Psychiatric Liaison Research Articles

Accreditation Models of Mental Health Care: A Systematic Review

Purpose: To identify accreditation models in mental health and their effects on performance of health plans and health facilities. Methods: We conducted a free search in Databases of PubMed , Scopus , EMBASE , PsycINFO and Google Scholar up to March 2014 ,searching for “mental health” and “accreditation” in keywords, titles , abstracts and all indexed fields . Inclusion criteria were English or Persian language of of the articles, and Presentig accreditation models in mental health (processes or effects). Exclusion criteria were manuals of accreditation ,guidelines of accreditation,revisions of standards and Interview with pioneers. Results: Seven models of accreditation in mental health were determined. They were Peer or professional accreditation, The Memory Services National Accreditation Programme (MSNAP), Accreditation of acute in-patient mental health services (AIMS), Psychiatric Liaison Accreditation Network (PLAN), Electroconvulsive Therapy accreditation Service (ECTAS), psychiatric intensive care unit (AIMS-PICU), JCAHO Mental Health Care Network .All models used self-review and external peer review in collection of related data. Five accreditation models clearly focused on Continous Quality Improvement projects. Conclusion: Upon results of this systematic review, it is concluded that there are various accreditation models in mental health care . there arent enough researches about accreditation impacts on community mental health . It is recommended that a study be conducted about accreditation effect on efficiency and effectiveness of health programs and mental health care.

EPA-1325 - Relevance of a mobile psychiatric team for elderly patients within institutions for old people

As they grow older, patients with severe psychiatric illness often have less access to psychiatric care due to loss of autonomy and difficulties in getting about. The recently created Psychiatric Liaison Experimental Unit - ULP - (made up of psychiatrists, nurses and a coordinator), a mobile team in the retirement homes and residences of Paris's Social Services Center (2,600 beds) must enable residents suffering from psychiatric problems to get better treatment. In old people's homes, residents rarely have the opportunity to consult a psychiatrist. Geriatric staff are often at a loss when faced with the expression of psychiatric symptoms, with the specificity of caring for younger patients whose behaviour is different from older people with neurodegenerative disorders. The involvement of community mental health services lacks homogeneity. Professionals in the field of psychiatry and geriatrics are not very familiar with each other's work. The team's purpose is to create a link between the two, to promote partnerships so as to find housing for ageing dependent psychiatric patients. They also provide their expertise in complex cases. Appointed and financed over three years by the health authorities, this team will be assessed on how they set up partnerships, on the quality of the links they create and on the improvement in the living conditions and the care these older patients get. We will present the various missions of this team and a model of a locally based network approach of psychiatric care for elderly patients.

A Study of the Effectiveness of Psychiatric Clinical Liaison Nurses and Determinants of Psychiatric Admission in an Accident and Emergency Department of Hong Kong

Background This study examines how psychiatric clinical liaison nurses (CLN) services in the accident and emergency department (ED) meet the demand for those people with mental health problems. In addition, we aim to identify determinants for psychiatric admission. Methods All psychiatric patients attended the ED within the periods of May to July of 2007, May to July of 2008 and January to March 2012 were recruited. Data was recorded on patients' demographics, past mental history, time of arrival to the ED, time of discharge from the ED, length of stay in the ED, time to urgent psychiatric services (CLN services in 2008 and 2012, and urgent psychiatrist consultation in 2007), and on clinical symptoms and outcome. Results Totally 484, 519 and 587 attendances were analysed in 2007, 2008 and 2012 respectively. Results showed that the introduction of CLN to the ED significantly shortens the waiting time for patients from registration in the ED to urgent psychiatric services, from 33.5 hours to 21.4 hours then to nine hours. However, the mean length of stay in the ED was prolonged from three hours to five hours. Overall admission rate was similar. Re-attendance rate was decreased. Five significant determinants of psychiatric admission in an attendance to the ED were identified: patients presented with psychotic symptoms, violent behavior, suicidality, known to mental health services and depressive symptoms. Conclusions The CLN service as described in this study appears to be a useful resource in the ED for patients with mental health problems. Five determinants of psychiatric admission are identified. (Hong Kong j.emerg.med. 2013;20:364-370)

