CONSULTATION-LIAISON PSYCHIATRY AT AN ACADEMIC
MEDICAL CENTRE COMPARED WITH A LITERATURE REVIEW
Susmita Hazarika*,Subhashish Nath**,Atmesh
Kumar***,Pranjal Sharma****, Debjit Roy*****,Shyamanta Das******,Kamal
Department of Psychiatry, Silchar Medical College and Hospital
******,*******Assistant Professor, Department of Psychiatry, Silchar Medical
College and Hospital
Background Consultation-liaison psychiatry
is an important component of a multidisciplinary hospital yet often being
overlooked and underused in our set up. There is also a dearth of study in the
region.AimThe study of clinical and sociodemographic variables of
psychiatric consultations among patients attended outdoor patients department
(OPD) as well as admitted in indoor departments of various other specialties.
Settings and Design Cross sectional study design in the setting of a
tertiary care teaching hospital. Methods and Material Sample consisted
of indoor as well as outdoor patients referred from various departments and
attending psychiatry OPD and ‘out-of-hours’ for consultation, over a period of
four months. Psychiatric diagnoses were carried out according to ICD-10.
Sociodemographic data were collected using a standard proforma prepared for the
study. Statistical analysis used Descriptive statistical analysis. Results
out of 218 referrals, 75.6% had only psychiatric diagnoses and 15.6% had
psychiatric disorders with co morbidities. 68.8% patients were referred from
department of medicine. 25.11% patients were referred just for psychiatric
opinion, whereas 21.5% with conversion reaction, 18.3% with abnormal behavior.
30.9% patients were diagnosed as having dissociative [conversion] disorders,
18.18% mood [affective] disorders, 12.7% substance related disorders. Mean age
of the patients was 31.97 years, 51.9% were males, and 82.5% belonged to rural
locality, Hindus constituted 51.9% and Muslims 48.1%. Conclusions
Considering the high prevalence of psychiatric disorders and their negative
effects on physical condition, turning the faces of other medical professionals
towards detecting psychiatric co-morbidities can result in the promotion of patients'
health and quality of life.
Key words Consultation-liaison psychiatry, Clinical
variables, Sociodemographic variables.
Historically, psychosomatic medicine was
known as consultation-liaison psychiatry (CLP), and it represented the care
delivered by psychiatrists to patients with co-occurring medical and
psychiatric problems who were treated primarily in medical settings. The term
psychosomatic is derived from the Greek words psyche (soul) and soma (body).
The term literally refers to how the mind affects the body.1
In India, the interplay of mind and body
is known since antiquity.2 An ancient Indian medical text, Sushruta
Samhita3 describes a type of insanity borne out of grief, Shokaja,
which ‘…… occurs in a person who is frightened by a thief, a king’s officer, or
his own enemy; or due to the loss of wealth; or bereavement; or disappointment
in love …’ Another text4 describes four types of insanity which
manifest when mind is afflicted ‘… by passion, anger, greed, excitement, fear, attachment,
exertion, anxiety or grief’ and also caused by ‘fierceful battles, destruction
of countries, communities and towns …’
The department of psychiatry in a general
hospital setting has a multidimensional role, providing inpatient care,
maintaining strong interaction with community psychiatric services and offering
specialist services to the general hospital wards either as part of the
multidisciplinary approach to patient management or by offering specialist
inpatient care to patients already hospitalized in other departments by
transferring certain patients to the psychiatry department.5,6
The CLP service is the link between any
general hospital ward and the department of psychiatry.7
The consultation-liaison psychiatrist is called upon to evaluate and
treat a wide variety of psychiatric disorders in patients with general medical
disorders.8 CLP bridges nonpsychiatric and psychiatric wards in
general hospitals.9 At least 30-60 % of inpatients in general
hospitals seem to be involved in one or more psychiatric disorders
simultaneously.8 This co-morbidity worsens the course and prognosis
of medical illnesses10 and also makes hospitalisation period longer.11
Since mid-20th century, research in
psychosomatic medicine and consultation-liaison has taken two interconnected
paths. Psychosomatic medicine research has generally focused on understanding
psycho physiologic mechanisms underlying mind-body relationships.
Consultation-liaison research, on the other hand, has largely been directed at
understanding psychiatric problems among clinical population with medical
This study aims to find out:
1. The clinical variables of the patients
being referred for psychiatric consultation from other specialties i.e. Source
of referral, reason for referral, other medical and/or surgical illness,
2. The sociodemographic variables of the
patients referred for psychiatric consultation from other specialties e.g. Age,
gender, religion, locality.
