Psychiatric Liaison Service Research Articles

The Suicide Status Form-4 (SSF-IV) as a potentially therapeutic suicide risk assessment tool.

Empirically supported suicide risk assessment and conceptualization is a central aim of the Zero Suicide model. The Suicide Status Form (SSF) is the essential document and scaffolding of the Collaborative Assessment and Management of Suicidality-Brief Intervention (CAMS-BI) and is hypothesized as an example of a psychological assessment as therapeutic intervention (PATI). However, this hypothesis has never been directly tested. N = 57 patients deemed at risk for outpatient suicidal behavior and treated as part of an inpatient psychiatric consultation and liaison service were recruited to participate in CAMS-BI at a Level 1 trauma center in the southeastern United States. During the CAMS-BI process, patients were asked to rate their subjective units of distress (SUDS) at five time points throughout the intervention (k = 285). The omnibus random intercept multilevel model revealed a significant difference in pre- to post-session ratings of SUDS across patients. Post hoc pairwise comparisons revealed no significant differences between SSF sections (e.g., Section A, Section B, and Section C) and relative reductions in SUDS; however, there was an observable trend toward a favorable effect of Section A of the SSF. The SSF may represent an example of PATI pending replication and extension of the current results.

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.

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.

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.

COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement.MethodsWe conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services.ResultsWe included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that “COVID-19-related psychosocial care” (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential.ConclusionMore than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support.Trial RegistrationClinicalTrials.gov NCT04753242, version 11 February 2021.

The influence of the COVID-19 pandemic and the first UK lockdown on older age presentations to a regional psychiatric liaison service: A retrospective observational study.

Background:Loneliness and social isolation may have increased during the coronavirus disease 2019 (COVID-19) pandemic, possibly increasing mental health problems. However, due to fears of contracting COVID-19, patients may not have presented to hospitals.Aims:We assessed the impact of the COVID-19 pandemic measures and lockdown on elderly (≥65 years) presentations to a psychiatric liasion service.Settings and Design:A UK regional liasion psychiatry service.Materials and Methods:Mixed methods methodologies were used to assess data between 01/01/20 and 31/08/20, which were compared to data from the same time period in 2019. Statistical and thematic analyses were conducted to understand drivers of presentations.Statistical Analysis:Nonparametric testing and analysis of variance (ANOVA).Results:Presentations to liaison psychiatry reduced by 13% for 01–08/2020 compared to 01–08/2019, with a 42% reduction during lockdown. Average weekly presentations significantly decreased during the main lockdown months only (April 2019 vs. 2020: 213.0 [12.3] vs. 110.3 [22.9] [adjusted P = 0.006], May 2019 vs. 2020: 209.5 [14.6] vs. 148.8 [12.3] [adjusted P = 0.006]). There was only a trend toward reduced elderly presentations from January to August 2020 and during lockdown. Lockdown pressures did not drive significantly more new elderly presentations. However, we still found a highly significant difference in the distribution of causal factors for the elderly presentations affected by the pressures of lockdown compared to those who were not.Conclusions:A trend toward reduced elderly presentations during lockdown and the pandemic was found. Thematic analysis supported by further statistical analysis of the drivers of elderly presentations showed that the pressures of lockdown clearly affected older age liaison psychiatry presentations.

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.

Psychiatric liaison service referral patterns during the UK COVID-19 pandemic: An observational study

Background and objectivesCOVID-19 has had a profound effect on mental health. Liaison psychiatry teams assess and treat people in mental health crises in emergency departments (EDs) and on hospital wards. During the first pandemic wave, new Mental Health Crisis Assessment Services (MHCAS) were created to divert people away from EDs. Our objective was to describe patterns in referrals to psychiatric liaison services across the North Central London care sector (NCL) and explore the impact of a new MHCAS. MethodsRetrospective study using routinely collected data (ED and ward referrals) from five liaison psychiatry services across NCL (total population 1.5 million people). We described referrals (per week and month) by individual liaison services and cross-sector, and patterns of activity (January 1st 2020 -September 31st 2020, weeks 1–39) compared with the same period in 2019. We calculated changes in the proportion of ED attendees (all-cause) referred to liaison psychiatry. ResultsFrom 2019–2020, total referrals decreased by 16.5% (12,265 to 10,247), a 16.4% decrease in ED referrals (9528 to 7965) and 16.6% decrease in ward referrals (2737 to 2282). There was a marked decrease in referrals during the first pandemic wave (March/April 2020), which increased after lockdown ended. The proportion of ED attendees referred to liaison psychiatry services increased compared to 2019. ConclusionsPeople in mental health crisis continued to seek help via ED/MHCAS and a higher proportion of people attending ED were referred to liaison psychiatry services just after the first pandemic wave. MHCAS absorbed some sector ED activity during the pandemic.

