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PubMed2004

Coping strategies and the request for a consultation on complementary and alternative medicine -- a cross-sectional survey of patients in a psychosomatic and three medical departments of a german university hospital.

OBJECTIVE: To identify factors, predicting which patients of a large German university hospital request for a consultation on complementary and alternative medicine (CAM). PATIENTS AND METHODS: 350 patients of 3 medical and a psychosomatic department of the University Hospital Freiburg were consecutively surveyed with respect to their coping strategies, health locus of control, anxiety, depression, and the request for a consultation on CAM. Predicting factors were identified via logistic regression models. RESULTS: The request for a CAM consultation was primarily determined by an active coping strategy (odds ratio 1.66, 95% confidence interval 1.27-2.17, p = 0.0002) and a low Karnofsky index (odds ratio 0.79, 95% confidence interval 0.62-0.99, p = 0.0417). Anxiety, depression or internal health locus of control correlated with each other but could not be proved as independent factors for the request for a CAM consultation. CONCLUSION: Patients of a university hospital with an active disease coping have a need for information about CAM.

Adaptation, Psychological↗
PubMed1985

Use of projective testing on a consultation-liaison service.

Projective psychological testing is a valuable but underrated tool in consultation-liaison psychiatry. By reviewing psychiatric consultations with supporting psychological testing done over a 12-month period at the Beth Israel Hospital, the authors pinpointed clinical problems where projective testing was particularly helpful. The authors found suicidality, depression, and regression to be diagnostic dilemmas in which use of the Rorschach and TAT was decisive in the crisis setting of some consultations. The psychodynamic information offered by these tests guided both proper medication selection and verbal interventions as well as facilitated medical education. 4 cases were selected to illustrate the relevance of projective testing to consultation-liaison work.

Adult↗
PubMed1987

Multidisciplinary teams in consultation-liaison psychiatry: the Yale model.

The consultation-liaison service at Yale features integrated teams of psychiatrists, social workers, and clinical nurse specialists working together in both consultation and outpatient settings. The model is based on the tenets that (1) comprehensive evaluation of patients is essential for effective treatment; (2) role definition is necessary for specific disciplines, including the definition of overlapping and separate areas of expertise and practice. The multidisciplinary teams are coordinated by a psychiatric resident, who is supervised by an attending psychiatrist. The role of the resident is that of a diagnostician and coordinating physician. The social worker functions as an expert in family evaluation and treatment, and the nurse specialist functions as supportive therapist and liaison with the nursing staff. The structure of the division of consultation-liaison and ambulatory services at Yale is described and the advantages and disadvantages of the multidisciplinary team concept are discussed in comparison with other models of consultation-liaison psychiatry.

Combined Modality Therapy↗
PubMed1977

Mental health consultation in a law school clinic.

The author describes mental health consultation with legal interns in a law school legal clinic. Unique characteristics of this setting are described, including that it is not primarily a mental health area and that the consultees are trainees. Various types of consultee-centered consultation and direct and indirect client-centered consultation are discussed, as are problems that must be avoided, e.g., an excessive psychological focus on the part of the consultant or consultee.

Community Mental Health Services↗
PubMed1982

How to write a psychiatric consultation.

The written psychiatric consultation is the distillation, the official permanent record, and the one universal element of the consultation process. Both the document and process present a good and growing opportunity for service and teaching. The authors offer a conceptual and practical scheme to help potential consultants make decisions about the content, style, and wording of their written communications. Each of the components of the consultation document, including headings, openings, history, examination, and formulations, is considered in terms of its effects on the liaison with the consultee and the care of the patient.

Humans↗
PubMed1989

Effect of a psychiatric liaison program on consultation rates and on detection of minor psychiatric disorders in cancer patients.

Because only 2% of the 47% of cancer patients with psychiatric disorders receive psychiatric consultations, the authors investigated the impact of a psychiatric liaison program on improving consultation rates on a gynecologic oncology unit. Consultation rates for gynecologic cancer patients before and after introduction of the program were compared to rates from other cancer patients in the same hospital during the same 7-year period. Rates for the gynecologic patients were higher after the program (9%) than before (4%), as were rates for follow-up consultations, and the detection of minor DSM-III disorders improved. The authors conclude that liaison improves access to psychiatric treatments that often enhance the quality of life for seriously ill patients.

Female↗
PubMed1991

Cost offset from a psychiatric consultation-liaison intervention with elderly hip fracture patients.

