Consultation-Liaison Psychiatry—from theory to clinical practice: an observational study in a general hospital

BMC Research Notes

Massimiliano Piselli⁴  Patrizia Moretti³  Laura Ferranti³  Silvia Ferrari¹  Laura Scarponi¹  Angela Piazzoli¹  Martina Giulietti¹  Tiziana Sciarma³  Roberto Quartesan³  Giuseppina De Giorgio² 

[1] Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy;Functional Homogeneous Area, Local Health Authority 3, Umbria, Italy;Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy;Psychiatry School, University of Perugia, Perugia, Italy

关键词: Psychological distress;    Comorbidity;    Consultation-Liaison Psychiatry;   

Others  :  1230027
DOI  :  10.1186/s13104-015-1375-6

 received in 2015-01-23, accepted in 2015-08-24,  发布年份 2015

【 摘 要 】

Background

To investigate significant association between various clinical and extra-clinical factors brought out the activities of Consultation-Liaison Service.

Methods

Data from all psychiatric consultations for patients admitted to the Perugia General Hospital and carried out over a 1-year period (from July the 1st 2009 to June the 30th 2010) were collected by a structured clinical report including: socio-demographic features, features of referrals, features of back-referrals. T-test, Mann–Whitney U-test, χ ² -test and Fischer’s were statistically used.

Results

1098 consultations were performed. The consultations carried out the Emergency Unit were excluded from the study. The type and the reasons for the referrals were discussed such as the ICD-10 diagnosis and the liaison interventions too. Significant associations emerged between gender and: social status and occupation (p < 0.05 and p < 0.01 respectively). Clinical sector related with reason for referral (p < 0.01), type of consultation (p < 0.01), liaison investigations (p < 0.01) and long-term treatment plan after hospital discharge (p < 0.01). The ICD-10 psychiatric diagnosis (Schizophrenia, Affective Syndrome and Neurotic-StressSomatoform Syndrome) was associated with social status (p < 0.01), social condition (p < 0.01), consultation type (p < 0.01), advice (p < 0.01) and reason for consultation (p < 0.01).

Conclusions

The need for better physical and psychological investigation is confirmed in order to promote not only disease remission but overall wellbeing.

