Patterns of psychiatric consultations in Kuwait general hospitals

Two hundred and nineteen consecutive referrals to psychiatric consultation services from all general hospitals in Kuwait over a 3-month period were studied and compared with a control group of 100 patients who were not referred for psychiatric consultation. The two groups differed significantly in age, sex, marital status, employment, and past psychiatric treatment. Inpatients were more often referred than outpatients with an overall low referral rate of 0.3%. The department of general medicine referred 74.4% of patients in contrast to 11.4% referred by the department of general surgery. The most common reason for referral was for assessment of a suicide attempt in the inpatient group, and the absence of organic cause for patients' physical symptoms in the outpatient group. Acute situational disturbance that resulted in a suicide attempt was the most common psychiatric diagnosis (26%), followed by depressive illness (19.5%) and organic psychotic disorders (8.2%). Our findings are similar to those reported in the literature, and the present study suggests a national underutilization of psychiatric consultation services in general hospitals.     

A psychiatric consultation/liaison clinic: follow-up of fifty-four patients referred from neurology

To assess the impact of psychiatric consultation, the authors reviewed the charts of patients referred from a neurology clinic to an outpatient consultation/liaison psychiatry clinic. The patients were found to have both significant neurologic and psychiatric disorders. Only 46 percent returned to see their neurologists within six months of the referral. This finding highlights a major problem in outpatient consultation.     

Consultation liaison psychiatry in a Kuwaiti general hospital

The authors analysed the psychiatric profile of 208 general hospital patients referred for psychiatric consultation, about half of these patients presented with parasuicidal behaviour. The diagnoses of depression and adjustment disorders predominated. Characteristics of the referred patients, source of referral and main forms of psychiatric intervention are documented. Means to promote good relationships between psychiatrists and physicians are suggested. The need for a better liaison psychiatric service is emphasised.     

Geropsychiatric consultation in a general hospital in Taiwan

The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age > or =65 years) inpatients consecutively referred for consultation-liaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17-50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation.     

Referrals to a psychogeriatic consultation–liaison service

This study reviews referrals of elderly medically ill patients to a psychogeriatric team in a district general hospital. Sociodemographic variables, medical diagnosis, source and reasons for referral, and primary DSM III diagnosis were determined. The impact on referral patterns of the introduction of a pscychogeriatric liaison attachment to complement the existing consultation service was also assessed. In three years, 217 patients were referred, the majority from the general medical specialities. The median age of the sample was 79.5 years, more than half were female and over 60% demonstrated multiple physical pathology, particularly cerebrovascular and cardiovascular disorders. The most prevalent psychiatric diagnoses were dementia, delirium and depression. The pattern of referrals changed significantly with the introduction of the consultation–liaison service. The number of referrals increased by over 100% and there was a significant increase in the recognition and referral of functional psychiatric disorders, especially depression. The role of the geriatricians and the liaison psychiatry attachment in promoting these changes and the clinical, teaching and research advantages of this type of collaboration are discussed.     

Is consultation at the psychiatric outpatient clinic a useful service for patients and their doctors?

The aim of this retrospective study was to examine the views of patients and general practitioners on consultation after referral to a psychiatric outpatient clinic. Consultation was defined as less than five sessions. One hundred and sixty patients who had consultations at a mean of 42 months before were invited to the study. Ninety-one took part, and they filled in a questionnaire on their views and Symptom Checklist 90-R. Thirty-eight (79%) of 48 GPs gave their opinions on a questionnaire of 128 (80%) written feedbacks from the 160 consultations. The patient and the GP questionnaires showed good psychometric properties. Fifty-one (56%) patients considered the help received at the psychiatric outpatient clinic as good or very good. In 73 (57%) of the cases, the GPs found the consultations helpful. At follow-up, the patients had a significantly reduced mental symptom load. Going to work and living with a spouse were characteristics of patients satisfied with the consultation. Administrative variables did not influence satisfaction. A clear focus and emphasis on patient information as to the nature and treatment opportunities of the mental disorders seems to be a cheap and relevant way of improving patients' satisfaction with consultations. The patients were least satisfied with consultation given by psychiatric nurses. In conclusion, there is need for improvement, but consultations should continue as an important part of the psychiatric service for primary care.     

