Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-18T12:42:21.573Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychiatric Referrals within the General Hospital: Comparison with Referrals to General Practitioners

Published online by Cambridge University Press:  02 January 2018

Francis Creed ,
Elspeth Guthrie ,
Dawn Black  and
Mark Tranmer
Francis Creed*
Affiliation:
Department of Psychiatry, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL
Elspeth Guthrie
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary
Dawn Black
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary, now Consultant Psychiatrist, Hope Hospital, Salford
Mark Tranmer
Affiliation:
Department of Psychiatry, Manchester Royal Infirmary
*
∗Correspondence
Get access Rights & Permissions [Opens in a new window]

Abstract

The increase in referrals to a new consultant psychiatrist within a teaching hospital was documented. During 1987/88 there were 279 consecutive referrals from physicians and surgeons (159 out-patients and 120 ward-consultation requests) which were compared with 184 consecutive GP referrals over the same period. Hospital referrals tended to be older, and less socially disadvantaged, but with psychiatric disorder of similar severity to GP referrals. They were more likely to have a concurrent physical diagnosis, and demonstrate somatisation. The latter was not confined to patients without physical disorder; half of the patients classified as ‘psychological reaction to physical disorder’ showed somatisation. ICD–10 appeared to perform better than ICD–9 or DSM–III for somatoform disorders, but a comprehensive classification system is still needed for liaison psychiatry. Personal discussion with the referring doctor was most common among the ward-consultation requests; in this situation the referring doctor usually continued primary management of the patient.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 162 , Issue 2 , February 1993 , pp. 204 - 211
Copyright
Copyright © Royal College of Psychiatrists, 1993 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
Anderson, H. M. (1989) Liaison psychiatry in Scotland: the present service. Psychiatric Bulletin, 13, 606–608.Google Scholar
Appleby, L., Fox, H., Shaw, M., et al (1989) The psychiatrist in the obstetric unit establishing a liaison service. British Journal of Psychiatry, 154, 510–515.Google Scholar
Bass, C. & Benjamin, S. (1993) The management of chronic somatisation. British Journal of Psychiatry (in press).CrossRefGoogle Scholar
Bass, C. & Benjamin, S. & Murphy, M. (1990) The chronic somatizer and the Government White Paper. Journal of the Royal Society of Medicine, 83, 203–205.CrossRefGoogle ScholarPubMed
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.Google Scholar
Brooks, P. & Walton, H. J. (1981) Liaison psychiatry in Scotland. Health Bulletin, 39, 218–227.Google ScholarPubMed
Brown, A. & Cooper, A. F. (1987) The impact of liaison psychiatry service on patterns of referral in a general hospital. British Journal of Psychiatry, 150, 83–87.CrossRefGoogle ScholarPubMed
Brown, T. M. & Waterhouse, J. (1987) A psychiatric liaison service in a general hospital - eighteen years on. Health Bulletin, 45, 190–196.Google Scholar
Creed, F. & Guthrie, E. (1993) Interview techniques for the somatising patient. British Journal of Psychiatry (in press).Google Scholar
Crisp, A. H. (1968) The role of the psychiatrist in the general hospital. Postgraduate Medical Journal, 44, 267–276.Google Scholar
Fauman, M. A. (1983) Psychiatric components of medical and surgical practice, II: Referral and treatment of psychiatric disorders. American Journal of Psychiatry, 140, 760–763.Google Scholar
Gath, D. & Mayou, R. (1983) Consultation-liaison psychiatry in the United Kingdom. Advanced Psychosomatic Medicine, 11, 109–126.Google Scholar
Guthrie, E., Creed, F. H., Dawson, D., et al (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 100, 450–457.Google Scholar
Holmes, K. M., Salter, R. H., Cole, T. P., et al (1987) A profile of District Hospital gastroenterology. Journal of the Royal College of Physicians of London, 21, 111–114.Google Scholar
Hopkins, A., Menken, M. & DeFriese, G. (1989) A record of patient encounters in neurological practice in the United Kingdom. Journal of Neurology; Neurosurgery and Psychiatry, 52, 436–438.CrossRefGoogle ScholarPubMed