【 授权许可】

   
2015 De Giorgio et al.

【 参考文献 】

• [1]Ajiboye PO: Consultation-liaison psychiatry: the past and the present. Afr J Med Med Sci 2007, 36:201-205.
• [2]Zumbrunnen R: Psychiatrie de liaison. La consultation psychiatrique à l’hôpital général. Coll Médicine et psychothérapie. Masson, Paris; 1992.
• [3]Smith GC: From consultation-liaison psychiatry to integrated care for multiple and complex needs. Aust N Z J Psychiatry 2009, 43:1-12.
• [4]Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips M, et al.: No health without mental health. Lancet 2007, 370:859-877.
• [5]Smith GC: Challenges for psychotherapy and psychoanalysis. Aust J Psychother 2006, 25:32-55.
• [6]Ormel J, Vonkorff F, Oldenhinkel AJ, Simon G, Tiemens BG, Ustun TB: Onset of disability in depressed and non-depressed primary care patients. Psychol Med 1999, 29:847-853.
• [7]Saravay SM, Lavin M: Psychiatric comorbidity and length of stay in the general hospital. A critical review of outcome studies. Psychosomatics 1994, 35:233-252.
• [8]Chilshom D, Dichr P, Knap M, Patrick D, Treglia M, Simon G: Depression status, medical comorbidity and re source costs: evidence from an international study of major depression in primary care. Br J Psychiatry 2003, 183:121-131.
• [9]Kishi Y, Meller WH, Kathol RG, Swigart SE: Factors affecting the relationship between the timing of psychiatric consultation and general hospital length of stay. Psychosomatics 2004, 45:470-476.
• [10]Wise T: Update on consultation-liaison psychiatry (psychosomatic medicine). Curr Opin Psychiatry 2008, 21:196-200.
• [11]Strain JJ, Blumenfield M: Challenges for consultation-liaison psychiatry in the 21st century. Psychosomatics 2008, 49:92-96.
• [12]Fortin M, Dionne J, Pinho G, Gignac J, Almirall J, Lapointe L: Randomized-controlled trials: do they have an external validity for patients with multiple co-morbidities. Ann Fam Med 2006, 4:104-108.
• [13]Rigatelli M, Casolari L, Massari I, Ferrari S: A follow-up study of psychiatry consultation in the general hospital. Psycother Psychosom 2001, 70:276-282.
• [14]Moussavi S, Chatterji S, Yerdes E, Tandon A, Patel V, Ustun B: Depression, chronic disease, nd decrements in health: results from the World Health Survey. Lancet 2007, 370:851-858.
• [15]Fava GA, Belaise C, Sonino N: Psychosomatic medicine is a comprehensive field, not a synonym for consultation Liaison Psychiatry. Curr Psychiatry Rep 2010, 12:215-221.
• [16]Cottecin O, Versavel C, Goudemand M: Pour une vision systémique de la psychiatrie de liaison. Encéphale 2006, 32:305-314.
• [17]Su J-A, Chou S-Y, Chang C-J, Weng H-H: Changes in consultation-liaison psychiatry in the first five years of operation of a newly-opened hospital. Chang Gung Med J 2010, 33:292-300.
• [18]Leentjens AFG, Boenink AD, van der Feltz-Cornelis CM: Can we increase adherence to treatment recommendations of the consultation psychiatrist working in a general hospital? A systematic review. J Psychosom Res 2010, 68:303-309.
• [19]Leentjens AFG, Boenink AD, Herman NS, Strack van Scijndel RJM, van Croonenborg JJ, van Everdingen JJE, et al.: The guideline “consultation psychiatry” of the Netherlands Psychiatric Association. J Psychosom Res 2009, 66:531-535.
• [20]Goldberg RJ, Harrington CJ: Quality indicators in consultation-liaison psychiatry. Psychosomatics 2009, 50(5):550.
• [21]American Psychiatric Association: Diagnostic and statistical manual, fourth edition, text revised. American Psychiatric Association, Arlington; 2001.
• [22]Lobo A, Huyse FJ, Opmer DC: The ECLW collaborative study: Patient Registration Form (PRF) instrument, training and reliability. J Psychosom Res 1996, 40:143-156.
• [23]Söllner W, Creed F: EALCPP Workgroup on training in consultation-liaison psychiatry and psychosomatics. European guidelines for training in consultation-liaison psychiatry and psychosomatics. Report of the EACLPP workgroup on training in consultation-liaison psychiatry and psychosomatics. J Psychosom Res 2007, 62:501-509.
• [24]Huyse FJ, Herzog T, Malt UF, Lobo A: ECLW: The European Consultation-Liaison Workgroup (ECLW) Collaborative Study I. General Outline. Gen Hosp Psychiatry 1996, 18:44-55.
• [25]Feinstein AR: An analysis of diagnostic reasoning II. The strategy of intermediate decision. Yale J Biol Med 1973, 46:264-283.
• [26]Fava GA, Wise TN: Psychological factors affecting either identified or feared medical condition: a solution for somatoform disorders. Am J Psychiatry 2007, 164:1002-1003.
• [27]Clarke DM, Cook KE, Coleman JK, Smith GC: A qualitative examination of the experience of “depression” in hospital medically ill patients. Psychopathology 2006, 39:303-312.
• [28]Diefenbacher A, Strain JJ: Consultation-liaison psychiatry: stability and change over a 10-year-period. Gen Hosp Psychiatry 2002, 24:249-256.
• [29]Devasagayam D, Clarke D: Changes to inpatient consultation-liaison psychiatry service delivery over a 7-year period. Aust Psychiatry 2008, 16:418-422.
• [30]Huyse FJ, Herzog T, Lobo A, Malt UF, Opmeer BC, Stein B, et al.: Consultation-liaison psychiatry service delivery: results from a European study. Gen Hosp Psychiatry 2001, 23:124-132.
• [31]Gala C, Rigatelli M, de Bertolini C, Rupolo C, Gabrielli F, Grassi L: Italian C-L Group: A multi center investigation of consultation-liaison psychiatry in Italy. Gen Hosp Psychiatry 1999, 21:310-317.
• [32]World Health Organization 2004.. http://www.who.int/mental_health/en webcite
• [33]Piselli M, De Giorgio G, Santilli C, Sciarma T, Scarponi L, Rella A, et al.: Consultationliaison psychiatry in the general hospital: an experience in Perugia. J Psychopathol 2011, 17:31-39.
• [34]Raffard S, Bayard S, Capdevielle D, Garcia F, Boulenger JP, Gely-Nargeot MC: Lack of insight in schizophrenia: a review. Encephale 2008, 34:511-516.
• [35]Laursen TM, Munk-Olsen T, Agerbo E, Gasse C, Mortensen PB: Somatic hospital contacts, invasive cardiac procedures, and mortality from heart disease in patients with severe mental disorder. Arch Gen Psychiatry 2009, 66(7):713-720.
• [36]Bellomo A, Altamura M, Ventriglio A, Rella A, Quartesan R, Elisei S: Psychological factor affecting medical condition in consultation-liaison psychiatry setting. A multiside study. Adv Psychosom Med 2007, 28:127-140.
• [37]Rothenhausler HB, Stepan A, Kreiner B, Baranyi A, Kapffharmer HP: Patterns of psychiatric consultation in an Austrian tertiary care center-results of a systematic analysis of 3,307 referrals over 2 years. Psychiatr Danub 2008, 20:301-309.
• [38]Lipowski ZJ: Consultation-liaison psychiatry: an overview. Am J Psychiatry 1974, 131:623-630.
• [39]Qin X, Wang W, Jin Q, Ai L, Li Y, Dong G, Liu L, Phillips MR: Prevalence and rates of recognition of depressive disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China. J Affect Disord 2008, 110(1–2):46-54.
• [40]Aguglia E, Riolo A: Assistendo al dolore altrui. Collana Editoriale di Psichiatria, quando il corpo fa male. Pacini Editore, Pisa; 2008.
• [41]Christodoulou C, Fineti K, Douzenis A, Moussas G, Michopoulos I, Lykouras L: Transfers to psychiatry through the consulation-liaison psychiatry service: 11 years of experience. Ann Gen Psychiatry 2008, 14:7-10.
• [42]Smith JC: From consultation-liaison psychiatry to integrated care for multiple and complex need. Aust N Z J Psychiatry 2009, 43:1-12.
• [43]Strain J, Blumenfield M: Challenges for Consultation-Liaison Psychiatry in the 21st century. Psychosomatics 2008, 49:93-96.
• [44]Mays N, Pope C, Popay J: Sistematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 2005, 10:6-20.