Psychiatric Morbidity Managed by Liaison Psychiatry in a Tunisian Population

IntroductionThe epidemiology of the association between mental disorders and medical illnesses is the subject of many research studies, mainly due to the worse prognosis associated with this comorbidity.ObjectivesTo investigate the psychiatric morbidity associated with somatic diseases in liaison psychiatry outpatients and to identify factors associated with this morbidity.MethodsA descriptive and analytical cross-sectional study was conducted. It took place at the psychiatry outpatient unit at CHU Hedi Chaker of Sfax in Tunisia. We collected 110 files of patients having a medical and/or surgical condition, addressed for the first time in 2014, as part of liaison psychiatry.ResultsMajor depressive disorder (MDD) and adjustment disorder (AD) with anxious and/or depressive mood were the most common diagnoses in liaison psychiatry (respectively 53 cases and 28 cases).MDD has been diagnosed mainly during the course of three somatic illnesses: cancer, sciatica and hypertension, with respective rates of 90%, 85.7% and 60%.The onset of a MDD during the evolution of a somatic disease was significantly more common in female patients (P = 0.04) and those living in couple family (P = 0.005).ConclusionAmong all psychiatric disorders, depression and AD were the most frequently associated disorders with somatic diseases. This comorbidity may be explained by the physiological and psychological impact of certain somatic diseases, the iatrogenic effect of certain treatments, or the involvement of a biological, psychological or environmental common factor for both conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

Bangladesh Journal of Psychiatry ◽

10.3329/bjpsy.v31i2.45373 ◽

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

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A personal view

Bulletin of the Royal College of Psychiatrists ◽

10.1192/s0140078900025153 ◽

1987 ◽

Vol 11 (5) ◽

pp. 156-157

Author(s):

Paul Dedman

Keyword(s):

Interest Group ◽

Royal College ◽

Psychiatric Morbidity ◽

District General Hospital ◽

Full Time ◽

Personal View ◽

Liaison Psychiatry ◽

Ample Evidence ◽

High Prevalence ◽

Set Up

There is currently considerable interest in liaison psychiatry and recently a Royal College Special Interest Group has been set up in this field. Although few psychiatrists are employed full-time in this sub-speciality, it appears that much time is spent by psychiatrists in doing liaison work and this is likely to become more important with the increasing movement of psychiatrists into the District General Hospital (DGH). There is ample evidence to suggest that there is a high prevalence of psychiatric morbidity in a DGH population which can be seen as representing potential for expansion. However, there is no consensus as to the scope of liaison psychiatry, whether expansion would indeed be desirable and whether psychiatrists possess suitable skills for the job.

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The present state of consultation and liaison psychiatry

Psychiatric Bulletin ◽

10.1192/pb.14.6.321 ◽

1990 ◽

Vol 14 (6) ◽

pp. 321-325 ◽

Cited By ~ 27

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).

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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 ◽

10.1192/bjo.2020.85 ◽

2020 ◽

Vol 6 (5) ◽

Cited By ~ 2

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.

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Need Assessment of Consultation Liaison Psychiatry amongst the Clinical Faculty

Annals of the National Academy of Medical Sciences (India) ◽

10.1055/s-0040-1712751 ◽

2017 ◽

Vol 53 (02) ◽

pp. 097-103

Author(s):

Rakesh K Chadda ◽

Koushik Sinha Deb ◽

Sathya Prakash ◽

Mamta Sood

Keyword(s):

