Psychosomatic education in Turkey

Psychosomatic education during medical study is achieved within psychiatry courses in Turkey. Generally, postgraduate education in psychiatry provides, during the specialization period, also a certain amount of education in psychosomatics. Only the Cerraphasa Medical Faculty at Istanbul University presents a unique form of practice and educational activity in the field of psychosomatics. Here, the Psychoneuroses and Psychosomatics Department within the Psychiatry Clinic (the foundation of which goes back to 1970) provides for medical students a psychosomatic approach and an introduction to psychosomatic concepts within the medical psychology courses and a further theoretical as well as practical knowledge during the psychiatry courses and internships. Postgraduate training in psychosomatics is also unique for Turkey in this department, where psychiatry residents with special interest for psychosomatics spend the major part of their training period in the psychosomatics department and receive theoretical and practical training. Training in psychotherapy is also included in the program. The regular series of seminars and open-lectures organized by this department are directed also to other medical and non-medical staff in various departments and faculties. Consultation-liaison-psychiatry is also part of this training. The department provides under- and postgraduate training (master training) for psychologists. Nurse training (under- and postgraduate) and occupational therapist training are also included in the training program of this Department. The training as well as other therapeutic and research activities of this department are also supported by the Society of Psychosomatics and Psychotherapy.     

The teaching of psychosomatic medicine and liaison psychiatry at medical schools in the United Kingdom

A systematic questionnaire survey was carried out of education in psychosomatic medicine and liaison psychiatry by the university departments of psychiatry in the United Kingdom. There was an excellent response rate. Taking first psychosomatic medicine, it is clear that it is rare to have a special course for the students. However the majority provided specific lectures or teaching sessions during the psychiatric attachment, also specific lectures outside this attachment, and the subject was usually brought in during the course of other undergraduate sessions such as topic teaching and clinico-pathological conferences. In liaison psychiatry again it was found that special courses were rarely favoured. However teaching in many places paralleled the methods found for psychosomatic medicine above, and in addition students were usually involved in consultation procedures or linked with medical and surgical firms for this purpose. In some departments research projects were carried out by the students. Possible improvements in teaching these subjects are suggested.     

Status of behavioral medicine in American and Canadian medical training

This article reports a survey of attitudes and current practices regarding behavioral medicine in American and Canadian medical school departments of psychiatry. Participants were eighty-two chairpersons of departments of psychiatry. Five major areas were addressed concerning the existence, location, and composition of behavioral medicine faculty and their contribution to training and research programs. Results indicate that behavioral medicine is represented in the majority of medical schools and teaching hospitals. Faculty tended to be located in psychiatry. A majority of the respondents did not think that behavioral medicine should be considered a separate clinical specialty area, but in actual practice behavioral medicine was distinct from consultation/liaison psychiatry as often as integrated with it. The analysis of subjects and methods taught in residency training programs suggested a meaningful trend in the data. The implications of these results for models underpinning traditional medical education and psychosomatic medicine are discussed.     

Psychiatrie de liaison : quelle psychiatrie pour quelles liaisons ?

The term of “liaison psychiatry” is used for a wide range of medical practices. The liaison psychiatry is the exercise of psychiatry in general hospitals, with patients hospitalised in somatic care departments: full time hospitalisation, day-limited stays, emergency units, and outpatient's consultations. It also aims to help caregivers and medical institutions. Liaison psychiatry works in collaboration with psychologists. Liaison psychiatry is supposed to answer two requests: one from the patient and the other from the caregivers or their institution. The psychiatrist is supposed to have polyvalent abilities concerning the entire psychiatric spectrum, as well as an in depth knowledge of links between somatic and psychological symptoms. He is also required to have an expertise in some specific medical fields essentially in specialised medical or surgical department recruitments in the hospital he works in. The liaison psychiatrist is confronted to numerous difficulties, essentially due to his external position concerning the medical departments. Generally psychiatry is conceived as part of the institution's services. A good example of these difficulties has been provided by the psychiatric care given to suicidal patients who have ingested caustic products. Psychiatry liaison will expand in the future. Today the limited number of doctors allowed to practise in French hospitals essentially limits it.     

