10년간 정신과 자문의 변화양상

The Changing Patterns of Psychiatric Consultations in a Ten-year Period

A comparison was made as regards to referral patterns, diagnoses and consultants* recommendations etc. in psychiatric referrals from other departments, over each period of one year in 1976, 1981 and 1986. The findings are as follows. 1. The recent rate of referral was 2.66%, which showed 0.82% of increase in a 10-year period. 2. There has been nearly three-fold increase in referral among the age group over 60 years in a 10-year period. 3. Those patients were most frequently referred to Internal medicine in which the rate of referral has been steadily decreased * in contrast, it has been steadily increased to some degree in neurology. 4. The most frequent consultation requests were for unexplained somatic symtoms in 1976, but for psychiatric evaluation in 1986. There has been an increase in psychological symptoms but a marked decrease in suicidal attempt and bizarre behavior. 5. 71.8 % of the consultation patients in 1986 showed concurrent physical and psychiatric disorders, in which there has been a consistent increase. 6. The diagnoses of depressive disorders were the commonest uuua^nout a ten-year period. There has been a steady increase in organic mental disorders, but a consistent decrease in somatoform disorders. 7. In the distribution of physical symptoms, a consistent increase in endocrine-metabolic and musculoskeletal systems，and a consistent decrease in nervous and skin systems were observed. 8. The consultants’ recommendations of medication in 1986 were markedly increased in comparison to those in 1976，but a decrease in comparison to those in 1981. The transfer to psychiatry recommended has been steadily decreased, whereas follow-up evaluations have been routinely recommended since the establishment of the consultation-liaison service. The above results suggest that the rate of referral depends on the extent of consultants* activity and that education for medical students，interns, residents of other departments as well as residents of psychiatry is needed for effetive consultation-liaison activity.