scholarly journals The present state of consultation and liaison psychiatry

1990 ◽  
Vol 14 (6) ◽  
pp. 321-325 ◽  
Author(s):  
Richard Mayou ◽  
Helen Anderson ◽  
Charlotte Feinmann ◽  
Gail Hodgson ◽  
Peter L. Jenkins
Keyword(s):  
General Hospital ◽  
Psychiatric Care ◽  
Community Care ◽  
Psychiatric Morbidity ◽  
Liaison Psychiatry ◽  
Major Pathway ◽  
Lower Priority ◽  
Strategic Plans ◽  
Hospital Patients ◽  
Hospital Doctors

Although referral by general hospital doctors is a major pathway to specialist psychiatric care, and there is known to be much clinically unrecognised psychiatric morbidity among general hospital patients, consultation and liaison services have received much less emphasis than community care. A 1984 survey found that consultation liaison services were haphazard (Mayou & Lloyd, 1985). Despite recent evidence of increasing clinical and academic interest, few local strategic plans refer to consultation and liaison services; even when mentioned they are given a lower priority than community developments (Kingdon, 1989).

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.

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

Psychiatric Disorder in the General Hospital

1986 ◽  
Vol 149 (2) ◽  
pp. 172-190 ◽  
Author(s):  
Richard Mayou ◽  
Keith Hawton
Keyword(s):  
Psychiatric Disorder ◽  
General Hospital ◽  
Psychiatric Morbidity ◽  
Routine Clinical Practice ◽  
Standard Methods ◽  
Different Types ◽  
Patient Groups ◽  
Hospital Doctors ◽  
The Many

There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice.

Quality of psychiatric care in the general hospital: referrer perceptions of an inpatient liaison psychiatry service

2011 ◽  
Vol 33 (3) ◽  
pp. 260-266 ◽  
Author(s):  
Luke C. Solomons ◽  
Ajoy Thachil ◽  
Caroline Burgess ◽  
Adrian Hopper ◽  
Vicky Glen-Day ◽  
...  
Keyword(s):  
General Hospital ◽  
Psychiatric Care ◽  
Liaison Psychiatry

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.

scholarly journals Origins of a Section: liaison psychiatry in the College

2001 ◽  
Vol 25 (8) ◽  
pp. 313-315 ◽  
Author(s):  
Geoffrey G. Lloyd
Keyword(s):  
Psychiatric Disorder ◽  
General Hospital ◽  
Psychological Problems ◽  
Surgical Patients ◽  
Liaison Psychiatry ◽  
High Prevalence ◽  
Abundant Evidence ◽  
Hospital Patients ◽  
The Uk

Why has liaison psychiatry been slow to develop in the UK? The asylum mentality and the current flight into the community have focused psychiatric resources on chronic psychotic illnesses, neglecting the psychological problems of general hospital patients. Nevertheless, there is abundant evidence that medical and surgical patients have a high prevalence of psychiatric disorder that can be effectively treated with psychological or pharmacological methods.

Six-month and 12-month mental health outcome of medical and surgical patients admitted to general hospital

2000 ◽  
Vol 30 (2) ◽  
pp. 359-367 ◽  
Author(s):  
M. BALESTRIERI ◽  
G. BISOFFI ◽  
M. DE FRANCESCO ◽  
B. ERIDANI ◽  
M. MARTUCCI ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Outcome ◽  
General Hospital ◽  
Psychiatric Morbidity ◽  
Structured Interview ◽  
Poor Mental Health ◽  
Mental Health Outcome ◽  
Second Phase ◽  
Hospital Patients

Background. We have recently reported a two-phase study on psychiatric morbidity in a sample of general hospital patients. This paper reports the results of the 6-month and 12-month follow-up of these patients.Methods. The screening questionnaire was the GHQ-12. The main diagnostic instrument used in the second phase was the CIDI-PHC. All patients who had been interviewed with CIDI-PHC (N = 363) were followed-up and the baseline assessment was compared with the scoring on questionnaires administered in the 6-month postal enquiry and with the psychopathological status at 12-month, elicited with a telephone structured interview.Results. Sixty-two and 87% of patients completed the 6- and 12-month follow-up assessment respectively. The first follow-up indicated no significant decrease in the level of symptoms. The 12-month follow-up interview showed that 23% of males and 40% of females had poor/mostly poor mental health. The logistic model showed that females with a definite ICD-10 diagnosis, admitted to a medical department, who had consumed psychotropic drugs in the previous year, had the most unfavourable outcome. The risk of a poor/mostly poor outcome steadily increased with the severity of the psychopathology during hospitalization.Conclusion. In medical and surgical general hospital patients the risk factors associated with a poor mental health outcome are similar to those found in primary care patients. Greater attention should be paid in assessing routinely mental health status of general hospital patients during hospitalization.

A Comparative Study of Screening Instruments for Mental Disorders in General Hospital Patients

1993 ◽  
Vol 23 (4) ◽  
pp. 323-337 ◽  
Author(s):  
David M. Clarke ◽  
Graeme C. Smith ◽  
Helen E. Herrman
Keyword(s):  
Drug Abuse ◽  
Anxiety Disorder ◽  
Mental Disorders ◽  
General Hospital ◽  
Psychiatric Morbidity ◽  
The Other ◽  
Screening Instruments ◽  
R Classification ◽  
Hospital Patients ◽  
Better Than

Objective: Self-administered questionnaires are frequently used in studies of hospitalized physically ill patients to identify and measure psychiatric morbidity. This study examines the validity of some commonly used questionnaires in this context. Method: One hundred and seventy-nine patients in a general hospital completed the GHQ, HAD, BDI and STAI and were interviewed using the SCID-R. The findings were evaluated against DSM-III-R diagnoses using the QROC curve. Results: Thirty-eight percent of patients obtained one or more DSM-III-R diagnoses; 25 percent mood disorder, 12 percent anxiety disorder, 11 percent drug abuse or dependence, 2 percent a somatic syndrome. Eleven percent had more than one diagnosis. As screening instruments for general psychiatric morbidity there were no statistically significant differences between versions of the GHQ and the HAD. With respect to identifying depression, the GHQ tended to perform better than the other instruments. Conclusions: The questionnaires identified general morbidity and depression satisfactorily but anxiety and drug abuse and dependence syndromes poorly. The results also support the notion that the DSM-III-R classification has a number of deficiencies when used in this population.

Consultation-liaison psychiatry hits a midlife crisis

2002 ◽  
Vol 10 (3) ◽  
pp. 229-231
Author(s):  
Sandy Macleod
Keyword(s):  
General Hospital ◽  
Future Development ◽  
Psychiatric Services ◽  
New Work ◽  
Work Skills ◽  
Job Descriptions ◽  
Liaison Psychiatry ◽  
Midlife Crisis ◽  
Hospital Patients ◽  
Consultation Liaison Psychiatry

Objective: To illustrate the crisis affecting consultation-liaison psychiatry and its practitioners. Conclusions: There are several options that may be taken, or have already been taken, to secure a future for this psychiatric subspecialty. The need is apparent, and clinicians are willing, but funders are reluctant. The College's response has been critically important, but psychiatrists also need to develop new work skills and innovative job descriptions to ensure the continuation and future development of psychiatric services to general hospital patients.

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