两种精神科服务方法的比较：会诊与联络精神病学研究的结果
A comparison of two psychiatric service approaches: findings from the Consultation vs. Liaison Psychiatry-Study.
作者信息
Lücke Caroline, Gschossmann Jürgen M, Schmidt Alena, Gschossmann Juliane, Lam Alexandra Philomena, Schneider Charlotte Elizabeth, Philipsen Alexandra, Müller Helge H
机构信息
Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy - University Hospital, Karl-Jaspers-Klinik, Hermann-Ehlers-Strasse 7, Bad Zwischenahn, D-26160, Germany.
Department of Internal Medicine, Klinikum Forchheim, Forchheim, D-91301, Germany.
出版信息
BMC Psychiatry. 2017 Jan 10;17(1):8. doi: 10.1186/s12888-016-1171-4.
BACKGROUND
Psychiatric comorbidities are common in somatically ill patients. There is a lack of data that can provide clear insights into substantial comparative advantages of different Consultation/Liaison Psychiatry (CLP) services.
METHODS
The Consultation versus Liaison Psychiatry-Study collected and analyzed data of 890 primarily somatically ill hospital inpatients presenting with psychiatric symptoms in a prospective observational study design. One group was treated via a liaison-model (LM) with regular consultation hours, the other via an on-demand-model (ODM) with individually requested consultations.
RESULTS
Five hundred forty-five LM and 345 ODM patients were compared. Patients in the LM were, on average, older compared to the patients of the ODM. The vast majority (90.8%) of individuals for whom a psychiatric consultation was requested came from internal medicine. The most common diagnoses were affective disorders (39.3%), organic mental disorders (18.9%), alcohol-induced mental disorders (11.3%) and reactions to severe stress/adjustment disorders (10.4%). Organic mental disorders were significantly more common in patients seen in the LM (24.0% vs. 10.3%, p < 0.001) while affective disorders were more frequently diagnosed in the ODM (46.6% vs. 34.8%, p = 0.001). Patients seen in the ODM were, on average, more severely affected compared to patients seen in the LM and required more extensive treatment. 16.3% of ODM patients were regarded as potentially suicidal; among these, 3.5% were acutely suicidal and 12.8% latently suicidal. Any form of further treatment was required by 93.0% of ODM patients compared to 77.8% in the LM. Pharmacological treatment with benzodiazepines, usually used as short-term treatment, was more frequently prescribed to patients seen in the ODM while patients seen in the LM were more often started on selective serotonin reuptake inhibitors, indicative of long-term treatment.
CONCLUSIONS
Patients in need of less acute treatment were considerably less common in the ODM. The data indicate a possible risk of such patients to remain unrecognized. A quasi-liaison model is recommended to be the best suitable and cost-effective way of providing psychiatric care to somatically ill patients with psychiatric comorbidities.
背景
精神疾病合并症在躯体疾病患者中很常见。目前缺乏数据能清晰洞察不同会诊/联络精神病学（CLP）服务的显著比较优势。
方法
会诊与联络精神病学研究采用前瞻性观察性研究设计，收集并分析了890名主要患有躯体疾病且伴有精神症状的住院患者的数据。一组通过联络模式（LM）接受治疗，有固定会诊时间；另一组通过按需模式（ODM）接受治疗，根据个体需求进行会诊。
结果
对545名LM组患者和345名ODM组患者进行了比较。LM组患者的平均年龄高于ODM组患者。绝大多数（90.8%）被要求进行精神科会诊的患者来自内科。最常见的诊断是情感障碍（39.3%）、器质性精神障碍（18.9%）、酒精所致精神障碍（11.3%）以及对严重应激/适应障碍的反应（10.4%）。器质性精神障碍在LM组患者中更为常见（24.0%对10.3%，p < 0.001），而情感障碍在ODM组中诊断更为频繁（46.6%对34.8%，p = 0.001）。与LM组患者相比，ODM组患者平均受影响更严重，需要更广泛的治疗。16.3%的ODM组患者被认为有潜在自杀倾向；其中，3.5%为急性自杀倾向，12.8%为潜在自杀倾向。93.0%的ODM组患者需要任何形式的进一步治疗，而LM组为77.8%。通常用作短期治疗的苯二氮䓬类药物的药物治疗在ODM组患者中更频繁地被处方，而LM组患者更常开始使用选择性5-羟色胺再摄取抑制剂，这表明是长期治疗。
结论
在ODM组中，需要较少急性治疗的患者相当少见。数据表明这类患者可能有未被识别的风险。建议准联络模式是为患有精神疾病合并症的躯体疾病患者提供精神科护理的最合适且具成本效益的方式。
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