上海市综合医院精神卫生服务现状调查

目的 了解上海市综合医院精神卫生服务资源等现状。方法 对上海市区15所三级和14所二级综合医院的精神卫生服务现状进行问卷调查。内容包括:医院规模及医疗服务资源;精神卫生服务机构设置及人员配置状况;会诊联络精神病学开展情况以及医院对临床医师进行精神卫生知识培训情况等。结果 (1)在29所综合医院中,17所甲等医院设置精神卫生科室,占59％,显示近年来综合性医院开始重视精神卫生服务工作。(2)已设立精神卫生科室的医院中精神科年会诊率为0.63％;而未设立的医院中精神科会诊率为0.10％,两者间差异具非常显著性(P>0.01)。(3)在被调查医院中仍有55％的医院未开展或仅是偶尔开展会诊联络精神病学工作。(4)精神科医师以不同形式和程度参加各科医疗工作;(5)已设立精神卫生科室的医院其临床医师在接受精神卫生培训方面显著优于未开设精神卫生科室的医院。结论 需要大大提高综合医院精神卫生服务能力,且设立精神卫生机构势在必行。     

Child psychiatry-pediatrics consultation-liaison services in the hospital setting: A review

The historical background of the child psychiatry-pediatrics consultation and liaison field is summarized. Two recent national surveys of consultation and liaison programs are presented; one survey was sent to departments of pediatrics, while the other covered divisions of child psychiatry. The development of a multidisciplinary, multidepartmental consultation and liaison group in a children's hospital is described and offered as a possible paradigm. Finally, the author discusses the problems revealed by the surveys and offers some possible solutions.     

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.     

综合医院精神科会诊5年变迁

目的：了解大型综合医院精神医学联合会诊的变化趋势。方法：将本院1994年和1999年邀请精神科会诊的科室分布、病种、诊断、转科及用药情况进行对比分析。结果：会诊科室中内、外科会诊比例显著上升,妇产科、神经内科会诊比例显著下降。诊断以器质性精神障碍、抑郁性神经症显著上升,情感性精神障碍,心因性精神障碍比例有一定程度上升,精神分裂症比例有较大幅度下降。会诊后转入精神科的比例显著下降,使用精神药物的比例显著上升。结论：综合医院的精神医学问题需要精神科医生的协助处理。应加强联络－会请精神病学的工作,精神医学服务特别是对轻性精神障碍的诊疗应主动延伸至综合科室。     

The teaching of consultation-liaison psychiatry in the undergraduate curriculum of Canadian medical schools

The teaching of consultation liaison psychiatry in the undergraduate curriculum of the 16 Canadian medical schools and the views of the directors of undergraduate psychiatric education were surveyed with a 25-item questionnaire. Some teaching in consultation liaison psychiatry is provided by 14 medical schools. The predominant format of teaching is that of supervised experience, and systematic evaluation of this teaching is uniformly absent. The amount of consultation liaison teaching was small. More than 90% of the students were assigned primarily or exclusively to an inpatient service during their psychiatric clerkship. The majority of the respondents thought that the response of staff and students to the teaching of consultation liaison was good or excellent, that this teaching should be an obligatory part of the curriculum, that it would increase in the next five years, that insufficient staff was a factor impeding it, and that an increase in staff psychiatrists specializing in consultation liaison psychiatry would facilitate this teaching in their department. It is suggested that the consultation liaison psychiatry teaching of medical students should be increased, in the short term by making greater use of services and resources. In the longer term, however, such increase would be dependent on the growth and development of consultation liaison services in the teaching hospitals across the country.     

Arbeitsfelder eines biopsychosozial ausgerichteten psychiatrischen Konsiliardienstes: Ergebnisse einer prospektiven 2-Jahres-Erhebung

Background

Since the establishment of the European Association of Consultation-Liaison Psychiatry and Psychosomatics in 1992, C/L psychiatry in European countries has been increasingly recognized as a subspecialty of clinical psychiatry and psychosomatic medicine. The study explored the areas of work of the biopsychosocial oriented psychiatric consultation – liaison (C/L) service at the university hospital LKH Graz (Austria).

