Elsevier

General Hospital Psychiatry

Volume 21, Issue 4, July–August 1999, Pages 310-317
General Hospital Psychiatry

Law, Ethics, and Psychiatry
A multicenter investigation of consultation-liaison psychiatry in Italy

https://doi.org/10.1016/S0163-8343(99)00015-8Get rights and content

Abstract

In order to evaluate the extent and quality of consultation-liaison (C-L) activity in Italy, a multicenter investigation was conducted in 17 general hospitals. All of the hospitalized patients referred to C-L psychiatry during a 1-year period were assessed by means of a specific instrument (Patient Registration Form, PRF-SF). Of 518,212 patients, 4182 were referred to C-L services (referral rate = 0.72%). Typical consultations were for female patients (60.1%), admitted to medical wards (71.5%), aged 55–75 years. Most interventions were carried out within 2 days; a minority (22%) were urgent requests. Gastrointestinal and cardiovascular disorders, and unexplained medical symptoms were the most frequent ICD-9 somatic diagnoses at admission. One-third of the patients were not informed of having been referred to C-L and half of them had a lifetime history of psychiatric disturbances. Most frequent ICD-10 psychiatric diagnoses were neurotic, stress-related, and somatoform syndromes (33.1%), affective syndromes (19.4%), and organic mental syndromes (10.7%). Two-thirds of the patients were given only one consultation whereas the reminder received two to four follow-up visits. The rate of transfer to psychiatric wards was low (2.1%). Psychopharmacological treatment was suggested in 65% of cases, and 75.5% of the patients were referred to community psychiatric care at discharge. The implications of the findings are discussed.

Introduction

Over the past 15 years there has been an increasing development of Consultation-Liaison (C-L) psychiatry in several countries, particularly in the USA, the UK, and the Netherlands [1], although the institution of comprehensive C-L services within general hospitals remains the exception rather than the rule [2]. In Italy, despite the innovations determined by the Italian psychiatric reform (Law 180, 1978) in community psychiatry [3] and the development of psychiatric units in general hospitals [4], a specific interest in C-L psychiatry has been slow to develop. In most regions of Italy, consultation is still limited to the 24-hour psychiatric service provided in Emergency Departments by psychiatrists working in psychiatric wards within the general hospitals (or by community psychiatrists, where no psychiatric ward is available in the hospital itself) and/or evaluation, on a consultative basis, of acute psychiatric or behavioral problems of hospitalized medically ill patients. However, a few specific and integrated C-L services were established during the early 80s in university-based hospitals (e.g., Milan, Modena, Padua) 4, 5, 6 on the basis of which, in subsequent years, other centers in the country implemented C-L services (e.g., Naples and Ferrara).

In order to provide a clearer picture of the C-L situation in Italy, a project was developed by the Italian C-L Group under the auspices of the Italian Society of Consultation Psychiatry and Medical Psychology. The study, which is the first multicenter investigation in Italy, had the twofold aim of evaluating the characteristics and type of C-L activity in Italy and developing training and research protocols to be used throughout the country. The purpose of this report was to analyze the general data from the Italian Multicenter Study.

Section snippets

Study design

The study was conducted on a nationwide level, involving 12 provinces (6 in the north of Italy, 3 in central Italy, and 3 in southern Italy), for a total of 17 hospitals (19,804 beds in all) and 17 corresponding psychiatric consultation services.1 All of the patients admitted to the hospitals and referred to psychiatry during a period of 12 consecutive months, between 1993 and 1994, were assessed using an abridged version of the Patient Registration Form (PRF-SF) 7, 8, with the necessary

Sociodemographic and clinical characteristics of the sample

During the study period, 518,212 patients were admitted to the participating hospitals. For 4182 of them a psychiatric consultation was requested (rate = 0.72%). Ninety-three percent of the consultations were for inpatients (N = 3925) and 6.15% (N = 257) for day-hospital patients.

Sociodemographic and clinical data are presented in Table 1. There were 1699 men (39.9%) and 2511 women (60.1%), with a mean age of 50.82 ± 18.77 years (range 18–84); 17.5% of the patients were aged 65–74, 16.7% were

Discussion

This is the first comprehensive study of C-L psychiatry in Italy. The results presented here make it possible to clarify a number of aspects of C-L within Italian general hospitals and to compare the Italian data with findings of other European countries and the USA. The results reveal that only a small percentage (0.7%) of the patients admitted to general hospitals were referred to C-L services. Although if this figure is lower than the 1.5%–3% rate reported in other C-L studies 12, 13, it is

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