European Consultation-Liaison Workgroup Research Articles

Psychosomatic psychiatry: A Spanish proposal for a new dimension

Psychosomatic Medicine has undergone important evolutionary changes throughout its history, from its flowering in the 20th century up to the present. Two important reasons have determined this evolution. The first one has to do with the movement out of the focus in illnesses such as the bholy seven,Q illnesses with histological lesions once believed to have a psychogenic origin [1]. The knowledge about biological, ethiopathogenic mechanisms involved and effective treatment in these illnesses has improved considerably; on the contrary, psychogenic theories have been criticized on the basis of insufficient evidence. The second reason is the increasing demand for psychiatry to care for mental disorders in medical patients. Psychiatric disturbances are common in medical patients. On the other hand, the sharp increase in all aspects of medical practice, including prevention, diagnosis, and treatment, has generalized health care. Diagnostic and therapeutic techniques have dramatically improved life expectancy, and present-day prospects for recovery from illness would have been considered to be fantastic only a few years ago. However, extreme situations arise as a result of the new developments and the ethical problems they give rise to, which constantly threaten the psychological balance of the individual. The probability of needing psychiatric help when suffering somatic illnesses has increased significantly. A conservative estimate by the European Consultation-Liaison Workgroup for General Hospital Psychiatric and Psychosomatics [2] considers that approximately 10% of the patients admitted to a general hospital require consultation with a psychiatrist.

C-L Psychiatry and Psychosomatic Medicine are separated disciplines?

Several issues enhance the differences that have gradually developed between Consultation-Liaison Psychiatry (CLP) and Psychosomatic Medicine (PM). PM has a strong and solid tradition in the research field, as is well demonstrated by numbers of highly significant works in international literature; it also does well in the area of education and teaching, either under- or postgraduate. But it is in the field of clinical activities and organisation of services that a blank is left: neither the “psychosomatist” nor the specialisation do exist in most countries. CLP instead has only recently walked its first steps in the field of research, with some specific projects such as those brought about by the European Consultation-Liaison Workgroup (ECLW), though a further statement of identity is needed; it is also gaining growing importance with teaching and training activities, addressed not only to students but also to a variety of professional figures, with varying strategies: the liaison is in itself a very powerful and direct, everyday educational tool, even in its less structured form. It is then in the field of clinical activities and organisation that CLP has historically developed most, and “psychosomatic problems” represent only a small proportion of the CL psychiatrist's competencies. Some brief considerations are collected in this paper over the complex relationship between CLP and PM, which is far from being clear and definitive.

Consultation-liaison psychiatry in obstetrics and gynecology

Data documenting the activity of Modena and Reggio Emilia University Hospital Consultation-Liaison Psychiatry Psychosomatic Service (C-LPPS) to the 59 bed gynecological-obstetric unit are compared to the corresponding European Consultation Liaison Workgroup (ECLW) study results and discussed in the light of recent epidemiological studies suggesting a low rate of detection and psychiatric referral in obstetric and gynecological patients. All psychiatric consultations of gynecological-obstetric inpatients during a 3-year (1996-1998) period were included in this study and data were derived from valid and reliable consultation forms tested for reliability. Within the 3-year period 55 patients were referred to C-LPPS by the gynecological-obstetric unit for psychiatric consultation. Referral rate was 0.5% of the admitted patients in the unit. The gynecological-obstetric group represented 2.5% (vs. 4.5% ECLW study) of all psychiatric consultations requested in the study period. The most frequent reasons for referral were: current psychiatric symptoms (47.3% Modena study vs. 39% ECLW), psychiatric history (20% vs. 7.3%), unexplained physical symptoms (12.7% vs. 16.2%) and coping-compliance problems (3.6% vs. 16.6%). The most common ICD-10 psychiatric diagnoses were: neurotic, anxiety and adjustment disorders (41.8% vs. 31.2%), mood disorders (29% vs. 18.4%), personality disorders (7.3% vs. 6.1%), schizophrenic and other psychotic disorders (5.5% vs. 7%).

Consultation-Liaison psychiatric service delivery: results from a European study

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation–liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.

Patterns of comorbidity in relation to functioning (GAF) among general hospital psychiatric referrals. European Consultation-Liaison Workgroup.

Improvement of services for physically ill patients with concurrent psychiatric problems is a noteworthy issue in general hospitals. Among 1249 general hospital in-patients referred for psychiatric consultation, concurrent mental and behavioural disorders (ICD-10) were diagnosed in 84% of cases. Any concurrent mental and behavioural disorder was associated with dramatically low functioning (GAF = 46), indicating serious psychosocial impairment. This is a striking new finding of clinical importance. The effect on functioning was similar for substance use disorders, other mental disorders, and combined mental and substance use disorders (dual diagnoses), with no gender differences. This finding highlights the need for specialized interventions among general hospital in-patients referred for psychiatric consultation.

