Objective:To describe the nature of psychiatry work within a general medical hospital and to compare and contrast the nature of that work between emergency department and inpatient settings. Method:The data from the Royal Melbourne Hospital (RMH) consultationliaison service database relating to referral, patient demographics, psychiatric diagnosis service use, management and discharge arrangements was recorded for all referrals to the RMH C-L service in 1999. The inpatient and emergency department arms of the service were compared. Results:The referral rate for inpatients and the emergency department was 2.9% and 2.1% respectively. The reasons for referral and frequency of psychiatric diagnosis differed significantly between the two settings. Conclusions:The provision of C-L services to inpatients and the emergency department needs to be tailored to the different patient populations.

The implementation of a database and clinical indicators was a useful addition to the C-L service. The use of clinical indicators was effective in improving clinical performance. These benefits need to be balanced against increased administrative burden.

In this report, we demonstrate through a putative case that Dementia with Lewy Bodies (DLB) can present with a catatonic syndrome which can pose diagnostic and management challenges. The patient was an 88-year-old gentleman presenting with acute psychotic and catatonic symptoms on a background of 5 months of functional decline. He showed good response of catatonic symptoms to Clonazepam and psychotic symptoms to Olanzapine. This led to resolution of behavioral problems and the establishment of a putative diagnosis of DLB.Patients with DLB may present with catatonic states; benzodiazepines help resolve catatonic symptoms and facilitate assessment in such patients; and Olanzapine effectively treats psychotic symptoms in DLB.

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