The paper reviewed here is ‘Transfers to Psychiatry through the Consultation-Liaison Psychiatry Service: 11 Years of Experience’ by Christodolou and colleagues and freely available here. The authors aimed to characterise patients that were seen by Consultation-Liaison Psychiatry services and transferred to the inpatient environment. In the abstract they write that
‘Medical diagnoses do not seem to play a major role in the transfer to the psychiatric ward. From the psychiatric diagnosis, depressive and dysthymic disorders are the most common in the transferred population, whilst the transfer is influenced by social factors regarding the patient, the patient’s behaviour, the conditions in the ward she/he is treated in and any recent occurrence(s) that increase the anxiety of the staff‘
The study was undertaken in a district general hospital in Athens with 650 general hospital beds and 18 beds on the psychiatric unit. The data was sampled from a 10-year period ending just prior to a change in law (March 1989- December 1999) which influenced admission of detained patients to psychiatric units. A control sample consisted of patients that were not transferred to the psychiatric ward during a single year of the study period. The control group were corrected for age and sex. Demographic and other details were recorded and these are identified in the methods section.
In the results section, 294 patients were transferred over the 10 year period and 225 patients were identified for the control group. The researcher provide a number of different results. Some of the results I found particularly interesting. Thus 5.2% of the referrals to the consultation-liaison (C-L) service were eventually transferred to the psychiatric unit while 9.9% of the admissions to the psychiatric unit were from the C-L service. The majority of the control group and the transfers were medical referrals. The differences between the transfer and control group in terms of marital status were particularly interesting with married status being significantly more likely in the control group. In the transferred group 75.8% had a past psychiatric history whereas in the control group this figure was significantly lower at 63.1% (p<0.01 – Fisher’s exact test). In terms of diagnostic labels, the transfer group were significantly more likely than the control group to have a personality or mood disorder while the reverse was true for acute adjustment disorders and no diagnosis. A number of other results are presented and the authors discuss the implications.
The authors note in their discussion that this was a retrospective study and suggestive a prospective design as a basis for subsequent studies. I would argue also that this is an exploratory study in that the data is being used to characterise the different populations i.e. transfers and non-transfers. Thus it is likely that some of the correlations will produce false positives but the positive findings in this study can serve as testable hypotheses in subsequent studies. The other question to ask is to what extent are these results unique to a district general hospital in Greece. The researchers note that legislation following the study period changed the nature of transfers and the psychiatry service set-up and so it is reasonable to suppose that differing legislations in other countries might impact on the relationships identified. A finding I thought significant was that marital status was significantly different in both groups and again to what extent does culture interact with this relationship?
In summary I thought this retrospective study used a large dataset to generate testable quantitative hypotheses (e.g transfers are significantly more likely to be married than non-transfers) that would lend themselves to a prospective study or replication studies. The researchers have also generated a number of testable qualitative hypotheses (e.g the hypothesis involving the relationship between impulsive/disruptive behaviour, somatic illness and transfer) which can be supported both through strengthening of the quantitative findings on which they were based as well as qualitative approaches to either replication of confirmation through other paradigms.
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