Methods and materials
The study prospectively included a series
of 218 patients consecutively referred between February and May 2010 to the
psychiatric consultation-liaison service of a tertiary care teaching hospital.
The consecutive consultations were performed by a team including a consultant psychiatrist
and psychiatric residents and diagnosis was according to the International
Statistical Classification of Diseases and Related Health Problems, Tenth
Revision (ICD-10): Clinical descriptions and diagnostic guidelines for mental
and behavioral disorders.12
In a descriptive analytic cross-sectional
study, all the consultations requested were evaluated with regard to referring
department, reason for referral as given by the physician making the referral,
other medical and/or surgical illness, psychiatric diagnosis according to
ICD-10 based on the consultation interview and sociodemographic characteristics
(age, gender, religion and locality).
Out of a total sample size of 218, 165
(75.6%) patients had only psychiatric diagnoses, 34 (15.6%) patients had
psychiatric disorders with other comorbidities, and 17 (7.8%) patients had only
medical/surgical illness; in
2 (0.91%) patients, the psychiatric diagnoses were deferred (figure 1).
Figure 1 Disorders.
Referring departments One hundred and
fifty (68.8%) patients were referred from medicine followed by 15 (6.8%) from
surgery, 15 (6.8%) from otorhinolaryngology, 11 (5.1%) from obstetrics and
gynecology, 11 (5.1%) from orthopedics, 9 (4.1%) from dermatology, 3 (1.3%) from
cardiology, 3 (1.3%) from pediatrics, and 1 (0.4%) from tuberculosis and chest
department (figure 2).
Figure 2 Referring departments.
Reason for referral (as given by the
physician making the referral) Fifty six (25.11%) patients were referred for
psychiatric opinion, 48 (21.5%) for conversion reaction, 41 (18.3%) for
abnormal behaviour, 20 (8.9%) for somatic complains, 14 (6.2%) for substance
use, 10 (4.48%) for suicidal behaviour, 4 (1.79%) for confessional state, 4
(1.79%) for depressed mood; there were no diagnosis in 8 (3.58%) and others
included 18 (8.07%) (figure 3).
Psychiatric diagnosis (according to
ICD-10) Fifty one (30.9%) patients were diagnosed with dissociative
[conversion] disorders, 30 (18.18%) with mood [affective] disorders, 21 (12.7%)
with substance related disorders, 13 (7.8%) with anxiety disorders, 10 (6.06%)
with intentional self harm, 9 (5.45%) with organic mental disorders, 9 (5.45%)
with schizophrenia, schizotypal and delusional disorders, 7 (4.24%) with acute
stress reaction, 6 (3.63%) with somatoform disorders, 4 (2.42%) with sexual
dysfunction, 2 (1.21%) with sleep disorders, and others constituted 3 (1.81%)
patients (figure 4).
Figure 4 Psychiatric diagnoses.
Mean age of the patients was 31.97 years
with 46 (21.1%) in the age group of 11 to 20 years, 70 (32.1%) in 21 to 30
years, 53 (24.3%) in 31 to 40 years, 26 (11.9%) in 41 to 50 years, 19 (8.7%) in
51 to 60 years, and 4 (1.8%) in 61 to 70 years. One hundred and thirteen
(51.9%) were males and 105 (48.1%) were females. Hindus constituted 113 (51.9%)
and Islam was 105 (48.1%). One hundred and eighty (82.5%) patients belonged to
rural while 38 (17.5%) to urban locality (table 1).
Table 1 Sociodemographic
Age (in years)
Gender, n (%)
Male: 113 (51.9)
Religion, n (%)
Locality, n (%)
Urban: 38 (17.5)
Psychiatrists reportedly believe that
psychopathology in the hospitalised population at any moment, even with
conservative estimations, exceed 30% and ranges from 30 to 50%.13
Psychiatric units have been said to be reluctant to receive patients
transferred from the general hospital and this has been an important issue.
