Consultation-Liaison Psychiatry in Kwai Chung Hospital

SUMMARY The Consultation-liaison Team of Kwai Chung Hospital has collected data regarding the psychiatric service it provided to the in-patients of a nearby regional general hospital in the period between July 94 and June 95. The characteristics of the referrals were documented and discussed. Information on all the 968 consultations seen was collected in the following areas, namely, demographic data, source and reason of referral, past psychiatric and suicidal histories, current suicidal attempt, psychiatric diagnosis, significant medical problem, psychiatric outcome and number of session(s) provided. 77% of the total sample were from the department of medicine and 45% had a past psychiatric history. Suicide attempt was the commonest reason of referral, accounting for one-third of all referrals, while self overdosing was the method adopted by 44% of the suicide attempters. 41% of attempters were under 26 years old and 84% under 46 years old. Half of them, nonetheless, were not suffering from any formal psychiatric problems apart from adjustment disorders. Out of the 229 patients suffering from schizophrenia referred to us for assessment, 116 of them had no significant physical problem, Apart from describing the experience of a local service, this study also -suggests in-patient treatment in general hospital may not be necessary for some suicide attempters and patients presented with schizophrenic symptoms. Keywords: consultation-liaison psychiatry, Hong Kong, suicidal attempt, Schizophrenia INTRODUCTION Consultation-liaison (C-Q psychiatry may be defined as a subspecialty of psychiatry, one concerned with clinical service, teaching, and research at the borderland of psychiatry and medicine (Lipowski, 1986), and its main goal is to bring medicine and psychiatry closer together so as to improve patient care in its psychosocial and psychiatric aspects. Lipowski (1986) reviewed the 50 years' history of C-L psychiatry in the United States and described its development as divided into four overlapping phases: the beginnings, the organizational phase, the phase of conceptual development, and the phase of rapid growth. However, the status of a subspecialty of psychiatry was only achieved in the country after 1970 (Lipowski, 1983). In Australia, the history of C-L psychiatry was shorter and it only started in 1970s, under influence of the North American model of liaison psychiatry, with its emphasis on the biopsychosocial model and psychoanalysis. Anyway, the development of the subspecialty has been said to be slow in the country and variable in different hospitals (Smith et al,, 1993). In the United Kingdom, its development has been even slower, despite recognition of deficiencies in psychiatric service offered to general medical units (Creed, 1991). The reasons behind include hesitation to alter current psychiatric practice and lack of resources. In Hong Kong, C-L psychiatry is not yet recognized as a subspecialty and only treated as a part of general adult psychiatry by the Royal College of Psychiatrists and the Hong Kong College of Psychiatrists. KWAI CHUNG HOSPITAL C-L TEAM Kwai Chung Hospital (KCH) is a mental hospital located next to a regional general hospital, Princess Margaret Hospital (PMH). It started its operation in 1981. Besides admitting psychiatric in-patients, the hospital also provided psychiatric consultation to PMH in-patients, All along, the duty was shared among general adult psychiatric teams. In 1994, a consultation-liaison team was established. It took over the duty of psychiatric consultation to PMH, except for patients under age of 16. Although a psychogeriatric team would take care of a proportion of patients in geriatric wards, the C-L team provided psychiatric consultation to the majority of elderly patients, without upper age limit, in various wards of PMH. In 1994, the team comprised 1 consultant psychiatrist, I senior medical officer and 3 medical officers. …