综合医院精神心理科会诊患者特点分析

目的 了解综合医院精神心理科联络会诊的原因、患者的科室分布、病种构成及处理情况,以更好地指导精神心理科医生的联络会诊工作,为进一步完善会诊精神医学在综合医院内的发展提供参考.方法 本研究采用回顾性方法复习综合医院住院患者的精神科会诊情况,分析在现代医学模式下综合医院的患者对精神卫生服务需求的特点,汇总2012年1月-2013年12月精神心理科联络会诊病历,资料完整者共612例,对一般人口资料、各科会诊人数及病种构成、会诊原因、诊断、处理构成等情况进行描述分析.结果 全部临床科室都有邀请精神心理科会诊,比例最高的科室前5位为：神经内科113例（18.5％）、心血管内科83例（13.6％）、消化内科69例（11.3％）、干部科56例（9.2％）、急诊科52例（8.5％）.病种主要为神经症性、应激相关的及躯体形式障碍151例（24.7％）,心境障碍139例（22.7％）,器质性精神障碍108例（17.6％）,伴有生理紊乱和躯体因素的行为综合征84例（13.7％）;精神科用药以SSRIs类药物、非典型抗精神病药物及苯二氮革类应用较多.结论 综合性医院各科存在较多的精神医学问题,住院患者伴发的精神障碍涉及各类疾病,综合医院就诊的患者精神心理障碍应引起重视,精神科会诊联络非常重要,可以提高临床各科医师对精神障碍的认识,减少或消除人们对精神科会诊的顾虑与不信任,提高会诊效率,治疗躯体疾病的同时应及时使用心理和药物等多种干预手段,使患者得到全面康复,从而提高患者的生命质量.     

Change in accuracy of recognizing psychiatric disorders by non-psychiatric physicians: five-year data from a psychiatric consultation-liaison service

Aim: Psychiatric disorders are easily underestimated and under‐recognized by physicians. The aim of the present study was to investigate the change in accuracy of recognizing psychiatric symptoms. Methods: Consecutive 5‐year consultation–liaison data were collected and patients with one of the five common psychiatric diagnoses, including depressive disorders, substance use disorders, delirium, anxiety disorders and psychotic disorders, were chosen for analysis. The primary care physician's initial impression of a psychiatric diagnosis was recorded based on their reason for referral on the referral sheets. Accurate recognition was defined as matching of the physician's initial impression with the psychiatrist's final diagnosis. Mentioning the core symptoms of psychiatric diagnostic criteria or common synonyms would be considered as correct recognition. Results: The overall accuracy of recognition was 41.5% and there was no significant change during this 5‐year period. Substance use disorders were the one diagnosis with the highest agreement, followed by delirium, depressive disorders, anxiety disorders, and psychotic disorders. As for the factors associated with accurate recognition, male patients or those with multiple physical illnesses were more likely to have their psychiatric symptoms recognized correctly. Conclusions: Without comprehensive postgraduate psychiatric education, the accuracy of recognizing psychiatric symptoms does not improve year by year. Education should focus on common psychiatric problems among medical inpatients, especially those easily misdiagnosed, such as depression and delirium.     

Psychiatric consultation to a general hospital medical evaluation service

Psychiatric consultation to a general hospital medical evaluation service was reviewed and compared with consultation patterns for general hospital inpatients and psychiatric emergency service patients. Results of a questionnaire survey indicated nearly 1 in 5 patients admitted to this acute medical service (24-hour maximum stay) required psychiatric consultation. A study of those patients seen by psychiatric consultants is reported. The prevalence of depressive illness as well as the psychiatric hospitalization referral rate was substantially greater than in general hospital inpatient or psychiatric emergency service evaluations. The implications of this relatively new area of consultation-liaison for hospital staffing and medical education are discussed.     

Psychiatric consultation among hospitalized arthritis patients

Fifty consecutive psychiatric consultations on 48 patients over an 18-month period in an arthritis hospital are analyzed. The range of psychiatric disorders and their relationship to characteristics of the patient population, such as age, sex, and medical diagnosis, are described. Approximately 2% of patients admitted to the hospital during this period elicited psychiatric consultation. This rate is one-third of the consultation rate of an acute medical and surgical hospital serviced by the same consultants. The relative distribution of psychiatric diagnoses—depression 59%, personality disorders and drug abuse 15%, psychosis 10%, conversion reaction 10%, and “other” 6%—was similar to that encountered in an acute general hospital setting. Although depression was the most prevalent psychiatric problem, it was severe enough to elicit consultation only in 1% of the total hospitalized population; its severity did not correlate directly with the severity of rheumatoid arthritis, the most common medical diagnosis encountered. Neither a particular medical illness nor sex accounted for a disproportionate share of the psychiatric consultations.     

