Patterns of referral and diagnostic profiles in consultation-liaison psychiatry: Perspectives from a study in Kashmir

Background and Objective: Consultation-Liaison Psychiatry (C-LP) services, an important aspect of every general hospital has wide variations in their pattern of services being utilized. Studies in this area are mostly conducted in northern states of India. Our study aims to see the pattern of inpatient referrals to the department of psychiatry in a tertiary hospital in South India. Material and Methods: One hundred and seventeen inpatient referrals to the Department of Psychiatry of a tertiary care hospital in Puducherry over a period of six months were included for the study. Informed consent was taken. Information about sociodemographic profiles was collected. Mini International Neuropsychiatric Interview (MINI-PLUS), a semi-structured diagnostic interview tool was administered for psychiatric diagnosis. Results: The inpatient referral rate was 1.50%. Evaluation of para-suicide was the commonest reason for referral (36.7%), followed by depressive symptoms (12.8%), alcohol related problems (12.8%), and abnormal behaviour (10.3%). Psychiatric diagnosis was found in 86% of cases referred; 41% had multiple psychiatric diagnoses. Deliberate Self-harm (DSH) was present in 28% and depressive disorder in 22% of cases. Gastro-intestinal disorders (12%), infectious disorders (11%) and cardiovascular disorders (9%) were the commonest medical diagnoses in the population. Department of Medicine had the highest referral rate; however referrals from most departments were very low. Conclusion: The study depicts a low referral rate which can be attributed to the lack of knowledge and high rate of stigma of psychiatric disorders. Thus, there is an urgent need to strengthen the existing C-LP services and screen for psychiatric disorders in non-psychiatric inpatients.

BackgroundConsultation liaison psychiatry as a subspecialty is defined as the area of clinical psychiatry that encompasses clinical understanding, teaching and research activities of psychiatrists in the non-psychiatric divisions of a general hospital. The aim of this study was to access clinical profile of intensive care unit (ICU) referral availing consultation-liaison (CL) psychiatry services in a tertiary care hospital.Materials & MethodsThe study population comprised all referrals from intensive care unit to consultation liaison psychiatry services over a period of 6months. In a semistructured proforma, demographic profile, reason for referral and psychiatric diagnosis were recorded and analysed using descriptive statistics.ResultsA total of 36 patients were referred to consultation liaison psychiatry for evaluation. The most common reason for referral was abnormal behaviour 16(44.4%) followed by suicide or self-harm 8(22.2%) and substance use history 6(16.7%). The most common psychiatric diagnosis was delirium 21(58.3%). Majority of referrals were from medical intensive care unit (MICU) 26(72.2%).ConclusionDelirium was the most common diagnosis in the intensive care settings while as abnormal behaviour was the most common reason of referral.

PurposeThe purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services.Design/methodology/approachAll inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan.FindingsThe compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan.Originality/valueSpecialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.

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.

Background: The intricate bidirectional relationship between physical and psychological health is well established. Studies highlight a significant prevalence of diagnosable psychological comorbidities in patients with physical disorders, often impacting health outcomes. Consultation-liaison psychiatry (CLP) specializes in integrating psychiatric care into general hospitals, addressing the intersection of physical and mental health. Despite its pivotal role, CLP referral rates in most parts of the world remain low, with few institutions offering specialized CLP services. Furthermore, research in this field is scarce. Hence, this study aimed to assess the 3-year trend in the pattern and utility of CLP services in a tertiary care center in North India. Methods: This is a retrospective, descriptive study of 3-year referral records maintained by the CLP services in a multispecialty tertiary care teaching hospital. Results: The mean age of the sample was 36.0 ± 16.4 years, with predominant referrals from medicine (51.4%) and surgery (15.8%) departments. Psychiatric diagnoses included depression, delirium, psychosis, mania, anxiety, eating disorder, and dissociation. Geriatric patients had the highest prevalence of delirium (24.1%), whereas intentional self-harm was often seen in adults (13.6%); alcohol dependence was observed across all age groups. More than a quarter (26.6%) had no specific psychiatric diagnosis. Interventions varied, with psychotropic medications being the most common treatment in adults (58%) while psychotherapy was primarily used in children (39.5%). Conclusion: This study highlights an increasing trend in CLP referrals, with predominant cases from medicine and surgery departments. The high prevalence of delirium among older adults and self-harm among adults underscores the need for better integration of mental health services in general hospitals.

