 Wysłany: Pon 8:15, 25 Kwi 2011 Temat postu: Consultation liaison psychiatry Current Situation |
|
| Consultation liaison psychiatry Status and Development
Of: Guohui Rong Ren Yumin Li Youhui Key words psychiatry; consultation liaison; situation and development In the WHO, the World Bank and Harvard University joint According to GDB study, the global burden of mental illness is very high, in our country also is a major disease burden in 1998, 19.3% of the total burden of disease from mental illness. So far, about 16 million of mental illness. In addition, affected by mental disorders and behavioral problems of minors under 17 a about 3,000 million [1]. In recent years, and social development is closely related to the occurrence of mental disorders and their solution, means treatment of mental illness, physical illness and mental disorder comorbidity problems, mental health services and the actual demand and other issues, has aroused concerns of the community. As China's traditional culture, and public awareness of mental health knowledge is low, especially on approach is general hospital, so bite to be face of general hospital services, mental health status. 1 consultation? Liaison psychiatry the concept of consultation? Liaison psychiatrists psychiatry is carried out in the general hospital psychiatric care, teaching and research, focusing on general hospital in mental health, social factors, physical illness and the relationship between mental disorders, psychiatric and other clinical subjects to strengthen the joint and collaboration between,tory burch outlet, from the psychological, social and biological factors for the patients with multi-dimensional medical and rehabilitation services. The scope of work includes two aspects: consultation (Consulation) and contact (Liaison). Contact can be considered as consultation? Easy contact form and one understood to refer to psychiatrists and to contact a special department within the surgery or regular contact with medical personnel, psychiatrists for the treatment of team members; consultation is not, but psychiatrists were invited to to make recommendations on certain issues or comments, were not considered treatment team members, from the narrow sense, the purpose is to help or to contact the guidance of non-psychiatric medical staff to identify and deal with patients during treatment occurred in psychosocial issues and Mental Medicine problem, but also patients and medical staff channels of communication [1]. 2 General Hospital to carry out consultation? Contact status psychiatry outpatients in general hospitals, about more than 1 / 3 of the patients were physical illness, nearly 1 / 3 of patients are psychological range of diseases, and the remaining 1 / 3 of patients is closely related to psychological factors and physical disease [2]. Relevant statistics show that foreign countries: general hospital consultation rate of 1% of total [3,4], a common reason for consultation: 38.6% of the current psychotic symptoms, suicide or self-injurious behavior of 17%, 7.2% substance abuse. 18.6% of unexplained symptoms. Carr VJ, etc. The most common diagnosis was reported: 29% affective disorder, seizure disorder 29%, anxiety 14% and 12% of substance abuse. Alaj R studies have shown that patients on the proposed consultation made a mental diagnosis 87% of the total number of consultations, physical barriers to mental disorders combined 84% of the total number of consultations. The past, except for a few medical schools of general hospitals with psychiatric, the vast majority of hospitals do not have an psychiatry, mental hospitals or mental health centers exist independently, with little CLP's system and services. But in the last 10 a, the domestic requirements of many psychiatric professionals from the grounds of psychiatric consultation, consultation after diagnosis, consultation rate reported in different angles to carry out consultation in general hospitals? Liaison psychiatric conditions. The literature [5] reported that the top three requested psychiatric consultation because of mental disorders due to physical illness (57.6%), somatization disorder (26.2%) and physical disease with mental disorders (11.0%); which organic 41.0% of mental disorders, neurological disorders 21.4%, psychological reactions caused by physical disease 13.0%, 3.8% affective disorders, schizophrenia 8.6%. Otherwise reported in the literature [6] The first three reasons for mental disorders due to physical illness (44.8%), somatization disorder (20.0%) and physical disease with mental disorders (11.0%); of which 36.5% organic mental disorders, neurological disease 32.9%, psychological reactions caused by physical disease 10.3%, 2.9% affective disorders, schizophrenia 7.7%. Bo (2001) analysis shows that the main reason for the mental disorder caused by physical illness (47.8%), somatization symptoms (45.5%), physical disease with mental disorders (6.7%). Affective disorder in the general hospital were very common and easily overlooked by ordinary clinicians, in particular, patients are often referred to as the body does not appeal. 3 of General Hospital Mental Health Service Status 3.1 lack of mental health service resources for historical reasons, has long been the focus of mental health services is a heavy-duty psychiatric hospitals and psychiatric patients, mental health services less than 1%. Currently, the national average every 10 million population is only one psychiatrist. However, the existing resources and mental health service system and the contemporary needs and target a broad range of mental health services are far apart. Mental illness in China ranked first in the total burden of disease, children, adolescents, women, elderly and affected groups, such as mental and behavioral problems can not be ignored, but with the growing general hospital mental health service needs in the incompatible mental health services is a serious shortage of resources [6, 9]. This is largely administrative and health people on the modern medical model of understanding and awareness about mental health services. Due to lack of proper mental health services, not only a substantial proportion of mental disorders are not correct and timely diagnosis and treatment, especially for somatic complaints of patients failed to identify many unnecessary tests and treatment, resulting in medical and health resources waste and medical cost increases, and when mental disorders and physical illness coexist, the former the latter will affect the prognosis and outcome. 3.2 low recognition rate of mental disorders present, our general hospital clinicians in the lack of mental health knowledge. According to the Shanghai General Hospital and primary health care institutions found that physician recognition of mental disorders was only 15.9%, well below the international average (48.9%), and psychological problems have been identified, the treatment rate very low [6]. Lu Lin and other studies have shown that physician recognition of affective disorder was 10.5%, due to non-psychiatric physicians ignore the patient's psychiatric symptoms, the general hospital in the vast majority of psychological disorders associated with patients did not receive proper treatment . Comprehensive mental health of doctors is mainly due to lack of knowledge: mental health education, medical proof is not given due attention, making the psychiatric knowledge of medical students defects. The spirit of our country's medical schools are usually only 70 hours of medical courses (including trainees), more non-clinical practice, some medical schools even cancel the course. Teaching psychiatry mental illness did so mainly heavy, making the growing number of medical students on the nerve disease, various types of mental disorders, sleep disorders, drug dependence, mental problems old age psychiatry and other related issues is poorly understood. November 1999 held in Beijing, Beijing Medical University psychiatry WHO teaching seminars, the experts said: the current knowledge of psychiatry for medical students can not meet the needs of the 21st century, we must reform the teaching of psychiatry. Psychiatry doctors in general hospitals should be included in continuing education. As the spirit of physical illness often involves medical problems, general hospitals must pay attention to consultation liaison psychiatry, a number of difficult cases psychiatrists should be invited to participate in the discussion or request psychiatric consultation, through the exchange, will help expand the integrated disease clinics doctors thought improve the diagnosis and treatment. |
|