Carers’ perspectives on choosing a care home for a relative with dementia

This article describes findings from a project that explored what happens to people with dementia (PWDs) following discharge from a general hospital to a residential care home. In 15 out of 109 cases referred to a hospital psychiatric liaison team, admission to a residential care home was indicated during the hospital stay. This ‘last resort’ for families, following repeated hospital admissions and a deteriorating condition, was accepted when all involved agreed that it was in the best interests of the PWDs. Four months after the move, carers reflected on their criteria for choosing the home, their expectations and whether these were met. Carers’ own wellbeing improved and their mental distress reduced as the PWDs appeared settled and safer. However, the findings suggest a continuing key role for family carers of PWDs in care homes and emphasises the need for advocacy for PWDs without such support.

Educational Impact of a Psychiatric Liaison in the Medical Intensive Care Unit

Despite high rates and increased risk of mortality, delirium remains underdiagnosed and a minimal focus of formal medical education. This is the first study to examine the educational impact of a psychiatric liaison on beliefs and knowledge about delirium among both nurses and residents. One psychiatrist spent 9 months rounding weekly in the medical intensive care unit, interacting with critical care nurses and internal medicine residents. Preintervention and postintervention surveys were distributed in July 2009 and June 2010, respectively, to staff (critical care nurses: n = 23 and n = 25, respectively; internal medicine residents: n = 31 and n = 23, respectively) and a comparison group (psychiatry residents: n = 29 and n = 23, respectively). Participants responded to 12 statements regarding delirium on a 5-point Likert scale. There were no statistically significant differences between the presurveys and postsurveys for any item when examining all respondents together, as well as psychiatry and internal medicine residents as individual groups. Critical care nurses showed a significant change between surveys for the statements, "Patients with new-onset anxiety or depression in the intensive care unit most commonly have delirium" (17.4% agree presurvey vs 56.0% agree postsurvey, χ(2) = 7.62, P = .006) and "Delirium is diagnosed less often than it actually occurs" (100% agree presurvey vs 80% agree postsurvey, χ(2) = 5.13, P = .023). Though introduction of a psychiatric liaison was very well received by clinical staff, we did not meaningfully affect the attitudes and beliefs of trainees and nurses regarding delirium. Robust and lasting changes in attitudes regarding delirium may require more intensive efforts involving longer intervention periods, greater rounding frequency, or additional didactic teaching.

Troubles psychiatriques induits par la corticothérapie orale : mise au point sur la nature, l’incidence, les facteurs de risque et le traitement

Oral glucocorticoids have been used for several decades and psychiatric side-effects may occur. This review will discuss relevant data of the clinical specificities, the incidence, the risk factors for the occurrence of these episodes and the preventive and curative medications of these episodes. We performed a literature review by using PubMed database. We selected and discussed articles and studies with high standard of evidence. The occurrence of psychiatric symptoms is quite frequent. The varying intensity of clinical features ranges from minor signs (impregnation) to acute psychotic episodes which may occur from 5 to 30% of patients. Affective symptoms or disorders are the most prominent clinical features. Delirium may occur and suicidal risk could be increased. The significant predictive factors are prednisone dosage more than 40mg/day, particularly weight-based dosage, and a history of psychiatric disorders. When a reduced dosage of glucocorticoids is not sufficient to control the symptomatology, curative medication is mainly based on atypical antipsychotics such as olanzapine. Studies about neuropsychiatric complications of glucocorticoids present various and heterogeneous results. Further prospective clinical studies should be based on a close cooperation between physicians and consultation liaison psychiatrists. This collaboration is required for an optimized management of the patient who receive glucocorticoids.

Personality disorders in consultation–liaison psychiatry

Liaison psychiatrists treat patients who present with self-harm, with medically unexplained symptoms (MUSs) and physical illnesses with psychological comorbidity. We sought to explore recent studies into the impact of personality disorder in liaison psychiatry. One in five patients presenting to most liaison psychiatry services suffers from a personality disorder. Patients who have self-harmed have a high rate of personality disorder, but there is little research on how liaison psychiatrists can engage these patients in appropriate treatments. Most patients with MUSs or a functional somatic syndrome do not have a personality disorder, but the prevalence is probably higher than in the general population. Little is known about how a personality disorder might affect the efficacy of treatment in these conditions. Patients with personality disorders have higher rates of physical illness. Personality disorders may complicate the treatment of patients with long-term physical conditions, and talking therapies have recently been described in primary and secondary care. Liaison psychiatrists have an ideal therapeutic opportunity to engage patients with a personality disorder in treatment when these patients present with self-harm. There is a need to understand and research how personality disorders might affect the prognosis and treatment of patients with MUSs or a functional somatic syndrome. Personality disorders may complicate the treatment of patients with long-term physical conditions, and talking therapies recently described in primary and secondary care may help their physical and psychological health.