The European Consultation-Liaison Workgroup (ECLW) collaborative study: I. General outline

Previous C-L psychiatric service research is seriously limited by its parochial nature; very few results can be generalized outside of the hospital in which the original study was performed because of differences in the nature of the hospital and the type of C-L service. This article presents the general outline and methodology of a European multicentered C-L service delivery study effected by the European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW). The study is unique in its kind as it allows the comparison of very different C-L services; for example, some services are run by C-L psychiatrists, others are run by C-L psychosomaticists and the study encompasses a large variety of different settings. As a result, both common factors in C-L service delivery and specific local patterns can be explored. The overall hypothesis tested in this study was that the most developed services would see (as well as more patients) a wider variety of clinical problems than small services. The implication is that the absence of well-developed C-L services in a general hospital may mean that there are patients with unmet mental health needs. In separate articles the training and reliability testing of the new Patient Registration Form (PRF) and the Institutional and Provider characteristics will be described. The former includes the use of ICD-10 in the general hospital setting. This study is a collaborative effort made by 226 consultants from 56 psychiatric C-L services in 11 countries. Each consultant recorded details of 1 year's caseload leading to a thorough description of 14,717 patients collected between 1991 and 1993. The advanced methodology included a multicentered international approach, rigid training for all participating consultants, and the development and testing of new instruments. This will allow us to assess the impact of important structural and process variables on the outcome of C-L service delivery in several European countries. These results will be reported in papers both in the international and national literature of the participating countries.

Consultation-liaison psychiatry in Australia

Consultation-liaison (C-L) psychiatry as a service entity has developed slowly and to a variable extent in Australia despite the presence of factors conducive to its development. These include a compulsory national health insurance system and a favorable disposition to the biopsychosocial model and to psychoanalytic ideas. C-L psychiatry, however, does enjoy a high profile in many undergraduate medical and postgraduate psychiatry teaching programs. Research on C-L psychiatry is emerging, complementing a strong history of research in psychosomatic medicine. An Australian and New Zealand C-L psychiatry interest group is being formed. Collaboration with the MICRO-CARES Consortium and the European Consultation-Liaison Workgroup is proving to be a great stimulus.

Post-treatment resource program for promoting the quality of life of cancer survivors: The first two years

s from C-L Forum Education, as to ramifications of medical illnesses, including AIDS, remains a need for psychotherapists in private practice, particularly those who are not MDs. Twenty Years of Psychiatric Consultation in a Swiss General Hospital: Changing or Unchanging Patterns? R. Zumbrunnen, L. Wieland, L. Tricot, A. Gunn-Sechehaye Department of Psychiatry, University of Geneva, Hipita Cantonal Universitaire Genezla, Switzerland A psychiatric consultation-liaison unit was established at the Hopital Cantonal Universitaire of Geneva in 1963. One of us (A. G.-S.) has taken part in the consultations from the beginning, and is now still in charge of the service. Aside from this personal stability, profound modifications have affected the C-L unit, the hospital, and the society during this period of time. The present study was conducted to investigate changes that may or may not have occurred since the creation of the C-L unit regarding the patterns of the psychiatric consultations in the medical and surgical wards. A total sample of 500 consultation reports, i.e., 100 for each index year (1965, 1970, 1975, 1980, 1985), was randomly extracted from the C-L unit file records and analyzed. The results of the study can be summarized as follows: changes regarded mostly the caretaker-related variables (among others: staff’s reasons for consultation, consultant’s diagnostic and therapeutic recommendations), whereas patient-related variables remained more stable and consistent over time. European Consultation-Liaison Workgroup (ECLW) Multi-Centered Registration Study F. 1. Huyse arzd Members of the ECLW Consultation-Liaisorz Psychiatry, Academisch Ziekenlzuis der Vrije Unizlersitat, Amsterdam, The Netherlands Concerning the state-of-the-art of C-L psychiatry in Europe, the current level of C-L service delivery in general hospitals seems inadequate and unprepared to cope with the expected growth of admissions of elderly, AIDS, risk-taking behavior, stress-related illness, and chronic illness, all related to psychiatric sequelae. Aware of these impediments, a Workgroup (European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics [ECLW]) started in 1987 and formulated as a major goal stimulation of collaborative research programs to improve psychological and psychiatric care within the general hospital. The ECLW is in the process of a project, funded by the European Community, that focuses on the development of guidelines for C-L service delivery in the general hospital derived from empirical data. The specific goal of the study is the assessment of the impact of C-L service manpower characteristics on the service delivered; for example, consult rates, lag times, profile of services, length of stay and post-discharge placement. Therefore, a patient registration form, including a manual with operational guidelines, has been developed. In addition, basic C-L service and hospital characteristics will be described. A pilot study, a reliability study, and training sessions are included in the research design; these are currently in progress. The study is facilitated through the use of a flexible Kaiser Optical Mark Scanner system directly linked to SPSS and a database. Preliminary results of the pilot study and the reliability study will be presented. The development of the ECLW has been greatly facilitated through generous support from Upjohn Medical Sciences Liaison (MSL). Members of ECLW in alphabetical order: Belgium: I. Pelt, D. Razavi, M. van Moffaert; Denmark: P. Beth, D. Loldrup; Finland: P. Tienari; France: E. Guillibert, G. Marx; Germany: M. Wirsching, T. Herzog; Greece: C. Stefanos; Italy: G.A. Fava, S. Grandi, M. Rigatelli; The Netherlands: M.W. Hengeveld, F.J. Huyse; Norway: U.F. Malt, I. Refne; Portugal: F. da Fonseca; Spain: M.D. Crespo, A. Lobo; Sweden: T. Person, A. Nagy; Switzerland: R. Zumbrunnen, B. Radanov.

European consultation-liaison workgroup (ECLW) multi-centered registration study

European consultation-liaison workgroup (ECLW) multi-centered registration study

Consultation-liaison psychiatry: Does it help to get organized?

Since 1987 consultation-liaison (C-L) psychiatrists in Europe have decided to develop a closer collaboration to stimulate the development of the C-L field. A first result of this collaboration is a companion paper on the history and current state of C-L psychiatry in Europe. This paper describes the arguments for the development of the European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW), and the results of the first 3 years of collaboration.