Psychiatric Consultation-liaison Service Research Articles

Forensic-Psychiatric Consultations in General Psychiatry

A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.

The Effectiveness of Interventions on Improving the Mental Health Literacy of Health Care Professionals in General Hospitals: A Systematic Review of Randomized Controlled Trials.

Suboptimal mental health literacy levels among general hospital health care professionals negatively impact the care coordination of patients with physical-mental comorbidity. This review is to examine the evidence on the effectiveness of interventions to improve the mental health literacy of general hospital health care professionals. A systematic search of literature was conducted in 13 electronic databases with manual searching of reference lists from 1980 to 2021. Studies were screened by pre-set eligibility criteria, that is, participants who were general hospital health care professionals taking care of adult patients, the interventions aimed at improving any components of participants' mental health literacy, comparisons were alternative active intervention or no intervention, and the primary outcomes were any aspects of mental health literacy. Eight randomized controlled trials (N = 1,732 participants) were included in this review. Evidence indicated that mental health literacy interventions with educational components can improve components of the health care professionals' mental health literacy, in terms of mental health knowledge and mental illness-related attitudes/stigma. In addition, few studies evaluated all components of participants' mental health literacy. Based on the available evidence, educational interventions had a positive effect on components of general hospital health care professionals' mental health literacy. Health care organizations should provide educational programs to enhance general hospital health care professionals' mental health literacy. Further studies are needed to explore interventions that target all components of general hospital staff's mental health literacy and to evaluate its impact on the psychiatric consultation-liaison service utilization in general hospitals, as well as patient outcomes.

An overview of the rehabilitation and psychiatric diagnoses of patients referred to a psychiatry consult liaison service at an inpatient rehabilitation hospital.

Patients presenting for inpatient rehabilitation following injury or illness are commonly affected by comorbid psychiatric illness. Currently, little is known about the utilization of a psychiatry consult service in an inpatient rehabilitation hospital. To identify which rehabilitation patient populations most frequently received psychiatric consultation and recognize the most common psychiatric comorbidities after the implementation of a psychiatry consult liaison (PCL) service. A retrospective observational study in the form of a chart review examining the utilization patterns of a psychiatric consultation liaison service in the inpatient rehabilitation setting. Chart review was performed to extract patient demographics (age and sex), rehabilitation diagnosis, cause of rehabilitation diagnosis (intentional, accident, self-inflicted, or disease), reason for referral to psychiatry, and psychiatric diagnosis on initial consultation. Statistical software was used for statistical analysis to answer the pre-specified research questions. A 178 bed, free-standing, academic rehabilitation hospital located in an urban Canadian center. Any patient admitted to the inpatient rehabilitation hospital who received a psychiatric consultation between September 2016 and December 2019 was eligible for inclusion. A total of 1016 charts were reviewed in the initial chart review and 1008 were included. The most common rehabilitation diagnoses that were associated with a psychiatric consult were (% admissions receiving consultation): amputations (38%); burns (35%), neurologic disorder (28%), deconditioning (14%), and musculoskeletal injury (7%). Although 20% of patients did not meet criteria for a psychiatric diagnosis, most common psychiatric diagnoses included mood disorder, adjustment disorder, neurocognitive disorder, and delirium. There are significant perceived needs for psychiatric services in the inpatient rehabilitation setting. Although some patient groups such as patients with amputations, burns, and trauma may exhibit the highest utilization, the service supports mental health needs from many patient groups.

Clinical audit of the Consultation-Liaison psychiatric service of a metropolitan hospital.

The primary objective of this study was to use clinical indicators to track changes in efficiency of a Consultation-Liaison service as part of a clinical audit cycle. This was a clinical audit cycle. The auditing phase involved measuring the efficiency of the service. The 'intervention' was simply the team's awareness and involvement in tracking these statistics. Subsequently, these indicators were re-audited. In the initial audit cycle, 315 referrals to the C-L service were audited over a 3month period, showing a 24hour time-to-seen rate of 80% and a 36hour time-to-seen rate of 89.2%. Upon re-auditing of 112 referrals following our intervention, 24hr timeliness had risen to 92% and 36hr timeliness had risen to 96.4%. The measuring of clinical indicators of efficiency in C-L may give service improvement personnel a reflection of the functionality of a C-L service. By involving team members in the measuring and tracking of these indicators, we may be able to boost overall clinical efficiency and outcomes.