Methods

We conducted two prospective 1-year surveys over two years of observation. Survey I comprised 1,505 consecutive new consultations, and the more recent Survey II extended over 1,478 consecutive new referrals to our C/L service. Psychiatric referrals were analyzed with regard to demographic characteristics, referring departments, principal reasons for referral, diagnostic characteristics, and intervention patterns.

Results

In both surveys, the most common patient to be referred was a middle-aged woman. Internal medicine consistently accounted for almost one third of all referrals, followed by neurology. The most prominent reasons for biopsychosocial referral were any signs of abnormal mood, behaviour, psychotic symptoms or cognitive impairments. The most common mental disorders according to ICD-10 were adjustment disorders, depressive disorders, and delirium. Psychopharmacotherapy and combined psycho- and pharmacotherapy were the most frequent actions in both surveys, followed by biopsychosocial evaluation pretransplant.

Conclusions

To ameliorate the provision of biopsychosocial care for general hospital patients, the need for specially planned biopsychosocial C/L services with equal involvement of specialists in medical psychology, C/L psychiatry, and clinical psychology should be underscored.     

会诊联络精神病学在综合医院的现状分析

目的对综合医院精神病学会诊现状进行分析研究。方法2007年度申请精神科会诊的病例279例,分析其申请科室、原发病、申请理由及精神科诊断处理。结果综合医院精神病学会诊中最常见的精神科诊断是脑器质性精神障碍、躯体疾病伴发精神障碍、焦虑障碍和抑郁障碍。结论应在综合医院积极开展会诊联络精神病学服务及对综合科医生加强精神病学知识教育。     

综合医院精神科急会诊与普通会诊的比较

目的探讨综合医院精神科急会诊与普通会诊的特征差异。方法2007年度申请精神科会诊的病例279例,分析申请科室、原发病、申请理由、精神科诊断处理,比较急会诊与普通会诊的差异。结果综合医院精神病学急会诊主要为脑器质性精神障碍及躯体疾病所致精神障碍(75%~85%),普通会诊以抑郁障碍、焦虑障碍及神经症为主。结论应在综合医院积极开展会诊-联络精神病学服务,急会诊与普通会诊的诊断差异有助于精神科会诊临床实践。     

Effect of liaison psychiatry on attitudes toward psychiatry, rate of consultation, and psychosocial documentation

Prior literature suggested that psychiatric liaison on medical wards would produce a more positive attitude towards psychiatry, more psychosocial chart documentation, and a higher consultation request rate. Over 3 years, liaison was conducted on two medical wards, and its effect was contrasted with two control (consultation only) medical wards. Liaison activities were more favorably received by consultees than consultation alone and increased the consultation request rate, but produced no change in psychosocial documentation. Additional effectiveness of liaison activities might be achieved through direct, focused interventions, and through active involvement of senior medical faculty.     

Liaison psychiatry: A model for medical care on a general hospital psychiatric unit

Liaison psychiatry is traditionally practiced on the medical and surgical floors of the general hospital. The need for liaison psychiatry on the inpatient psychiatric unit as opposed to its usual setting was realized when the medical care requirements of hospitalized psychiatric patients was assessed. In many general hospitals this medical care is provided by a psychiatrist in consultation with medical and surgical colleagues. Over a three-year period at the Medical Center Hospital of Vermont 563 medical/surgical consultations were provided to the inpatient psychiatric unit. To utilize these consultations most effectively, the role best suited for the psychiatrist was that of liaison-consultee. Case examples are used to demonstrate the effectiveness of employing liaison skills in the treatment of somatic problems on the inpatient psychiatric unit. The educational implications of learning the liaison model in this context are discussed.     