2347 – Consultation-liaison psychiatry and antipsychotics

Liaison psychiatry is the branch of psychiatry that specialises in the interface between medicine and psychiatry. The liaison psychiatrist uses a wide range of drugs and antipsychotics are among them. To analyse the prescription of antipsychotics at the liaison psychiatry service of a general hospital. This is a transversal study. All patients evaluated by the liaison psychiatry service of a general hospital from the 1/01/2012 to the 31/05/2012 were included. The sample consisted of 128 patients (53’1% women; mean age 65’34±17’18). The majority of them were Spanish (92’2%). Internal Medicine was the service who asked for more psychiatric evaluations, followed by General Surgery (19’5%) and Nephrology (10’2%). The most frequent main complain was depression (46’9%), behavioural disorders (18%) and anxiety (10’2%). The diagnosis given were more often affective disorders (43’8%), delirium (11’7%), psychotic disorders (10’9%) and anxious disorders (9’4%). Within the 128 patients, 34 (26’6%) did receive antipsychotics during the admission. We compared the two groups (antipsychotic group vs non-antipsychotic group) and obtained the following results: we found that the antipsychotic group more often had behavioural disorders (34’3%) and delusions/hallucinations (20%). A significant increase in delirium diagnose was to be seen (42’9%). Antipsyhotics are the second most used treatment at the liaison psychiatry service. Patients who receive them are more often affected by delirium and to a minor extent by a psychotic disorder. The first generation antipsychotics such as haloperidol still are the first option. However, the use of second generation antipsychotics is increasing remarkably.

2213 – The role of liaison psychiatry in the general hospital

Few data are reported in medical journals about physicians perception in optimal care of mental health disturbed patients accessing emergency departments in general hospitals. To investigate the subjective psychological burden and perception of proficiency in managing patients with somatic psychiatric comorbidities between physicians providing emergency care in County Emergency Hospital of Timisoara. An anonymous multiple choice questionnaire was distributed to active medical personnel from emergency units in September 2012. 105 doctors answered- emergency unit 27, ICU 12, neurosurgery 15, trauma and surgical services 51. 38,1% declared at least a lifetime burn-out episode, 19% an episode last year, 69,5% declared they should request professional help. Psychiatric disturbances estimated in emergency care: dementia 1 out of 5 patients, depression 1: 4. Confidence rates in diagnosing dementia(%): very good 7,6, good 35,2, satisfactory 41,9, unsatisfactory 15,2; depression: very good 8,6, good 42,9, satisfactory 41, unsatisfactory 7,6. 78,1 respective 7,6% of the responders declared that mental health issues is insufficiently or not at all addressed in an emergency department. Disturbed mental status in patients was considered responsible for communication 89,5%, and treatment 85,7% difficulties, poor compliance 88,6%, and outcome 66,7%. 80% would appreciate a screening mental health program. 98,1% valued liaison psychiatrist collaboration. By acknowledging the increasing incidence in mental health disturbances among patients accessing emergency services and their medical care management challenges, as well as their own psychological needs, medical and surgical professionals in SCJUT appreciate the active involvement of the liaison psychiatry department in emergency care.

