경북대학교병원의 정신과 자문 현황에 대한 임상적 고찰

A Clinical Study of Psychiatric Consultation at Kyungxjok National University Hospital

The study was conducted to evaluate the current status of consultation at Kyungpook National University Hospital. The subjects of this study was 223 patients as an initial group and 138 patients as an secondary ; The patients were admitted at this hospital and referred for psychiatric consultation between Jan. 1，1992 and Dec. 31, 1992. A nd the authors also surveyed the opinion o f nonpsychiatric doctors in connection with current consultative activities by the consultation psychiatrists. The results were as follows : 1) The percentage of the patients referred for consultation in all inpatients during one year was 1.07%. 2) Males accounted for the majority as the patients consulted(61.0%) and the ages between 30s and 50s showed higher frequency in age distribution. 3) The department that requested most consultation was internal medicine followed by general surgery, neurology and chest surgery. The consultation rate by a department was in such order as neurology, internal medicine and chest surgery. 4) The order of frequency in terms o f reasons for consultation was changes in consciousness, somatic symptoms without laboratory findings, excessive emotional reaction and the cases with previous psychiatric history. 5) In psychiatric diagnoses, the order ran as organic mental disorder, dysthymia and anxiety disorder. 6) The priorities of the recommendation by psychiatrists were medication only, medication with diagnostic procedure, continual observation and exclusive psychotherapy. 7) The findings of the survey through questionaires were (1) The cases believed to have psychiatric problems were found to be 1—4% (highest) ; More than 30% o f the patients with problems were referred to for psychiatric consultation, which received the highest response in the questionaire and the half answered they referred less than 10% of the patients for consultation. The most outstanding reason for requesting for psychiatric consultation was the past psychiatric history and to differentiate organic factor from psychologic factor. (2) The consultees’ dissatisfaction with the current psychiatric activities and the patients’ misconception of the psychiatric department hinders the efforts to request for consultation. The cases with psychiatric problems which have not been referred to psychiatric department for consultation was either treated at the discretion of the doctors in charge or been recommended to visit the psychiatric department after discharge, which indicated lack of discreet manage ment. (3) In the present consultation system, half the consultees feel satisfied, the understanding on the part o f the patients have been enhanced through consultation and the psychiatric ways of treatment have helped in clinical practice. O n the other hand, dissatisfactions were found in the answers in questionaires were not concrete, inept in terms o f real application, not rapid enough and lack in the sincerity in follow-up. (4) As to the psychological effects on physical changes, most consultees were found to have reached significant understanding, recognizing the necessity of regular clinical and academic exchanges with psychiatrists. Other requests from the current consultation status call for rapid transfer to psychiatric department, more through explanation to patients or their guardians, consultation on special psychiatric fields including pediatric psychiatry and drastic intervention in the cases of terminal cancer.