Liaison Psychiatry in General Hospitals

Rap id growth of general hospital psychiatr ic units all over the world has piovided impetus to consultation-liaison work ca r r ied out by the psychiatrists in the non-psychiatr ic depar tments of general hospitals . Liaison psychiatry has acquired the status of a subspeciality within psychiatry and its development has paral le led the shift of psychiatry from men ta l hospitals to general hospital setting. This has resulte J in closei links between physical and psychological medicine and provides oppor tuni ty to the psychiatrists to be directly involved in the care of the physically ill. T h e area thus covers the fields of psychosomatic medicine; stress and the precipitation/ perpetua t ion of illnesses; psychological consequences/concomitants of physical illnesses; a n d the problems relat ing to the pa t ien t ' s families and heal th care professionals in their management . "Consu l t a t ion" refers largely to the services performed for the physically ill pat ients and families, often at the bedside in the general hospital , upon the referral of the a t tending physician or other health professional. "L ia i son" refers to the services provided for the physician and staff, trying together the t rea tment of the pat ient and family using educational conferences, psychosocial teaching rounds and holistic t rea tment plans. T h e r e is ample evidence based on epidemiological data t ha t positive correlation exists between physical and psychiatr ic disorders. According to Lipowski (1975), "Physical illness is a major cause of psychiatr ic morbid i ty . " Lipowski (1967) in his review of the general hospital popula t ion surveys repor ts tha t 30-60 per cent of inpatients a n d 50-60 per cent of outpat ients suffer from psychic distress or disorder of sufficient severity to create a problem for the heal th professionals. Eastwood and Trevelyn (1972) in a comparat ive study on persons registered wi th London group pract ice found that psychiatrically ill persons h a d a significantly greater prevalence of physical diseases of al l kinds. Rosen et al. (1972) in his study, on patients seen in several general medica l clinics in Monroe count ry New York found tha t emotional disorder was diagnosed in 2%-2 3 % of pat ients in the various groups of somatic diagnoses. Incidence of depression in medical inpat ients has been variously reported to be 20 per cent (Schwab et al., 1967); 64 per cent of hospitalized cardiac pat ients (Dovenmuchle and Verwoerdt , 1962); 20 per cent of severely ill medical pat ients (Stewart et al. 1965); 29 pe r cer.t pa t ients hospitalized for acute myocardia l infarction (Stern , 1974). Similarly in psychiatr ic populat ion higher incidence of organic diseases has been repor ted. The figures are 50 per cent by K o r a n y l (1972); 33.5 per cent by Magui re a n d Granvil le Grossman (1968). Half of these were not d iagnosed pr ior to psychiatric referral. In addi t ion , there are a large number of