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Highlighting the need for
more services.
The following argument has been put forward (with thanks to
Geraldine Swift). The three main points:
- High rates of undiagnosed depression, anxiety, delirium and
dementia in general hospitals, both in-patients and
out-patients.
- The prevalence of diagnosable psychiatric disorder (i.e.
significant mental illness) in consecutive patients admitted to an
acute medical setting is 28%, and a further 41% have
sub-clinical symptoms of anxiety/depression(1).
- For older adults in general hospital beds the rates of
psychiatric illness are even higher: up to 40% have dementia, 53%
depression and 60% have delirium(2).
References:
- Creed F, Morgan R, Fiddler M, et al . Depression and
anxiety impair health-related quality of life and /are associated
with increased costs in general medical in-patients.
Psychosomatics, 2002, 43(4): 302-9
- Working Group for Liaison Mental Health Services for Older
People, Faculty of Old Age Psychiatry, Royal College of
Psychiatrists - Who Cares Wins (2005)
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Liaison psychiatry is
effective in diagnosing and treating these
conditions.
References:
- Stiefel F, Zdrojewski C, Bel Hadj F, Effects of a
Multifaceted Psychiatric Intervention Targeted for the Complex
Medically Ill: A Randomized Controlled Trial, Psychotherapy
and Psychosomatics 2008 77: 247-56.
- Strong V, Waters R, Hobberd C et al (2008) Management of
depression for people with cancer (SMaRT oncology 1): a randomised
trial. Lancet: 372: 40-48.
- Katon WJ, Russo JE et al Long-Term Effects on Medical Costs
of Improving Depression Outcomes in Patients With Depression and
Diabetes. 2005 : 28: 2668-2672. * This study demonstrates
clear cost savings following a CL intervention.
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Liaison psychiatry services
across the country are patchy at best, perhaps because they do not
directly link in to government targets.
References:
- Geraldine Swift and Else Guthrie Liaison psychiatry
continues to expand: developing services in the British Isles.
Psychiatr. Bull., Sep 2003; 27: 339 - 341.
- Divya Sakhuja and Jonathan I. Bisson Liaison psychiatry
services in Wales Psychiatr. Bull., Apr 2008; 32: 134 -
136.
Further arguments could be made
regarding the role of liaison psychiatry in managing disturbed
behaviour, alcohol problems, complex capacity issues and medically
unexplained illnesses in the general hospital.
If you have any further comments to make, please contact
Dr
Swift directly.
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