Somatoform disorders: the role of consultation liaison psychiatry

The somatoform disorders are encountered commonly in both primary and secondary care. Despite their high incidence, few hospitals have teams with the expertise to manage this group of conditions. The lack of appropriate carers leads to inappropriate care, including increased numbers of admissions and investigations, to the detriment of the patients. The absence of appropriate care also increases the cost to the health services. Multidisciplinary Consultation Liaison (C-L) Psychiatry teams operate within non-psychiatric settings and are dedicated to the mental health care of patients presenting in these areas. Their unique skills and approaches offer support and education to these non-psychiatric teams and care to this group of patients. They are thus ideally placed to assess, diagnose and manage individuals presenting with somatoform disorders. Unfortunately, these teams are not widely available, largely because the current climate within psychiatry leads services to concentrate on what is defined as serious mental illness, a term usually used synonymously with psychotic disorders, despite the large number of people suffering from somatoform disorders and the cost of their care. The dislike that some colleagues have for this group of conditions may further hamper the creation of these services. In order to provide efficient assessment of and treatment for individuals with somatoform disorders, C-L Psychiatry teams must be created to lead clinical development, research and training in this discipline. These teams will also lead on the further research required.     

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。     

Somatoform disorders: The role of consultation liaison psychiatry

The somatoform disorders are encountered commonly in both primary and secondary care. Despite their high incidence, few hospitals have teams with the expertise to manage this group of conditions. The lack of appropriate carers leads to inappropriate care, including increased numbers of admissions and investigations, to the detriment of the patients. The absence of appropriate care also increases the cost to the health services. Multidisciplinary Consultation Liaison (C-L) Psychiatry teams operate within non-psychiatric settings and are dedicated to the mental health care of patients presenting in these areas. Their unique skills and approaches offer support and education to these non-psychiatric teams and care to this group of patients. They are thus ideally placed to assess, diagnose and manage individuals presenting with somatoform disorders. Unfortunately, these teams are not widely available, largely because the current climate within psychiatry leads services to concentrate on what is defined as serious mental illness, a term usually used synonymously with psychotic disorders, despite the large number of people suffering from somatoform disorders and the cost of their care. The dislike that some colleagues have for this group of conditions may further hamper the creation of these services. In order to provide efficient assessment of and treatment for individuals with somatoform disorders, C-L Psychiatry teams must be created to lead clinical development, research and training in this discipline. These teams will also lead on the further research required.     

Supervision in liaison and consultation psychiatry

This paper reports special problems and techniques of teaching liaison and consultation psychiatry to psychiatric residents. It has become apparent that traditional methods of resident training are inadequate, and that specialized techniques of supervision are required to help the resident deal with the unique aspects of the liaison and consultation environment. Specific recommendations are made and discussed.     

The role of an old age psychiatry consultation liaison nurse

Objective. To assess and describe service changes when a psychiatric consultation liaison nursing service is introduced. Design. Prospective collection of basic service data before and after implementation of the service change. Setting. A newly established comprehensive old age psychiatry service. Patients. People on medical and surgical wards aged over 65 years referred for psychiatric assessment. Outcome measures. Numbers of referrals made and patients seen, details of psychiatric diagnoses made and follow-up offered before and after the change in the service. Results. Within 6 months there was an increase in liaison referrals to the service. The proportion of people offered follow-up showed little change and delay before assessment decreased substantially with the PCLN service. Conclusions. A psychiatric consultation liaison nursing (PCLN) service was successfully initiated. Numerous difficulties were encountered but this is a useful model for old age psychiatry services to consider researching and developing further. © 1998 John Wiley & Sons, Ltd.     

Interventions in consultation/liaison psychiatry. Part I: Patterns of recommendations

In a previous study, a checklist and a schema for operationalized interventions have been described. In this study, these operationalized interventions have been used in clinical practice in 820 cases. In 287 cases (35%), recommendations focusing on the medical treatment, other than diagnostic action (41%) and medication (68%), were provided. This emphasis on the intensity of medical treatment is an unreported finding. The further distribution of recommendations over the different intervention domains was: obtaining additional psychosocial information, 30%; psychosocial management on the ward, 61%, specifically its organization; discharge planning, 41%; and aftercare management, 24%. Recommendations infrequently used included: monitoring of cognition and behavior, referrals to occupational therapy and alcohol- and drug-related facilities, and a detailed specification of postdischarge care. Since consultee concordance with the consultant's recommendations is important to treatment outcome, this method of a systematic recording of operationalized recommendations is a first step toward enhancing the evaluation of treatment recommended and provided by consultation/liaison (C/L) psychiatrists. Moreover, these operationalized recommendations help advance the specification of protocols for psychiatric intervention studies.     

