A comparison of two psychiatric service approaches: findings from the Consultation vs. Liaison Psychiatry-Study.

BACKGROUND: Psychiatric comorbidities are common in somatically ill patients. There is a lack of data that can provide clear insights into substantial comparative advantages of different Consultation/Liaison Psychiatry (CLP) services. METHODS: The Consultation versus Liaison Psychiatry-Study collected and analyzed data of 890 primarily somatically ill hospital inpatients presenting with psychiatric symptoms in a prospective observational study design. One group was treated via a liaison-model (LM) with regular consultation hours, the other via an on-demand-model (ODM) with individually requested consultations. RESULTS: Five hundred forty-five LM and 345 ODM patients were compared. Patients in the LM were, on average, older compared to the patients of the ODM. The vast majority (90.8%) of individuals for whom a psychiatric consultation was requested came from internal medicine. The most common diagnoses were affective disorders (39.3%), organic mental disorders (18.9%), alcohol-induced mental disorders (11.3%) and reactions to severe stress/adjustment disorders (10.4%). Organic mental disorders were significantly more common in patients seen in the LM (24.0% vs. 10.3%, p < 0.001) while affective disorders were more frequently diagnosed in the ODM (46.6% vs. 34.8%, p = 0.001). Patients seen in the ODM were, on average, more severely affected compared to patients seen in the LM and required more extensive treatment. 16.3% of ODM patients were regarded as potentially suicidal; among these, 3.5% were acutely suicidal and 12.8% latently suicidal. Any form of further treatment was required by 93.0% of ODM patients compared to 77.8% in the LM. Pharmacological treatment with benzodiazepines, usually used as short-term treatment, was more frequently prescribed to patients seen in the ODM while patients seen in the LM were more often started on selective serotonin reuptake inhibitors, indicative of long-term treatment. CONCLUSIONS: Patients in need of less acute treatment were considerably less common in the ODM. The data indicate a possible risk of such patients to remain unrecognized. A quasi-liaison model is recommended to be the best suitable and cost-effective way of providing psychiatric care to somatically ill patients with psychiatric comorbidities.

Results of contralateral anastomosis of microvascular free flaps in head and neck reconstruction.

OBJECTIVES: Despite various solutions to the issue of ipsilateral vessel-depleted neck in microvascular head and neck reconstruction, concrete data on its safety and implementation are scarce. This paper focuses on the feasibility and success rates of contralateral anastomosis in free flap reconstruction in the head and neck region. METHODS: This single-center retrospective study at a tertiary referral center includes all patients who underwent free flap reconstruction of the head and neck with contralateral anastomosis between January 1st, 2007 and February 28th, 2021. Primary objectives were frequency, success, and flap-associated complication rates. Secondary objectives were recipient vessels and flap type. RESULTS: Of 318 patients who underwent microvascular reconstruction, anastomosis was performed on the contralateral side of the neck in 32 patients (10.0%). Recipient vessels involved mainly the superior thyroid artery (74.2%; n = 23) and the facial vein (51.1%; n = 23). Thirty patients (93.8%) received a radial forearm free flap. Flap-associated complications occurred in 12.5% of included cases (n = 4): one partial flap necrosis (3.1%), one anastomotic insufficiency (3.1%), one venous thrombosis of the microvascular pedicle (3.1%), and one wound dehiscence (3.1%). All of these complications were resolved without complete flap loss. CONCLUSION: This study demonstrates that contralateral anastomosis is a successful and safe option in microvascular head and neck reconstruction, especially using a radial forearm free flap. Thus, anastomosing to the contralateral side of the neck can be advocated as a valuable option in the ipsilateral vessel-depleted neck.