Psychiatric disorders and the need for mental health services among a sample of orthopedic inpatients.

This report concerns psychiatric disorders and the need for mental health services among patients admitted to a general orthopedic surgery service. The planning of mental health services for medical and surgical inpatients in terms of current community mental health concepts is discussed.It has been observed that patients being treated for medical or surgical conditions have a higher than expected incidence of psychiatric disorders.^1–6 Previous studies of inpatients with orthopedic or other surgical conditions report a wide range (19%–86%) of psychiatric disorders depending upon the diagnostic criteria employed. In spite of the documented need for mental health services among such patients, primary physicians are often reluctant to request psychiatric consultation, and the psychiatrist is usually consulted only when a patient presents a difficult management or diagnostic problem.^3,7,8 Thus, many other medical or surgical patients could benefit from mental health consultation if their needs could be identified.In recent years, psychiatrists have become more involved in the functioning of general medical services, with consideration being given to the application of the principles of community mental health to the consultation services.^2,4,9–12 Psychiatrists have participated in indirect consultation through the medical and nursing staff in addition to providing direct consultation within medical and surgical settings. In planning this type of consultation service, more information is needed about the kinds of mental health problems experienced by medical and surgical patients.     

Effects of cortical lesion location on psychiatric consultation referral for depressed stroke inpatients

Although post-stroke depression occurs with lesions to either cortical hemisphere, increasing evidence supports the view that depression is more prevalent after left hemispheric damage. This retrospective study of depressed post-stroke inpatients referred for psychiatric consultation shows a significantly higher referral rate for patients with right-hemispheric lesions. The results suggest an underutilization of psychiatric consultation to patients with left-sided lesions, and perhaps underrecognition of affective disorders in these patients. Various reasons for this underutilization are proposed, including the greater likelihood of speech impairment in left-sided brain-damaged stroke patients, who may have greater difficulty verbally communicating their psychic distress. Increased physician awareness of the clinical presentations of post-stroke depression will result in more patients benefitting from available treatments.     

Positive influence of a liaison program on the rate of psychiatric consultation referrals for cancer patients

To improve access to psychiatric consultation for cancer patients as well as non-cancer patients with psychiatric disorders, a psychiatric liaison programme to communicate closely with physicians and ward staff regarding anticipated psychiatric morbidity in patients, was introduced in each ward of a general hospital. The rate of psychiatric consultation referrals for cancer patients was significantly higher after the psychiatric liaison programme was established. The programme had a greater impact on the rate of psychiatric consultation in a unit with cancer patients who were informed of their diagnoses. The greater consultation rates in cancer patients after the liaison programme might be, in part, associated with the physicians' attitude toward the more open disclosure of the cancer diagnosis.     

The changing pattern of referrals for psychogeriatric consultation in the general hospital: An eight-year study

An eight-year retrospective evaluation of referrals to a psychogeriatric consultation service demonstrated a highly significant linear increase of total referrals with a selective change of case mix that included more depressions and fewer cases of acute confusion or referrals with no psychiatric disorder. This did not occur with referrals from general practice, where case mix remained stable though total referrals also increased. It is suggested that this selective change relates to an educational influence of the specialist consultation service operating within the hospital and represents a desirable change of referral behaviour. The degree of psychiatric morbidity on general hospital wards far exceeds the capacity of a consultationservice whose primary objective must be education to enable non-psychiatrists to detect and manage the majority of these disorders without recourse to specialist referral. Research that will further define the elements of the educational process that have greatest impactis needed and offers a new research direction for liaison psychiatry of old age.     

Consultation-liaison psychiatry: A comparison of two service models for geriatric patients

In general hospitals the psychiatric morbidity in the old and frail is at least 40%. Two models for the provision of a psychiatric service to hospitalized geriatric patients were evaluated in order to identify which model most effectively fulfilled the aims of liaison psychiatry. At present, consultation type services predominate and there is some concern that an active liaison service could increase the referral rate of cases more appropriately dealt with by physicians. In this study an active liaison model was not associated with a marked increase in the referral rate, and when compared to a service with an emphasis on consultation, there was a higher degree of diagnostic accuracy by referring doctors in the liaison type model.     

