Changes in patterns of psychiatric referral in a German general hospital: results of a comparison of two 1-year surveys 8 years apart.

The aim of this study was to investigate the issues of changes in patterns of referral and interventions and of consistency of psychiatric diagnoses assigned by a psychiatric consultation-liaison service in a general hospital over an 8-year period. We compared two 1-year surveys 8 years apart. Survey A comprised 713 referrals in 1990, and Survey B included 1025 consecutive new consultations in 1998. Data pertained to demographic characteristics, source of referral, reason for referral, psychiatric diagnosis according to DSM-III-R, and intervention. Our study demonstrated significant changes in diagnostic characteristics and in patterns of referral and intervention over the years. Changes in source of referral and psychiatric diagnoses were associated with the increasing involvement of clinical psychologists and specialists in psychosomatic medicine. Also, surgeons and physicians were increasingly aware of psychiatric morbidity in medical-surgical populations. Modern psychopharmacological treatment approaches resulted in a higher rate of recommendation of psychotropic medication. To ameliorate the provision of psychiatric care for general hospital patients, the need for a biopsychosocial conceptual framework at the interface of psychiatry and medicine in general hospitals should be underscored.