Liaison psychiatry

Liaison psychiatry refers to the branch of psychiatry involving assessment and treatment in the general hospital of referred patients, for example in casualty or following deliberate self harm.

Psychiatric disorders, including anxiety, depression, and/or organic brain syndromes, are present in up to 50 per cent of any population of medical or surgical patients. Some disorders are mild and transient, but 10-20 per cent of patients are severely affected. The majority of patients identified by research surveys are not receiving psychiatric treatment, and apparently have not been recognized by medical or nursing staff.

This psychiatric 'co-morbidity' adds to patients' suffering, and, because it tends to be associated with poor response to medical treatments and extended hospital stays, it adds to health-care costs.

The association between psychiatric and physical conditions may be explained in several ways:

• Pre-existing psychiatric illness or personality disorder may have played a role in causing the physical disorder, or hindering recovery and response to treatment (see below).

• The stress of the physical illness (see below) may precipitate psychiatric disorder.

• An organic brain syndrome (see Chapter 10) has developed secondary to the physical illness or its treatment.

• There is somatic presentation of a primary psychiatric condition (see Chapter 9).

• Medically unexplained symptoms, rather than objective medical or surgical pathology, dominate the clinical picture.

The links between medical and psychiatric illness are reflected in the raised suicide rate of some, but not all, medical conditions: high-risk disorders include HIV/AIDS; cancer, especially of the head and neck; Huntington's disease; multiple sclerosis; peptic ulcer; renal failure; spinal cord injury; and systemic lupus erythematosus (SLE). Primarily neurological conditions such as epilepsy are even more likely to be associated with psychiatric problems.

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