Liaison Psychiatry and Indian Research

Article excerpt

Byline: S. Parkar, N. Sawant

Liaison in Psychiatry refers to the branch of Psychiatry involving assessment and treatment in the general hospital of referred patients, like in the casualty, or patients of deliberate self farm. The Indian scene also reveals major reference from medicine, surgery, surgical super specialty and orthopedics with psychiatric disorders like anxiety, depression and / or organic brain syndromes seen in about 40 to 50 % of the medical or surgical patients. Though the Indian published data is limited, most tertiary hospitals in India carry out liaison work with various departments like Neurology, Organ transplant, Intensive Care Units and Cosmetic Surgery, so as to give comprehensive health services to patients. Liaison in Psychiatry has thus brought the emphasis on the teaching of psycho-social aspects of medicine and also increased research possibilities.

Introduction

Mental health consultation is the need of the hour and has been emphasized on since time immemorial. [sup][1] In the beginning, medical professionals reacted unfavorably to the admission of psychiatric patients in general hospitals. However with recognition of organicity and superimposed psychological reaction to medical illness in medical and surgical departments, psychiatry was appreciated and eventually integrated. [sup][2] The rapid growth of general hospital psychiatric units all over the world has provided impetus to consultation-liaison work carried out by the psychiatrists. Consultation liaison psychiatry (CLP) was generally limited to the diagnostic, research and therapeutic activity in the non psychiatric departments of the general hospital. It is synonymous to liaison psychiatry (psychiatric dictionary, Oxford 1970). The mainstay CLP reports are to recommend the referrer basic logical clinical findings, appropriate treatment and follow-up programs. In addition, other objectives are educational, ethical and medico-legal. Though general hospital psychiatry was considered to come to light as a result of the lack of sufficient funds to initiate new lunatic asylums, today it is acknowledged as a major part of the public health system that takes care of mental health problems of a large population. Today, Liaison Psychiatry has acquired the status of a subspecialty within psychiatry and this has helped shift psychiatry from mental hospitals to a general hospital setting. This has also increased referrals from the non-psychiatric departments and given the psychiatrist an opportunity to directly deal with the physically ill. [sup][3] In general, there is no specific philosophy or particular clinical context being identified in Liaison Psychiatry, at present, in India.

Referral types

Several researchers have found a lower referral rate in the Indian counterparts as compared to the western figures. Jindal et al.(1980) found a poor referral rate in their study as compared to other studies conducted in India. [sup][4] The in-patient referral rate in their study was 0.15%, as compared to 1.4%. in the study by Prabhakaran (1968) and 0.66% in the study by Parekh et al. (1968). [sup][4],[5],[6] Chatterjee and Kutty (1977) reported a referral rate of 2.64% among the out-patients as compared to 0.06% by Jindal et al. [sup][7],[4] Most studies quote about 60% of referrals from general medicine and 14% from surgery and surgical super-specialties. [sup][4],[5],[6]

There is also a paucity of data concerning psychiatric emergency referral in the Indian setting. Most of the available studies pertain to the routine inpatient referral. Though psychiatric services are available in almost all teaching general hospitals in India, little is known as to why the psychiatrist is called in emergency situations and what is the magnitude of the problem. Kelkar et al. (1982) found suicidal attempt (13%), excitement and violence (10%) and altered sensorium (9%) which constituted 32% of the total emergency referrals. …