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.     

Beyond liaison: a future role for psychiatry in medicine

Integrated biopsychosocial treatment is necessary for medical patients in whom psychosocial and behavioral issues strongly influence medical outcome. In this article the authors identify several large groups of such patients, and point out the limitations of three established approaches to improving their care: psychosocial education for non-psychiatrists, traditional consultation-liaison psychiatry, and 'behavioral medicine.' They present reasons why many of these patients would best be served by having psychiatrists as their primary physicians. Primary care of selected medical patients by psychiatrists is feasible and would improve patient care, interspecialty communication, reimbursement, and recruitment of psychiatric residents.     

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.     

综合医院精神科联络会诊分析

目的探讨综合医院各临床科室请精神科联络会诊的特点。方法收集2007年7月～2008年8月共计14个月的会诊病例,通过会诊邀请单及自编的会诊情况问卷收集资料。采用SPSS12．0进行统计。结果邀请会诊年龄在5～97岁,平均（52±21）岁,男性占50％以上;按会诊分配比例由高到低的科室为神经内科、骨科、脑外科、老年病科、消化科、心内科等。结论精神科联络会诊在各年龄段均有,以中老年为主;申请科室中除神内、脑外以外,骨科和老年病科也较多;年转入率减低,而精神科药物使用在各科室逐渐增多。生物-心理-社会医学模式渐入人心。     

A marketplace model of consultation psychiatry in the general hospital.

The manner in which internists and surgeons view potential psychiatric consultations is analogous to the way in which consumers evalute a service or product in the marketplace. Factors that determine a purchase or a consultation request include 1) perception of need, 2) prior attitude and experience, 3) projected image, 4) availability, and 5) cost/benefit ratio. The author presents a model of psychiatric consultation, with similarities between research and development, manufacturing and merchandising phases on the one hand, and negotiation, investigation, and implementation phases on the other.     

综合医院老年精神科联络会诊：附131例分析

目的了解和探讨综合医院老年精神科联络会诊的特点。方法对申请精神科会诊的131例综合医院老年患者,通过精神检查依照ICD—10进行诊断,并电话随访疗效。结果患者年龄65～109岁,平均（77．62±9．09）岁;会诊请求中最困扰的精神问题为行为障碍（69．5％）,会诊诊断谵妄状态（42．0％）最为常见;会诊后疗效很好和有效的比例分别为36．6％、57．1％。结论综合医院老年精神科会诊有其特点,会诊有助于精神状态的判别和治疗。     

Teaching liaison psychiatry and clinical practice of psychosomatic medicine in the general hospital.

One of the recent trends in the general hospital is the increase of psychiatric units and the number of psychiatrists working therein. Thus the psychiatrist has had greater opportunities to participate as a member of a clinical team in the care of patients of other units. Accordingly, daily cooperation with other specialties casts him into new roles which transcend those of the traditional psychiatric consultant. The role of liasion psychiatrist involves the complex relations of doctor--nurse--patient--family, interdepartmental relations, communications and so on. By improving these relationships he tries to bring about a more holistic approach in the general hospital.     

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

Aims

To explore the experience of senior staff on acute medical wards using an established inpatient liaison psychiatry service and obtain their views on clinically relevant performance measures.

Methods

Semistructured face-to-face interviews with consultants and senior nurses were taped, transcribed and analyzed manually using the framework method of analysis.

Results

Twenty-five referrers were interviewed. Four key themes were identified — benefits of the liaison service, potential areas of improvement, indices of service performance such as speed and quality of response and expanded substance misuse service. Respondents felt the liaison service benefited patients, staff and service delivery in the general hospital. Medical consultants wanted stepped management plans devised by consultant liaison psychiatrists. Senior nurses, who perceived themselves as frontline crisis managers, valued on-the-spot input on patient management.

Conclusions

Consultants and senior nurses differed in their expectations of liaison psychiatry. Referrers valued speed of response and regarded time from referral to definitive management plan as a key performance indicator for benchmarking services.