Referrals to a liaison psychiatry service, based in a District General Hospital, were studied over a six month period. 190 [89%] of the 214 referrals were for assessment following an episode of deliberate self harm. An excess of these referrals were male [57%] and a large proportion particularly of the males [36%] were diagnosed as having a significant alcohol problem. Many were felt to have no significant psychiatric problem [31%], and a large proportion were discharged with no psychiatric follow-up [28%]. Patterns of diagnosis and disposal differed between the sexes. Referring junior medical staff when asked to give their opinions on the likely management and overall need for psychiatric referral of patients were found to reach reasonable agreement with the assessing psychiatrist, even without prior training, and to be more cautious in their assessment. In many centres the trend is towards selective referral of deliberate self harm patients, and this appears a safe and appropriate development which can be achieved without intensive training or major alterations to working patterns, and which will result in modest but important reductions in inappropriate referrals.
The success of an in-patient therapeutic programme depends, in many instances, on the willingness of the patient to co-operate with medical and nursing staff, and to react positively to the permissive regime characteristic of the modern psychiatric hospital.
An analysis of the general results of a drug monitor in a psychiatric unit have been reported previously (Gardiner and Hall, 1971). One of the principal findings of that analysis was that the propensity for ‘untoward events' increased as the number of drugs that a patient received increased. The definition of ‘untoward event’ was that given by Finney (1965)—a‘n event is a particular untoward happening experienced by a patient, undesirable either generally or in the context of his disease. The term is not to be limited either to recognised side-effects of a drug or to incidents that are in some sense unexpected’. This paper takes this particular aspect of the investigation further in an attempt to describe the prescribing practice and to discover any particular drug or combination of drugs that was associated with a high frequency of ‘untoward events'.
Much psychiatric care is provided outside the hospital setting. It is important for general practitioners (GPs) to have available information of good quality, provided promptly, after patients' discharges from in-patient psychiatric care to enable them to provide a high standard of follow-up care. In order to assess the value of hand-written Immediate Discharge Letters sent by fax we undertook a postal questionnaire survey of GPs, and examined a proportion of the clinical notes relating to 160 patients who between January and March 1998 had been discharged from in-patient care in the psychiatry admission wards at Crichton Royal Hospital, Dumfries. We found that structured letters, hand-written on a patient's discharge from in-patient status were generally valued by GPs as was their transmission by fax. Though certain deficiencies were confirmed in their completion, they are of value pending the arrival of a more definitive final discharge summary. We conclude that the continued use of such immediate discharge letters in psychiatry and their continued transmission by fax is justified.
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