Objective To explore the characteristics of consultation-liaison psychiatry service of patients from cardiovascular department in general hospital. Methods 222 inpatients were enrolled from January 1, 2016 to December 31, 2016, who were referred to the consultation-liaison psychiatry service in a general hospital. These data were analyzed, including rate of conclusion, reasons for referral, psychiatric diagnosis, management suggestions and the rate of outpatient visits after discharge and its influencing factors. Results Among all departments of this hospital in 2016, the cardiovascular department took the largest proportion to require consultation-liaison psychiatry service, with the rate of 5.8% (237/4 097) . The principal reasons for psychiatric referral were unexplained physical symptoms or non-satisfactory therapy effect (29.7%, 66/222), the treatment of anxiety symptoms (17.6%, 39/222), having previous history of anxiety or depression (11.3%, 25/222), the treatment of sleep problems (10.8%, 24/222). Anxiety disorders (51.8%, 115/222), depression disorder (13.5%, 30/222), sleep disorders (6.8%, 15/222), stress reaction and adjustment disorder (5.4%, 12/222) were the major psychiatric diagnose. The main management suggestions included antidepressants (48.2%, 107/222), benzodiazepines (41.9%, 93/222) , adjustment of lifestyle (9.5%, 21/222) and non-benzodiazepine sleep drugs (7.7%, 17/222). The rate of outpatient visits after discharge was 7.8% (17/217), and the main influencing factors were: whether the psychotropic medication given at discharge (OR=4.356, 95%CI (1.148-16.535) , P=0.031) and suggestions for psychiatric revisits listed in discharge instruction (OR=4.888, 95%CI (1.566-15.253) , P=0.006) . Conclusion The cardiology inpatients in general hospital have a prominent demand for psychiatric consultation, and anxiety disorder is the most common disease among them. The rate of outpatient visits after discharge is quite lower. Key words: Cardiovascular diseases; Psychotic disorders; Hospitals, general; Referral and consultation

Consultation-liaison psychiatry (CLP) services sit between mental health and the general hospital, and risk being poorly understood by both systems. The aim of this study was to develop an operational manual for a CLP service, which defined functions and governance. The CLP literature was reviewed with a focus on descriptions of CLP roles, organisational processes, quality measures and service development. The CLP team held service planning meetings and met with members of the mental health and hospital executives. Site visits and collaboration with other CLP services occurred in defining the roles of the CLP service and organisational governance. A CLP operational document was developed, including a description of the service, its functions, staff roles and governance. Procedural information such as the CLP timetable, referral process, triage and assessment, documentation, activity recording, quality assurance and relevant policies were outlined. The development of a dedicated operational manual for CLP clarified the roles, functions and governance of CLP within the general hospital and mental health systems. The development process facilitated the engagement of key clinicians and administrators of these systems, the determination of quality improvement targets and greater transparency and accountability.

Background: Consultation-liaison (C-L) psychiatry is the subspecialty of psychiatry dealing with mental health disorders in nonpsychiatric settings. The ubiquity of mental health problems has increased the need for such a service to exist in general hospital psychiatric units, as many psychiatric patients report to a different specialty of medicine for the first time. This study aims to evaluate the utilization of psychiatry C-L services by nonpsychiatric inpatient units in a general hospital psychiatry unit taking into consideration the paucity of data for understanding the trends and improving service provision in the future. Materials and Methods: A retrospective chart review of all inpatient referrals received by the psychiatry department from July 2015 to February 2017 was conducted. The sociodemographic profile, source of referral, reason for referral, and psychiatric diagnosis using the International Statistical Classification of Diseases-10 were analyzed using descriptive statistical methods. Results: A total of 605 patients were referred, which comprised 0.86% of total indoor admissions. Maximum number of consultations was sought from internal medicine. “Unexplained physical symptoms” was the most common reason for referral (35%). Consequently, neurotic, stress-related, and somatoform disorder (25.5%) was the most common psychiatric diagnosis followed by mood disorder (19.8%). Conclusion: Poor and variable referral rate from various departments highlights the increasing need to sensitize all clinicians regarding psychiatric comorbidity. There is a need to explore factors that would result in increasing referral rates and making psychiatric consultation services effective and efficient.

