Change in diagnosis at termination of psychiatric consultation

Changes in 358 initial diagnoses made by psychiatric consultants in a medical inpatient setting were examined. Initial diagnoses from five groups--major depression, adjustment disorder with depressed mood, dementia, delirium, and the somatoform disorders--were compared with diagnoses made at termination of consultation. Differences in stability of diagnosis between the groups failed to reach significance (pz = .078). However, a trend was found for diagnoses of major depression to be the least stable; 21.7 percent of initial diagnoses were changed by termination. The results emphasize the provisional nature of initial psychiatric diagnoses in the medical setting and suggest the need for repeated assessment of the patient before beginning potentially hazardous treatment, especially for major depression.     

Neuropsychological consultation in psychiatric practice

A specialty area with historical roots in behavioral neurology as well as experimental and clinical psychology, clinical neuropsychology offers a unique contribution to psychiatric practice in the form of consultation regarding cognitive, perceptual, and motor functioning. Using quantified, standardized, and repeatable measures, this comprehensive assessment can be helpful in identifying cortical dysfunction, in measuring decline or recovery, and in assessing response to treatment.     

Depression in patients referred for psychiatric consultation A need for a new diagnosis

The authors analyzed 329 referrals for psychiatric consultation from medical and surgical wards. They found depression to be the most prevalent diagnosis (34%), with Major Depression being the most common DSM-III subtype (49%). Depression was predominant in the elderly (p<0.05), in women (p<0.05), and in patients with a high degree of psychosocial stressors (p<0.01). There were significant differences among the DSM-III subtypes of depression in some of these correlates. The authors emphasize the importance of DSM-III in differentiating among the subtypes of depression in referred patients but they suggest the need for a new diagnosis for depression in the physically ill.     

Delirium: patient characteristics that predict a missed diagnosis at psychiatric consultation

OBJECTIVE: This study evaluates patient characteristics that might predict a missed diagnosis of delirium prior to being seen by a psychiatric consultant. METHOD: Study participants were assessed using quantitative standardized scales of cognitive function, delirium and physical impairment. RESULTS: Referring service personnel missed the diagnosis of delirium in 46% of psychiatric consultations. Two factors were associated with their failure to identify delirium accurately: use of a past psychiatric diagnosis to explain delirium symptoms and the presence of pain. Symptoms of delirium and quantitative scale scores did not distinguish between patients with whom diagnosis had been missed and those with accurate diagnoses. CONCLUSION: The consulting physicians of patients with delirium often incorrectly turn to past psychiatric diagnoses and/or are distracted by the presence of pain and, thus, fail to accurately diagnose delirium.     

A model for psychiatric consultation in the general hospital

A model for psychiatric consultation in the general hospital is described. The authors stress that extrapsychic and societal factors as well as intrapsychic processes influence patients' reactions to illness and hospitalization. An analogy between dreams and their manifest and latent content and the consultation request itself is made.     

Data-based psychiatric consultation: applying mainframe computer capability to consultation

Critical, intertwined objectives for consultation psychiatry include 1) the development of data-based clinical practices, and 2) heightening the effectiveness of consultation. Toward these ends, the Consultation Psychiatry Service at the University of Minnesota has previously conducted systematic studies of consultation and established an ongoing data collection system for consultations. Both steps have relied extensively upon mainframe computer capability. This primary application of computer capability to the field of psychiatric consultation is reviewed by the authors.     

综合医院精神科会诊临床分析

目的 对综合性医院精神科会诊情况进行分析研究.方法 回顾性分析我科会诊的718例住院病人的临床资料,包括请会诊科室、会诊病人的诊断和处理等.结果 申请会诊科室共19个,其中针灸科（神经内科）会诊的人数最多,占43.3%.会诊的疾病前三类是：器质性精神障碍（71%）、心境障碍（8.6%）和神经症（6.0%）.所选的药物以苯二氮类（67.8%）、新型抗抑郁药（51.8%）和非典型抗精神病药（27%）应用较多.结论 我综合性医院会诊有年会诊率更高、患者年龄更大、以器质性精神障碍多见以及多选用新型药物治疗为主等特点.     

Data omitted from psychiatric consultation notes

To assess how often psychiatric consultants omit written data from their consultation notes, the authors reviewed 78 initial consultation notes written by second-year psychiatric residents. Data considered essential for an adequate psychiatric evaluation were typically omitted. Categories that were observed to have the highest frequencies of missing data included family history of psychiatric illness (60.3%), history of substance abuse (44.9%), marital status (37.2%), previous psychotropic drug use (35.9%), previous psychiatric treatment (26.9%), and patient history of psychiatric illness (24.4%). The frequencies of omissions were significantly (p less than .001, except for the last item, p less than .01) higher than those from the consultation notes written by a second cohort of psychiatric residents who used a worksheet that listed data categories. The authors' findings argue for the use of worksheets delineating data categories to ensure that clinicians write adequate consultation notes.