Robert E. Hales

Compliance with psychiatric referrals from a general hospital psychiatry outpatient clinic

This study examines the referral patterns of 949 patients seen in a general hospital psychiatry outpatient clinic during a 15-month period. One hundred patients referred to outpatient psychotherapists were interviewed by telephone to determine compliance rates with referral recommendations. Forty-five percent reported compliance with the referral, defined as attendance at one or more psychiatric follow-up visits. Factors associated with higher compliance rates were being married, being referred at the initiation of the therapist and not the patient, and, for a subgroup of patients, receiving a list of potential psychotherapists. Neither diagnosis nor severity of illness predicted compliance, and self-referral was not associated with improved compliance. There was also no relationship found between satisfaction with the referral procedure and subsequent compliance with the referral. In 49% of the noncompliant cases, reasons cited were a self-perceived lack of need for continuing treatment due to symptom resolution and insufficient motivation.

Psychiatric consultations in a military general hospital: A report on 1065 cases

The authors describe the demographic and diagnostic characteristics of 1065 medical and surgical inpatients referred for psychiatric consultation over a 1-year period at a military medical center. The referral rate was 5.8% of all hospital admissions with the percentage of referrals from surgical and neurology services being higher than recent civilian studies. Although the variety and frequency of psychiatric and physical disorders are quite similar to civilian consultation-liaison (C/L) psychiatric services, the authors reported lower rates of personality disorder diagnoses and higher percentages of V code and no-psychiatric-disorder diagnoses.

The benefits of a psychiatric consultation-liaison service in a general hospital

In this period of increased governmental regulation and decreased reimbursement for psychiatric services by third-party carriers, a fully staffed and financially stable psychiatric consultation-liaison service in the general hospital may still generate significant benefits for patients, hospital administrators, and psychiatrists: an increased rate of diagnosis of psychiatric and medical disorders, a reduction in the length of stay of medical or surgical patients, a decreased utilization of medical services and the development of innovative consultation-liaison activities. This article summarizes these benefits and outlines training obstacles that must be overcome to increase cooperation between psychiatry and medicine so that these benefits may be realized.

An evaluation of patients who received an organic mental disorder diagnosis on a Psychiatric Consultation-Liaison Service

The authors conducted comprehensive medical record reviews of 100 medical and surgical patients who received an organic mental disorder diagnosis by the Psychiatry Consultation-Liaison (C/L) Service of a large teaching hospital. The cases were randomly selected from among 182 patients with an organic mental disorder diagnosis, who, in turn, were drawn from 1085 consecutive psychiatric consultations conducted during a 1-year period. Dementia (34%) and delirium (32%) constituted the most common diagnoses. Approximately 78% of the patients were noted to have laboratory abnormalities (2.7 per patient), three quarters of which were routine tests. The mean age of patients without laboratory abnormalities (47.6 years) was 15 years younger than those with abnormal findings (62.6 years). The patients averaged 5.7 medications, with delirious patients averaging 7 medications and those with dementia, 4.5, a statistically significant difference. Patients with no laboratory abnormalities were receiving less medication (2.6) than those with abnormalities (6.5).

Teaching psychosocial issues to medical house staff: A liaison program on an oncology service ☆

In a one-year controlled study, the authors assessed the impact of an active consultation-liaison teaching program on the attitudes of medical house officers toward psychosocial issues related to the care of oncology patients, consultation-liaison psychiatry, and its importance for them and their patients. Fifty medical interns, residents, and fellows, divided into a test group (N = 25) and a control group (N = 25), were followed during a one year period. A 52-item questionnaire was administered to test group subjects before and after a one- to two-month clinical rotation on the hematology/oncology service, and to the control group members at similar intervals. After their experience with consultation-liaison psychiatry, the test group members showed a significant positive change in the importance they placed upon psychiatric consultations, case presentations and the role of psychiatrists in the development of their attitudes toward the psychological care of cancer patients. The house officers also recorded significant positive changes in their attitudes toward the effectiveness and role of the consultation-liaison service in educating and assisting them in learning more about psychosocial issues. The control group demonstrated no significant change.

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends there specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, through their contact with primary care-oriented psychiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.

Inpatient participation in treatment planning: A preliminary report

This study investigated the effect of patient participation in treatment planning conferences (TPCs) upon length of hospitalization and upon the frequency of military soldiers being returned to duty. Patients with major affective disorders and schizophrenic disorders showed an 8.2% decrease in hospital stay whereas patients with minor affective disorders, personality disorders, substance abuse, and adjustment disorders showed a 98.8% increase. Additionally, the percentage of active duty soldiers with a major depressive episode who were returned to duty increased significantly when they participated in their TPC.

Training Issues in Combat Psychiatry

Training Directors of Army Residency Programs must ensure that their graduates are not only clinically competent, but also knowledgeable about the aspects of their specialty unique to the practice of military medicine. Psychiatrists, in particular, must be prepared for the unique demands of both the peacetime field environment and the combat environment.