Liaison Psychiatry and Organic Illness

2014 ◽  
Author(s):  
Andrew Horton ◽  
Mark Broadhurst
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Mental Illnesses ◽  
Working Relationships ◽  
Liaison Psychiatry ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
The Uk

Liaison psychiatry is a subspecialty of psychiatry which involves the diag­nosis, treatment, and management of psychiatric illness in patients who have physical illnesses or present with physical symptoms. There is considerable overlap between psychiatric and medical condi­tions which requires close working relationships with medical colleagues. Liaison psychiatry is a fascinating area where the range of psychiatric presentations is wide, every case is different, and there is opportunity to keep up to date with medicine as it evolves. Within the UK there are different models practiced in different areas, ranging from assessment and signposting services to services with provi­sion for long-term outpatient follow-up. There is increasing interest in the provision of liaison services in primary care because of the challenges faced by GPs in treating patients with medically unexplained symptoms. Another driver is the hugely increased morbidity and mortality rates seen in patients with co-morbid physical and mental illnesses who receive the majority of their treatment in secondary care.

scholarly journals Medically Unexplained Symptoms (MUS): Faults and Implications

2019 ◽  
Vol 16 (7) ◽  
pp. 1247 ◽  
Author(s):  
Michiel Tack
Keyword(s):  
Medically Unexplained Symptoms ◽  
Health Condition ◽  
Negative Consequences ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Underlying Pathology ◽  
Long Term Studies

The classification of medically unexplained symptoms (MUS) could have negative consequences for patients with functional somatic syndromes (FSS). By grouping related but distinct syndromes into one label, the MUS classification fails to inform clinicians about their patients’ health condition. In research settings, the MUS classification makes patient samples more heterogeneous, obstructing research into the underlying pathology of FSS. Long-term studies have shown that MUS are often appraised as medically explained symptoms at follow-up and vice versa, raising doubts about the reliability of this distinction.

Travelling at a hundred miles an hour and not being able to get off: Examining a patient’s journey from medically unexplained symptoms

2018 ◽  
Vol 6 (3) ◽  
pp. 400
Author(s):  
Kelvin Leung ◽  
Foluke Odeyale ◽  
Itoro Udo
Keyword(s):  
Mental Health ◽  
Mental Health Treatment ◽  
Medically Unexplained Symptoms ◽  
Severity Of Illness ◽  
Physical Symptoms ◽  
Mental Wellbeing ◽  
Liaison Psychiatry ◽  
Patient’S Experience ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Objectives: To understand a patient’s experience of treatment and recovery from medically unexplained tremors affecting hand and neck. The patient attended a Liaison Psychiatry Outpatient Clinic.Method: A case study using interview method focusing on the nature and severity of illness; effects of symptoms; expectations of treatment; changes observed and the patient’s expectation of services.Results: The patient was “extremely” stressed about his symptoms and “apprehensive” about attending mental health services. He experienced resolution of physical symptoms and improvements in mental wellbeing. Mental health treatment comprised medications and psychological therapies.Conclusions: Persons experiencing medically unexplained symptoms deserve positive experiences of well-funded specialist healthcare.

Learning to provide patient-centered care with patients with medically unexplained symptoms: a grounded theory study in Australian general practice.

2015 ◽  
Vol 4 (3) ◽  
pp. 173-179
Author(s):  
Louise Stone ◽  
Jill Gordon
Keyword(s):  
General Practice ◽  
Grounded Theory ◽  
Medically Unexplained Symptoms ◽  
Patient Centered Care ◽  
Physical Symptoms ◽  
Patient Centered ◽  
Grounded Theory Study ◽  
Centered Care ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Background Culture shapes the way illness is experienced and disease is understood. Patients with medically unexplained symptoms describe feeling their suffering is not valued because they lack a “legitimate” diagnosis. Doctors also describe feeling frustrated with these patients. This is particularly problematic for young general practitioners (GPs) who lack experience in managing patients with medically unexplained symptoms in primary care settings.Objectives To explore how general practice supervisors help registrars to provide patient-centered care for patients with medically unexplained. Methods A constructivist grounded theory study was undertaken with 24 general practice registrars and supervisors from Australian GP training practices in urban, rural and remote environments. Participants were asked to describe patients with mixed emotional and physical symptoms without an obvious medical diagnosis. Results Registrars came from hospital posts into general practice equipped with skills to diagnose and manage organic disease but lacked a framework for assessing and managing patients with medically unexplained symptoms. They described feelings of helplessness, frustration and sometimes hostility. Because these feelings were inconsistent with their expressed value systems, they were uncomfortable and confronting. The registrars valued interactions that helped them explore this area. Conclusions In hospital practice, biomedical language and explanations predominate, but in general practice patients bring different explanatory illness models to the consultation, using their own language, beliefs and cultural frameworks. Medically unexplained symptoms occupy a contested space in both the social and medical worlds of the doctor and patient. Negative feelings and a lack of diagnostic language and frameworks may prevent registrars from providing patient-centered care.

