Consultation-liaison psychiatry to renal medicine: Work with an inpatient unit

Objective: To provide an overview of the work of a liaison psychiatry service to a renal medicine inpatient unit, Based on a comprehensive clinical database, in order to provide a basis for comparison with similar units and to identify issues of concern. Method: The MICRO-CARES prospective clinical database system was used to obtain data on all patients referred to the Liaison Psychiatry Service, and the hospital clinical database was used to compare referred patients with total Renal Unit admissions in a large, suburban, university-affiliate hospital. Results: Two hundred and ninety-nine inpatient referrals were made in the three years from 1990 to 1992: a referral rate of 17%. There was no bias in referral on age, sex or marital status. Coping problems (27%), depression (20%) and noncompliance (11%) were the most frequent reasons cited. Forty-five per cent of referrals required a pre-dialysis assessment. There was good agreement between consultee and consultant about noncompliance, but poorer agreement about organic brain syndromes, depression, anxiety and alcohol problems. The highest prevalence of DSM-III-R diagnoses was for V Codes (35% of patients), Adjustment Disorders (30%), Mood Disorders (24%) and Organic Mental Disorders (23%). Referred patients had a length of stay significantly longer than that of the total admissions (20.5 days +/- 20.6 SD compared with 8.7 +/- 12.5 SD, p<.001). Psychotropic drugs were prescribed in 25% of referrals, and liaison psychiatry staff spent a mean of 181 +/- 148 SD minutes per patient, reflecting the emphasis on psychological management. The systems issues are discussed. Conclusions: The high level of complex physical/psychiatric comorbidity present and the systemic issues involved suggest that the management of patients in a renal medicine inpatient unit requires a dedicated attachment of a consultant psychiatrist-led, multidisciplinary, liaison psychiatry team which is well trained in psychodynamic issues and is comfortable with the complexity of biological issues which arise. The data provide a reliable basis for comparison with other services.