CONSULTATION-LIAISON PSYCHIATRY IN GENERAL-PRACTICE

Objective: This paper describes the characteristics of 303 consecutive referrals, over a 12-month period, to a consultation-liaison (C-L) ps ychiatry service provided to eight group general practices in Newcastl e, Australia. Method: A purpose designed service audit form was used t hroughout the evaluation period to collect information about demograph ic characteristics, reasons for referral, service contacts, psychiatri c diagnoses and clinical management, In addition, patients were invite d to participate in a separate, prospective outcome evaluation study, which involved structured interviews and questionnaires. Results: The most common reasons for referral were: depression (33%); anxiety (12%) ; diagnostic assessment (9%); and impaired relationships (8%). The mos t common psychiatric diagnoses were: mood disorders (29%); mild, trans ient conditions (29%); anxiety (14%); and substance abuse disorders (1 2%), Following the psychiatric consultation(s), GPs were actively invo lved in patients' treatment in 53% of cases. However, there was a high er than expected rate of referral (44%) to another mental health agenc y. Selected comparisons are also reported between patients referred to the C-L service (n=303) and a sample of non-referred GP attenders (n= 535). Conclusions: As expected, the diagnostic profiles of patients at tending the C-L service differed in several respects from those using similar services in general hospitals, There were comparatively low ra tes of organic brain syndromes, suicide risk evaluations, and problems of differential diagnosis of somatic symptoms, Greater emphasis needs to be placed on more formal psychiatric education for GPs, on ways of screening out from the referral process those patients with mild, tra nsient conditions who do not require specialist expertise, and on the development of strategies to help GPs manage such conditions.