Psychiatric Evaluation of Mental Capacity in the General Hospital: A Significant Teaching Opportunity

BackgroundRequests for evaluation of mental capacity in general hospitals have increased in frequency.ObjectiveThe authors sought to determine the interventions required to respond adequately and assess the initiating circumstances.MethodQuestionnaires completed by psychiatric consultants were analyzed, and chart reviews were completed.ResultsCapacity evaluation alone resolved 32% of the requests; 31% required an evaluation plus additional interventions; 37% did not require a capacity evaluation. Patients threatening to leave against advice, and/or refusing treatments or procedures represented 64% of requests. Consultants successfully resolved 88% of such cases.ConclusionA mental capacity evaluation alone was insufficient to resolve two-thirds of problems eliciting requests. Consultation–liaison psychiatrists can use these evaluations as teaching opportunities.(Reprinted with permission from Psychosomatics 2009; 50:468–473)

1217 – Obstetrical and neonatal outcomes after prenatal exposure to psychiatric medication - experience of the early intervention unit

Introduction Pregnancy and postpartum are periods of increased vulnerability for psychiatric disorders, such as mood disorders, anxiety and psychotic disorders, that, when left untreated, imply serious consequences for the pregnant and the fetus. Since 1995, the Psychiatric Liaison Consultation in Bissaya Barreto Maternity (MBB) is part of the Early Intervention Unit (UIP), which consists of a multidisciplinary team that ensures a specific intervention in pregnant and postpartum women with psychiatric illness. Objectives The purpose of this study was to evaluate the effects of prenatal exposure to psychiatric medication on obstetrical and neonatal outcomes. Methods The authors conducted a case-control study to compare obstetric and neonatal outcomes among pregnant women exposed to psychotropic drugs (antidepressants, antipsychotics, mood stabilizers and benzodiazepines), observed at the Psychiatry - Obstetric Consultation (n= 69), with those of women followed at the Obstetric Consultation, without psychopathology during pregnancy, who were not exposed to psychiatric medication (n=69). The study was performed during a period of six months (October 2011 - March 2012). Results The results were analyzed using the Statistical Package for the Social Sciences - SPSS (19th version). Conclusions Preliminary results show that obstetrical and neonatal outcomes in the group exposed to psychiatric medication are, at least, as good as in the control group, supporting that the use of psychotropic drugs during pregnancy is safe, as long as used with caution. Early psychiatric intervention during pregnancy, in conjunction with obstetrics, seems to be the best way to follow up pregnant women with mental illness.

Article Commentary: Psychiatric Issues in Palliative Care: Assessing Mental Capacity

Issues surrounding capacity to consent to or refuse treatment are increasingly receiving clinical and legal attention. Through the use of 3 case vignettes that involve different aspects of mental health care in palliative care settings, mental capacity issues are discussed. The vignettes tackle capacity in a patient with newly developed mental illness consequent to physical illness, capacity in a patient with mental illness but without delirium and capacity in a patient with known impairment of the mind. These discussions give credence to best practice position where physicians act in the best interests of their patients at all times. It is important to emphasize that capacity decisions have to be made on a case by case basis, within the remit of legal protection. This is a fundamental requirement of the Mental Capacity Act 2005, England & Wales (MCA). The later is used as the legal basis for these discussions. The psychiatric liaison service is a useful resource to provide consultation, advice and or joint assessment to clinicians encountering complex dilemmas involving decision-making capacity.

Impact of an integrated rapid response psychiatric liaison team on quality improvement and cost savings: the Birmingham RAID model

Aims and methodTo evaluate whether the implementation of the Rapid Assessment, Interface and Discharge (RAID) integrated model improves access to psychiatric assessment and reduces cost of health service provision in an acute hospital. Length of hospital stay was calculated using a case-by-case matched control design. Readmission rates were calculated and survival analysis was used to measure endurance in the community following discharge.ResultsIn an acute hospital with 600 beds, the total savings in bed days through reducing length of stay and readmissions was 43–64 beds per day. The elderly care wards provided the majority of bed savings.Clinical implicationsThe development of a rapid response, age-inclusive, comprehensive psychiatric team integrated in an acute hospital can lead to significant savings in health service provision.

Current status and problems of the psychiatric liaison team

Current status and problems of the psychiatric liaison team

Psychiatric nursing liaison in a combat zone: an autoethnography

Military mental health nurses are tasked with providing psychiatric liaison to British forces deployed to combat zones. This forms part of a wider effort to maintain the combat effectiveness of the fighting force. During a recent deployment, I maintained a reflexive journal of my experience of liaising with the British Chain of Command. I then used line by line coding via the NVIVO 9 software package to formulate the core themes that became a framework for this autoethnography. My personality and social anxieties shaped how I performed the psychiatric liaison role. I was able to develop a template for liaison that accounted for both 'me' and my need to feel authentic or credible as a nurse, yet still enabled me to communicate effectively with the Chain of Command. One template for psychiatric nursing liaison with British combat forces is to focus upon key stakeholders within the Chain of Command, specifically, the Officer Commanding, the Sergeant Major, the Trauma Risk Management co-ordinator (usually the Sergeant Major) and the embedded medical asset. Further research is needed to establish how other nurses approach psychiatric nursing liaison.