Their 'preference' to patients with psychiatric diagnoses only is based not
only on the pressure from the community for such admissions, but also on the
argument that patients with somatic illnesses may exert a 'negative' influence
on the therapeutic environment or are difficult to take care of.14,15
The term 'difficult to take care of'
usually refers to those patients who present with a variety of, mainly behavioral,
problems in addition to their somatic illness, which actually makes them 'not
wanted' in any ward.16-18
Some of these problems may have been the reason that led their physicians to
refer them for a psychiatric consultation or even discuss a transfer to
psychiatry ward in the first place.19
Psychiatric symptoms and disorders are
serious problems absorbing high health service provision capacities.10
Kisely et al.20 claims that 30-60 % of admitted patients in general
hospitals suffer from one major psychiatric disorder. Meanwhile, somatoform,
mood and anxiety disorders are among the most prevalent diagnosed disorders.21
The management of co-morbid psychiatric and physical illness is an important
issue for health services.22 It seems that co-morbid psychiatric
disorders, negatively affect the course and prognosis of the medical diseases
due to changes and irregularities in autonomous nervous, endocrine and immune
There have already been numerous studies
about the effect of CLP on the quality of life in hospitalised patients,
indicating a noticeable association between the diagnosis and treatment of
psychiatric disorders in physical patients and their faster cure, shorter
hospitalisation period, less recurrence of disease and lower costs of treatment.24
For example, Chadda25 showed that spending just two million dollars
on CLP can save sixteen million dollars in return.
Present study detected 165 (75.6%)
patients with psychiatric diagnoses, 34 (15.6%) having psychiatric disorders
with comorbidities, and 17 (7.8%) patients with medical/surgical illnesses. The
psychiatric disorders most commonly associated with comorbid medical/surgical
illness were found to be dissociative disorders, mood disorders, and anxiety
Maroufi et al.26 found 156 (42.7%)
of the evaluated subjects had psychiatric co-morbidities and the most prevalent
psychiatric symptoms determined in this group were depression, somatisation and
Altogether, there were 37 cases of
delirium out of 968 referrals reviewed by Ku et al.27 Nearly all
cases had significant physical illness, except 2 cases for whom organic
etiology were not certain. Out of these 37 patients, 4 were found to have
There were 229 referrals given
schizophrenia or related psychotic disorders as the primary diagnosis in the
total sample reported by Ku et al.27 One hundred and three (45.0%)
were suffering from significant physical illness, which might be the main
reason for hospitalisation.
Referring departments Ozkan28
observed that between the years 1989 and 1991, the distributions of
consultations made by various referring clinics were as follows: Internal
Medicine (48.99 %), Surgery (21.21 %), and Neurology (9.43 %). In the years
1995 and 1996, the distribution was: Internal Medicine (41.8 %), Surgery (31.8
%), Physical Therapy and Rehabilitation (7.6 %). In the years 1997 and 1998,
the highest number of consultations was requested by Internal Medicine (38.8
%). This was followed by Surgery (24.1 %). In 2003, the distribution was:
Internal Medicine (50.1 %), Surgery (26.6 %), and Physical Therapy and
Rehabilitation (10.0 %).
In most of the studies13,29-31,
the highest proportion of referrals was from the department of internal
medicine. In a review study32, a percentage of 47.7 % - 90 % was
reported. The range of percentages fell between 10 % - 90 %.32,33
The proportion of referrals from the department of surgery generally ranks
second in general hospital consultations. In a review carried out in the 1980s,
Hengeveld et al.32 reported a range of 7 % - 34.7 %. A more recent
study reported a percentage of 25.5.34 Grant et al.35
reported that the Intensive Care Unit provided for the second greatest number
of requests for consultations. Rothenhausler et al.36 reported that
internal medicine accounted for one-half of all referrals.
In our study, Medicine was found to be the
most common referring department (68.8%) followed by Surgery (6.8%). Similar
observations were seen in the study done by Singh et al.37 where
49.8% referrals were from Medicine followed by 11.2% Surgery. Christodoulou et
al.19 reported that the majority of the transferred patients to the
psychiatry ward came from medicine (73.1%) and the remainder (26.8%) from
surgery. Forty-five percent of consultations in the study by Alhuthail38
were from medicine followed by surgery (25.3%). Seventy seven
percent of the total sample reviewed by Ku et al.27 was from the
department of medicine.
Physicians and surgeons are increasingly
becoming aware that one third to two thirds of their patients have significant
psychiatric symptomatology which is amenable to treatment by psychiatrists.39,40
The fact, that psychiatric patients can also present to the medical or
surgical units due to antecedent physical illnesses and may need additional
care by psychiatrists is being recognised.2
Reasons for referral According to Ozkan28
an overall assessment of the patterns of reasons for referral over 14 years
• During the first years, consultation
requests for differential diagnoses (organic-psychogenic) (25%) were
• Consultation requests for anxiety (14.4%
in 1989-1991; 17.7% in 2003) and depressive state (14% in 1989-1991; 21.8% in
2003) associated with or accompanying physical illness have meaningfully
increased in 14 years.