Tertiary Care ◽

Psychiatric Morbidity ◽

Faculty Members ◽

Psychological Problems ◽

Psychosocial Issues ◽

Clinical Faculty ◽

Liaison Psychiatry ◽

Online Questionnaire ◽

Cross Sectional ◽

Consultation Liaison Psychiatry

ABSTRACTNearly 20-40% of patients with medico-surgical illnesses in general hospitals have a co morbid psychiatric illness or psychosocial issues, which interfere in improvement of the primary illness. It is important to assess the attitudes and awareness of non-psychiatrist clinicians about the co-existing psychiatric morbidity in their patients and their felt needs, which can help in mitigating this morbidity. The present study attempts to gauge the non-psychiatrist clinician's perception, felt needs and barriers to referral/ intervention in a tertiary care teaching hospital. A cross-sectional, descriptive, online questionnaire-based method was used. Of the 239 clinical faculty members, only 45 responded. Responses indicated that clinicians were aware of the existence and signiﬁcance of psychological problems in their patients, but could do with further increased levels of awareness and more speciﬁc training in evaluation and intervention. Stigma, lack of awareness of available services, and lack of detailed understanding regarding psychological problems were the important barriers to referral/ intervention. Better teamwork, training and more manpower were the speciﬁc suggestions for improvement in the future.

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Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital

Indian Journal of Psychological Medicine ◽

10.1177/02537176211022146 ◽

2021 ◽

pp. 025371762110221

Author(s):

Nisha K. Prajapati ◽

Nimesh C. Parikh ◽

Nilima D. Shah ◽

Vinodkumar M. Darji ◽

Heena B. Jariwala ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Psychiatric Morbidity ◽

Adjustment Disorder ◽

P Value ◽

Fisher Exact Test ◽

Care Hospital ◽

Liaison Psychiatry ◽

Exact Test ◽

Consultation Liaison Psychiatry

Background: The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. Method: This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal–Wallis test, and fisher exact test. Results: Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. Conclusions: Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.

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Solo obstetric liaison service

Psychiatric Bulletin ◽

10.1192/pb.23.1.37 ◽

1999 ◽

Vol 23 (1) ◽

pp. 37-40 ◽

Cited By ~ 3

Author(s):

Sue Smith

Keyword(s):

Special Interest ◽

Psychiatric Morbidity ◽

Clinical Implications ◽

Liaison Psychiatry ◽

Senior Registrar ◽

General Psychiatry ◽

Set Up ◽

Psychiatric Problems ◽

Obstetric Department ◽

Number Of Births

Aims and methodTo set up a liaison psychiatry service for an obstetric department and review how much of the work involved in such a service can be undertaken by a senior registrar in two special interest sessions.ResultsIt was clear there was a demand for a service for women with psychiatric problems associated with childbirth. Referrals from colleagues in general psychiatry meant that the available time was soon used up. This did therefore not allow time to develop efficient systems for referral and management or to then see the extra referrals this would have produced. The limited and temporary service was well received by other professionals and by patients. The number of referrals received fell far short of the expected morbidity.Clinical implicationsIn an area with this number of births and its consequent level of psychiatric morbidity, it would not seem possible, within two special interest sessions, to develop a more formalised or comprehensive system.

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Consortium-Based Consultation/Liaison Research: Commentary and Perspective

The International Journal of Psychiatry in Medicine ◽

10.2190/7rj2-c7q9-wmb7-h9vd ◽

1988 ◽

Vol 17 (3) ◽

pp. 237-248 ◽

Cited By ~ 20

Author(s):

Jeffrey S. Hammer ◽

James J. Strain ◽

John Petraitis

Keyword(s):

Psychiatric Morbidity ◽

Cost Benefit ◽

Basic Research ◽

Research Strategy ◽

Research Strategies ◽

Liaison Psychiatry ◽

Prevalence Studies ◽

Advantages And Disadvantages ◽

Benefit Evaluation ◽

Research Consortium

Although a consortium approach for clinical trials is a common research strategy which has made important contributions in other disciplines in medicine, to date it has not been employed for research efforts in the consultation/liaison setting. There are several reasons for this: the relative newness of the field, lack of administrative control over patient care, and the unavailability of a standard methodology that could be adapted to multiple sites. Four basic research strategies can be employed within the framework of a research consortium to advance scientific knowledge in consultation/liaison psychiatry: 1) prevalence studies of psychiatric morbidity in medical settings; 2) interrelationship among psychiatric and medical conditions; 3) the outcome of psychiatric interventions within medical milieu; and, 4) cost-benefit evaluation. A field-tested computerized database protocol and a software system useable on an office-based microcomputer were employed to obtain standardized data across multiple training sites. The advantages and disadvantages of consortium studies are described.

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