Psychiatric Morbidity among Patients Living with Cancer in a Nigerian Oncology Centre

Introduction: Cancer is a leading cause of mortality worldwide and is associated with a wide range of psychiatric morbidities. The study aimed at determining the profile of psychiatric morbidity among cancer patients. Methods: In this descriptive study, 130 patients with different types of cancer were selected by systematic random selection and were interviewed. Information on sociodemographic characteristics, medical comorbidity, duration of the cancer, and duration of treatment was obtained. Psychological distress was assessed using the GHQ-12. The MINI was used to establish the presence or absence of any psychiatric diagnosis, Information on the receipt of formal psychiatric treatment was also obtained. Associated factors and predictors of “any mental disorder” (AMD) were determined. Statistical analysis was carried out using SPSS 20.0 Results: Prevalence of psychological distress was 63.8%, adjustment disorder 20.0%, anxiety disorder 29.2%, major depression 36.2%, delirium 6.9%, psychosis 2.3%, mania 0.8%, 12-month alcohol use disorder 3.8%, 12-month tobacco use disorder 0.8%, 12-month opioid use disorder 1.6%, 12-month cannabis use disorder 0.8%. In all, 66.9% had Any Mental Health Problems. The most common medical comorbidity was hypertension (36.2%) and diabetes (23.1%). Predictors of AMD were long duration of cancer OR = 6.27, 95% CI (1.22-12.1), duration of cancer treatment above 6 months OR = 5.04, 95% CI (1.97-12.92); and the presence of any medical comorbidity OR = 2.53, 95% CI (1.04-6.19). Conclusion: Cancer is associated with significant psychiatric morbidity, necessitating a collaborative Consultation-Liaison Psychiatric Service in cancer care.

Evaluation of consultation liaison psychiatry in Australian public hospitals (AU-CLS-1).

This study aimed to determine whether consultation liaison psychiatric service (CLS) staffing within Australian public hospitals meet national and international minimum staffing standards. Semi structured interviews were conducted with CLS Directors across Australia from August to December 2021. Data were collected on demographics, staffing, funding, hospital size and admissions. The majority of services did not meet minimum standards for CLS staffing. Non-medical staff outnumbered medical staff with increasing rurality. Psych-oncology CLS had the greatest resources, skill mix and service breadth. Although CLS are heterogeneous, most services are inadequately resourced to provide baseline specialist mental health care in Australian hospitals. Establishing national minimum standards for CLS staffing will facilitate uniform service development and quality care provision.

2.26 Impact of the COVID-19 Pandemic on the Child and Adolescent Psychiatric Consultation-Liaison Service (CL) in a Large Urban Hospital

The objective is to assess the impact of the pandemic on patients seen by the Psychiatry Consultation-Liaison (CL) service in a tertiary care hospital in Dallas, Texas. Our hypothesis was that an increased number of patients diagnosed with depression, anxiety, and suicidal ideation (SI) with and without attempts were seen during the pandemic.

Suicide risk in medically ill inpatients referred to consultation-liaison psychiatric services: A multicenter study

BackgroundThe aim of this multicenter study was to investigate the suicide risk in medically ill patients admitted to six Italian hospitals for whom a consultation-liaison intervention was requested. MethodsParticipants completed socio-demographic and clinical report forms and the Brief Illness Perception Questionnaire. Suicidality was assessed using the P4 screener that investigates the presence of Past suicide attempts, Plans to commit a suicide, Probability of completing suicide, and Preventive factors. Participants were categorized as being at no, low or high suicide risk. Univariate and multivariable associations of categorical and continuous variables with suicide risk were investigated using multinomial logistic regression. ResultsOf the 641 inpatients, with mean age 60 years (SD = 16.9) and 49.2 % male, 13.2 % were at high suicidal risk (HR), 7.6 % low risk (LR) and 79.2 % no risk. Contacts with psychiatrists in the previous six months were associated with LR and HR (OR = 2.159 and 2.634, respectively), ongoing benzodiazepine use was associated with a threefold likelihood of LR (OR = 3.005), and the experienced intensity of illness symptoms was associated with LR and HR (OR = 1.257 and OR = 1.248, respectively). CL psychiatrists prescribed appropriate psychotropic drugs and activated liaison interventions and psychological support for the level of suicidal risk. LimitationsThe use of self-report measures bears the risk of recall bias. ConclusionsOur findings based on psychiatric consultations in the general hospital underscore the need to include suicide risk in the routine assessment of inpatients referred to CL psychiatric services and to plan an appropriate management of suicidal risk after discharge.

