Liaison Psychiatry - a New Clinical Subspecialty?

Article excerpt

Abstract

The term "liaison psychiatry" expresses, on the one hand, the act of consultation, the psychiatric intervention intended for the patient and, on the other hand, it emphasizes the assistance given to the physicians and the therapeutic team treating the patients. Liaison psychiatry aims to become a new subspecialty of psychiatry whose purpose is to study and manage mental disorders in patients treated by other medical disciplines. The activities of liaison psychiatry involve: initial focus on the consultation of the admitted patient, extensive services with multidisciplinary personnel, offers for various hospital activities (e.g. emergency care) and specialties (e.g. obstetrics and oncology), services for specific medical problems requiring collaborative planning, training and the supervision of the medical team, liaison and consultation by the liaison team, an increased interest in the treatment of functional symptoms, activities for discharged patients, connections with primary care, training and supervision for clinical medical and surgical teams. Recent reviews of the literature suggest that liaison psychiatry will require determination and political abilities if it is to assume the role it plays in multidisciplinary medical care approaches.

Key words: liaison psychiatry, activity, efficacy, perspectives

The term of American origin "liaison psychiatry" expresses, on the one hand, the act of consultation, the psychiatric intervention intended for the patient and, on the other hand, it emphasizes the assistance given to the physicians and the therapeutic team treating the patients.

The history of liaison psychiatry is rather recent. Its roots have obviously been influenced by the development of psychiatry, psychosomatics, clinical psychology, and by the presence of psychiatric units in general hospitals.

As a result of the outcomes attained by units affiliated to liaison psychiatry and particularly due to Lipowski's efforts, starting with 1974, the importance of liaison psychiatry in the training of psychiatrists and physicians of other specialties has been widely recognized in the USA and Canada (Lipowski & Wise, 2002).

Beginning with the 1960s-1970s, liaison psychiatry acquired credit in Europe, particularly in France, Switzerland, United Kingdom, Spain, Germany, Netherlands and Italy, which then extended to Australia, South America and New Zealand. Starting with the 1990s, the term liaison psychiatry has become widely used in the literature (Mayou, 2007).

However, confusion persists regarding the objectives and the area of liaison psychiatry. Moreover, the term is considered ill-chosen by many psychiatrists, it has generated numerous discussions and conceptual polemics, and there are a number of different labels used in various countries. Thus, in some countries the term of psychosomatic medicine is preferred, in others psychological medicine, general psychiatry or behavioral medicine, all of which essentially reflect the areas covered by liaison psychiatry. The various terms reflect attempts of describing the objectives, the clinical problem, the specific population or the way in which the service is offered. The unsolved problem of terminology reflects the unsolved problem of the mind-body relationship, of the somatic-psychiatric symptoms relationship. In most, if not all, developed countries, there is a "segregation" of general health services and mental health services.

In this context, the legitimate question arises regarding the extent to which psychosomatic medicine and liaison psychiatry overlap. Psychosomatic medicine has focused particularly on theoretical approaches of the mind-body relationship, highlighting the role of psychosocial factors in the onset of somatic diseases and of psychiatric interventions in their treatment. In its current meaning, the term "psychosomatics" designates somatic symptoms usually attributed to mental disorders of affective origin or of conflicting nature. …