A comparison of two psychiatric service approaches: findings from the Consultation vs. Liaison Psychiatry-Study

BMC Psychiatry

Research Article

Jürgen M. Gschossmann¹  Juliane Gschossmann²  Caroline Lücke³  Charlotte Elizabeth Schneider³  Alexandra Philomena Lam³  Alena Schmidt³  Alexandra Philipsen³  Helge H. Müller⁴ 

[1] Department of Internal Medicine, Klinikum Forchheim, D-91301, Forchheim, Germany;Heinrich Heine University Düsseldorf, D-40225, Düsseldorf, Germany;Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy – University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Strasse 7, D-26160, Bad Zwischenahn, Germany;Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy – University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Strasse 7, D-26160, Bad Zwischenahn, Germany;Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, D-91054, Erlangen, Germany;

关键词: Consultation psychiatry;    Liaison psychiatry;    Psychiatric treatment;   

DOI  :  10.1186/s12888-016-1171-4

 received in 2016-09-28, accepted in 2016-12-13,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPsychiatric comorbidities are common in somatically ill patients. There is a lack of data that can provide clear insights into substantial comparative advantages of different Consultation/Liaison Psychiatry (CLP) services.MethodsThe Consultation versus Liaison Psychiatry-Study collected and analyzed data of 890 primarily somatically ill hospital inpatients presenting with psychiatric symptoms in a prospective observational study design. One group was treated via a liaison-model (LM) with regular consultation hours, the other via an on-demand-model (ODM) with individually requested consultations.ResultsFive hundred forty-five LM and 345 ODM patients were compared. Patients in the LM were, on average, older compared to the patients of the ODM. The vast majority (90.8%) of individuals for whom a psychiatric consultation was requested came from internal medicine. The most common diagnoses were affective disorders (39.3%), organic mental disorders (18.9%), alcohol-induced mental disorders (11.3%) and reactions to severe stress/adjustment disorders (10.4%). Organic mental disorders were significantly more common in patients seen in the LM (24.0% vs. 10.3%, p < 0.001) while affective disorders were more frequently diagnosed in the ODM (46.6% vs. 34.8%, p = 0.001).Patients seen in the ODM were, on average, more severely affected compared to patients seen in the LM and required more extensive treatment. 16.3% of ODM patients were regarded as potentially suicidal; among these, 3.5% were acutely suicidal and 12.8% latently suicidal. Any form of further treatment was required by 93.0% of ODM patients compared to 77.8% in the LM. Pharmacological treatment with benzodiazepines, usually used as short-term treatment, was more frequently prescribed to patients seen in the ODM while patients seen in the LM were more often started on selective serotonin reuptake inhibitors, indicative of long-term treatment.ConclusionsPatients in need of less acute treatment were considerably less common in the ODM. The data indicate a possible risk of such patients to remain unrecognized.A quasi-liaison model is recommended to be the best suitable and cost-effective way of providing psychiatric care to somatically ill patients with psychiatric comorbidities.

【 授权许可】

CC BY   
© The Author(s). 2017