First-Episode Psychosis and the Role of the Psychiatric Consultant.

Timely recognition and treatment of first-episode psychosis (FEP) is paramount. Studies suggest a significant relationship between longer duration of untreated psychosis and poorer functional outcomes. Limited data exist that characterize how treatment for FEP is initiated by consultation-liaison psychiatric services. We conducted a systematic review of FEP treatment by a consultation-liaison service at a large academic medical tertiary care. Approach to care was reviewed including recommendations for clinical assessment and management. Psychiatric consultations performed at a tertiary academic center were reviewed to identify potential FEP cases during a 12-month period. Patients of ages 15-49 years, for whom the diagnostic assessment was concerning for possible FEP, were included. Demographic features and management were summarized. A total of 3365 new psychiatric consults were conducted during our study period. Of these, 28 were identified as having symptoms consistent with possible FEP (0.83% of total sample). However, only 12% were referred to coordinated specialty care for psychosis after discharge from an inpatient medical or psychiatric hospital. The results of our systemic chart review indicate that workup, management, and disposition recommendations for FEP patients seen by consultation-liaison services are variable, suggesting a need for a standardized, evidence-based approach in the medical setting.

Intentional self-harm in individuals referred to consultation liaison psychiatry services in a tertiary care hospital.

Intentional self-harm (ISH) is one of the most important entities of consultation-liaison psychiatry. This study aimed to assess the clinical profile of individuals with intentional self-harm referred to consultation-liaison (CL) psychiatric services in a tertiary care hospital. The present study was a cross-sectional hospital-based study, in which purposive sampling was done for sample selection. A total of 60 subjects of ISH referred for evaluation in a tertiary care psychiatry hospital on specified days were recruited to the study after obtaining informed consent. Demographic and clinical details such as the nature of the self-harm attempt, method of attempt, number of attempts, the reason for the attempt, and regret/remorse about the attempt were documented using the semi-structured proforma. A total of 60 subjects were included in the study. About 80% of them were below the age of 30 years. The majority (80%) were females, 65% were from a rural background, 56.7% were married. The most common method of ISH was self-poisoning. Interpersonal conflicts with family members (50%), followed by interpersonal conflicts with the spouse/partner (21.7%) were the commonest reason/precipitating factors that lead to intentional self-harm. Also, 45% of our study population did not have any diagnosable psychiatric illness at the time of assessment, and the most common psychiatric diagnosis was personality disorders (20%). Intentional self-harm is common in young married females from rural backgrounds. Self-poisoning is the most common method of deliberate self-harm. More than half of the individuals were diagnosed with the psychiatric illness at presentation.

Associated factors of delirium tremens in the inpatients receiving psychiatric consultation-liaison service for alcohol-related problems

Associated factors of delirium tremens in the inpatients receiving psychiatric consultation-liaison service for alcohol-related problems

Patient Satisfaction with a Psychology Consultation-Liaison Service at an Academic Medical Center.

One to two-thirds of all medically admitted patients have comorbid psychiatric concerns. To address the cognitive, behavioral, and emotional factors that affect medical hospitalization, psychological or psychiatric consultation-liaison (CL) services are consulted. The current study was designed to understand patient satisfaction with a CL psychology service and how it was associated with satisfaction with overall hospitalization, taking into consideration relevant factors. Adults medically admitted to an academic teaching hospital (N = 220), who were seen at least once by the CL psychology service, completed satisfaction and demographic questionnaires. Most patients reported being satisfied with the CL psychology service, with women reporting higher satisfaction than men. Satisfaction with the CL psychology service was associated with satisfaction with overall hospitalization, but did not differ based on age, race/ethnicity, education, income, length of stay, number of visits, or presence of psychiatric diagnosis. The results suggest that CL psychology services may contribute to improving overall patient experience.

