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Liaison psychiatrist in a specialist diabetes centre

  • Madhusudan Dalvi (a1), Michael Feher (a2), Esra Caglar (a3) and Jose Catalan (a4)
Abstract
Aims and Method

To identify psychiatric conditions that may require psychiatric treatment in individuals referred from a diabetes centre to a liaison psychiatry diabetes clinic and to examine the referral pattern and reasons for referral. the study was a prospective case-note survey over a 12-month period.

Results

The most common reason for referral was low mood (37.5%) and the most common psychiatric diagnosis was adjustment disorder (28.6%). Most individuals were referred by diabetes specialist nurses (53.1%). the majority (85.7%) were seen by a clinical psychologist after an initial assessment by a psychiatrist.

Clinical Implications

Common mental disorders occur frequently in individuals referred to a liaison diabetes clinic, hence the importance of early diagnosis. the involvement of psychiatrists in specialist diabetes clinics is very limited and better involvement is desirable.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Anderson, R. J., Clouse, R. E., Freedland, K. E., et al (2001) The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care, 24, 10691078.
Department of Health (2001) National Service Framework for Diabetes. Department of Health.
Mitchel, C., Catalan, J., McIntosh, C., et al (2000) Joint liaison psychiatry–diabetes clinic: a new specialist service. Diabetes Medicine, 17, 481483.
Rubin, R., Peyrot, M. & Saudek, C. D. (1989) Effect of diabetes education on self-care, metabolic control and emotional well-being. Diabetes Care, 12, 673679.
Saudek, C. D., Rubin, R. R. & Shump, C. S. (1997) The Johns Hopkins Guide to Diabetes. The Johns Hopkins University Press.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Liaison psychiatrist in a specialist diabetes centre

  • Madhusudan Dalvi (a1), Michael Feher (a2), Esra Caglar (a3) and Jose Catalan (a4)
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eLetters

Diabetes and Liaison Psychiatry: what about transition?

Peter Trigwell, Consultant in Liaison Psychiatry
11 January 2009

We read with interest the paper “Liaison psychiatrist in a specialistdiabetes centre” (Dalvi et al 2008). As stated in the paper, there are very few diabetes centres in the UK with a psychiatrist as part of the team. Our service in Leeds is one of those few and has been in existence since 1998. Prompted by the Dalvi twelve month case note review, describing a service in London (Chelsea and Westminster), we looked retrospectively into our service records for the calendar year of 2008 in order to make comparisons with that service.

There were several similarities between the two services, including the number of patients referred, gender split of those patients, rates of non-attendance and range of interventions offered. The differences included referral source (usually consultant diabetologists in Leeds but diabetes nurse specialists in London), presenting complaints (broadly difficulties coping being the largest group in Leeds but low mood in the London service) and who provides the various interventions (liaison psychiatrists in Leeds but, apart from initial assessment, the majority inLondon are seen by a clinical psychologist). The most striking difference, however, is with regard to the type of diabetes suffered by those referred and their age. In the Leeds service 84% of referrals are people with Type I diabetes, across a total patient age range of 18 - 74 years, which contrasts with the London service in which 44% of referrals have Type I diabetes and the age range is much more limited, being 31 - 71years of age. Within this, the Leeds figure for people referred from the diabetes service to liaison psychiatry who are less than 30 years of age is 64%, compared with London’s figure of zero. The fact that none of the patients seen in London are in their teens or twenties is surprising to us. This is particularly the case given the increasing focus nationally upon the relatively high prevalence of psychological and psychosocial difficulties experienced by people with diabetes in the stage of “transition” (i.e. moving from childhood to adulthood with diabetes). National and regional working groups are focusing upon the age range 16 - 25 years of age in calling for the provision of specific physical and mental health services, to come in line with existing requirements within the Diabetes NICE Guidance and National Service Framework (NICE 2004, DoH 2001 and 2007). Dalvi et al do not mention any separate service for the psychological needs of younger people with diabetes in their centre, whichsuggests that they are not being identified as requiring specialist psychological help, or not referred on for that help. If this is the case, and given the increasing recognition of the particular needs of thisgroup, we would wish to raise the issue of this apparent gap in service provision.

Dalvi et al. (2008). Liaison psychiatrist in a specialist diabetescentre. Psychiatric Bulletin. 32, 461-463.

National Institute for Health and Clinical Excellence (2004). Type 1 diabetes in children, young people and adults. NICE Guideline CG15.

Department of Health (2001). National Service Framework for Diabetes:standards. Health Service Circular (HSC 2001/026).

Department of Health (2007). Making every young person with diabetes matter: report of the children and young people with diabetes working group.

Dr Ashish RanaST3 in Liaison Psychiatry

Dr Peter Trigwell *Consultant in Liaison Psychiatry

Department of Liaison PsychiatryLeeds General InfirmaryGreat George StreetLeeds LS1 3EX

* Corresponding Author peter.trigwell@leedsth.nhs.uk0113 3925246

Declaration of interest: None for either author
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Conflict of interest: None Declared

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