[Psychiatric consultations in a general hospital]

[Brief intervention in psychiatric consultation]

This essay presents a perspective on intervention in psychiatric consultation based on the patient's subjective experience as supported by Kendler in 2005 in the American Journal of Psychiatry in his position against biological reductionism in psychiatry, distinguishing the psychic approach from the biological. The paper presents aspects of the setting and major features of the assessment in the consultation process, then proceeds to discussing principles of intervention as to specify dimensions of the psychiatric intervention in this particular context.

[Psychiatric consultations in a general hospital (III): Positions of the consultant]

Various clinical situations are described to illustrate the specific psychological assumptions toward which the psychiatric consultant is drawn in the course of daily liaison work in the general hospital. The purpose is to stress the usefulness and relevance of hitherto known models of consultation and models of patient-doctor relationships.

Delirium: 100 cases

One hundred consecutive cases of delirium seen in a psychiatric consultation service of a general hospital are discussed. Two thirds of the patients came from pneumology and cardiology since the hospital serves as a regional thoracic center. The frequency of delirium was 12.6% of consultations: three men were seen for every one woman; 80% of cases were over fifty years of age. The clinical aspects of delirium are studied according to DSM-III criteria to evaluate: a) the frequency of the symptoms, b) the temporal course of the disorder, c) any clinical characteristic of delirium linked with potential etiological factors, d) the role of anxiety.

[Psychiatric consultation at a general hospital (II): The problem of the patient with a somatic disorder]

The article presents the difficulties of the psychiatric consultation with patients having somatic complaints. A model of evaluation and intervention is proposed in which the link between the somatic complaint and the doctor-patient relationship is emphasized. A closer look at the manifest request for consultation often leads to interpreting the consultation as a symptom of the patient's relationship to his doctor. The consultation is often a confrontation with the hidden conflict of the patient embedded in his symptom, but actualized with his referring doctor. The focus is on the patient as the agent of his trouble. A clinical vignette is presented.