Integration of DSM-III and ICD-8 to be used in a consultation-liaison psychiatric service. Preliminary experiences.
In 1983 a total of 405 patients received psychiatric supervision in somatic departments in the general hospital. At this supervision, these patients were registered by means of a five-axial diagnostic coding according to the DMS III principle, and this was combined with a quantitative global assessment of the severity of the condition. Reliability testing was undertaken by five supervising physicians with a total of 15 patients. The total number of supervisions constituted one supervision per somatic bed per annum. Women were overrepresented, and medical departments made the greatest use of psychiatric supervision. Reactive conditions dominated parallel with a high relative incidence of alcohol-related conditions. In patients with diagnoses of psychoses, only slight to moderate psychiatric symptoms were encountered. This held true also for personality deviations. 50% of the patients had experienced significant psychosocial stress, but 10% of these were diagnosed as having non-reactive psychoses, 52% of the patients had moderate to pronounced disturbances of social function. Half of the patients supervised in this manner could be investigated or treated in the referring departments. Approximately half of the patients in whom referral to private psychiatric specialists was made did not keep these appointments. Reliability testing in the material shows the employability of the diagnostic armamentarium. All in all, the investigation suggests that extension of the liaison psychiatric service in somatic departments would result in a relative increase in the number of patients who could be treated in the referring department and an increase in the number of psychiatric conditions diagnosed. Establishment of a psychiatric outpatient clinic in the somatic environment appears to be indicated.
D000437:Alcoholism / Q000175:diagnosis; D003866:Depressive Disorder / Q000175:diagnosis; D006801:Humans; D008370:Manuals as Topic; D001523:Mental Disorders / Q000175:diagnosis*; D019965:Neurocognitive Disorders / Q000175:diagnosis; D009497:Neurotic Disorders / Q000175:diagnosis; D010554:Personality Disorders / Q000175:diagnosis; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D012017:Referral and Consultation; D012559:Schizophrenia / Q000175:diagnosis; D012803:Sick Role