric Diagnoses ◽  
Psychiatric History ◽  
Upper Respiratory Tract ◽  
Liaison Psychiatry ◽  
Wide Range ◽  
Consultation Liaison Psychiatry

Background Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients’ clinical status. Representative samples are needed to inform service planning and research. Aims To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar. Method Retrospective review of 50 consecutive referrals. Results Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%). Conclusions A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.

The Written Report in Consultation–Liaison Psychiatry: A Proposed Schema

2002 ◽  
Vol 36 (2) ◽  
pp. 251-258 ◽  
Author(s):  
Timothy Alexander ◽  
Sidney Bloch
Keyword(s):  
Focus Group ◽  
Clinical Data ◽  
Effective Means ◽  
Psychiatric History ◽  
Note Taking ◽  
Liaison Psychiatry ◽  
Pertinent Literature ◽  
The Core ◽  
Consultation Liaison Psychiatry

Objective: The consultation–liaison psychiatry (CLP) written report serves several crucial functions; it therefore needs to be presented in a meaningful format to its readers. Surprisingly little has been written about its optimal nature. Our aim is to offer a schema which promotes effective communication. Methods: We have reviewed pertinent literature, consulted with CLP colleagues and convened a focus group that a number of them attended. Results: The core functions of the CLP report are to offer the referrer (and other relevant professionals) key comprehensible findings, recommendations for treatment and advice for follow up. Additional purposes are educational, archival and medico-legal. Our schema contains eight sections: Who is the patient? Why you referred the patient to us at this particular time? What did we find? Who are the patient's family and other supports? How do we understand these findings? What do we recommend regarding management? What further clinical developments have ensued? and What do we recommend regarding psychosocial follow-up? We provide guidelines concerning the content of each section and illustrate the use of the schema with two clinical cases. Conclusions: The functions of the CLP report are not satisfied through conventional psychiatric-history note taking. Our related yet different framework is inclined to be a more effective means to convey necessary clinical data and treatment recommendations.

scholarly journals Substance use and psychiatric disorders in patients referred to consultation-liaison psychiatry within a regional general hospital

2021 ◽  
Author(s):  
Murray Tucker ◽  
Harry Hill ◽  
Emma Nicholson ◽  
Steven Moylan
Keyword(s):  
Substance Use ◽  
Psychiatric Disorders ◽  
General Hospital ◽  
Psychiatric Diagnosis ◽  
Diagnostic Category ◽  
Adjustment Disorder ◽  
Post Traumatic Stress ◽  
Liaison Psychiatry ◽  
Hospital Patients ◽  
Consultation Liaison Psychiatry

Abstract Little is known about clinically important differences between patients depending on the number of comorbid psychiatric disorders, or the presence or absence of a substance use disorder (SUD) comorbidity. This study investigated for differences in psychosocial disadvantage, psychiatric disorders, and health service amongst 194 general hospital patients referred to consultation-liaison psychiatry (CLP) with no psychiatric diagnosis, single psychiatric diagnosis, multiple (non-SUD) psychiatric diagnoses, or psychiatric diagnosis plus SUD comorbidity. The results showed that SUDs were the commonest diagnostic category (34%). The SUD comorbidity group had more disadvantaged housing, were prescribed most psychoactive medications, and 20% prematurely self-discharged against medical advice. Increased SUDs were associated with reduced length of stay, men, younger age, increased investigations, and reduced private health insurance subscription. Patients with SUD comorbidity versus multiple psychiatric diagnosis had reduced odds of Adjustment Disorder, Somatic Symptom Disorder, and Insomnia Disorder. Post Traumatic Stress Disorder was the strongest predictor of multiple SUDs, followed by Cluster B personality disorders. In conclusion, SUDs have become a leading clinical focus for CLP. The presence or absence of SUDs amongst patients with multiple psychiatric disorders has important clinical implications for engagement, diagnosis, prescribing, and outpatient follow-up.

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