The continuing evolution and update of a literature search schema for consultation-liaison psychiatry: 1991.
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Database Management Systems↗
Biomedical subjects
R Mayou
Publications and source records attributed to R Mayou.
What should British consultation-liaison psychiatry be doing?
Despite increasing clinical interest and research consultation-liaison (C-L) services in the United Kingdom are mainly haphazard and unsatisfactory. Although the clinical problems are similar to those in other Western countries, the answers must reflect the British health care system. The national C-L organization must formulate and promote detailed policies for 1) clinical priorities; 2) staffing and other resources; 3) integration with other specialist psychiatric services for local populations and primary care; and 4) persuading other medical organizations to place greater emphasis on psychological skills, training requirements, and practice. Some of our conclusions are parochial, some are generally applicable; others are applicable only to countries with comprehensive health care.
Clinical Protocols↗
Consultation-liaison psychiatry in western Europe. The European Consultation-Liaison Workgroup.
Consultation-liaison psychiatry (C-L) services have developed throughout Europe, largely as a result of individual local initiative. Reviews by contributors from 14 countries reveal similarities in national approaches and in the problems caused by inadequate resources, lack of recognition from psychiatric colleagues, and difficulties in integrating C-L with comprehensive systems of psychiatric care, which are mainly oriented toward community care. National C-L organizations and a recently established European Workgroup have focused attention on the clinical importance of C-L and the need to define national and local policies for its clinical role, staffing, and other resources. There is considerable and increasing interest in European C-L research.
Cross-Cultural Comparison↗
Comorbidity and use of psychiatric services by general hospital patients.
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Cohort Studies↗
Psychiatric morbidity in young adults with insulin-dependent diabetes mellitus.
Psychiatric disorder and sub-threshold psychological distress were more common in 113 young men and women with insulin-dependent diabetes living in a defined area than in comparable general population samples. Twelve per cent of men and 19% of women were classified by the PSE as psychiatric 'cases'. Forty per cent of women and 47% of men reported at least one major social problem; effects of diabetes on everyday activities were common. There were associations between medical and social variables. The clinical implications are discussed.
Adolescent↗
Psychiatric problems among medical admissions.
The prevalence, nature, associations and outcome of psychiatric morbidity among four hundred and fifty severe general medical admissions are described. Affective disorder was diagnosed in 13 percent of men and 17 percent of women. It was associated with a history of previous psychiatric disorder and current social problems. Persistent affective disorder after discharge was associated with continuing medical and social problems. Alcohol problems were common in men, especially in those with social problems, and often went unrecognized by medical staff. Cognitive impairment was confined to the elderly and was associated with longer hospital stay and high mortality. Patients with emotional and cognitive disorder make considerable demands on medical, social and psychiatric services during and following admission. The implications for improved recognition and management of psychiatric morbidity in general medical patients are discussed.
Adolescent↗
Quality of life in non-insulin-dependent diabetes and a comparison with insulin-dependent diabetes.
The reported effects of diabetes on quality of life have been assessed in two groups of attenders at out-patient clinics: 1. One hundred and twenty-one non-insulin-dependent diabetic patients randomly allocated to diet, tablet or ultralente insulin therapy; 2. Fifty-seven patients with insulin-dependent diabetes consecutively attending an out-patient clinic. The overall picture for those with non-insulin-dependent diabetes was of relatively little disruption to most areas of life, but 27% reported considerable loss of enjoyment and reduction in social life. High fasting plasma glucose was significantly associated with fatigue and leisure difficulties. The type of therapy, tablet, diet or insulin, made little difference to psychological, social or attitude variables. Those with insulin dependent diabetes showed similar psychological morbidity, but described a rather different pattern of social consequences with more effects on work and less on leisure.
Activities of Daily Living↗
The evolution of a literature search schema for consultation/liaison psychiatry: the database and its computerization.
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Curriculum↗
Significance of psychiatric symptoms in general medical patients with mood disorders.
Little difference was found between the psychiatric symptoms of medical patients and general-population subjects with affective disorder, both groups having been assessed with the same procedure (Present State Examination). Discrimination between medical patients with and without affective disorder was best achieved when patients with depressive and anxiety disorders were considered separately. Depressed mood, morning depression, and hopelessness were the key symptoms in the depressives, and nervous tension, free-floating anxiety, panic attacks, and specific phobias in the patients with anxiety disorders. Symptom profile did not distinguish patients with persistent affective disorders from those whose disorders had resolved at a 4-month follow-up.
