The severity of a patients psychopathology23

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In the European study described above, patients seen by CL services included those with delirium, dementia, psychoses, mood and anxiety disorders, somatoform disorders, less common diagnoses such as eating disorders, no psychiatric diagnosis, and problems of coping, and those who were not alert enough for a psychiatric diagnosis to be made. Those findings closely follow the classification in ICD-10 and DSM-IV, and reflect the broad range of referable disturbances.

The severity and type of psychopathology varied with the physical diagnostic profile and the department in which they were treated. Patients were seen with injuries, cancer, other physical diagnoses, and no clear physical illness. They were seen in surgical, neurological, and medical units, and, less frequently, in obstetrics/gynaecology and dermatology units. This pattern reflects the important clinical differences between patients referred by surgical and medical departments. Surgical patients generally have a clear diagnosis and usually require urgent consultations, often for the prevention of substance use withdrawal or the treatment of delirium pre- or postoperatively. In contrast, patients from medicine and neurology departments usually present with diagnostic dilemmas.

In making clinical decisions, CL psychiatrists have to take into account impairment of judgement, the level of behavioural disturbances, and the clarity of the physical diagnosis. In the European study, about a third of patients referred for reasons other than attempted suicide were 65 years of age or older and about 12 per cent were 75 years of age or older. The elderly often have multiple diseases, and several related impairments and handicaps. These problems, and any age-related dementia, make these patients more vulnerable for delirium. Patients with chronic physical disease have a higher incidence of psychiatric disorders, specifically affective disorders. Patients with an additional psychiatric disorder use general health-care services more frequently, they are admitted more often and for longer, and they make more outpatient as well as emergency room visits.(24,25)

The referred population is considered further in Cha2t§1..5.6.

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