Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giuseppe Campi, 287-41125 Modena, Italy.
Department of Economics & Marco Biagi Foundation, University of Modena and Reggio Emilia, Via J. Berengario, 51-41121 Modena, Italy.
Int J Environ Res Public Health. 2021 Jan 17;18(2):749. doi: 10.3390/ijerph18020749.
Consultation-liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000-2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen's kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression ( = 4937; 32.3%), followed by agitation ( = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.
联络精神病学（CLP）负责管理因躯体原因住院的患者的精神科护理。我们评估了精神病发病率、转诊原因和转诊医生与 CL 精神病医生之间诊断一致性的模式。回顾性分析了意大利摩德纳 GH 的 CLP 服务在 20 年（2000-2019 年）期间的转诊情况。使用 Cohen's kappa 统计量来评估 CL 精神病医生做出的诊断与转诊医生考虑的诊断之间的一致性。分析涵盖了 18888 次转诊。最常见的转诊原因是怀疑抑郁（=4937；32.3%），其次是激越（=1534；10.0%）。对 13883 次（73.8%）转诊进行了精神病诊断。发现抑郁障碍（kappa=0.281）和谵妄（kappa=0.342）的一致性较好，焦虑共病抑郁（kappa=0.305）和多动性谵妄（kappa=0.504）的一致性增加。酒精或物质滥用（kappa=0.574）的一致性为中度。转诊医生正确识别了因外源性病因或明显临床症状引起的精神疾病；此外，阳性症状（如惊恐或激越）的存在增加了诊断一致性。CL 精神病医生和 GH 医生之间的日常密切合作导致了正确识别共病精神疾病的能力的提高。