Management strategies in geriatric depression by primary care physicians and factors associated with the use of psychiatric services: a naturalistic study

Approximately 10% of elderly patients in primary care have depression yet it is often under-diagnosed and under-treated. It is unclear exactly how patients are being managed in primary care or what factors are associated with referral to psychiatric services. This study aimed to establish in a naturalistic setting how older depressed patients are managed in primary care; to determine which patients are referred to psychiatric services and the differences between patients referred and those not; in terms of primary care consultation rate and degree of co-morbid illness. Computerised records and referral letters were read for 1089 elderly patients in a large practice in central Manchester, UK. Of the 9% identified as depressed, 90% were managed in primary care alone, a third without antidepressants. More than half of those prescribed antidepressants received tricyclic antidepressants. Suicidal ideation and treatment failure were the principle reasons for referral. Patients referred had a greater psychiatric co-morbidity and had consulted their GP more frequently in the past year. Management of depression in the elderly may be conservative and older antidepressants may be over-prescribed. Increased primary care consultation rate and a greater psychiatric co-morbidity may be associated with referral to psychiatric services.     

Patterns of comorbidity in relation to functioning (GAF) among general hospital psychiatric referrals. European Consultation-Liaison Workgroup

Improvement of services for physically ill patients with concurrent psychiatric problems is a noteworthy issue in general hospitals. Among 1249 general hospital in-patients referred for psychiatric consultation, concurrent mental and behavioural disorders (ICD-10) were diagnosed in 84% of cases. Any concurrent mental and behavioural disorder was associated with dramatically low functioning (GAF = 46), indicating serious psychosocial impairment. This is a striking new finding of clinical importance. The effect on functioning was similar for substance use disorders, other mental disorders, and combined mental and substance use disorders (dual diagnoses), with no gender differences. This finding highlights the need for specialized interventions among general hospital in-patients referred for psychiatric consultation.     

神经症患者就医情况调查

目的：了解神经症患者发病后的在情况。方法：对１９９８年７月～１９９９年８月前来门诊咨询,符合ＣＣＭＤ－２Ｒ神经症诊断标准的患者１００例,了解其发病后的就医情况。结果：有４８例首诊于精神科‘４７例首诊或反复长期就诊于综合医院内科等,尤以焦虑症和凝症症患者为多;５例癔症发作时求助于迷信活动。结论：约有半数神经症患者发病后去综合医院治疗,因此在综合医院普及精神医学知识,设立心理咨询或精神科门诊,开展联络     

General practice consultation rates for psychiatric disorders in patients aged 65 and over: prospective cohort study

OBJECTIVE: To examine consultation rates for psychiatric disorder in general practice among patients aged 65 years and over; and to examine the effect of sociodemographic factors (gender, age, social class and accommodation) on consultation rates. DESIGN: Prospective cohort study. The fourth national survey of morbidity in general practice carried out between September 1991 and August 1992. Sixty volunteer practices in England and Wales took part; study population comprised a 1% sample of the population (502,493 patients). GPs recorded the reasons for all consultations and these were converted into an ICD9 code. Trained fieldworkers collected sociodemographic data on the patients in the survey. METHOD: Psychiatric disorders were categorised by compiling the appropriate ICD9 codes. Annual consultation rates (per 1000 patients) according to psychiatric disorder and sociodemographic factors were calculated after adjustment for differing length of follow-up. RESULTS: Only 4.4% of all consultations were for psychiatric disorders. Women had consultation rates 75% higher than men. Social class had no effects on rates. Consultation rates were highest for neurotic disorders and depression. Those living alone had highest rates for depression, whilst those living in residential and nursing homes had substantially higher consultation rates for dementia and bipolar affective disorder. CONCLUSION: Consultation rates were significantly lower than expected from previous epidemiological studies. This indicates that there is considerable hidden morbidity that is being untreated in primary care. Social class appears to have no effect on consultations for psychiatric disorder in the elderly. The increasing age of the population may result in a significant increase in consultations for dementia, but not for depression or neurosis.     

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.