What happens to frequent attenders when they attend psychiatric liaison services? a clinical and demographic profile

AimsWe aimed to describe the demographic and clinical profile, and management of frequent attenders to a psychiatric liaison service.BackgroundFrequent Attenders to emergency departments contribute significantly to the burden on health services and by definition are subjectively highly stressed. It is therefore important that mental health services develop effective responses to this group of patients. A systematic literature search indicated a paucity of information on this group of patients.MethodWe conducted a case series of 49 frequently attending patients to the Psychiatric Liaison service in Tower Hamlets, East London NHS Foundation Trust.We defined frequent attenders as seeing the Psychiatric Liaison Service 5 or more times in 2018. We excluded 4 patients aged <18 years or >65 years.For each patient we collected data regarding their demographics; the details of each attendance to the Psychiatric Liaison Service; and their use of other psychiatric services.We then conducted a multivariate analysis, including stratification of patients based on number of attendances to identify correlation between frequency of attendance and the other information.ResultDemographic: The 45 patients reviewed had a mean age of 37 and a mean of 7 attendances during the study period.Clinical: 89% had a history of emotional trauma, 71% of substance misuse, and 49% of any personality disorder. Only 9% of the patients were under the care of the locality Personality Disorder Service.73% of the patients were under the care of any other psychiatric service. There was no correlation between being under other services and the frequency of attendance.Only 31% had contact with the locality Frequent Attenders Service during the study period, as this was established recently.ConclusionPsychiatric Frequent Attenders have complex needs, which do not fit neatly into existing psychiatric diagnoses and services.The high frequency of emotional trauma, substance misuse and personality disorder indicates a need for training of clinicians in these services to manage these patients, as well as planning for referral pathways for this group of patients who provide services with major challenges in appropriate pathways to care and follow-up

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.

Why is hitting A&E time targets so hard?: using Nudge theory and modelling to improve response times

AimsTo improve the one hour response times to referrals made to psychiatric Liaison in A&E without adding or changing available resources.MethodResponse time data of referrals made to the Homerton University Hospital psychiatric liaison service was collected dating back from August 2016 to October 2019 (n = 10225).A nudge was introduced in the form of a large display showing referrals arriving in real time in the staff office.Data was then collected over a period of 5 weeks (n = 436) to measure if any change had occurred in response times.ResultResponse times appear to follow a Poisson like distribution curve. The average referral was responded to within 6 minutes (n = 1577) prior to the nudge, and 6 minutes (n = 88) after. Prior to the nudge the 95% referral envelope fell within 134 minutes (n = 9728) and was 122 minutes (n = 414) after the intervention. Significant statistical difference is observed upon considering response in the first 240 minutes.ConclusionNudge interventions could be a useful resource-sparing method to improve services. The average referral to the HUH liaison team was quickly responded to within 6 minutes and yet hitting the 1 hour 95% target appears ever-elusive. Hitting targets of 95% responses within 1 hour may prove very difficult if we are not considering natural distributions, such as Poisson, occuring in the backgroung which ultimately may require a change in approaches to how we set performance targets.

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.

Brain Injury in Critical Illness and a Note on the Virus

Brain Injury in Critical Illness and a Note on the Virus

Accuracy of individual and combined risk-scale items in the prediction of repetition of self-harm: multicentre prospective cohort study.

Individuals attending emergency departments following self-harm have increased risks of future self-harm. Despite the common use of risk scales in self-harm assessment, there is growing evidence that combinations of risk factors do not accurately identify those at greatest risk of further self-harm and suicide. To evaluate and compare predictive accuracy in prediction of repeat self-harm from clinician and patient ratings of risk, individual risk-scale items and a scale constructed with top-performing items. We conducted secondary analysis of data from a five-hospital multicentre prospective cohort study of participants referred to psychiatric liaison services following self-harm. We tested predictive utility of items from five risk scales: Manchester Self-Harm Rule, ReACT Self-Harm Rule, SAD PERSONS, Modified SAD PERSONS, Barratt Impulsiveness Scale and clinician and patient risk estimates. Area under the curve (AUC), sensitivity, specificity, predictive values and likelihood ratios were used to evaluate predictive accuracy, with sensitivity analyses using classification-tree regression. A total of 483 self-harm episodes were included, and 145 (30%) were followed by a repeat presentation within 6 months. AUC of individual items ranged from 0.43-0.65. Combining best performing items resulted in an AUC of 0.56. Some individual items outperformed the scale they originated from; no items were superior to clinician or patient risk estimations. No individual or combination of items outperformed patients' or clinicians' ratings. This suggests there are limitations to combining risk factors to predict risk of self-harm repetition. Risk scales should have little role in the management of people who have self-harmed.

