Creed F, Guthrie E, Black D, Tranmer M
Department of Psychiatry, Manchester Royal Infirmary.
Br J Psychiatry. 1993 Feb;162:204-11. doi: 10.1192/bjp.162.2.204.
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.
一家教学医院向一位新的精神科顾问医生转诊的病例数增加情况得到了记录。在1987/1988年期间，内科医生和外科医生连续转诊了279例（159例门诊患者和120例病房会诊请求），并与同期全科医生连续转诊的184例进行了比较。医院转诊的患者往往年龄较大，社会经济劣势较小，但精神疾病严重程度与全科医生转诊的患者相似。他们更有可能同时患有躯体疾病诊断，且表现出躯体化症状。后者并不局限于没有躯体疾病的患者；被归类为“对躯体疾病的心理反应”的患者中有一半表现出躯体化症状。对于躯体形式障碍，国际疾病分类第10版（ICD - 10）似乎比国际疾病分类第9版（ICD - 9）或精神疾病诊断与统计手册第3版（DSM - III）表现更好，但联络精神医学仍需要一个全面的分类系统。在病房会诊请求中，与转诊医生进行个人讨论最为常见；在这种情况下，转诊医生通常会继续对患者进行初级管理。