Etheldreda Nakimuli-Mpungu: innovator in mental health

Etheldreda Nakimuli-Mpungu is a rising researcher and clinician doing innovative work in mental health and HIV in sub-Saharan Africa. She is a Senior Lecturer and psychiatric epidemiologist in the Department of Psychiatry at Makerere University College of Health Sciences (MakCHS) and head of the consultation–liaison psychiatric service at Mulago National Referral Hospital, Kampala, Uganda. Almost a decade ago, she recalls that “around that time, there were researchers who had resolved that Africans cannot comprehend psychotherapy; therefore, they gave persons living with HIV antidepressants as first-line treatment for mild-to-moderate depression in their research studies. In fact, there was an NIH funded grant in my department at the time that was evaluating the use of antidepressants for depression among people living with HIV. I said to myself, but this is not right because antidepressants are not the first-line treatment.” She “strongly believed that what we should be doing was to develop culturally appropriate psychotherapy for depression” in this population.

Psychosis in youth in Singapore: a case series

ObjectiveIn this report, we present a case series of children with psychotic symptoms referred to a child consultation liaison psychiatric service within a tertiary paediatric hospital in Singapore. The purpose of this case series is to identify common symptoms at presentation, review the current practices in our hospital for investigation and treatment of first episode psychosis and short-term outcomes.Case reportWe identified 9 cases over a 1 year period, for which 7 were seen whilst admitted to hospital and 2 in the outpatient clinic. There were 6 females and 5 males ranging in age from 11 to 16 years old. The commonest symptoms on presentation were perceptual disturbance (88%) most commonly auditory hallucinations and altered behaviour (55%). Of the 7 children admitted to hospital, all were seen by the neurology team prior to the request for a psychiatric opinion. All admitted patients had blood and radiological investigations carried out. Most of the children were started on a short course of antipsychotic medication with the majority continuing to attend follow-up outpatient.DiscussionOnly 9 cases were identified in this case series over a 1 year period highlighting that psychosis is not a common presentation in the paediatric population. From the history alone, it can be challenging to distinguish between primary and secondary causes of psychosis. Acute onset of symptoms and the presence of other neurological signs should raise the suspicion of an underlying organic cause. Out of 9 cases, only 1 case was treated for a presumed organic aetiology, which is consistent with findings from other authors who only found underlying organic factors in 12.5% of cases.In this case series, we also noted that 45% of cases reported having symptoms for over 1 year before seeking help. This is also seen in the adult population in Singapore. Stigma, denial and lack of information about psychosis may all contribute to delay in seeking help. Although prolonged duration of untreated psychosis has been shown to be associated with poor long-term outcome, we found in our case series that even patients who reported a long duration of symptoms still responded well to medication.ConclusionThere is room for collaboration with our neurology colleagues in the approach towards children with first presentation of psychosis, both in terms of investigations and management. Identifying reasons for disengagement from psychiatric care is an area for further investigations to improve outcomes in our patients.

Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision

BackgroundThe SARS-CoV-2 pandemic has led to drastic changes in how psychiatric consultation-liaison (C-L) services conduct business and required rapid transition to telepsychiatry. We describe the practice changes implemented to rapid transition to virtual care in a large, academic psychiatry C-L service in response to the pandemic.ObjectiveTo describe clinical service structural changes, timelines and impacts on consultation volume as well as present quantitative and qualitative data regarding the experience of this transition from the standpoints of both psychiatric trainees and attending physicians.MethodsWe present the narrative descriptions of transition details based on focused interviews with inpatient C-L leadership. Inpatient consult volume and charge data were gathered using analysis of health system data. Attending and trainee experience of the transition to virtual care were assessed using anonymous, online surveys.ResultsDuring the pandemic, the average weekly consultation volume and average weekly charges were significantly lower compared with prepandemic. Both volume and charges were affected by addition of video consultation capability. Both attendings and trainees had moderate or high comfort and moderate satisfaction with telephone and video consultations. Overall, the trainee satisfaction with supervision, learning, and their consult psychiatry experience did not seem to be affected by the pandemic.ConclusionsOur results support the feasibility of the rapid implementation of virtual care in a psychiatric academic C-L service without negatively impacting the learner's consult psychiatry experience. This should provide comfort to academic C-L services that required rapid implementation of virtual care.

The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital.

The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.

