Diagnoses, Requests and Timing of 503 Psychiatric Consultations in Two General Hospitals
-
Mohammad Arbabi
,
Reza Laghayeepoor
,
Banafshe Golestan
,
Abolfazl Mahdanian
,
Aliakbar Nejatisafa
,
Amir Tavakkoli
,
Elahe Sahimi Izadian
,
Mohammad Reza Mohammadi
Abstract
The high comorbidity of medical and psychiatric diagnoses in the general hospital population requires collaboration between various medical fields to provide comprehensive health care. This study aims to find the rate of psychiatric consultations, their timing and overall diagnostic trend in comparison to previous studies. Tehran University of Medical Sciences has got an active psychiatric consultation-liaison service which includes services provided by four faculty psychiatrists (two full-time and two part-time). This study was done in two general hospitals by simple sampling in available cases. For each consultation, a board-certified faculty psychiatrist conducted a clinical evaluation based on DSM-IV-TR. Other than psychiatric diagnoses, socio-demographic variables, relative consultation rates, reasons for referral, medical diagnoses and the time stay after admission were assessed. Among 503 patients who were visited by the consultation-liaison service, there were 54.3% female with mean age of 39.8 years. In 90.1% of consultations, at least one DSM-IV-TR diagnosis was made. The most frequent diagnosis groups were mood disorder (43.5%), adjustment disorder (10.9%) and cognitive disorder (7.6%). In about 10.9% of the consultations, multiple psychiatric diagnoses were made. The mean length of hospital stay before the consultation was 12.56 days (range=1-90, SD=13). Based on our findings, the mood and cognitive disorders still remain major foci of consultation-liaison practice in general hospitals; however our findings showed high rate of adjustment disorders diagnosis and ambiguous request for psychiatric consultation which need more interdisciplinary interaction.
Ormont MA, Weisman HW, Heller SS, Najara JE, Shindledecker RD. The timing of psychiatric consultation requests. Utilization, liaison, and diagnostic considerations. Psychosomatics 1997;38(1):38-44.
Bourgeois JA, Wegelin JA, Servis ME, Hales RE. Psychiatric diagnoses of 901 inpatients seen by consultation-liaison psychiatrists at an academic medical center in a managed care environment. Psychosomatics 2005;46(1):47-57.
Andreoli PB, Citero Vde A, Mari Jde J. A systematic review of studies of the cost-effectiveness of mental health consultation-liaison interventions in general hospitals. Psychosomatics 2003;44(6):499-507.
Grant JE, Meller W, Urevig B. Changes in psychiatric consultations over ten years. Gen Hosp Psychiatry 2001;23(5):261-5.
Handrinos D, McKenzie D, Smith GC. Timing of referral to a consultation-liaison psychiatry unit. Psychosomatics 1998;39(4):311-7.
de Jonge P, Huyse FJ, Ruinemans GM, Stiefel FC, Lyons JS, Slaets JP. Timing of psychiatric consultations: the impact of social vulnerability and level of psychiatric dysfunction. Psychosomatics 2000;41(6):505-11.
Wallen J, Pincus HA, Goldman HH, Marcus SE. Psychiatric consultations in short-term general hospitals. Arch Gen Psychiatry 1987;44(2):163-8.
Clarke DM, Smith GC. Consultation-liaison psychiatry in general medical units. Aust N Z J Psychiatry 1995;29(3):424-32.
Craig TJ. An epidemiologic study of a psychiatric liaison service. Gen Hosp Psychiatry 1982;4(2):131-7.
Diefenbacher A, Strain JJ. Consultation-liaison psychiatry: stability and change over a 10-year-period. Gen Hosp Psychiatry 2002;24(4):249-56.
Malhotra S, Malhotra A. Liaison psychiatry in an Indian general hospital. Gen Hosp Psychiatry 1984;6(4):266-70.
Karasu TB, Plutchik R, Steinmuller RI, Conte H, Siegel B. Patterns of psychiatric consultation in a general hospital. Hosp Community Psychiatry 1977;28(4):291-4.
Sobel SN, Munitz H, Karp L. Psychiatric consultations in two Israeli general hospitals. Gen Hosp Psychiatry 1988;10(4):298-304.
Ramchandani D, Lamdan RM, O'Dowd MA, Boland R, Hails K, Ball S, Schindler BA. What, why, and how of consultation-liaison psychiatry. An analysis of the consultation process in the 1990s at five urban teaching hospitals. Psychosomatics 1997;38(4):349-55.
Schofield A, Doonan H, Daly RJ. Liaison psychiatry in an Irish hospital: a survey of a year's experience. Gen Hosp Psychiatry 1986;8(2):119-22.
Taheri PA, Butz DA, Greenfield LJ. Academic health systems management: the rationale behind capitated contracts. Ann Surg 2000;231(6):849-59.
Wachter RM, Katz P, Showstack J, Bindman AB,= Goldman L. Reorganizing an academic medical service: impact on cost, quality, patient satisfaction, and education. JAMA 1998;279(19):1560-5.
Scutchfield FD, Lee J, Patton D. Managed care in the United States. J Public Health Med 1997;19(3):251-4.
Bourgeois JA, Seaman JS, Servis, ME. Delirium, dementia, and amnestic disorders. In: Hales RE, Yudofsky SC, editors. Textbook of Clinical Psychiatry. 4th ed. Washington, DC: American Psychiatric Publishing; 2003. p. 259-308.
Coyne JC, Fechner-Bates S, Schwenk TL. Prevalence, 11nature, and comorbidity of depressive disorders in primary care. Gen Hosp Psychiatry 1994;16(4):267-76.
Simon GE, VonKorff M, Wagner EH, Barlow W. Patterns of antidepressant use in community practice. Gen Hosp Psychiatry 1993;15(6):399-408.
Mack AH, Franklin JE, Frances RJ. Substance use disorders. In: Hales RE, Yudofsky SC, editors. Textbook of Clinical Psychiatry. 4th ed. Washington, DC: American Psychiatric Publishing; 2003. p. 309-77.
Sadeghi M, Mirsepassi G. Psychiatry in Iran. [online] 2005 Oct 10 [cited 2011 Aug 15]; International Psychiatry; Available from: URL:http://www.rcpsych.ac.uk/PDF/IP10.pdf
Maroufi M, Pedram A, Malekian A, Kianvash F, Maroufi M, Gerivani Z. Consultation-liaison psychiatry in a general hospital. J Res Med Sci (JRMS) 2006;11(3):193-7.
McKegney FP, McMahon T, King J. The use of DSM-III in a general hospital consultation-liaison service. Gen Hosp Psychiatry 1983;5(2):115-21.
Loewenstein RJ, Sharfstein SS. Psychiatric consultations at the NIH. Gen Hosp Psychiatry 1983;5(2):83-7.
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington, DC: American Psychiatric Press, 1980.
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 3rd ed, Revised (DSM-III-R). Washington, DC: American Psychiatric Press, 1987.
American Psychiatric Association (APA). Diagnostic andStatistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press, 1994.
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 4th ed, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Press, 2000.
International Narcotics Control Strategy Report (INCSR). Bureau of International Narcotics and Law Enforcement Affairs, 2003.
Strain JJ, Smith GC, Hammer JS, McKenzie DP, Blumenfield M, Muskin P, Newstadt G, Wallack J, Wilner A, Schleifer SS. Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaisonpsychiatry setting. Gen Hosp Psychiatry 1998;20(3):139-49.
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(6):470-6.
Zhong BL, Chen HH, Zhang JF, Xu HM, Zhou C, Yang F, Song J, Tang J, Xu Y, Zhang S, Zhang Y, Zhou L. Prevalence, correlates and recognition of depression among inpatients of general hospitals in Wuhan, China. Gen Hosp Psychiatry 2010;32(3):268-75.
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| Issue | Vol 50, No 1 (2012) | |
| Section | Original Article(s) | |
| Keywords | ||
| Consultation-liaison psychiatry Psychiatric diagnoses Consultation rate | ||
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