Psychotherapy in liaison psychiatry

Treatingpsychoses in the firsthalfof the 20th century 195s

837. Treatments in consultation liaisonpsychiatry

Chairmen: S Wessely, M Musalek

THE ROLE OF PSYCHOPHARMACOLOGY IN LIAISONPSYCHIATRY

G.A. Fava, Department of Psychology, University of Bologna. vlaleBerti Pichat 5. [-40127 Bologna. Italy

Psychotropic drugs prescription is the most frequent therapeuticmodality of consultation-liaison psychiatry in the general hospitalsetting. In many instances, it provides a substantial contributionto the management of acute psychiatric reactions and emergencies(e.g.•delirium). These interventionsare generallycircumscribedandshort-term. In other cases. however. the psychiatric consultant onlystarts a psychopharmacological treatment that should be continuedonce the patient is discharged from the hospital. The most importantexample is provided by use of antidepressantsdrugs in the medicalpatient. Psychotropic drug treatment in the settingof medicaldiseaseis a complex task that requires considerableskills and knowledgeofspecific interactions. The most viableapproach in general psychiatricsettings may not be the most suitable for medical patients. A fewclinical examples are outlined. Long-term psychopharmacologicalstrategies are likely to be successful as much as adequate followup is provided. The clinical value of liaison outpatient clinics isunderscored. Unfortunately. such services are currently neglectedbyconsultation liaison psychiatry in Europe.

CONSULTATION LIAISON(CL) PSYCHIATRIC ANDPSYCHOTHERAPY RESEARCH: TIME AS TREATMENTVARIABLE

T. Herzog. B. Stein and the European Liaison Workshop(ECLW).Dept. ofPsychosomatics and Psychotherapeutic Medicine.University of Freiburg, Hauptstr: 8. D·79I04 Freiburg, Germany

Objective: lime is a central but often neglected aspect of any psy­chological treatment and of particular importance under restrictedconditions of psychiatric or psychosomatic consultations in thegeneral hospital or practice. The following questions are being ad­dressed: I) How much time is realistically availableunder everydaypractice conditions? 2) What are the kind of effects that we can (andcannot) expect given the time available?3) What consequencesdoesthis have for CL treatment research and clinical practice?

Method: I) Examination for CL patterns of the ECLWdata baseof 14.717consecutiveconsultations across Europe [I] . 2) Reviewofpsychotherapy research on the differentialeffect of time with specialemphasis on de dose-effect paradigm [2] and the phase model [3].

Results: I) Most consultations are restricted to little more thantwocontacts (M=2.5: S0=2.6) and the total time availablefora givenepisode rarely exceeds two hours (M=121'.SD=16O'). In more than50% of all consultations the interventions are purely psychological.2) Many patients already respond to a diagnostic assessment andsome therapeutic effect can be expected for 50% of psychotherapypatients after eight sessions (2). Treatment response may be in threephases. each dependent on the other: progressive improvement ofsubjectively experienced well-being. reduction in symptomatology.and enhancement of life functioning [3]. Chronic distress symp­toms respond fastest and characterological symptomsslowest. Acutedistress symptoms show the highest average of patients recoveredacross doses [4].

Discussion: Research on psychological treatments in CL andclinical practice must both take on the reality of service delivery andthe time requirementsfor different therapeuticgoals into account.[I] Huyse F.J.. Herzog T., Malt UF.. Lobo A.& ECLW (1996) TheEuropean

Consultation Liaison Workgroup (ECLW)Collaborative study. I. GeneralOverview. Gen. Hosp, Psychiatry 18: 44-55.

[2] Howard KI. Kopta SM. Krause MS, Orlinsky DE(1986) Thedose-effectrelationshipin psychotherapy. Am Psycbo! 41 : 159-164.

[3] Howard KL, Lueger RJ. Mahng MS. MartinovichZ(1993) Aphase modelofpsychotherapyoutcome: causalmediationofchange.J.Consult ClinPsy­chol 61: 678-685.

(4) Kopta SM. Howard KI, Lowry JL, Beutler LE(1994) Patterns of symp­tomatic recovery inpsychotherapy. J Consult Clin Psychol 62: tOO9- 10I

PSYCHOTHERAPY IN LIAISONPSYCHIATRY

Michael Sharpe. University Department ofPsychiatry, Oxford

The main clinical areas of concern to the general hospital li­aison psychiatrist are those of medically unexplained symptoms.medical/psychiatric comorbidity and deliberate self harm. This pre­sentation will focus particularly on the application of cognitivebehaviourtherapy to these problems. The cognitivebehaviouralcon­ceptualisation offers an integrated approach ideally suited to liaisonpsychiatry. The strengths and weaknesses of cognitive behaviouraltherapy in the medical setting will be examined and the empiricalevidencefor its effectiveness reviewed. Finally the need for integrat­ing psychotherapeutic approaches into general medical care and theobstaclesencountered will be examined.

838. Treating psychoses in the first half ofthe 20th century

Chairman: THTurner

Abstractsnot received.

839. The long-term care and managementof psychoses in the elderly

Chairmen: R Howard, B Lawlor

PSYCHOSIS ANDBEHAVIOURAL DISTURBANCE IN THEELDERLY: PREVALENCE, PHENOMENOLOGY,DIFFERENTIAL DIAGNOSIS

Stephen M. Aronson. Psychiatry Education. OakwoodHospitalandMedical Center, Dearborn. Michigan 48124. USA: DepartmentofPsychiatry, University of Michigan Medical School. Ann Arbor,Michigan48109. USA

The management of behavioural changes in elderly patients is oneof the more difficult challenges in clinical medicine and calls onmultiple skills in the practitioner. However. adequate descriptionof symptoms, signs and comprehensive differential diagnosis mustprecededecisions regarding treatment intervention. Given the demo-