Identification, psychiatric diagnosis, and preconsultation management of medical and surgical patients who eventually receive a psychiatric consultation.

Abstract

Previous literature has raised the question as to why the identification by non-psychiatrists of psychopathology among inpatients does not lead to rapid psychiatric consultation requests. For patients who at some point received psychiatric consultation, charts from general medical (N = 62) and general surgical wards (N = 57) were examined for time of psychopathology recognition (documentation), length of hospital stay, time of psychiatric consultation, pre-consultation trial psychiatric management and psychiatric diagnosis. Of the total group, 66 per cent (N = 78) had documented recognition at admission, and of these recognized at admission, 54 per cent (N = 42) were referred early (in the first third) in their hospital stay. The combined group of patients with psychosis and neurosis were more likely to be recognized at admission, and given pre-consultation trial management, than the combined group of patients with personality disorder or transient situational disturbance. Once recognized at admission, the combined group of patients with neurosis, psychosis and personality disorder were more likely to be referred early for psychiatric consultation than patients with transient situational disturbance. Suggested reasons for consultation delay included perceived stability of psychopathology, lack of interference of psychopathology with non-psychiatric management and the view that some psychopathology does not constitute an abnormality subject to management.