Laille Gabinet

Effect of liaison psychiatry on attitudes toward psychiatry, rate of consultation, and psychosocial documentation

Prior literature suggested that psychiatric liaison on medical wards would produce a more positive attitude towards psychiatry, more psychosocial chart documentation, and a higher consultation request rate. Over 3 years, liaison was conducted on two medical wards, and its effect was contrasted with two control (consultation only) medical wards. Liaison activities were more favorably received by consultees than consultation alone and increased the consultation request rate, but produced no change in psychosocial documentation. Additional effectiveness of liaison activities might be achieved through direct, focused interventions, and through active involvement of senior medical faculty.

The Identification of Psychiatric Morbidity by Internists and Subsequent Selection for Psychiatric Referral

Past literature raises the question as to the degree of identification of psychiatric morbidity among medical inpatients. A psychosocial information scale was used to rate charts of seventeen inpatients who later received a psychiatric consultation and seventeen who did not during the index admission. More psychosocial items were generally present in the charts with those patients receiving later psychiatric consultation overall and specifically in the areas of psychiatric chief complaint, history of behavior change and past psychiatric history. It was concluded that many patients with psychiatric morbidity on medical wards were not so identified and this was a prime reason for their non-referral, although several of the sub-groups of such patients could benefit from psychiatric treatment. Non-psychiatrists were urged to adopt a more holistic approach to medicine with emphasis on continuity of care to insure comprehensive diagnosis and management.

The impact of ward dynamics on psychiatric consultation and liaison

Abstract This article has examined the particular characteristics of several medical and surgical services as they affect interaction with psychiatric services. Two central themes have emerged. The first is that physicians in various specialties have different types of commitments to their patients. All are committed to the healing process and request psychiatric consultation when the patients mental status endangers the healing process. When the danger is less serious, the overall responsibility the doctor feels for his patient, which depends to a large extent on the length and intensity of the doctor-patient relationship, influences the level of his interest in the patients psychosocial status. Responsibility for management of psychiatric problems often falls on nonphysician staff members. The second theme is that each service has an individual combination of staff personalities, distribution of responsibility amount disciplines, and adminstrative structure. These influence the nature of the C-L work that can be done. A particular liaison intervention cannot be effective in all ward climates and will continue to be disappointing to the C-L staff which provides it. Liaison activities must be designed for the milieu of the specific ward. Teaching should be directed toward the individuals who need and appreciate it most, be they nurses on one ward, social workers on another or physicians on the third.

Shared parenting: a new paradigm for the treatment of child abuse

The thesis of this article is that child abuse can be most effectively prevented by recasting it as a part of a larger problem of inadequately parented families. Services for these families may be offered for voluntary participation. They need not be thought of as treatments since they would be designed to prevent rather than treat injuries. The goal of the services would be to improve the childrearing experiences of children in two ways: by helping their parents to function more effectively and providing whatever elements of parental functioning (nurture, education, discipline, or protection) which the natural parents could not give. The proposed facilities would provide supplemental parenting and other services for children as necessary. Facilities would include outreach into the homes, family drop-in centers, family half-way houses for parents who can take care of their children only with onsite supervision, and residential facilities and foster homes at which natural parents would be encouraged to visit and participate. The majority of child abuses occur when there is stress on parents who are inadequate because they themselves have received deficient parenting. The proposed services would relieve stress on parents. This sharing of parental responsibilities between the natural parents and the sharing parents encountered in the proposed facilities would provide children with more adequate parenting than they could receive from their natural parents alone. This would give them a chance to grow into adequate, nonabusive parents and thus interrupt the generational cycle of abuse.(ABSTRACT TRUNCATED AT 250 WORDS)