Reasons for referral and diagnostic concordance between physicians/ surgeons and the consultation-liaison psychiatry team: An exploratory study from a tertiary care hospital in India

Abstract

Background:Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams.Aim:This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team.Materials and Methods:Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team.Results:In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ < 0.3) for depressive disorders and delirium and better for the diagnosis of substance dependence (κ = 0.678) and suicidality (κ = 0.655).Conclusions:The present study suggests that delirium is the most common diagnosis in referrals made to CL psychiatry team, and there is poor concordance between the psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable.

Psychiatric Referral Pattern in a General Hospital

“…10,11 Patients with psychiatric disorders give much priority to the somatic symptoms due to which they tend to visit general physician rather than psychiatrists for the treatment of their physical symptoms. 12,13,14,15 Another reason may be due to lack of awareness about the psychiatric origin of the physical symptoms and due to social stigma about the psychiatric illnesses.…”

Diagnostic Usefulness of an Ultra-Brief Screener to Identify Risk of Online Gaming Disorder for Children and Adolescents

“…In addition, IGD was diagnosed using a semi-structured diagnostic face-to-face interview schedule, the Diagnostic interview for Internet Addiction (DIA) [ 17 ], which was developed based on the IGD diagnostic criteria proposed in the DSM-5. Inter-rater concordance for mental health status was reported as low as 0.20–0.39 [ 18 - 20 ]. In this study, the inter-interviewer reliability of DIA was fair, with Cohen’s kappa=0.38 [ 21 ].…”

Depression in the medically ill

“…Paradoxically, although depressive disorders are often undetected in many medical settings, they may also be over-diagnosed, at times resulting in inappropriate treatment with antidepressants. The factors that contribute to these symptoms should be identified to ensure appropriate intervention, which include attention to pain or other physical distress, social or psychological factors (Grover et al, 2017;Iaboni et al, 2015;Kose et al, 2018). To prevent the over-diagnosis of MDD in the medically ill, an understanding of the spectrum of sadness is required.…”

“…Delirium is an important differential diagnosis as well, especially in inpatient and nursing home settings where rates of delirium are >25% (Ahmed et al, 2014). A large proportion of referrals to psychiatry services for depression in inpatient medical settings are identified as delirium upon further assessment (Grover et al, 2017). The presentation of delirium includes acute onset of fluctuating cognitive function, inattention and sleep-wake disturbances secondary to an underlying organic cause (APA, 2013).…”