Consultation-liaison psychiatry in a chronic care hospital: the consultation function

This paper describes psychiatric consultations in a chronic care and rehabilitation hospital. It reports that although 60% of consultation requests were for depression, only 8.6% of patients seen received a diagnosis of Affective Disorder. Many patients seen, 51.4%, did not receive a formal psychiatric diagnosis and were found not present problems in adapting to chronic disabling illnesses. These problems included difficulties with convalescent and rehabilitative tasks, manifested by pathological behaviours such as persistent denial and pseudoindependence, as well as characteristic reactions to specific catastrophic illnesses. It is important to recognize that in this population psychotropic medication should be used judiciously, and interpersonal and milieu approaches should be emphasized. It is also important for the psychiatric consultant to maintain an optimistic, therapeutic attitude in what often seem to be rather foreboding consultation settings.