O'Brien Finian M, Devitt Pauline, Corcoran Ciaran D, Murphy Kieran C
Beaumont Hospital,Beaumont Road,Dublin 9,Ireland.
Department of Psychiatry,Royal College of Surgeons in Ireland,Education and Research Centre,Beaumont Hospital,Dublin 9,Ireland.
Ir J Psychol Med. 2009 Dec;26(4):187-190. doi: 10.1017/S0790966700000689.
This study examined and compared the number and pattern of referrals from neurosurgery and neurology specialist services to the inpatient liaison neuropsychiatry service in the years 2002 and 2005. We estimated the prevalence of psychiatric illness and evaluated the results of subsequent psychiatric assessment and follow-up of all patients reviewed by the neuropsychiatry service.
The medical notes of those patients referred to the neuropsychiatry team were retrospectively examined to obtain appropriate information on assessment and management of these cases.
There were 544 referrals over the two years selected for study. Rates of referral to the inpatient neuropsychiatry service increased overall by 35% between 2002 and 2005. Overall, referrals from neurology comprised 85%, neurosurgery 15%. Patients with epilepsy comprised the majority of referrals (36%). A total of 378 (73%) had an acute psychiatric disorder and this group had a significantly higher rate (p = 0.01) of past psychiatric disorder (40%) than that in those with no acute mental illness (33%). Depressive episode was the most frequent acute psychiatric diagnosis (38%), followed by anxiety and organic psychiatric disorder (both 15%). Overall, 21% of patients diagnosed with acute mental illness were referred on discharge to the neuropsychiatry outpatient clinic for specialist follow up and the remainder followed-up by either local mental health teams or their GP.
These findings provide clear evidence that further resources should be allocated to expanding neuropsychiatry mental health services to improve detection and management of mental illness in this vulnerable patient group.
本研究调查并比较了2002年和2005年神经外科和神经内科专科服务转介至住院联络神经精神病服务的数量及模式。我们估算了精神疾病的患病率，并评估了神经精神病服务所审查的所有患者后续精神科评估及随访的结果。
对转介至神经精神病团队的患者病历进行回顾性检查，以获取有关这些病例评估和管理的适当信息。
在选定进行研究的两年中，共有544例转介病例。2002年至2005年期间，转介至住院神经精神病服务的比率总体上升了35%。总体而言，来自神经内科的转介病例占85%，神经外科占15%。癫痫患者占转介病例的大多数（36%）。共有378例（73%）患有急性精神障碍，该组既往有精神障碍的比率（40%）显著高于无急性精神疾病的患者（33%）（p = 0.01）。抑郁发作是最常见的急性精神科诊断（38%），其次是焦虑和器质性精神障碍（均为15%）。总体而言，被诊断为急性精神疾病的患者中有21%在出院时被转介至神经精神病门诊进行专科随访，其余患者由当地心理健康团队或其全科医生进行随访。
这些发现提供了明确的证据，表明应分配更多资源来扩大神经精神病心理健康服务，以改善对这一脆弱患者群体中精神疾病的检测和管理。