• Confusional state (10.3% in 1997-1998;
11.8% in 2003) has become the third most-occurring reason for consultation in
the last 6 years.
• Past psychiatric history has always been
regarded as a routine reason for psychiatric consultation.
One of the main objectives and
consequences of the CLP service is that psychiatry in medicine is not limited
to “functional cases or suicide attempts” and psychiatric disorders of various
kinds occur in medical patients (comorbidity). As the CLP service developed,
not only was there an increase in the number of requests for psychiatric
consultation, reasons for psychiatric consultations also grew in kind such that
psychiatric cooperation was indicated for all kinds of psycho-situational
conditions (e.g. Organic mental, psychosocial, behavioural, adaptive
disturbance) associated with or accompanying physical disorders. The fact that
the presence of a confusional state has become the third most prevalent reason
for consultation requests implies that physicians have become able to recognize
cases of delirium better.28
Altogether, the data of 14 years imply
that the understanding that physical and psychiatric disorders can co-exist has
improved.28 Diefenbacher and Strain41 reported that the
primary reasons for referral remained constant, with “depression and
behavioural management/agitation” being the most frequent.
We found 25.11% referrals for psychiatric
opinion, 21.5% for conversion reaction, 18.3% for abnormal behaviour, 8.9% for
somatic complains, 6.2% for substance use, 4.48% for suicidal behaviour, 1.79%
for confusional state, 1.79% for depressed mood; there were no diagnosis in
3.58% and others included 8.07%.
Grant et al.35 reported that in
a study covering a ten year period, depression and chemical dependency
assessment appeared to be the main reasons for referral. A study from Italy
indicated the distribution of reasons for psychiatric consultation as defined
by the referring physician as: psychological symptoms (63.9 %), unexplained
physical symptoms (9.3 %), suicide attempts (5.9 %), history of psychiatric
illness (3.1 %).42 Evaluation of depression was the reason for
referral in one-third of the total number of consultations, whereas suspected
substance abuse represented only 1.1% (the least).38
Ku et al.27 found that suicide
assessment was the commonest reason of psychiatric consultation and accounted
for about one-third of referrals from medical, surgical and orthopedic units.
Altogether, there were 58 (6.0%) out of 968 cases referred for the reason of
depressed mood. Neurotic and somatic symptoms were infrequently quoted as the
main reason for psychiatric consultation, and only accounted for 25 (2.6%) and
16 (1.7%) cases respectively. Revision of psychiatric drugs was asked for in 23
cases (2.4%) and most were concerned with side effects of antipsychotic or
Some referring doctors requested
psychiatric consultation by giving unclear or non-specific reasons, such as
“routine assessment”, “psychiatric assessment” or “past history of psychiatric
problem” etc. It gave rise to about 20% of all referrals.27
According to Ku et al.27 there
was still little emphasis in the interface between physical and mental health,
concerning the current practice of CLP. In the year, they found only 16
referrals quoted with somatic symptoms as the main reason of psychiatric
consultation. Some patients with significant physical illness might had
adjustment problem or depression, but they were usually not referred until
gross depression or having suicidal intent. It might reflect the physician’s
low awareness of psychiatric morbidity among physically ill patients.
Psychiatric diagnosis Ozkan28, in all four studies,
found the distribution of psychiatric diagnoses to follow a similar trend with
depressive disorder, adjustment disorder, and delirium comprising the first
three psychiatric states, though in differing degrees of frequency. Adjustment
disorder had become the most prevalent psychiatric diagnosis in recent years.
