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

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 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.

Reasons for referral and consultation liaison psychiatry diagnoses

2010 ◽  
Vol 27 (3) ◽  
pp. 123-129 ◽  
Author(s):  
John Lyne ◽  
Brian O'Donoghue ◽  
Maurice Bonnar ◽  
Daniel Golden ◽  
Claire Mclnerney ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Management Strategies ◽  
Referral And Consultation ◽  
International Studies ◽  
Liaison Psychiatry ◽  
Consultation Service ◽  
Consultation Liaison Psychiatry ◽  
Effective Distribution ◽  
Available Resources

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.

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 Need Assessment of Consultation Liaison Psychiatry amongst the Clinical Faculty

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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