Diagnostic problems in liaison psychiatry and the ICD-10

Liaison psychiatry is an area fraught with diagnostic problems due to the complex overlap between psychopathology and physical illness. The worst difficulties arise where patients also exhibit maladaptive behaviour such as deliberate self harm. In these situations a number of professionals may become involved including physicians, psychiatrists and social workers. As the level of complexity of a case increases an accurate formulation and diagnosis become essential. The International Classification of Diseases 10th revision (ICD-10) in its 1986 draft is currently being field tested. Chapter V (F) 'Mental, Behavioural and Developmental Disorders, is a descriptive clinical psychiatric classification, which will soon be incorporated into a multi-axial schema. This draft classification was used to make a diagnosis for 50 consecutive referrals to a liaison psychiatrist working in a large District General Hospital. This report assesses the applicability of ICD-10, V (F) in liaison psychiatry, and also comments on the characteristics of this group of patients. This leads to a discussion of the requirements for the other axes that would be needed to produce a multi-axial schema capable of allowing complex problems to be accurately formulated.