Organization, Strengths, and Challenges of Consultation-Liaison Psychiatry Services in Flanders (Belgium): Findings from a Cross-Sectional Survey.

Consultation–liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000–2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

The aim of the study was to describe referral patterns of maternity inpatients to the consultation-liaison psychiatry (CLP) service at a large women's hospital in metropolitan Melbourne, Australia. Clinicians recorded socio-demographic data, referring unit, consultee's reason for referral, psychiatric diagnosis made, and treatment provided for all maternity inpatients referred from 2004 to 2008. Main reasons for referral were detection of depression, past psychiatric history, and concern regarding a woman's coping. Most common diagnoses were depression, substance use disorders and anxiety disorders. Many women referred for assessment while inpatients were initially seen in the antenatal period. Pregnant women referred to a CLP service present with a range of mental health problems, most often depression, anxiety and substance use disorders. Many of these problems are evident in and require intervention during the antenatal period as well as at the time of confinement. CLP services to maternity hospitals should be provided in the antenatal as well as the inpatient setting.

ObjectiveTo explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic. MethodsData were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total. Dependent variable: workload-related stress levels in CLP services due to COVID-19 (0–10 point scale). Independent variables: hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed. ResultsThere was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74). ConclusionOur findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.

A review of psychiatric consult notes of 96 obstetric inpatients referred to a Consultation-Liaison (C-L) psychiatry service in a tertiary-level university general hospital was carried out in order to compare the characteristics of such a service in a North American setting with similar services in other parts of the world. Data extracted from consult notes included: reason for referral, current diagnosis (DSM-IV-R), psychiatric history, obstetrical history, recommended treatment approaches, current psychotropic medications, current gestational age or number of days postpartum, patient age, and partnership status. In addition, obstetrical referrals were calculated as a percentage of hospital-wide referrals to C-L psychiatry. The most prominent findings include: (1) a high C-L psychiatry referral rate from obstetrics as a percentage of total C-L referrals within the study hospital; (2) past psychiatric history alone as a prevalent reason for referral; (3) adverse reproductive event (past and/or current) as a common reason for referral. These findings differ markedly in certain ways from comparable studies and may reflect both the hospital's large high-risk pregnancy service that represents an at-risk group for mental health issues, and the focus on educational collaboration with obstetrical staff regarding risk factors for, and consequences of, perinatal mental illness. Inpatient perinatal C-L psychiatric services require creative approaches to the accurate identification and treatment of women at risk for antenatal and postpartum mental illness due to psychiatric history and/or reproductive crises.

This paper describes the characteristics of 303 consecutive referrals, over a 12-month period, to a consultation-liaison (C-L) psychiatry service provided to eight group general practices in Newcastle, Australia. A purpose designed service audit form was used throughout the evaluation period to collect information about demographic characteristics, reasons for referral, service contacts, psychiatric diagnoses and clinical management. In addition, patients were invited to participate in a separate, prospective outcome evaluation study, which involved structured interviews and questionnaires. The most common reasons for referral were: depression (33%); anxiety (12%); diagnostic assessment (9%); and impaired relationships (8%). The most common psychiatric diagnoses were: mood disorders (29%); mild, transient conditions (29%); anxiety (14%); and substance abuse disorders (12%). Following the psychiatric consultation(s), GPs were actively involved in patients' treatment in 53% of cases. However, there was a higher than expected rate of referral (44%) to another mental health agency. Selected comparisons are also reported between patients referred to the C-L service (n = 303) and a sample of non-referred GP attenders (n = 535). As expected, the diagnostic profiles of patients attending the C-L service differed in several respects from those using similar services in general hospitals. There were comparatively low rates of organic brain syndromes, suicide risk evaluations, and problems of differential diagnosis of somatic symptoms. Greater emphasis needs to be placed on more formal psychiatric education for GPs, on ways of screening out from the referral process those patients with mild, transient conditions who do not require specialist expertise, and on the development of strategies to help GPs manage such conditions.

The effectiveness of consultation-liaison psychiatry in the general hospital setting: A systematic review