scholarly journals Liaison psychiatry in detection and management of mental illness

1996 ◽  
Vol 20 (8) ◽  
pp. 466-469
Author(s):  
Margaret Semple ◽  
David Brown ◽  
Elizabeth Irvine
Keyword(s):  
Mental Illness ◽  
Mental Disorder ◽  
Alcohol Misuse ◽  
Psychiatric Service ◽  
Psychiatric Ward ◽  
Liaison Psychiatry ◽  
Deliberate Self Harm ◽  
General Psychiatry ◽  
Self Harm

Of 299 referrals to the Dundee general psychiatry liaison service over a six month period, deliberate self-harm (DSH) was the reason in 83%. An overdose was used in 94%, and alcohol misuse occurred in 56% of DSH episodes. Fifty-two per cent of referrals were followed up by the general psychiatry service; 31% of these were admitted directly to a psychiatric ward, 10% on a compulsory basis. At follow-up, 23% remained in contact with the Dundee psychiatric service. Twenty-three per cent of all patients referred to the Area Alcohol Service (AAS) were in contact with it six months later. Clearly, liaison psychiatry has a role in detection and management of significant mental disorder.

scholarly journals Comparison of the assessment by doctors and nurses of deliberate self-harm

2003 ◽  
Vol 27 (02) ◽  
pp. 57-60
Author(s):  
Sian Nerys Weston
Keyword(s):  
Mental Illness ◽  
Psychiatric Nurses ◽  
Deliberate Self Harm ◽  
Use Of Resources ◽  
Community Psychiatric ◽  
Significant Difference ◽  
Referral Practices ◽  
Self Harm ◽  
Doctors And Nurses

Aims and Method To compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment. Results There was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)). Clinical Implications Further research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.

scholarly journals Comparison of the assessment by doctors and nurses of deliberate self-harm

2003 ◽  
Vol 27 (2) ◽  
pp. 57-60 ◽  
Author(s):  
Sian Nerys Weston
Keyword(s):  
Mental Illness ◽  
Psychiatric Nurses ◽  
Deliberate Self Harm ◽  
Use Of Resources ◽  
Community Psychiatric ◽  
Significant Difference ◽  
Referral Practices ◽  
Self Harm ◽  
Doctors And Nurses

Aims and MethodTo compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.ResultsThere was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).Clinical ImplicationsFurther research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.

scholarly journals Emergency and liaison psychiatry

1990 ◽  
Vol 14 (9) ◽  
pp. 548-549
Author(s):  
Alison Gourdie ◽  
Vivienne Schnieden
Keyword(s):  
Psychiatric Service ◽  
Psychiatric Services ◽  
Liaison Psychiatry ◽  
College Hospital ◽  
Deliberate Self Harm ◽  
Accident And Emergency ◽  
University College ◽  
Self Harm ◽  
Psychiatric Staff

The post of Emergency and Liaison Registrar in the Bloomsbury Rotation was created in 1988 to provide a psychiatric service at University College Hospital, London, in the Accident and Emergency (A&E) Department and to the A&E Ward for assessment of deliberate self harm (DSH) cases. It incorporated existing commitments of liaison to the UCH wards and provision of urgent psychiatric assessments. The service had previously been shared among a number of psychiatric staff. The registrar can thus be seen as a ‘central pivot’ within the District Psychiatric Services.

Assessment and Aftercare for Deliberate Self-Harm Patients Provided by a General Hospital Psychiatric Service

Crisis ◽  
2003 ◽  
Vol 24 (4) ◽  
pp. 145-150 ◽  
Author(s):  
Camilla Haw ◽  
Keith Hawton ◽  
Linda Whitehead ◽  
Kelly Houston ◽  
Ellen Townsend
Keyword(s):  
Open Access ◽  
General Hospital ◽  
Psychiatric Service ◽  
Deliberate Self Harm ◽  
Patients Satisfaction ◽  
Assessment And Treatment ◽  
Self Harm

Summary: We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.

Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort

2016 ◽  
Vol 46 (16) ◽  
pp. 3397-3405 ◽  
Author(s):  
K. Beckman ◽  
E. Mittendorfer-Rutz ◽  
P. Lichtenstein ◽  
H. Larsson ◽  
C. Almqvist ◽  
...  
Keyword(s):  
Mental Illness ◽  
Young Adults ◽  
Mental Disorder ◽  
Psychiatric Hospitalization ◽  
Adverse Outcome ◽  
Long Term Follow Up ◽  
History Of ◽  
Self Harm

BackgroundSelf-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.MethodWe conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.ResultsSelf-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9–20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8–6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7–3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.ConclusionWe found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

A Psychiatric Liaison Service in a General Hospital Referrals and Their Appropriateness

1994 ◽  
Vol 39 (5) ◽  
pp. 141-144 ◽  
Author(s):  
D.J. Hall
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Psychiatric Problem ◽  
Prior Training ◽  
Liaison Psychiatry ◽  
Deliberate Self Harm ◽  
Intensive Training ◽  
Psychiatric Referral ◽  
Self Harm

Referrals to a liaison psychiatry service, based in a District General Hospital, were studied over a six month period. 190 [89%] of the 214 referrals were for assessment following an episode of deliberate self harm. An excess of these referrals were male [57%] and a large proportion particularly of the males [36%] were diagnosed as having a significant alcohol problem. Many were felt to have no significant psychiatric problem [31%], and a large proportion were discharged with no psychiatric follow-up [28%]. Patterns of diagnosis and disposal differed between the sexes. Referring junior medical staff when asked to give their opinions on the likely management and overall need for psychiatric referral of patients were found to reach reasonable agreement with the assessing psychiatrist, even without prior training, and to be more cautious in their assessment. In many centres the trend is towards selective referral of deliberate self harm patients, and this appears a safe and appropriate development which can be achieved without intensive training or major alterations to working patterns, and which will result in modest but important reductions in inappropriate referrals.

