The practice of consultation psychiatry in Italy: A multi-centre study

Poli, Roberto; Carreca, A; Colmegna, Fabrizia; Ferraris, Silvia Deborah; Gagliardi, Emanuela; Tamborini, Stefania; Toscano, Marco

doi:10.1016/j.jpsychores.2017.03.005

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…Affective disorders were diagnosed in 45% of the patients, followed by neurotic, stress-related disorders, and somatoform disorders. Certain groups of diagnosis were less frequent in our sample than in other investigations; for example, a diagnosis of mental or behavioural disorder due to the use of psychoactive substances was infrequent (3.8%) in this population compared to the highest rates found in other studies (Poli et al, 2017) suggesting that general practitioners refer these patients to specific services, such as for dependence ones.…”

Section: Discussioncontrasting

confidence: 83%

Consultation-Liaison Psychiatry for Outpatients in a Great Metropolitan Hospital

Porcellana¹,

Panariello²,

Percudani³

2019

JPR

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Consultation-liaison psychiatry remains the guardian of holistic approach to the patient and consultation services in general hospital could therefore be referred to as "filters" for mental health care, in particular for patients with minor depressive or anxiety disorders. It is worth noting that psychiatric disorders, even when sub-clinical, worsen outcome whereas their early detection and treatment reduce health care costs significantly. The present study was transversal, exploratory, and descriptive in order to investigate the sample of outpatients referred from general practitioners (GP) to service of consultation-liaison psychiatry of the ASST Great Metropolitan Hospital Niguarda of Milan over a 7-months period. Data from all psychiatric consultations for outpatients were collected by a structured clinical report including socio-demographic features, features of referrals, and features of back-referrals. Five hundred and eleven consultations were performed. Participants were mainly female (58.7%) with an average age between 45 and 55 years (27.6%); 31.1% of these patients was at the first contact with a mental health specialist. The diagnoses formulated were distributed as follows: The most common diagnoses were affective disorders (44.6%), followed by neurotic disorders (34.1%), personality disorders (6.8 %), and finally, psychosis (6.2%). The study showed an example of a consultation-liaison service situated in a Great Metropolitan Hospital offering to GP the opportunity of a diagnostic assessment and shared management of minor psychiatric disorders. This approach could lead to several vantages, such as the management in a non-psychiatric setting of patients with reduction of stigma and reduced costs for specific psychiatric services where are referred more severe patients.

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Section: Discussioncontrasting

confidence: 83%

Consultation-Liaison Psychiatry for Outpatients in a Great Metropolitan Hospital

Porcellana¹,

Panariello²,

Percudani³

2019

JPR

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“…Mood disorders, Psychoses, Anxiety disorders and Attempted Suicides are the most frequent reasons for consultations. These data are in line with those emerging from literature with regard to psychiatric consultations for general hospitals in Italy outside a situation of emergency [30,31]. Only 8% of Wards have registered an increased rate of violence towards self or others among inpatients.…”

Section: Seventysupporting

confidence: 91%

Psychiatry during the Covid-19 pandemic: a survey on mental health departments in Italy

Carpiniello

Tusconi

Zanalda³

et al. 2020

BMC Psychiatry

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Background To date, very few nationwide studies addressing the way in which mental health services are addressing the current pandemics have been published. The present paper reports data obtained from a survey relating to the Italian mental health system conducted during the first phase of the Covid-19 epidemic. Methods Two online questionnaires regarding Community Mental Health Centres (CMHC) and General Hospital Psychiatric Wards (GHPW), respectively, were sent to the Heads of all Italian Mental Health Departments (MHDs). Statistical analysis was carried out by means of Chi Square test with Yates correction or the Fisher Exact test, as needed. Results Seventy-one (52.9%) of the 134 MHDs and 107 (32.6%) of the 318 GHPWs returned completed questionnaires. Less than 20% of CMHCs were closed and approx. 25% had introduced restricted access hours. A substantial change in the standard mode of operation in CMHCs was reported with only urgent psychiatric interventions, compulsory treatments and consultations for imprisoned people continuing unchanged. All other activities had been reduced to some extent. Remote contacts with users had been set up in about 75% of cases. Cases of COVID positivity were reported for both staff members (approx. 50% of CHMCs) and service users (52% of CHMCs). 20% of CMHCs reported cases of increased aggressiveness or violence among community patients, although only 8.6% relating to severe cases. Significant problems emerged with regard to the availability of personal protective equipment (PPE) for staff members. A reduced number of GHPWs (− 12%), beds (approx.-30%) and admissions were registered (87% of GHPWs). An increase in compulsory admissions and the rate of violence towards self or others among inpatients was reported by 8% of GHPWs. Patient swabs were carried out in 50% of GHPWs. 60% of GHPWs registered the admission to general COVID-19 Units of symptomatic COVID+ non-severe psychiatric patients whilst COVID+ severe psychiatric patients who were non-collaborative were admitted to specifically set up “COVID-19” GHPWs or to isolated areas of the wards purposely adapted for the scope. Conclusions The pandemic has led to a drastic reduction in levels of care, which may produce a severe impact on the mental health of the population in relation to the consequences of the expected economic crisis and of the second ongoing wave of the pandemic.

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“…This study, however was an opt-in model and likely included those services who were most interested in research and service development. A more recent Italian study of 5 hospitals of various sizes concluded that the better resources and more active a hospital service, the more likely patients were to be referred, and that the existence of strong services overcame systemic barriers to patients receiving needed mental health care, consistent with finding of Chen et al from an Australian study ( 20 , 21 ). Lobo et al in a survey of Spanish CLP services reported higher proportions of services with psychology provision and less specialist nursing provision.…”

Section: Discussionsupporting

confidence: 60%

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

et al. 2021

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Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

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The practice of consultation psychiatry in Italy: A multi-centre study

Cited by 3 publications

References 23 publications

Consultation-Liaison Psychiatry for Outpatients in a Great Metropolitan Hospital

Consultation-Liaison Psychiatry for Outpatients in a Great Metropolitan Hospital

Psychiatry during the Covid-19 pandemic: a survey on mental health departments in Italy

Consultation-Liaison Psychiatry Services in Ireland: A National Cross-Sectional Study

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