AN EVALUATION OF THE DEVELOPMENT OF CONSULTATION LIAISON PSYCHIATRY IN THE ISTANBUL FACULTY OF MEDICINE: PSYCHIATRIC CONSULTATIONS IN 14 YEARS

Abstract

Objective: This is an evaluation of the development of the Department of Consultation Liaison Psychiatry (CLP) in the Istanbul Faculty of Medicine over 14 years. The aim was to get an idea of the effect of composition of the CLP team and the patterns of service delivery on utilization of psychiatric consultation. Materials and methods: All the consultations requested in 2003 were evaluated with regard to demographic characteristics, the sources of referral, reasons for referral, psychiatric diagnoses, and suggested treatment modalities. The results of the three surveys (1989-1991, 1995-1996, 1997-1998) that were done earlier in our department and this 2003 survey were analyzed to compare changes in the patterns of consultations with the changes in the composition of CLP team and the service given. Four surveys over 14 years were evaluated. These four periods coincided with major changes and developments concerning the characteristics and organization of the CLP service. Results: The study revealed a gradual and consistent increase in the rate of consultations over these 14 years. Over time, significant changes in the demographic characteristics of patients appeared. During the early days of the department, requests for consultation were mostly derived from cases requiring assistance for differential diagnosis or suicide cases. Over time, cases increasingly involved co-morbidity. Depression has always been the most prevalent psychiatric disorder. Recently, however, adjustment disorder has replaced depression as the most common diagnostic category. The use of psychopharmacology has, in time, become more prevalent. Conclusion: Holding hospital characteristics constant, expanding the multidisciplinary nature of the CLP service, and training non-psychiatric physicians and liaison work have contributed to the improvement of psychiatric referrals as well as the quality of the service given. Our experience and institutionalization of critical services has become a model for the country. The data suggest how CLP services have developed in time.