Abstract
Background
The Mental Health Service for Older People (MHSOP) Liaison Service in North Dublin noted an exponential increase in suicide attempts in those over 65 over a period of 3 years ...(2020–2022). Annually in Ireland, more than 400 people die by suicide and a further 12,500 present to hospital following self-harm, of which approximately 15% are older adults (aged >60). Worldwide, the age group that is most likely to die by suicide is represented by older adults, in particular men.
Methods
Analysis of referrals to the service from an established clinical database was performed to include those referred post suicide attempt or those referred for suicidal ideation or expressing a Passive Death Wish (PDW). Data was anonymized and recorded using Microsoft excel.
Results
There was a highly significant difference between the number of males who were referred post suicide attempt between 2021 (n = 1) and 2022 (n = 13), with z = +3.21 p < 0.001. Referrals post suicide attempt in 2021 consisted of 2% (n = 6) of all referrals to the service, and 6% (n = 20) in 2022. In 2021 the mean age of those referred was 75.16, and in 2022 was slightly lower at 72.65, with 60% of those in the 65–72 year age range. Alcohol was involved in 45% of all suicide attempts in 2022. The overall referrals to the service for suicidality (post suicide attempt and PDW) increased from 5% to 16% from 2021 to 2022 of all those referred.
Conclusion
A Suicide prevention working group was established to include members of: MHSOP, Older Persons Services, Public Health and the National Office for Suicide Prevention (NOSP) to explore evidence based suicide and self-harm prevention strategies and guidelines in order to address the multiple precipitative factors for suicidality in older persons by developing improved care pathways and integration of services.
Summary
Although descriptions of quality of life and patient reports of mood in sickle cell disease (SCD) have become more common in the literature, less is known about psychiatric illness ...prevalence, presentation, and treatment, particularly for adults. We provide a narrative review of what is known about common and debilitating psychiatric conditions such as depression, anxiety, and cognitive impairment, specifically for adults with SCD. We discuss the limitations of the current evidence, make provisional recommendations, and identify opportunities for research and improved care.
The psychiatric comorbidities associated with sickle cell disease (SCD) in adults are in a complex multi‐directional pathway with medical symptoms and complications of SCD. Vaso‐occlusive crises (VOC) lead directly to crisis pain, chronic pain and end‐organ damage, which can in turn cause psychiatric manifestations for either biological (stroke and renal disease) or quality of life (infertility) reasons. Depression, anxiety, alcohol use and cognitive impairment can directly impact patients' ability to fully adhere to treatment, leading to worse care, more pain and more pain medication use. When non‐adherence affects the consistent use of disease‐modifying agents or the ability to follow up, consequences include more VOC and other morbidities. Improving the screening, referral, diagnosis and treatment of psychiatric comorbidities in SCD might help to break this cycle.
Consultation-liaison (CL) is a specialized area of practice in psychiatry delivering mental health care to medical patients in inpatient and outpatient settings. In this article, we describe the ...development of an inpatient-focused interprofessional CL training program customized to fellow-level psychologists. This includes a description of CL psychology experiences, important ethical and professional development topics particularly relevant for psychologists in CL settings, and contributions of the psychologist to the interprofessional CL treatment team. Finally, we offer recommendations for advancing research in this still emerging area of psychology practice.
Public Significance Statement
This article describes the development of a consultation-liaison (CL) training program for psychology fellows. The CL discipline is well-established in psychiatry-involving specialized practices such as performing bedside assessments and interventions with medical inpatients and acting as a consultant to medical providers-yet there are few programs available to psychologists seeking CL competency. Our findings suggest that psychology fellows offer unique value to CL and benefit from CL-specific training.
Liaison psychiatry services provide mental health care for patients in physical healthcare (usually acute hospital) settings including emergency departments. Liaison work involves close collaboration ...with acute hospital staff so that high quality care can be provided. Services however are patchy, relatively underfunded, heterogeneous and poorly integrated into acute hospital care pathways.
We carried out in-depth semi-structured interviews with 73 liaison psychiatry and acute hospital staff from 11 different acute hospitals in England. The 11 hospitals were purposively sample to represent hospitals in which four different types of liaison services operated. Staff were identified to ensure diversity according to professional background, sub-specialism within the team, and whether they had a clinical or managerial focus. All interviews were audio-recorded and transcribed. The data were analysed using a best-fit framework analysis.
Several key themes emerged in relation to facilitators and barriers to the effective delivery of integrated services. There were problems with continuity of care across the secondary-primary interface; a lack of mental health resources in primary care to support discharge; a lack of shared information systems; a disproportionate length of time spent recording information as opposed to face to face patient contact; and a lack of a shared vision of care. Relatively few facilitators were identified although interviewees reported a focus on patient care. Similar problems were identified across different liaison service types.
The problems that we have identified need to be addressed by both liaison and acute hospital teams, managers and funders, if high quality integrated physical and mental health care is to be provided in the acute hospital setting.
Objective:
The aim of this study was to conduct the first national survey of consultation-liaison psychiatry (CLP) services in New Zealand.
Method:
An online survey based on the Multidimensional ...Matrix for Consultation-Liaison Psychiatry (mMAX-LP) was circulated to a psychiatrist at each of 12 identified CLP services nationally during April–May 2018. Existing data for Middlemore Hospital (where the lead author is based) were added later for completion.
Results:
Most CLP services in New Zealand are funded and managed by the mental health division, operate within office hours, and have psychologists and other allied health staff external to their service. However, there was significant heterogeneity amongst these services in terms of structure and function and in particular, the coverage of emergency departments and young/older patient groups.
Conclusion:
This first national survey has provided a snapshot of CLP services in New Zealand in 2018 and found striking heterogeneity. The survey has established a baseline for future local and international comparisons.
Introduction
Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry ...(CLP) activity in Italy (SIPC-2—2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1—1998).
Methods
We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same
ad hoc
60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome.
Results
Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (
d
= 0.54) and hospitalized for a longer duration (
d
= 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07).
Conclusion
CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy.
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