Consultation-Liaison Psychiatric Service

History

Interest in the mental dimension of man is one of the most discussed subjects in medicine, from the mechanical and dualistic tradition of the Knidos school to the monistic one of the Hippocratic school of Cos. Hippocrates defined in his Aphorisms the roles of physicians, patients and events as significant variables to be considered in health and sickness processes:

"Life is short, and the Art long; the occasion fleeting; experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate".

He also indicated the need to know the person before  knowing the disease:

"It is more important to know what sort of person has a disease than to know what sort of disease a person has".
 

Such aspects, later separated in the the Cartesian paradigm of "res cogitans" and "res extensa", were gradually lost  in a medicine that had initially been based on the organ but became more and more oriented to a mechanization of man and sickness, with an organic and parcelled vision of physical sickness and an "encephalo-iatric" and "cerebro-centric" vision of psychiatry.

In more modern times, since the beginning of the 20th century, two obvious needs became apparent: 1) the need of a global approach towards the person suffering from somatic pathologies; and 2) the need for deeper knowledge of the psychological concomitants of physical functioning in health and disease.

In 1902, in the United States, the first psychiatric department in a general hospital was established.  Similarly, in the twenties Consultation Psychiatry was born as a branch specifically oriented towards the evaluation and treatment of psychological problems of patients suffering from somatic diseases. As a result the groundwork was set to establish and spread theoretical and patient-assistance models, specifically applied to the various medical-surgical branches.

In the fifties and sixties oncology, cardiology, obstetrics, gynaecology and dermatology were the most influential disciplines to this phenomenon. In such disciplines the basic principles of Consultation Psychiatry are applied directly and precisely:

• the need to evaluate the influence of emotional variables from the onset of disease (psycho-somatic pathogenesis) 
• the need to study the effects between both psychological and biological factors (psycho-biology) 
• the need for educational training of physicians; the recognition of psychiatric and psycho-social problems in physically ill patients;
• the need for proper bio-psychos-social treatment 
• the need to develop experimental research in such areas 

Due to the diffusion of such a culture - strictly connected to the development of psycho-somatic medicine - today Consultation-Liasion  Psychiatry has its own role within Psychiatry; with Consultation-Liaison  Psychiatry programs available in the majority of the Hospitals throughout Italy. Very recently (April 2003) the American Board of Psychiatry and Neurology (ABPN) credited this discipline as a speciality of psychiatry: as of June 2003, the Accreditation Council for Graduate Medical Education (ACGME) began referring to the specialty as Psychosomatic Medicine.

In Ferrara, Consultation-Liaison Psychiatry and Psychosomatic Medicine services  were implemented in 1991 at in the S. Anna University Hospital and later, in the Mental Health Department.  

How to reach the Service

The Service is located in the S. Anna Hospital, within the Section of Psychiatry, Unit of Clinical Psychiatry (Tel +39 0532 237129; Fax +39 0532 212240).

Mission

The Consultation-Liaison Psychiatry Service has the mission of improving recognition and treatment of psychiatric disorders of patients suffering from medical illness (psychiatric co-morbidity), in the settings of the General Hospital and Community Medicine. 

The primary objectives are four-fold:

• to ensure the “transitional care” of patients suffering from medical disorders, staying in hospitals or out-patients 
• to establish a close liaison with the General Hospital Acute Psychiatric Unit. This service is responsible for urgent psychiatric interventions in the Emergency Room and in the Medical and Surgical Departments of the University Hospital of S. Anna as defined by an agreement between the University Psychiatric Unit and the Emergency Psychiatry Unit

• to develop programs aimed at integrating the training of doctors and nurses to better recognize and address the most frequent psychiatric problems, second to medical pathologies (e.g. delirium, depression). In addition, promulgating the importance of patients suffering from heavy mental pathologies to General Medicine. 
• to improve communications amongst several health teams, health agencies and services providing patient-care both in the Department and post-discharge.  This includes, but is not limited to the Mental Health Department, GPs, Social Services, Substance and Alcohol Abuse services and other speciality services of the General Hospital

Organization 

The service consists of full-time psychiatrists supported by two psychologists and other physicians in formal psychiatric training.  Information on the hours of operation and its activities is available in the catalogue of Psychiatry Activities in the General and University Hospital S. Anna in Ferrara.

Documents   

Additional information on  Consultation-Liaison Psychiatry may be found on the web-sites of the European Society of Consultation-Liaison Psychiatry  and the Academy of Psychosomatic Medicine site, the official American Organization of Consultation and Liaison Psychiatry. Further information on the important role of this branch of Psychiatry can be found in the recent document, The Psychological care of Medical Patients: A Practical Guide, jointly set in U.K. by the Royal College of Psychiatrists and the Royal College of Physicians.