Wie arbeiten ambulante Konsiliar- und Liaisondienste und was bewirken sie?

Many patients benefit from interventions performed by the psychiatric liaison service. Prospective longitudinal study of community dwelling elderly patients supplemented by a questionnaire answered by family members, as well as expert interviews with the members of the consultation-liaison team and semi-structured interviews with family members. The majority of patients had some benefit from the liaison psychiatric interventions, access to care was improved and lack of specialist support was reduced. In addition there was some cost offset due to prevention of admissions to nursing homes and inpatient hospital treatment. With regard to demographic developments gerontopsychiatric liaison services should be integrated into the present system of health care. This should be supported by adjusting judicial obstacles that hamper such strategies.

Providing quality care for the body and mind

Providing quality care for the body and mind

Assistenza psichiatrica agli autori di reato in Liguria: una realtà in evoluzione

IntroductionIn 1999 a group of psychiatrists of Mental Health Department of Genoa started building up a psychiatric liaison service to the Marassi Institute, the largest prison of Liguria. Over the years, the interest on the issue of forensic psychiatry has been increasing in the Ligurian Mental Health Departments as well as in the meetings of Ligurian Section of Italian Psychiatric Society. At the same time all the aforementioned subjects begun to argue about the shutdown of the forensic hospitals. DiscussionIn the subsequent years the real world psychiatric practice have become increasingly interwoven with legal issues, and nowadays the main questions to address in this field are: the organization of psychiatric care in prisons; the organization of care in the Mental Health Center and Day Hospitals for mentally ill offenders serving their sentence at home; the organization of care in residential facilities as an alternative measure to forensic hospital or imprisonment; the planning of a regional facility, after the shutdown of the forensic hospitals, to admit patients deemed incompetent to proceed by reason of mental insanity, but still at risk of future violence.

Violent Behavior in Cancer Patients—A Rarely Addressed Phenomenon in Oncological Treatment

Dealing with violent cancer patients can be particularly challenging. The purpose of this study was to collect data on the frequency, quality, and underlying variables affecting violent behavior as well as to examine the role played by this behavior in the premature interruption of treatment. A total of 388 cancer inpatients were examined by liaison psychiatrists. The data were assessed using the Staff Observation Aggression Scale (SOAS-R) and Psycho-Oncological Basic Documentation (PO-BADO); the quality of psychiatric disturbances was measured with a three-level rating according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria. Nineteen of 388 patients (4.9%) displayed violent behavior. The variable "cognitive limitations" was clearly associated with aggressive behavior. The interaction factor "constantly bedfast, nonterminal phase, and strong feelings of helplessness or subjection," was associated with aggressive behavior as a trend statistically. Eight of 19 inpatients showing aggressive behavior were prematurely released from the treatment facility. In a multivariate model the association of the variable "aggressive behavior" to premature interruption of treatment with unfinished diagnosis and therapy was weighted rather strong. Despite their methodological limitations, these results suggest that members of oncological teams should be able to identify violent behavior and its precursors at an early stage as important factors, which may decrease patient cooperation.

Del principio de beneficencia al principio de autonomía: aproximación a la evaluación de la competencia mental de los pacientes en el hospital general

IntroductionRefusing a medical procedure is a valid way of exercising every patient's right to autonomy. From the legal point of view, autonomy is based on the right to privacy. In recent decades the legal right to self-determination has gradually expanded and today patients in full possession of their mental faculties, have the moral and legal right to make their own decisions and these decisions take precedence over physician and family. Often liaison psychiatrists are called in to assess the mental competence of patients in the general hospital. ObjectiveTo determine the psychiatrist's role in evaluating these patients. Discussion and ConclusionsThe assessment of a patient's ability to decide and self-determine is a common clinical problem in general hospitals. Evaluation of these patients requires a proper understanding of the philosophical, ethical, and legal issues that guide the appropriate treatment of these complex clinical problems.