Anthrax Exposure, Belief in Exposure, and Postanthrax Symptoms Among Survivors of a Bioterrorist Attack on Capitol Hill

2018 ◽  
Vol 13 (03) ◽  
pp. 555-560
Author(s):  
Stephanie Chiao ◽  
Howard Kipen ◽  
William K. Hallman ◽  
David E. Pollio ◽  
Carol S. North
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Symptoms ◽  
Care Utilization ◽  
Physical Injury ◽  
Multivariate Models ◽  
Diagnostic Interviews ◽  
Capitol Hill ◽  
High Incidence ◽  
Medically Unexplained ◽  
Unexplained Symptoms

ABSTRACTBackgroundFollowing chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons.ObjectivesThis study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill.MethodsPostdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics.ResultsThe sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms.ConclusionsGiven the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness.2019;13:555-560)

scholarly journals New models of care: a liaison psychiatry service for medically unexplained symptoms and frequent attenders in primary care

2017 ◽  
Vol 41 (6) ◽  
pp. 340-344 ◽  
Author(s):  
Janine Bestall ◽  
Najma Siddiqi ◽  
Suzanne Heywood-Everett ◽  
Charlotte Freeman ◽  
Paul Carder ◽  
...  
Keyword(s):  
Primary Care ◽  
Evidence Synthesis ◽  
Medically Unexplained Symptoms ◽  
Cost Savings ◽  
Models Of Care ◽  
Liaison Psychiatry ◽  
Long Term Conditions ◽  
Early Results ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Aims and methodThis paper describes the process of setting up and the early results from a new liaison psychiatry service in primary care for people identified as frequent general practice attenders with long-term conditions or medically unexplained symptoms. Using a rapid evidence synthesis, we identified existing service models, mechanisms to identify and refer patients, and outcomes for the service. Considering this evidence, with local contingencies we defined options and resources. We agreed a model to set up a service in three diverse general practices. An evaluation explored the feasibility of the service and of collecting data for clinical, service and economic outcomes.ResultsHigh levels of patient and staff satisfaction, and reductions in the utilisation of primary and secondary healthcare, with associated cost savings are reported.Clinical implicationsA multidisciplinary liaison psychiatry service integrated in primary care is feasible and may be evaluated using routinely collected data.

Frequent attenders in secondary care: a 3-year follow-up study of patients with medically unexplained symptoms

2003 ◽  
Vol 33 (3) ◽  
pp. 519-524 ◽  
Author(s):  
S. REID ◽  
T. CRAYFORD ◽  
A. PATEL ◽  
S. WESSELY ◽  
M. HOTOPF
Keyword(s):  
Functional Impairment ◽  
Secondary Care ◽  
Service Use ◽  
Psychiatric Morbidity ◽  
Medically Unexplained Symptoms ◽  
Follow Up Study ◽  
Frequent Attenders ◽  
Medically Unexplained ◽  
Unexplained Symptoms

Background. There are few longitudinal studies of patients with medically unexplained symptoms. The aim of this study was to investigate outcome in frequent attenders in secondary care who present repeatedly with medically unexplained symptoms.Method. Forty-eight patients presenting with medically unexplained symptoms, from a sample of 61, participated in a 3-year follow-up study. Psychiatric morbidity, functional impairment and use of services were evaluated.Results. At follow-up there was a high prevalence of psychiatric morbidity with 69% having at least one psychiatric diagnosis. The sample continued to be high users of a range of health services and substantial functional impairment was reported.Conclusion. In this group of frequent attenders with medically unexplained symptoms outcome as measured by psychiatric morbidity, service use and functional impairment remained poor after 3 years.

Liaison psychiatry

2019 ◽  
pp. 839-880
Author(s):  
David Semple ◽  
Roger Smyth
Keyword(s):  
Medically Unexplained Symptoms ◽  
Physical Illness ◽  
Anxiety Symptoms ◽  
Differential Diagnoses ◽  
Psychotic Symptoms ◽  
Liaison Psychiatry ◽  
Medically Unexplained ◽  
Medical Population ◽  
Self Harm ◽  
Unexplained Symptoms

This chapter concerns liaison psychiatry and the assessment and management of psychiatric and psychological illnesses in the general medical population. It covers the 12 most common referral types, assessment of depressive and anxiety symptoms, psychotic symptoms and confusion, depression in physical illness, delirium, and management after self-harm. Focusing on capacity and consent, as well as differential diagnoses and potential management principles for medically unexplained symptoms, it covers the basis of working as a psychiatrist in a hospital.

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