Adult↗
Quality of life in cardiovascular disease.
Psychosomatic understanding of the consequences of cardiovascular disorders has had relatively little influence on the separate literature describing quality of life and evaluating interventions. This is partly because psychosomatic research has been too narrowly focussed but mainly because concepts and measures of quality of life take a limited view of its psychological aspects and neglect the significance of individual meaning. There is a need for more research which is based on carefully selected specific measures of quality of life chosen as being of particular importance to patients and to the hypotheses being tested. It is also essential to be aware of the wide range of individual response to cardiovascular disorders. Review of syndromes shows that there is considerable scope to improve understanding of the psychological aspects of quality of life and to develop and evaluate psychological interventions.
Activities of Daily Living↗
Liaison psychiatry.
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Hospitals, General↗
Invited review: atypical chest pain.
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Chest Pain↗
Prediction of outcome after coronary artery surgery.
Coronary artery surgery is usually successful in relieving angina but benefits for quality of everyday life are sometimes disappointing. Generalized linear inter-active modelling (GLIM) was used to examine pre-operation predictions of psychological and social outcome 3 and 12 months after coronary artery surgery. The study identified predictors of return to work (social class, previous employment status), psychiatric outcome (pre-operation mental state) and social adjustment (pre-operation mental state, age, social class). Although our analysis of potential predictors of 1 yr outcome at 3 months after surgery was less detailed, early convalescence is likely to be the best time for clinical identification of those at risk of poor long term outcome. The findings have implications for selection and preparation for surgery and identification of those who might benefit from extra rehabilitation.
Age Factors↗
Illness behavior and psychiatry.
The sociologic term illness behavior has been valuable in putting medical and psychiatric concept of illness in a broader perspective. The term is increasingly popular with psychiatrists, who use it in various ways, but particularly for patients who make considerable demands on their doctors. It has been seen as a symptom, a syndrome, or as a dimension. It is useful to see many patients, especially those seen within general hospitals, as suffering from "problems of illness behavior," but some other usages are idiosyncratic and unhelpful. We should avoid arbitrary statements about "abnormality" and ensure that the general term illness behavior is not used as a synonym for consultation behavior. Quantitative assessment requires multiple measures of particular aspects of illness behavior chosen for the particular purpose of the investigation.
Humans↗
The history of general hospital psychiatry.
General hospital psychiatry in Britain began in 1728, and thereafter several new voluntary hospitals provided separate wards for lunatics, but none survived beyond the middle of the 19th century. Less severe nervous organic disorder has always been common in the general wards of voluntary hospitals, and was accepted as the responsibility of neurologists and other physicians; all forms of disorder were admitted to the infirmaries of workhouses. During the present century psychiatrists began to take an interest in non-certifiable mental illnesses and in working in general hospitals. Out-patient clinics became more common following the Mental Treatment Act 1930. The growth of general hospital psychiatric units in the last 30 years began amidst controversy, but has received little recent critical attention.
England↗
What happens to medical patients with psychiatric disorder?
Medical, psychiatric and social outcome were examined in medical in-patients previously identified as suffering from psychiatric disorder. One third of patients with an affective (emotional) disorder on admission were still psychiatrically ill four months after discharge. Persistent disorder was associated with continuing physical illness. During the year following admission those with affective disorder on admission continued to make greater demands on medical, social and psychiatric services than matched controls and had double the mortality rate (not significant). Patients with organic mental states on admission had a high mortality and morbidity, and made considerable continuing use of general hospital social and psychiatric services. Improved recognition of psychiatric disorder during hospital admission could result in better overall care of medical patients' psychiatric and social difficulties and more effective use of medical resources.
Adult↗
A British view of liaison psychiatry.
Although the general hospital patients' needs for the psychologic care are similar in Britain and the United States, the role, boundaries, and organization of liaison psychiatry are very different. These differences are examined and the British approaches described. Greater awareness of the nature of these differences and of clinical developments and research in the two countries would contribute to the further development of consultation and liaison.
Adult↗