A review of psychiatric consult notes of 96 obstetric inpatients referred to a Consultation-Liaison (C-L) psychiatry service in a tertiary-level university general hospital was carried out in order to compare the characteristics of such a service in a North American setting with similar services in other parts of the world. Data extracted from consult notes included: reason for referral, current diagnosis (DSM-IV-R), psychiatric history, obstetrical history, recommended treatment approaches, current psychotropic medications, current gestational age or number of days postpartum, patient age, and partnership status. In addition, obstetrical referrals were calculated as a percentage of hospital-wide referrals to C-L psychiatry. The most prominent findings include: (1) a high C-L psychiatry referral rate from obstetrics as a percentage of total C-L referrals within the study hospital; (2) past psychiatric history alone as a prevalent reason for referral; (3) adverse reproductive event (past and/or current) as a common reason for referral. These findings differ markedly in certain ways from comparable studies and may reflect both the hospital's large high-risk pregnancy service that represents an at-risk group for mental health issues, and the focus on educational collaboration with obstetrical staff regarding risk factors for, and consequences of, perinatal mental illness. Inpatient perinatal C-L psychiatric services require creative approaches to the accurate identification and treatment of women at risk for antenatal and postpartum mental illness due to psychiatric history and/or reproductive crises.
Purpose. Twenty-eight women, referred to C-L Psychiatry during their obstetrical inpatient stay were interviewed six months post-discharge to determine how they experienced the consultation process, whether they recollected and adhered to treatment recommendations, and whether they developed or had a recurrence of mental health problems post-discharge.
Method. Semi-structured telephone interviews were conducted by a psychologist who had not been involved with patient care.
Results. There was strong congruence between reason for referral as stated in psychiatric consult notes and participants' recollections and strong congruence and compliance regarding treatment recommendations. Sixty-four percent of women had concerns regarding mood post-discharge, of whom 66% sought professional help within six months. Participants' recommendations for improving the effectiveness of the C-L service to obstetrical inpatients pertained mainly to sensitivity to patients' feelings, consistency of message and personnel, and post-discharge follow-up.
Conclusions. Obstetrical patients had good recollection of their experience of C-L psychiatry, and post-discharge compliance with treatment recommendations was high. A post-discharge telephone call might further enhance treatment compliance and encourage women who are struggling with mood difficulties to seek help. Contact between C-L psychiatry and patients' primary care physician may also enhance care post-discharge.
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