Consultation-liaison psychiatry in the general hospital: An experience in Perugia La psichiatria di consultazione e collegamento nell'ospedale generale: l'esperienza perugina

Objective: The European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW) and the Italian Consultation-Liaison Group advice that the aim of the Consultation-Liaison Psychiatry is to provide hospital treatment using valid and universal medical approaches, in full respect of personalized care. This study describes the Consultation-Liaison Service of the Perugia University and investigates the significant associations between a many variables of the assessed population. Methods: We used a clinical report derived from the Patient Registration Form in order to collect demographic and clinical data of hospitalized patients; the t-test, the Mann-Whitney U-Test, and the chi2-test-Fischer's test were used for statistical assessment. Results: During the time from July 2008 to June 2009, 722 consultations were performed at the general hospital in Perugia. First examinations were 605; 462 were in hospital ward and 143 were in emergency. These 143 were excluded from the study. Most consultations involved European patients (95,2%) of female gender (56.3%); mean age was 55.77 (SD ± 21.27) (Table I). Emergencies were 22.5%; one fifth of patients were not informed of having been referred to our service and half of interventions were requested by departments of internal medicine. The primary reasons for the referral were depression (18.6%), unexplained physical symptoms (12.3%) and anxiety (10.4%); most patients were already taking psychotropic medication before our intervention (58.8%). The most frequent ICD-10 (International Classification of Disease) diagnoses were the neurotic, stress-related and somatoform syndromes (29.0%), affective syndromes (23.4%), mental syndromes related to an organic illness (11.0%), but 15.4% of the patients did not have any psychiatric diagnosis; the most common liaison interventions were aimed at the staff of department (46.6%); drug treatment was suggest in 58.9% of cases. At discharge, 22.9% of patients were referred to community psychiatric services, 19.5% to our service and 11.9% to their own general practitioner. The significant associations are the following: associations between gender and social status (p < 0.01), social condition (p < 0.01), work (p < 0.01) and advice about the need of the consultation (p < 0.05) (Table II). The area (medical, surgical and specialized area) are related with the advice (p < 0.05), the reason (p < 0.01) and the type of the consultation (p < 0.01), the diagnostic explanations (p < 0.01), the liaison investigations (p < 0.01) and, at last, with the long-range plan after discharge (p < 0.01) (Table III). The main ICD-10 psychiatric diagnoses (Schizophrenia, Affective Syndrome and Neurotic-Stress-Somatoform Syndrome) are associated with social status (p < 0.01), social condition (p < 0.01), work (p < 0.01), hospitalization length (p < 0.01), consultation type (p < 0.01), advice (p < 0.01), reason of the consultation (p < 0.01), liaison investigations (p < 0.05) and long-range plan after discharge (p < 0.05) (Table IV). Discussion: The results agree with ISTAT (National Statistics Institute) data and with the international literature. The need for better physical and psychological investigation is confirmed. Clinicians must pay attention to bio-psycho-social status of hospitalized patients for promoting their wellbeing and not only illness remission.