Psychiatric disorders are reported to
occur in nearly two-thirds of hospitalised patients. The majority of hospital
psychiatry studies indicated that depression of various kinds and subtypes
constitute the most prevalent psychiatric diagnosis in inpatient psychiatric
referrals.5,43 Prevalence of depression in the medically ill ranges
between 10.8 and 27 % (with the median being 22 %), depending on the
The distribution of the most frequent
diagnostic characteristics of patients in Europe and American studies indicated
depressive disorder, adjustment disorder, delirium, somatoform disorder,
anxiety disorder and alcohol and substance disorder, in differing ranks.34-36,46
Rothenhausler et al.36 reported
significant changes in diagnostic characteristics in their study of comparison
of two 1-year surveys done 8 years apart. This study reported an increase in
the category of delirium and a decrease in the category of “no psychiatric
diagnosis.” Brown and Waterhouse47 reported a significant decrease
in the frequency of personality disorders and an increase in organic states. A
study of changes in psychiatric consultation over a ten-year period reported
meaningful changes over time. For instance, mood disorders, anxiety disorders
and delirium were replaced by mood disorders, alcohol problems, and other
substance use disorders.35 In a more recent study covering a 10-year
period, Diefenbacher and Strain41 reported that organic mental
disorders (e.g. Delirium, dementia and substance-induced organic mental disorders)
accounted for the majority of cases, followed by depressive disorders
(including adjustment disorders), and thirdly by substance use disorders.
The label “no psychiatric diagnosis” was
applied to a patient who has been referred for consultation, for whom no
diagnosis has been established. This is a reflection of the understanding that
cooperation with psychiatry is not limited to “functional” or “severe”
psychiatric disorders and that there are various emotional, behavioural,
situational or crisis areas that cannot be classified within classical nosology
but will benefit from psychiatric consultation. Restricting ourselves to
assisting in the diagnosis of classical psychiatric disorders will only go to
limit our development as a discipline.28
Most common psychiatric diagnosis in our
study was dissociative [conversion] disorder (30.9%) followed by mood
[affective] disorders (18.18%), substance related disorders (12.7%), anxiety
disorders (7.8%), intentional self harm(6.06%) , organic mental disorders (5.45%),
schizophrenia, schizotypal and delusional disorders (5.45%), acute stress
reaction (4.24%), somatoform disorders (3.63%), sexual dysfunction (2.42%),
sleep disorders (1.21%), and others constituted 1.81%.
Singh et al.37 found that
depression constituted 26.9% followed by anxiety disorder (15.5%). Alhuthail38
reported that mood disorders were diagnosed in 27.6%, whereas 20.6% of the
referred patients were not diagnosed with any psychiatric disorder.
In the study by Ku et al.,27
altogether, 99 (10.2%) patients were given organic mental disorders as the main
diagnosis including 46 dementia and 37 delirium. Eighty-one (8.3%) were
suffering from mental disorders due to psychoactive substance use. Among them,
42 were related to alcohol use. There were 241 (24.9%) patients suffering from
functional psychosis other than mood disorders, including 169 schizophrenia, 38
acute schizophrenia-like psychotic disorders and 22 delusional disorder. One
hundred and two (10.5%) patients had mood disorders, including 50 depressive
episode and 29 manic episode or bipolar disorder. Forty-one (4.2%) patients
suffered from neurotic disorders, such as phobic and anxiety disorders (10
cases) and dissociative disorders (10 cases). Besides, there were 205 (21.2%)
patients having diagnosis of reaction to stress, adjustment disorder or
problems due to psychosocial circumstances. Thirty-eight (3.9%) patients were
given no psychiatric diagnosis after seen and 112 (11.6%) could not be given
any definite diagnosis as most of them were discharged before seen by
The transferees were more likely to have
been diagnosed with a mood disorder (including bipolar disorder types I and II,
unipolar depression, dysthymic disorder) or a personality disorder, whereas the
non-transferred were more likely to have been diagnosed with adjustment
disorder as well as having ‘no psychopathology’.19 Depression has
always been the most prevalent psychiatric disorder. Recently, however,
adjustment disorder has replaced depression as the most common diagnostic
Christodoulou et al.19 found
that suicide attempts represented 49.6% of transfers, 70.5% of them being
related to drug overdose (self-poisoning), whereas the rest were not drug
related. According to Ku et al.27 suicide attempt was the commonest
reason of referral, accounting for one-third of all referrals.
In our study, suicidal behaviour
represented 4.5% of the referrals from various departments; 5.9% received a
psychiatric diagnosis of intentional self harm. Although many suicidal attempts
are usually regarded as having minor emotional turmoil and low risk of suicide,
the attempts should not be simply regarded as not genuine and of low suicidal
In our study, more than one psychiatric
diagnosis was given in consultations. The observation of multiple psychiatric
diagnoses leads to consideration of an as yet little-defined phenomenon: multiple
psychiatric co morbidity that complicates the management of medical/surgical
illness. In studies that considered only single or major psychiatric diagnoses,
the detail offered by consideration of multiple diagnoses is not provided.8
Out of 968 patients studied by Ku et al.27
68 were given more than one psychiatric diagnosis. Concerning the second
psychiatric diagnosis, personality disorder (21 cases) and mental retardation
(10 cases) were the commonest two.
