Reasons for referral and diagnostic concordance in Consultation Liaison Psychiatry : A descriptive cross-sectional study from a tertiary care hospital in North India

BACKGROUND: Consultation-liaison (CL) psychiatry is a young and upcoming subspeciality of psychiatry involving application of skills and knowledge of mental health professionals for evaluation and treatment of emotional and behavioural problems in patients with medical, surgical and other problems. AIM: This study aimed to evaluate the reason for referrals and diagnostic concordance amongst referring consultant and the CL psychiatrist. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted over a period of one year and a total of 786 inpatient referrals were assessed for reason of referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatrist. RESULTS: In 43.66% cases, specific psychiatric diagnosis/symptoms were mentioned by the referring consultant; commonly including substance dependence (19.60%), anxiety (9.16%), depression (6.49%). Delirium was the most common diagnosis made by the CL psychiatrist (22.65%) followed by anxiety disorder (15.90%), alcohol dependence (15.78%) and depressive disorder (14.50%). Diagnostic concordance between the referring consultant and CL psychiatrist was slight (K < 0.2) for delirium, fair for depressive disorder (K = 0.26), substantial for symptoms suggestive of anxiety disorder (K = 0.61) and substance use disorder (K = 0.70) and almost perfect agreement was seen for intentional self-harm (K=0.89). CONCLUSIONS: The present study suggests that the most common primary psychiatry diagnosis was delirium, followed by anxiety disorder. The overall diagnostic concordance was poor for delirium, fair for depressive disorder, substantial for anxiety symptoms and substance use disorder, and excellent for intentional self-harm.