English

BACKGROUND Sleep disturbances usually accompany osteoarthritis (OA) because of chronic pain. Poor sleep quality is related to many factors like pain, fatiguability, restless leg syndrome, immobility of joints, anxiety and depression. But the quality of the sleep in patients with osteoarthritis has been rarely studied. We wanted to assess the prevalence of sleep disturbances in OA patients, determine the sleep quality in osteoarthritis patients and evaluate the relationship between pains and sleep quality. METHODS 150 patients with osteoarthritis were selected through convenience sampling as per the inclusion and exclusion criteria. Pittsburgh Sleep Quality Index (PSQI) and Numerical Pain Rating Scale (NPRS) were applied. Data was analysed using SPSS. One sample T test and Pearson Correlation were applied to find the correlation between the pains and sleep quality. RESULTS A total of 86 (57 %) patients with osteoarthritis were found to have sleep disturbances and were assessed for sleep quality and pain level. This group contains 18 (20 %) males and 68 (80 %) females. A total of 62 (72 %) osteoarthritis patients including 14 males and 48 females were having poor sleep quality; 67 (78 %) patients had intolerable pain (NPRS > 7). Strong positive correlation (p-value < 0.001) was found between GPSQI and NPRS. CONCLUSIONS Patients with osteoarthritis with high NPRS values have poor sleep quality. There is significant association between pain and poor sleep quality. It will be highly useful for the patients with osteoarthritis if osteoarthritis treatment protocol includes assessment and management of poor sleep quality. As poor quality is an early indicator of majority of mental illnesses, psychiatric liaison services will be highly beneficial for patients with osteoarthritis. KEYWORDS Osteoarthritis, Pain, Sleep Quality, Numerical Pain Rating Scale (NPRS), Pittsburgh Sleep Quality Index (PSQI)

Self-inflicted upper limb injuries in a tertiary care rural Plastic Surgery unit - A psychiatric evaluation

Background: Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed. Methods: Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted. Results and discussion: Out of 48 patients, 20 (41.6%) belong to the 21-30 age group, 30 (62.5%) were males. 43 (89.6%) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1%), adjustment disorder (16.6%), alcohol dependence syndrome (14.6%), and bipolar mood disorder (12.5%). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up. Conclusion: Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.

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.

Assessment of Anxiety and Depression among Heart Failure Patients at King Faisal Cardiac Center, King Khalid Hospital, Jeddah

Background: Cardiovascular diseases are extremely common in Saudi Arabia. Depression and anxiety is highly prevalent in patients with heart failure disease and heralds adverse cardiovascular outcomes and increased health care costs. The aim is to assess the occurrence and severity level of anxiety and depression among heart failure patients. Methods: A Cross sectional correlational survey design was used to recruit 60 heart failure patients from King Faiesal cardiac center at King Khalid hospital Jeddah. The Arabic version of Beck Anxiety Inventory (BAI) and Zung self-rating depression scale were adopted and used to collect data. The results revealed that only (15%) of the study population have mild degree of depression while the majority 78.9% have moderate level of anxiety compared by 10.0% have severe level of anxiety. The study results showed a 23.52% of severe anxiety among patients who were diagnosed with heart failure 6-20 years ago and female, who had higher educational level and history of heart failure are at risk for depression and anxiety more than male patients. Conclusion: Anxiety and depression comorbid with heart failure patients with different degree starting from mild to severe level of anxiety and only mild level of depression was reported among study population. Female gender, duration of illness and pervious history of heart failure and psychiatric illness have an association with the severity of depression and anxiety with apparent significant difference among study population. Therefore, awareness training program targeting patients to help them detect depression and anxiety manifestations that may affect them either because of their long life chronic disease or dependency feeling on their families. Moreover, providing heart failure patients with psychosocial and Liaison psychiatric services to support patients’ mental health problems through referral or follow up.

Comparing the Renal Profile of Patients with Dementia Admitted to a Psychiatric Unit to Those with Delirium/Dementia Seen by the Liaison Psychiatric Services in District General Hospital (DGH) In Wales

Comparing the Renal Profile of Patients with Dementia Admitted to a Psychiatric Unit to Those with Delirium/Dementia Seen by the Liaison Psychiatric Services in District General Hospital (DGH) In Wales

Are patients with pre- orthotopic liver transplant psychiatric consultation different in bio-psycho-social complexity from other consultation inpatients? A study from a Consultation – Liaison Psychiatric Service

Are patients with pre- orthotopic liver transplant psychiatric consultation different in bio-psycho-social complexity from other consultation inpatients? A study from a Consultation – Liaison Psychiatric Service