OBJECTIVE: The authors hypothesized that psychiatric liaison screening of elderly patients with hip fractures would shorten the average length of hospital stay and increase the proportion of patients who returned home after discharge. METHOD: The study was performed at Mount Sinai Medical Center in New York and Northwestern Memorial Hospital in Chicago. The subjects were 452 patients 65 years or older who were consecutively admitted for surgical repair of fractured hips. During a baseline year the patients received traditional referral for psychiatric consultation. During the experimental year all the patients at Mount Sinai and the patients on one Northwestern Unit were screened for psychiatric consultation. RESULTS: The patients who received psychiatric liaison screening had a higher consultation rate than those who received traditional consultation. The rates of DSM-III disorders in the experimental year were 56% at Mount Sinai and 60% at Northwestern. The mean length of stay was reduced from 20.7 to 18.5 days at Mount Sinai and from 15.5 to 13.8 days at Northwestern, resulting in reductions in hospital costs ($647/day) of $166,926 and $97,361, respectively. Fees generated from Medicare service delivery could have paid for the $20,000 psychiatric intervention cost at each site. There was no difference, however, between the two years in the discharge placement of patients. CONCLUSIONS: Admission psychiatric liaison screening of elderly patients with hip fractures results in early detection of psychiatric morbidity, better psychiatric care, earlier discharge, and substantial cost savings to the hospital.

Aged↗
PubMedDate not supplied

Consultation-liaison psychiatrists on bioethics committees: opportunities for academic leadership.

OBJECTIVE: This article briefly reviews the history of the relationship between psychiatry and the leadership of ethics committees as a background for examining appropriate educational initiatives to adequately prepare residents and early career psychiatrists to serve as leaders of ethics committees. METHOD: A Medline review of literature on psychiatry and ethics committees and consultation as well as recent survey data from the Academy of Psychosomatic Medicine indicate that psychosomatic medicine psychiatrists are particularly qualified and interested in serving as chairs of ethics committees. The authors compare knowledge and skills obtained in psychiatric training with the Society for Heath and Human Values and the Society for Bioethics Consultation Task Force on standards for ethics consultation proposed as core competencies for ethics committee leadership. RESULTS: Psychiatric residency and fellowship training in psychosomatic medicine can provide the knowledge and skill sets to meet the standards for ethics consultation. Further professional development through pursuit of formal ethics training, advance degrees in bioethics, mentoring, and residency and felloships focus on ethics and enhance competency, confidence, and the skills required for ethics committee leadership. CONCLUSIONS: Academic psychiatrists, particularly those in psychosomatic medicine, have historically made a significant contribution as chairs of ethics committees. Continuation and expansion of this leadership may require interested psychiatrists to obtain additional training in bioethics.

Bioethics↗
PubMedDate not supplied

Implementation of a psychiatric consultation service: a single-site observational study over a 1-year-period.

This study describes changes in consultation process variables and referral patterns after implementation of a psychiatric consultation service at a university hospital in Germany. Two hundred eighty consecutive medical-surgical inpatient referrals for psychiatric consultation during a 1-year period were documented prospectively with a structured database. Changes took place in referral patterns and in psychiatric interventions and recommendations but not in psychiatric diagnoses. In addition, information is given on psychiatric and psychosomatic consultation service delivery in Germany.

Adult↗
PubMedDate not supplied

A systematic review of studies of the cost-effectiveness of mental health consultation-liaison interventions in general hospitals.

A systematic review of cost-effectiveness analyses of mental health consultation-liaison interventions in general hospitals was conducted. Few studies have evaluated the cost-effectiveness of consultation-liaison interventions, and only two articles met the criteria for inclusion in the review. The comparable variable was length of the hospital stay. It could not be concluded that psychiatric consultation had an effect on the duration of hospital stays. In one of the studies, the group that received psychiatric consultation showed improvement in depressive symptoms. Additional studies would have been relevant to this review if they had replicated clinical practice by using a naturalistic research design.

Cost-Benefit Analysis↗
PubMedDate not supplied

Psychiatric diagnoses of 901 inpatients seen by consultation-liaison psychiatrists at an academic medical center in a managed care environment.

The authors reviewed the diagnoses from all inpatient psychiatric consultations conducted by faculty psychiatrists during calendar year 2001 (N = 901) at an academic medical center In about 25% of the consultations, multiple psychiatric diagnoses were made. The most frequent diagnosis groups were mood (40.7%), cognitive (32.0%), and substance use disorders (18.6%). Among 671 consultations in which only one diagnosis was made, the rates of these diagnosis groups were 35.4%, 20.1%, and 10.2%, respectively. The findings were compared with the findings of 19 previous studies published over the past 27 years. Mood, cognitive, and substance use disorders remain major foci of consultation-liaison practice in the managed care era, although the rate of cognitive disorder diagnoses has increased. No evidence was found of a change over time in referral rates.

Academic Medical Centers↗
PubMed1976

Psychiatric consultation to a rehabilitation program for amputees.

