Dunsis A, Smith G C
Monash University Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria.
Aust N Z J Psychiatry. 1996 Feb;30(1):63-73. doi: 10.3109/00048679609076073.
The aim of this paper is to provide an overview of the work of a consultation-liaison (C-L) psychiatry service to an obstetric inpatient unit in a university affiliated teaching hospital, with the aid of a comprehensive clinical database.
The MICRO-CARES clinical database system was used for prospective recording of data on all obstetric inpatients referred to the C-L psychiatry service and the hospital clinical database was used to compare referred inpatients with all obstetric inpatients.
Ninety patients were referred in 3 years, a referral rate of 1.2% of obstetric admissions. There was no bias in referral on age, but there were significantly more unmarried patients in the referred group (p < 0.001). Referred patients had a significantly prolonged length of stay: a mean of 9 days for referred patients, with 6 days for all obstetric patients (p < 0.001). The most frequent reasons for referral were: coping problems, depression, anxiety/fear and past history of major psychiatric illness. The most common DMS-III-R psychiatric diagnoses were: Personality Disorders (19%), Mood Disorders (17%), Schizophrenic Disorders (15%) and Adjustment Disorders (13%). At least one confirmed diagnosis was made in 77% of patients, but 42% of diagnoses remained differential. There were significantly more patients with diseases of the nervous system, endocrine and circulatory disorders in the referred group (p < 0.001). Recommendations of psychosocial interventions predominated over psychopharmacological interventions, and concordance with these was 97% and 98%, respectively. Issues in the relationship of obstetrics and psychiatric C-L services are discussed and future directions indicated.
The referral rate was low compared with other specialty units. This is probably due to factors inherent in obstetric practice. A wide spectrum of psychiatric disorders was referred, including a higher than expected number of women with postpartum psychotic disorders, the majority of whom were managed successfully in the obstetric ward. There is a need for increased liaison with obstetric and community services and for collaborative research, with a particular emphasis on the prevention of psychiatric morbidity associated with pregnancy.
本文旨在借助一个综合临床数据库，概述大学附属医院产科住院部会诊-联络（C-L）精神科服务的工作情况。
使用MICRO-CARES临床数据库系统对转介至C-L精神科服务的所有产科住院患者的数据进行前瞻性记录，并使用医院临床数据库将转介患者与所有产科住院患者进行比较。
3年内共转介90例患者，转介率为产科入院人数的1.2%。转介在年龄方面无偏差，但转介组中未婚患者明显更多（p<0.001）。转介患者的住院时间明显延长：转介患者平均住院9天，所有产科患者平均住院6天（p<0.001）。转介的最常见原因是：应对问题、抑郁、焦虑/恐惧以及既往有严重精神疾病史。最常见的《精神疾病诊断与统计手册》第三版修订本（DMS-III-R）精神科诊断为：人格障碍（19%）、心境障碍（17%）、精神分裂症性障碍（15%）和适应障碍（13%）。77%的患者至少有一项确诊诊断，但42%的诊断仍存在差异。转介组中患有神经系统疾病、内分泌和循环系统疾病的患者明显更多（p<0.001）。心理社会干预的建议多于心理药物干预，与这些建议的一致性分别为97%和98%。讨论了产科与精神科C-L服务关系中的问题并指出了未来方向。
与其他专科单位相比，转介率较低。这可能是由于产科实践中固有的因素。转介了广泛的精神障碍，包括产后精神病性障碍患者数量高于预期，其中大多数在产科病房得到成功管理。需要加强与产科和社区服务的联络以及开展合作研究，尤其要重视预防与妊娠相关的精神疾病。