House, A. O. & Jones, S. J. (1987) The effects of establishing a psychiatric consultation-liaison service: changes in patterns of referral and care. Health Trends, 19, 10–12.Google Scholar
Katon, W., Ries, R. & Kleinman, A. (1984) A prospective DSM-III study of consecutive somatisation patients. Comprehensive Psychiatry, 25, 305–314.Google Scholar
Kingdon, D. (1989) Mental health services: results of a survey of English district plans. Psychiatric Bulletin, 13, 77–78.Google Scholar
Leonard, I., Babbs, C. & Creed, F. (1990) Psychiatric referrals within the hospital-the communication process. Journal of the Royal Society of Medicine, 83, 241–244.Google Scholar
Lloyd, G. G. (1980) Whence and whither “liaison” psychiatry? Psychological Medicine, 10, 11–14.Google Scholar
Maguire, P. & Sellwood, R. (1982) A liaison psychiatry service for mastectomy patients. In Medicine and Psychiatry: A Practical Approach (eds Creed, F. H. & Pfeffer, J. M.), pp. 377–395. London: Pitman.Google Scholar
Mason, A. S. (1975) Critical review of the psychiatric services: a physician's view. Medicine (second series), 11, 510–512.Google Scholar
Mayou, R. A. (1989) Consultation liaison psychiatry: an international perspective. Psychiatry Clinical Update. Crawley: Upjohn.Google Scholar
Mayou, R. A. & Lloyd, G. (1985) A survey of liaison psychiatry in the United Kingdom and Eire. Bulletin of Royal College of Psychiatrists, 9, 214–217.Google Scholar
Mayou, R. A. & Lloyd, G., Anderson, H., Feinmann, C., et al (1990) The present state of consultation and liaison psychiatry. Psychiatric Bulletin, 14, 321–325.Google Scholar
Mayou, R. A. & Lloyd, G., Anderson, H., Feinmann, C., & Smith, E. B. O. (1986) Hospital doctor's management of psychological problems. British Journal of Psychiatry, 148, 194–197.Google Scholar
Mezey, A. G. & Kellet, J. M. (1971) Reasons against referral to the psychiatrist. Postgraduate Medical Journal, 47, 315–319.Google Scholar
Pfeffer, J. M. (1982) The consultation process. In Medicine and Psychiatry: A Practical Approach (eds Creed, F. H. & Pfeffer, J. M.), pp. 70–85. London: Pitman.Google Scholar
Pilowsky, I. & Barrow, C. G. (1990) A controlled study of psychotherapy and amitriptyline used individually and in combination in the treatment of chronic intractable, ‘psychogenic’ pain. Pain, 40, 3–19.Google Scholar
Ramirez, A. J. (1989) Liaison psychiatry in a breast cancer unit. Journal of the Royal Society of Medicine, 82, 15–17.Google Scholar
Rodin, G. & Voshart, K. (1986) Depression in the medically ill: an overview. American Journal of Psychiatry, 143, 696–705.Google Scholar
Royal College of Psychiatrists (1988) Guidelines for training in liaison psychiatry. Bulletin of the Royal College of Psychiatrists, 12, 389–390.Google Scholar
Russell, G. F. M. (1973) Will there be enough psychiatrists to run the psychiatric service based on the district general hospital? In Policy for Action (eds Cawley, R. & McLachlan, G.), pp. 111–116. London: Oxford University Press.Google Scholar
Sartorius, N. (1987) Mental health policies and programs for the twenty-first century: a personal view. Integrative Psychiatry, 5, 151–158.Google Scholar
Seltzer, A. (1989) Prevalence, detection and referral of psychiatric morbidity in general medical patients. Journal of the Royal Society of Medicine, 82, 410–412.CrossRefGoogle ScholarPubMed
Sensky, T., Greer, S., Cundy, T., et al (1985) Referrals to psychiatrists in a general hospital - comparison of two methods of liaison psychiatry: preliminary communication. Journal of the Royal Society of Medicine, 78, 463–468.Google Scholar
Smith, G. R., Monson, R. A. & Roy, D. C. (1986) Psychiatric consultation in somatizaton disorder. A randomized controlled study. New England Journal of Medicine, 314, 1407–1413.Google Scholar
Thomas, C. J. (1983) Referrals to a British liaison psychiatry service. Health Trends, 15, 61–64.Google Scholar
Torem, M., Saravay, S. M. & Steinberg, H. (1979) Psychiatric liaison: benefits of an ‘active’ approach. Psychosomatics, 20, 598–611.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.Google Scholar
World Health Organization (1992) International Classification of Diseases (10th edn) (ICD-10). Geneva: WHO.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.