La psichiatria di consultazione e collegamento nell'ospedale generale: l'esperienza perugina
Consultation-Liaison Psychiatry in the General Hospital: an experience in Perugia
M. Piselli, G. De Giorgio, C. Santilli, T. Sciarma, L. Scarponi, A. Rella, T. Blasi, T. La Ferla, S. Ferrari*, R. Quartesan
Sezione di Psichiatria, Psicologia Clinica e Riabilitazione Psichiatrica, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Area Funzionale Omogenea di Psichiatria, Università di Perugia, AUSL 3 dell'Umbria; * Dipartimento di Salute Mentale, Università di Modena e Reggio Emilia
Summary
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 longrange 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.