Preface

Summary

The provision of psychiatric services to general hospitals has increased considerably during the last 10 years. New consultant posts have been created, multidisciplinary teams have been established and junior doctors are acquiring experience in an area of psychiatry hitherto denied them. Clinical psychologists have long made significant contributions to this field. They have recently been joined by an expanding number of nurses who have made major improvements particularly to the management of patients with acute behavioural disturbances and of those who have deliberately harmed themselves. But expansion has been uneven, concentrated on university-linked hospitals and dependent on the creative energies of individual clinicians. Many district hospitals in the UK and elsewhere still have a very rudimentary psychiatric service even though the high prevalence of psychiatric disorders in general hospital patients is now widely acknowledged.

This area of clinical practice is known by various terms – liaison psychiatry, consultation-liaison psychiatry, psychological medicine or psychosomatic medicine. Indeed the latter term has been revived by the American Board of Medical Specialties which now recognizes it as a new psychiatric subspeciality with its own training programme and certification examination. Whatever term is used in a particular country the clinical problems are similar, being concerned with the diagnosis and management of patients with combined medical and psychiatric problems and those whose psychiatric disorder presents with physical symptoms. The ultimate goal is to improve the quality of care and the outcome of patients attending general hospitals.