Thirteen-year follow-up of deliberate self-harm, using linked data

1998 ◽  
Vol 172 (3) ◽  
pp. 239-242 ◽  
Author(s):  
David J. Hall ◽  
Fiona O'Brien ◽  
Cameron Stark ◽  
Antony Pelosi ◽  
Helen Smith
Keyword(s):  
Linked Data ◽  
Attempted Suicide ◽  
Alcohol Misuse ◽  
Median Number ◽  
Contributory Factor ◽  
Data Set ◽  
General Hospitals ◽  
Deliberate Self Harm ◽  
Self Harm

BackgroundWe describe a national cohort of individuals surviving an episode of deliberate self-harm (DSH). Subsequent admissions for DSH and mortality over the following 13 years were studied.MethodIn 1981, 8304 individuals were discharged from Scottish general hospitals with a diagnosis of attempted suicide (E950–959). They were followed-up to the end of 1994 using the Scottish Linked Data Set. Mortality was compared to the Scottish population using person-years analysis.Results2624 people (31.6%) were readmitted with further episodes of DSH. The median number of readmissions was I, range 1–137. The observed: expected ratio for all-cause mortality was 2.26 (95% CI 2.13–2.26). One hundred and sixty-eight people (2%) died from suicide, and 46 (0.6%) from undetermined causes. The observed: expected ratio for suicide plus undetermined deaths was 12.17 (95% CI 10.64-13.91). Accidental deaths in men and homicide deaths in men and women were elevated. The pattern of deaths from other causes suggested that alcohol misuse was a contributory factor.ConclusionsPeople admitted to general hospitals in Scotland after attempted suicide are at high risk of readmission for further episodes of DSH. Long-term follow-up of such large cohorts is impractical, but services should review the scope for intervention in alcohol misuse following DSH.

A Clinical Study of Violence in Patients Referred on a Form I to a General Hospital Psychiatric Unit

1988 ◽  
Vol 33 (8) ◽  
pp. 711-715 ◽  
Author(s):  
A.J. Cooper
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Clinical Study ◽  
Hospital Stay ◽  
General Hospital ◽  
Alcohol Misuse ◽  
Psychiatric Ward ◽  
Violent Behaviour ◽  
Initial Management ◽  
Retrospective Examination

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.

scholarly journals Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

2004 ◽  
Vol 185 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Daniel Louis Zahl ◽  
Keith Hawton
Keyword(s):  
Relative Risk ◽  
Suicide Risk ◽  
Single Episode ◽  
Deliberate Self Harm ◽  
Young Females ◽  
Follow Up Study ◽  
Increased Risk ◽  
Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

The effect of referral for brief intervention for alcohol misuse on repetition of deliberate self-harm: an exploratory randomized controlled trial

2010 ◽  
Vol 40 (11) ◽  
pp. 1821-1828 ◽  
Author(s):  
M. J. Crawford ◽  
E. Csipke ◽  
A. Brown ◽  
S. Reid ◽  
K. Nilsen ◽  
...  
Keyword(s):  
Alcohol Consumption ◽  
Health Information ◽  
Brief Intervention ◽  
Primary Outcome ◽  
Alcohol Misuse ◽  
Controlled Trial ◽  
Information Leaflet ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Secondary Outcomes

BackgroundReferral for brief intervention among people who misuse alcohol is reported to be effective but its impact among those who present to services following deliberate self-harm (DSH) has not been examined.MethodConsecutive patients who presented to an Emergency Department (ED) following an episode of DSH were screened for alcohol misuse. Those found to be misusing alcohol were randomly assigned to brief intervention plus a health information leaflet or to a health information leaflet alone. The primary outcome was whether the patient reattended an ED following a further episode of DSH during the subsequent 6 months. Secondary outcomes were alcohol consumption, mental health and satisfaction with care measured 3 and 6 months after randomization.ResultsOne hundred and three people took part in the study. Follow-up data on our primary outcome were obtained for all subjects and on 63% for secondary outcomes. Half those referred for brief intervention received it. Repetition of DSH was strongly associated with baseline alcohol consumption, but not influenced by treatment allocation. There was a non-significant trend towards the number of units of alcohol consumed per drinking day being lower among those randomized to brief intervention.ConclusionsReferral for brief intervention for alcohol misuse following an episode of DSH may not influence the likelihood of repetition of self-harm. Longer-term interventions may be needed to help people who deliberately harm themselves and have evidence of concurrent alcohol misuse.

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