Consultation-liaison psychiatry: stability and change over a 10-year-period

Few long term studies have reported observations of changes over time with Consultation-liaison (C-L) populations. This is a longitudinal observational study of a tertiary care psychiatric C-L-service over a ten-year-period (1988-1997) using a standardized computerized clinical database to examine 4,429 consecutive referrals. Sociodemographic variables, relative consultation rates, reasons for referral and psychiatric diagnoses, apart from a shift from adjustment disorders with depressed mood to major depressive disorders within the depressive syndrome group, did not demonstrate significant changes during the study period. Levels of psychosocial and somatic functioning of referred patients decreased. Changes occurred in the pattern of C-L-psychiatric recommendations, e.g., in the prescription of antidepressants where tricyclic antidepressants were replaced by newer agents such as the selective serotonin reuptake inhibitors. Consulting psychiatrists were more likely to refer to private psychiatrists to follow patients, and more patients were transferred to inpatient psychiatric units. Due to a decrease in length of stay over the ten year observation period, the correlation of lagtime (the time from admission to the hospital until referral to C-L psychiatry) and length of stay decreased from very strong to moderate.