Validation of the Greek version of the distress thermometer compared to the clinical interview for depression

BackgroundThe Distress Thermometer (DT) is worldwide the most commonly used instrument for quick screening of emotional burden in patients with cancer. In order to validate the Greek version of the DT in the Greek population we aimed to explore the capacity of the DT to identify patients with comorbid depressive diagnosis.MethodsWe analyzed the routinely collected clinical data from 152 patients with cancer who had been evaluated by the consultation-liaison psychiatric service and had received a diagnosis of either depressive disorder or no psychiatric diagnosis. The score of the DT accompanied by the list of problems in the Problem List, the depression status, and the clinical and demographic characteristics entered the data sheet.ResultsThe ROC analysis revealed that the DT achieved a significant discrimination with an area under the curve of 0.79. At a cut-off point of 4, the DT identified 85% of the patients with an ICD-10 depressive diagnosis (sensitivity) and 60% of the patients without a psychiatric diagnosis (specificity). The positive predictive value was 44%, the negative predictive value 92% and the diagnostic odd ratio 8.88. Fatigue and emotional difficulties were the most commonly reported problems by the patients.ConclusionThe Greek version of the DT has a sufficient overall accuracy in classifying patients regarding the existence of depressive disorders, in the oncology setting. Therefore, it can be considered as a valid initial screening tool for depression in patients with cancer; patients scoring ≥4 should be assessed by a more thorough mental evaluation.

\u201cThe post-COVID era\u201d: challenges in the treatment of substance use disorder (SUD) after the pandemic

BackgroundCitizens affected by substance use disorders are high-risk populations for both SARS-CoV-2 infection and COVID-19-related mortality. Relevant vulnerabilities to COVID-19 in people who suffer substance use disorders are described in previous communications. The COVID-19 pandemic offers a unique opportunity to reshape and update addiction treatment networks.Main bodyRenewed treatment systems should be based on these seven pillars: (1) telemedicine and digital solutions, (2) hospitalization at home, (3) consultation-liaison psychiatric and addiction services, (4) harm-reduction facilities, (5) person-centered care, (6) promote paid work to improve quality of life in people with substance use disorders, and (7) integrated addiction care. The three “best buys” of the World Health Organization (reduce availability, increase prices, and a ban on advertising) are still valid. Additionally, new strategies must be implemented to systematically deal with (a) fake news concerning legal and illegal drugs and (b) controversial scientific information.ConclusionThe heroin pandemic four decades ago was the last time that addiction treatment systems were updated in many western countries. A revised and modernized addiction treatment network must include improved access to care, facilitated where appropriate by technology; more integrated care with addiction specialists supporting non-specialists; and reducing the stigma experienced by people with SUDs.

Psychiatric comorbidities in cancer patients: acute interventions by the psychiatric consultation liaison service.

The aim of this study was to explore the psychiatric comorbidities in cancer patients examined by the psychiatric consultation liaison services (CLP) in ageneral hospital. Furthermore, we intended to examine associations between certain cancers types and psychiatric disorders as well as to give an overview of the psychiatric treatments options that were recommended by the CLP. This retrospective analysis investigated 119 psychiatric consultations for cancer patients in aone year period. The assessment covered demographics and cancer diagnosis, psychiatric diagnosis and proceedings. One third of all patients were treated for hematological cancer, followed by lung cancer. Depression was the most common psychiatric disorder. One third of all patients with hematological cancer were diagnosed with depression, followed by delirium. Inpatient psychiatric treatment and psychotherapy were most commonly recommended by the consultant psychiatrist. Furthermore, 80.2% of all patients received recommendations for medication with antidepressants. Our data showed that the CLP provides an important service of detecting and initiating early and appropriate treatment for cancer patients with comorbid psychiatric disorders by directing patients to the relevant treatment procedure or facility.

Real-World Effectiveness of Ramelteon and Suvorexant for Delirium Prevention in 948 Patients With Delirium Risk Factors.

The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. The decision to take medication was left to the discretion of each patient. The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days. Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0%; odds ratio [OR] = 0.48;, 95% CI, 0.29-0.80; P = .005). Similar results were found among 422 patients with delirium (39.9% vs 66.3%; OR = 0.36; 95% CI, 0.22-0.59; P < .0001). Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice.