Yleissairaalapsykiatrinen konsultaatio Suomessa : yleissairaalapsykiatriseen konsultaatioon ohjautuvat työikäiset ja vanhukset
1University of Oulu, Faculty of Medicine, Department of Psychiatry
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|Persistent link:|| http://urn.fi/urn:isbn:951425466X
|Publish Date:|| 1999-11-24
|Thesis type:||Doctoral Dissertation
|Defence Note:||Esitetään julkisesti tarkastettavaksi Oulun yliopiston lääketieteellisen tiedekunnan suostumuksella psykiatrian klinikan juhlasalissa, Peltolantie 5,16. joulukuuta 1999 klo 12.
Docent Teuvo Koskinen
Professor Heimo Viinamäki
General hospital psychiatry operates between the somatic and psychiatric approaches concerning the treatment of patients, combining knowledge from both somatic and psychiatric medicine. To establish its position, the general hospital psychiatry has to specify its role and means when rendering services.
This study revealed how consultation had been arranged in six Finnish polyclinics of general hospitals. The goal was to find out which types of patients were referred to the consultation of the general hospital psychiatry and the extent of collaboration of the consulting psychiatrist with colleagues from other medical disciplines. Moreover, the focus of attention was on whether there were operational differences between the polyclinics of the University Hospital of Oulu and other hospitals. The work was also addressed to probing operational differences, if any, pertaining to people under or over 65. Additionally, one aspect to be clarified was how requests for psychogeriatric consultations and the responses of the consulting psychiatrists had developed during the five years period of the study.
This study was part of a broad European Consultation Liaison Working Group effort aimed at clarifying the organization of general hospital psychiatry in 56 units in 11 European countries. The Finnish material consisted of 1255 patients, of whom 202 were over 65. The research methods applied here were psychiatric interviewing of clinical patients, and filling in of data collection forms following the instructions of the ECLW Group.
The current work revealed that the number of psychiatric consultations was less than expected considering the incidence of psychiatric symptoms among somatically ill patients. Of the general hospital patients, elderly people were especially underrepresented. More than 90% of the patients who had a psychiatric consultation were diagnosed with a psychiatric problem. Thus the general hospital made available psychiatric treatment via psychiatric consultation, with a recommendation for future psychiatric care for more than half of the patients. However, one third of the patients under 65 and quarter of those above that age had already had on going psychiatric treatment. In view of this type of situation the position of the general hospital appears problematic. The object of consultation was in 90% of the cases the patients themselves, but in Oulu, almost half of the consultations were due to the personnel of the somatic disciplines in charge of the of the patients. The action mode in separate general hospitals was connected to established traditions, although the history of general hospital psychiatry is short and faces constraints put forward by the somatic hospitals. Collaboration between psychiatric and somatic disciplines was facing increasing difficulties during the five years observation period, probably due to economic recession.
Acta Universitatis Ouluensis. D, Medica
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