Treatment opportunities on a consultation/liaison service

The amount of time consultation psychiatrists in a large metropolitan teaching hospital spent providing direct services was studied over 1,104 consecutive consultation cases. Although the majority of cases required less than 5 hours of psychiatric time apiece, more than 10% of these cases each received more than 10 hours of direct services. This finding has important implications for understanding the types of psychiatric services provided to hospitalized medical/surgical patients.     

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.     

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.     

Psychiatric consultation services in an oncology hospital

Psychosocial oncology has become an area of considerable interest over the past ten to fifteen years. There has been little written about the development of psychiatric services or the profile of such services to this population. This paper describes the historical evolution of a psychiatric consultation service in a cancer hospital and provides a statistical analysis of the patient population and services provided. The special need for continuity of care and a comprehensive biopsychosocial approach is elaborated and clinical examples are reported. Finally, directions for the future development of this kind of service are suggested.     

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.     

Illness behaviour as a determinant of referral to a psychiatric consultation/liaison service

Recognition of psychiatric disturbance and rate of referral to psychiatric units in general hospitals falls far short of the prevalence of psychiatric morbidity in such hospitals. This study has sought to determine whether particular patterns of "illness behaviour" contribute to the decision to refer. A group of patients referred to a psychiatric service was compared to a group of non-referred patients using the General Health Questionnaire (GHQ) as a general measure of morbidity, the Inventory to Diagnose Depression (IDD), the State-Trait Anxiety Inventory (STAI) and the Illness Behaviour Questionnaire (IBQ). The rate of referral to the service was 2.9%. The estimated prevalence of psychiatric morbidity was 30%. Referred patients scored more highly on all measures of morbidity (GHQ, IDD, STAI) and on the IBQ scale Affective Disturbance, and scored lower on the Denial Scale. Data are reported which suggest that patients with a strong somatic focus are less likely to be referred for psychiatric assessment despite the presence of significant psychiatric morbidity. The implications for health care delivery and identification of psychiatric morbidity are discussed.     

Ombudsman Rounds on the otolaryngology service

An attempt to enhance psychiatric teaching on the Otolaryngology Service was undertaken by employing the vehicle of Ombudsman Rounds. The structure of these rounds is dictated by its major goal of maximizing the relationship of the surgeon and liaison psychiatrist as coteachers among the staff of the ENT surgical unit. Surgical residents, surgical clerks, nurses, and the social worker meet with the Chairman of the ENT Department and the liaison psychiatrist in a scheduled weekly conference, which addresses both staff and patient needs on the in-patient surgical service. Through patient interviews, multidiscipline staff presentations, chief of service surgical and prognostic summaries, and liaison psychiatrists' formulations, group discussions are undertaken. Through such an experience the staff become aware of the patient's feelings and understandings about their illness and care. The goal of Ombudsman Rounds is to enhance patient care, advance psychiatric knowledge of the multidiscipline staff, and provide and ongoing vehicle to change attitudes so that they incorporate a biopsychosocial approach to patient management on the ENT Service.     

Psychiatric, psychosomatic and medical psychological consultation and liaison activity in West Germany. Results of a survey

Results of the first survey of consultation/liaison psychiatry and psychosomatics in the Federal Republic of Germany are presented and discussed. All departments and units of psychiatry, psychosomatics and medical psychology were asked to fill in a questionnaire, characterizing the institution in question, the type and degree of cooperation with somatic units and the experiences made therewith, as well as special issues like the use of data bases and diagnosis, questions of organization, professional training and research in C/L work. The 177 institutions which replied (67% of the total of 263 institutions addressed) can be regarded as representative for those institutions which are involved in consultation/liaison work. As compared with psychiatry, psychosomatic (and medical psychology) departments are especially involved in C/L-work. Due to insufficient financing and relative neglect as concerns research and professional training and exchange, C/L-work in the Federal Republic of Germany at present is far from providing general hospital inpatients with the mental health care required, as indicated by prevalence estimates. Reasons for this are discussed and suggestions as to minimal standards of C/L-care are provided.     

The impact of ward dynamics on psychiatric consultation and liaison

This article has examined the particular characteristics of several medical and surgical services as they affect interaction with psychiatric services. Two central themes have emerged. The first is that physicians in various specialties have different types of commitments to their patients. All are committed to the healing process and request psychiatric consultation when the patient's mental status endangers the healing process. When the danger is less serious, the overall responsibility the doctor feels for his patient, which depends to a large extent on the length and intensity of the doctor-patient relationship, influences the level of his interest in the patient's psychosocial status. Responsibility for management of psychiatric problems often falls on nonphysician staff members.The second theme is that each service has an individual combination of staff personalities, distribution of responsibility amount disciplines, and adminstrative structure. These influence the nature of the C-L work that can be done. A particular liaison intervention cannot be effective in all ward climates and will continue to be disappointing to the C-L staff which provides it. Liaison activities must be designed for the milieu of the specific ward. Teaching should be directed toward the individuals who need and appreciate it most, be they nurses on one ward, social workers on another or physicians on the third.     

Psychiatric consultation to schools on remote islands

This article describes psychiatric consultation to schools with a diverse cultural group of youngsters in a geographically unique area. Collaborative aspects among the child psychiatrist, the sponsoring agency, and other community agencies are described.