Rustomjee S, Smith G C
Monash University Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
Aust N Z J Psychiatry. 1996 Apr;30(2):229-37. doi: 10.3109/00048679609076099.
To provide an overview of the work of a liaison psychiatry service to a renal medicine inpatient unit, based on a comprehensive clinical database, in order to provide a basis for comparison with similar units and to identify issues of concern.
The MICRO-CARES prospective clinical database system was used to obtain data on all patients referred to the Liaison Psychiatry Service, and the hospital clinical database was used to compare referred patients with total Renal Unit admissions in a large, suburban, university-affiliated hospital.
Two hundred and ninety-nine inpatient referrals were made in the three years from 1990 to 1992: a referral rate of 17%. There was no bias in referral on age, sex or marital status. Coping problems (27%), depression (20%) and noncompliance (11%) were the most frequent reasons cited. Forty-five per cent of referrals required a pre-dialysis assessment. There was good agreement between consultee and consultant about noncompliance, but poorer agreement about organic brain syndromes, depression, anxiety and alcohol problems. The highest prevalence of DSM-III-R diagnoses was for V Codes (35% of Mental Disorders (23%). Referred patients had a length of stay significantly longer than that of the total admissions (20.5 days +/- 20.6 SD compared with 8.7 +2- 12.5 SD, p < .001). Psychotropic drugs were prescribed in 25% of referrals, and liaison psychiatry staff spent a mean of 181 +/- 148 SD minutes per patient, reflecting the emphasis on psychological management. The systems issues are discussed.
The high level of complex physical/psychiatric comorbidity present and the systemic issues involved suggest that the management of patients in a renal medicine inpatient unit requires a dedicated attachment of a consultant psychiatrist-led, multidisciplinary, liaison psychiatry team which is well trained in psychodynamic issues and is comfortable with the complexity of biological issues which arise. The data provide a reliable basis for comparison with other services.
基于一个全面的临床数据库，概述联络精神科服务于肾内科住院部的工作，以便为与类似科室进行比较提供依据，并确定需要关注的问题。
使用MICRO-CARES前瞻性临床数据库系统获取转介至联络精神科服务的所有患者的数据，并使用医院临床数据库将转介患者与一家大型郊区大学附属医院肾内科的总住院人数进行比较。
1990年至1992年的三年间共进行了299例住院患者转介，转介率为17%。在年龄、性别或婚姻状况方面的转介没有偏差。应对问题（27%）、抑郁症（20%）和不依从性（11%）是最常提及的原因。45%的转介需要进行透析前评估。在不依从性方面，会诊医生和顾问之间的意见较为一致，但在器质性脑综合征、抑郁症、焦虑症和酒精问题方面的意见一致性较差。DSM-III-R诊断的最高患病率是V编码（占精神障碍的35%），其次是精神障碍（23%）。转介患者的住院时间明显长于总住院人数（分别为20.5天±20.6标准差和8.7±12.5标准差，p<.001）。25%的转介患者开具了精神药物，联络精神科工作人员平均每位患者花费181±148标准差分钟，这反映了对心理管理的重视。文中讨论了系统问题。
存在的高度复杂的躯体/精神共病情况以及所涉及的系统问题表明，肾内科住院部患者的管理需要一个由顾问精神科医生领导的、多学科的、联络精神科团队专门参与，该团队要在心理动力学问题方面接受良好培训，并能应对出现的复杂生物学问题。这些数据为与其他服务进行比较提供了可靠依据。