Bourgeois et al.8 reviewed the
diagnoses from all inpatient psychiatric consultations conducted by, faculty
psychiatrists during calendar year 2001 (N=901) at an academic medical center.
In about 25% of the consultations, multiple psychiatric diagnoses were made.
The most frequent diagnosis groups were mood (40.7%), cognitive (32.0%), and
substance use disorders (18.6%). Among 671 consultations in which only one
diagnosis was made, the rates of these diagnosis groups were 35.4%, 20.1 %, and
10.2%, respectively. Mood, cognitive, and substance use disorders remain major,
foci of consultation-liaison practice in the managed care era, although the
rate of cognitive disorder diagnoses has increased.
Mean age was found to be 31.97 years. Most
of the patients were in the age group of 21-30 years. The possible reason might
be that dissociative disorder was the most common psychiatric diagnosis in our
study and this disorder generally presents in younger age. Our study comprised
of 113 (51.9%) males and 105 (48.1%) females.
According to Bourgeois et al.,8
the group of patients seen by the consultation-liaison service was 52% male and
had a mean age of 48.59 years. Approximately 64.8% of the patients
were females, as reported by Alhuthail.38
Ozkan28 observed that the
demographic profile of the referred patients in terms of gender and age has
changed over the years. Demographically, two major findings stood out. First,
the ratio of males to females has increased e.g. the number of males referred
compared to females has increased, with the number of females relatively
declining over the years. Secondly, the mean age of referred patients has
Generally, it was reported that more
female patients are referred for psychiatric care in general and in an acute
care general hospital setting as well.32,35,36,42,48-50 The findings
of our study contradict this general tendency. We believe it is because
psychiatry has gradually lost the stigma attached to it, reflecting a general
transformation in the value system of the society. This has resulted in men
being less reluctant to seek psychological help. Thus, in examining this
phenomenon, the changes in the value system of the society need to be taken
into consideration.28 Gender differences in consultations have been
reported in three different settings in which men were referred more often.51-3
In general, these results confirm some
results of other studies and contradict others. Nevertheless, other studies do
not come up with a consensus about factors affecting referral. Rather, those
studies investigated the impact of such factors in different settings with
different methodologies. Thus, one has to consider all these issues, including
the cultural aspects and different patterns of practice before one generalizes
Study Limitations There are some methodological limitations
in this study. First, standardized psychiatric scales and structured clinical
interviews were not used in this study.38 Most of the cases were not
admitted and diagnosis was done on OPD basis. Therefore there is a thin
possibility of error in diagnosis. As our study was done in a tertiary care set
up it might not represent the actual picture prevailing in the community.
In conclusion, providing simultaneous and
ongoing psychiatric service within the medical-surgical departments has been a
very functional and rewarding platform through which communication and
collaboration between physicians has been possible. This has also enabled the
stigma associated with psychiatric disorders in the minds of physicians,
patients and the families to be altered, lessened, thus allowing for the
integration of psychiatry with medicine.28
Limiting general hospital psychiatry to
requested consultations are insufficient to reach the people who are in need of
service. Consultation-liaison connections have played a major role in the
training of non-psychiatric physicians and in the recognition of psychiatric
problems in the medical setting. In time this has increased both the quantity
and quality of psychiatric consultations and has made possible early
recognition of psychopathology, which has thus led to early collaboration. The
liaison model advances the concept of coexistence of psychiatric morbidity in
The larger multidisciplinary CLP service,
the training of nonpsychiatric physicians, and liaison work will contribute to
the improvement of psychiatric referrals and increase the quality of service
given.28 Establishing communal scientific meetings and paying more
attention to CLP in different levels of medical education seem essential.26
Besides suicidal assessment and management
of adjustment disorder or related problems, the consultation-liaison team’s
major workload was the care of patients with major psychoses admitted to
general hospitals. These two major areas of job would remain
consultation-liaison services’ bread and butter.27 the data revealed
the demand from the general hospital and might disclose the deficiency of the
consultation services. In other words, it would be a reference for the future
development of CLP in the region.27 Further studies are also needed
in this line of research
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