Staff on the rehabilitation unit for amputees at the Navy Regional Medical Center in Oakland, California, requested psychiatric consultation after a group of young patients had shown destructive behavior and resistance to the rehabilitation program. After two unsuccessful attempts at consultation, an approach was adopted in which a psychiatrist functions as a training consultant in group therapy to the orthopedic staff. The primary therapists are two orthopedic nurses, who conduct two weekly therapy sessions for the amputees under the consultant's supervision. The sessions have given amputees a chance to ventilate their feelings of alienation, powerlessness, and boredom, and have been effective in halting destructive behavior and increasing self-esteem.

Adolescent↗
PubMed1982

Attitudes of nonpsychiatric physicians toward psychiatric consultation.

The authors report on an opinion survey of 200 nonpsychiatric attending physicians at a university teaching hospital about the process and outcome of consultation psychiatry. Over-all, physicians felt that 37 per cent of their patients had problems with significant psychological components, but that consultation was indicated for only 11 per cent. Physicians reported a high level of global satisfaction with consultations; 68 per cent were satisfied frequently or almost always. Factor analysis reduced consultees' evaluations of 18 different consultation activities to five dimensions, with patient disposition considered the most important and services to medical and ward staff the least important. Analysis of differences by specialty revealed that family medicine physicians seemed the most oriented to psychological issues and surgeons the least.

Attitude of Health Personnel↗
PubMed1983

The new community consultation.

A large proportion of chronically mentally ill persons live in non-medical community residential facilities run by administrators and staff who are not specifically trained in the management of psychiatric patients; this situation makes consultation to residential facilities an issue of high priority. Consultants should be familiar with the facility's operating procedures; the wide range of social and vocational potential among long-term patients; and the needs of some patients for highly structured programs. They should be aware of the facility administrator's attitude toward mental health professionals and be prepared to deal with problems that can arise when they attempt to provide both consultation and direct service to the same facility. The authors recommend that consultants advise administrators on issues such as determining admission criteria; understanding the mental health system; and handling a variety of difficult behaviors.

Antisocial Personality Disorder↗
PubMed1987

Using family consultation as psychiatric aftercare for schizophrenic patients.

The families of 14 schizophrenic patients who were recently discharged from a Veterans Administration hospital received periodic consultation in their homes from members of a clinical team. The visiting clinicians educated the families and the patients about community resources, consulted with them about interpersonal problems, and were available for crisis intervention following the last scheduled visit. Three months and one year after their discharge, the patients were compared on various measures of outcome with a control group of 22 similar patients whose families did not receive periodic consultation. At the three-month follow-up, patients whose families received consultation had spent significantly fewer days in the hospital than had the control patients, but the difference was not significant at one-year follow-up. They also rated themselves significantly higher on the Vets Adjustment Scale at both the three-month and one-year follow-ups. The authors interpret the results in light of other studies of after-care interventions.

Adult↗
PubMed1988

Assessing competency in the physically ill: guidelines for psychiatric consultants.

Psychiatric consultants are increasingly asked to evaluate the competency of medically ill patients, but the absence of accepted guidelines and gaps in the law can make their task difficult. A model procedure for evaluating competency developed by the authors stresses the importance of conducting a complete clinical evaluation of the patient, prescribes interventions to clarify the role of the consultant for referring physicians, outlines medical and legal principles governing competency, and identifies the requirements of the consultant's note. Consulting psychiatrists cannot declare a patient legally incompetent; they can only give an opinion about the patient's apparent competency. They can withhold their opinion, however, until they have treated a psychiatric condition that may be affecting the patient's competency. Case vignettes illustrate the application of the guidelines.

Adult↗
PubMed1989

Diagnostic consultation to a state hospital.

As part of a program to assess the needs of patients in a state hospital scheduled to be closed, a psychiatrist provided consultation for 101 chronically ill patients, including formulation of a principal diagnosis by DSM-III-R criteria. Compared with earlier diagnoses made by the hospital, the consultant diagnosed fewer cases of schizophrenia and more cases of organic mental disorders, affective syndromes, and mental retardation and pervasive developmental disorders. The largest numbers of patients no longer diagnosed as schizophrenic received diagnoses of psychosis not otherwise specified, with further assessment recommended, or organic mental disorder. The author believes consultation programs like this one can help state hospital staff take a fresh look at long-term patients and can provide useful experience for psychiatric residents who assist with such consultations.

Adult↗
PubMed1993

A consultative study as a catalyst for improving mental health services for rural children and adolescents.

The consultative study is one model of academic involvement in public mental health services. However, the effects of consultation and how it acts as a catalyst for change have been poorly documented. The authors describe a consultative study in which a team from a academic training center examined the system of mental health and related human services for children and adolescents in a semirural county in western Pennsylvania. They also present results of a six-year follow-up survey assessing the study's effects. Improvement in the system of care during the follow-up period included creation and maintenance of a children's unit and a partial hospital program for adolescents at the country's community mental health center. The consultative study and the follow-up survey were instrumental in establishing a comprehensive range of services, including intensive case management for severely disturbed youngsters and a home-based mental health services program.

Adolescent↗