Problem based learning (PBL)--possible adaptation in psychiatry (debate)

Teaching psychiatry concerns mainly education of students studying medicine and clinical psychology, but it also concerns professional training the people specializing in psychiatry and in other fields of medicine. Since the requirements that medical professionals are obliged to meet are ever higher, it is essential to provide highest possible quality of teaching and to do so to use the best possible teaching models. One of the modern educational models is Problem Based Learning (PBL). Barrows' and Dreyfus' research as well as development of andragogy had major impact on the introduction of this model of teaching. There are favourable experiences of using PBL in teaching psychiatry reported, especially in the field of psychosomatics. Problem Based Learning gradually becomes a part of modern curricula in Western Europe. For this reason it is worth keeping in mind PBL's principles and knowingly apply them into practice, all the more the reported educational effects of using this method are very promising.     

Culturally informed psychotherapy in Asian consultation‐liaison psychiatry

Psychotherapy provides substantial benefits for patients with medical illness. Western‐based psychotherapies are commonly practiced by consultation‐liaison psychiatrists in Asia. Although such interventions benefit Asian patients, they are limited by their cultural applicability. Sociocultural factors shape the meaning, expression, and treatment of medical illnesses. In helping patients with medical problems, it is imperative that psychiatrists be mindful of the value of culture in their clinical work. The concept of the self, religion, spirituality, adaptation, coping, and defense mechanisms are all culturally determined. This article discusses how these concepts impact the practice of psychotherapy in the Asian consultation‐liaison psychiatry setting. Currently, there is a dearth of systematic research about this subject matter. Most studies describe the application of Western‐based psychotherapies for patients with medical illness with little input as to cultural modifications or implications of such interventions. The authors of this article identify culturally consonant psychotherapeutic techniques in the Asian consultation‐liaison psychiatry context. Furthermore, they also propose general guidelines in the cultural adaptation of psychotherapy interventions or development of indigenous psychotherapies.     

Consultation--liaison psychiatry. Possibilities for the 1990s

In order for consultation-liaison (C/L) psychiatry to enhance its acceptance and funding, carefully designed outcome studies that will demonstrate its clinical effectiveness to other disciplines in medicine, departments of psychiatry, hospital administration, third-party payors, and patients are required. The development of alternative methods of funding C/L services is described: (1) high-risk screening, renal transplant, geriatric units (Medicare); (2) salary stipends from collaborating disciplines, e.g., medicine, ENT, neoplastics; (3) consultation fees; (4) ambulatory C/L clinics (Medicaid); and (5) grants from collaborative research. With a change in structure when it can be employed (from consultation to the screen methodology), the development of scientifically derived outcome data of C/L psychiatry interventions, adequate documentation of the evaluation and treatment by C/L psychiatry, and the new tools biological psychiatry and psychopharmacology will provide, the 1990s could and should be an exciting time for this subspecialty of psychiatry.     

Psychosomatic clinic or pain clinic: Which is more viable?

Outpatient consultation-liaison (C-L) psychiatry has been beset with problems concerning funding and patient acceptance. Though the consultation, liaison, and referral clinic models for outpatient C-L psychiatry each offer advantages, they have not conquered these fundamental problems. This paper introduces the multidisciplinary pain clinic as an alternative means of addressing somatic symptoms and psychiatric disorders in an ambulatory medical population. The multidisciplinary pain clinic offers advantages in terms of reimbursement, patient acceptance, and opportunities for interdisciplinary research. The pain clinic model has disadvantages that include administration by departments other than psychiatry, traditional location in a tertiary care hospital, and limitations to who can be treated. However, it offers a place where both the physiological and psychological aspects of somatic symptoms may be addressed. The pain clinic nurtures the priorities and goals of primary care for a patient population whose complexities may outstrip the resources of a single primary care physician.     

A questionnaire for the examination of psychiatric liaison-consultation programs.

Liaison-consultation services have become an integral part of departments of psychiatry in medical schools and general hospitals. The evaluation of such services has focused most closely, thus far, on the efficacy of their educational programs. The author provides an extensive questionnaire which may be used for a global examination of the working structure of liaison-consultation services and recommends that liaison psychiatrists and personnel from the programs of other institutions be enlisted to participate in the process of evaluating programs.     

Consortium-based consultation/liaison research: commentary and perspective

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 usable on an office-based microcomputer were employed to obtain standardized data across multiple training sites. The advantages and disadvantages of consortium studies are described.