[Medico-sociologic analyses of the effectiveness of psychiatric consultation (author's transl)].

Certain observations led us to test the validity of the general assumption that hysterical syndromes occur more frequently among those inpatients who are refered to us from other departments of our faculty than among the psychiatric outpatients referred by private physicians. Such an assumption was verified in both hysterical neurotics and hysterical personality structures. Moreover, phobic neurotics, and depressive as well as infantile personality structures were underrepresented among the nonpsychiatric inpatients. These findings revealed a selection in psychiatric consultation. The social environment usually reacts to hysterical syndromes by showing vivid affective rejection; infantile syndromes are usually met by complementary protective attitudes. Phobic syndromes and depressive personality structures lead to withdrawal. We are inclined to believe that certain patterns of reactions of staff within the close communication network in a ward are responsible for the above mentioned selection. As far as therapy is concerned nonpsychiatric physicians deviated from the advice given by psychiatrists only in the case of psychogenic psychosyndromes. Despite specific psychiatric advice, their therapeutic measures tended to be uniform. Apparently the non-psychiatrist does not regard psychogenic psychosyndromes as diseases due to the lack of objective consideration. In summary: It appears that the neutral patient-clinician interaction is disturbed in the case of psychogenic psychosyndromes. This fact limits the effectiveness of "indications" and "therapy" in psychiatric consultation, especially if we bear in mind that psychogenic syndromes constitute by far the most prevalent psychic disturbances.