Somatization: the concept and its clinical application.

Somatization, a tendency to experience and communicate somatic distress in response to psychosocial stress and to seek medical help for it, poses a major medical, social, and economic problem. It is most often associated with depressive and anxiety disorders and constitutes the core of somatoform disorders. Its persistent form is especially costly and difficult to prevent and manage. The author discusses the prevalence, clinical manifestations, etiology, and treatment of somatization and presents a critical review of somatoform disorders.

Psychosomatic medicine in the seventies: an overview.

The author discusses the theoretical, investigative, clinical, and teaching aspects of psychosomatic medicine in the seventies. Major research and clinical developments are discussed in relation to key theoretical postulates and concepts. The rapidly expanding field of psychosomatic medicine is far more divant than ever before. Its hallmarks include a multifactorial approach to the study of health and disease, formulation of testable hypotheses and their careful validation, concern with the clinical applicability of research, and development of integrative theories. Current advances in the field have far-reaching inplications for medicine, psychiatry, and the behavioral sciences.

Psychiatric consultation: concepts and controversies.

There are two major models of consultation in the field of psychiatry, differing in their goals, participants, settings, and methods. The psychiatric-therapeutic model entails provision of optimal care for the individual patient; the community mental health model involves provision of assistance to mental health caregivers. The author believes that to enhance the value of consultation the consultation should restrict his or her role to that for which he or she has been trained. Current social needs, coupled with a limited supply of consultants, suggest that psychiatric consultation should be provided within comprehensive health care systems. There is a pressing need to clarify the concepts of formulations concerning the criteria of outcome of psychiatric consultation so that evaluation of its effectiveness can be advanced.

Transient cognitive disorders (delirium, acute confusional states) in the elderly.

Transient cognitive disorders (delirium and pseudodelirium) are highly prevalent among the elderly, especially those with brain damage. Delirium is a common feature of physical illness or drug intoxication in elderly patients and requires prompt medical attention. While potentially reversible, delirium may herald death. Pseudodelirium may be induced by psychosocial stress or accompany a functional mental disorder. Transient cognitive disorders must not be confused with dementia, a chronic syndrome. The author discusses clinical features, etiology, pathogenesis, diagnosis, and treatment of delirium and related transient disorders of cognition in the elderly.

A new look at organic brain syndromes.

The author points out that organic mental disorders have been neglected for the past 30 years and that the classification of these disorders is obsolete. On the basis of the new explicit criteria formulated in DSM-III, the growing recognition that organic disorders constitute a major public health problem, the advances made in the neurosciences, and the current focus on chronic diseases and critical care medicine, however, he predicts an increase in interest in organic mental disorders in the coming years. He outlines the new classification system, suggesting that it should stimulate research and thus lead to sorely needed therapeutic advances.

Holistic-medical foundations of American psychiatry: a bicentennial.

American psychiatry has reached its bicentennial. Holistic-medical foundations have been its hallmark, inspiration, and source of preeminence. Incorporated by psychobiology, the American school, they enabled the growth of psychiatry as a medical specialty and scientific discipline and stimulated unparalleled growth of general hospital psychiatry, psychiatric research and teaching, and psychosomatic medicine and liaison psychiatry. Holistic conceptions, a product of a democratic system and the liberal mind, continue to provide the best framework for psychiatry and an antidote to dogma and fanaticism.

The need to integrate liaison psychiatry and geropsychiatry.

About 30% of medical and surgical inpatients are 65 years old or older, and the latter account for about 30% of referrals for psychiatric consultation. Delirium, dementia, and depressive and anxiety disorders are prevalent in these patients, and liaison psychiatrists are forced to function as (untrained) geropsychiatrists. The author proposes that liaison psychiatrists take over the role of geropsychiatric consultants to elderly medical and surgical inpatients and that fellowships in geropsychiatry-liaison psychiatry be funded to provide appropriate training. Integration of liaison psychiatry and geropsychiatry in general hospitals would provide needed service for the elderly and enhance the stature of liaison psychiatry.

Liaison psychiatry: referral patterns and their stability over time.

The authors analyzed referral patterns for psychiatric consultation from medical and surgical wards on the basis of 2,000 referrals. They found that patients' demographic characteristics were stable over time. The diagnoses of depressive disorders and organic brain syndromes consistently predominated. Other studies have shown similar findings. The authors stress the importance of research on depressive disorders in the physically ill and of teaching the diagnosis of organic brain syndromes. They also underscore the value of the liaison nurse.

Update on delirium.

Delirium is a common syndrome in hospitalized medical and surgical patients and in those seen in emergency departments. It is particularly common in the demented elderly patients. To prevent it, for example by avoiding polypharmacy in the elderly, is important. It is most important to diagnose delirium early and to search for its cause without delay as this may be life-saving in some patients and may help avoid injury in others. This syndrome, long neglected by investigators, calls for vigorous research to establish its epidemiology, pathogenesis, and long-term outcome.

Consultation-liaison psychiatry: past failures and new opportunities.

Although the concept of liaison psychiatry is not new, progress in its development has been slow. Obstacles to its development are examined and new prospects discussed in light of combined economic, political, and social forces which provide the opportunity for an expanded scope of clinical, teaching, and research activities.

Consultation-liaison psychiatry: the first half century.

Consultation-liaison psychiatry is over 50 years old. Its main goal has been to bring medicine and psychiatry closer together so as to improve patient care in its psychosocial and psychiatric aspects. The history of this field may be divided into four overlapping phases: the beginnings, the organizational phase, the phase of conceptual development, and the phase of rapid growth. The highlights of each phase are outlined. The author concludes that C-L psychiatry has achieved the status of a full-fledged subspecialty of psychiatry, one whose main contribution has been to draw attention of clinicians and researchers to psychosocial aspects of physical illness, and to the psychiatric complications of such illness and of the medical and surgical therapies.

Discussion: liaison psychiatry and the quest for new knowledge.

Liaison psychiatry has become a subspecialty of psychiatry. This Symposium illustrates a new trend for liaison psychiatrists to become involved in collaborative research at the interface of medicine and psychiatry. The contributors have shown how such research can be organized with help of consultation-liaison clinical work. Liaison psychiatry's future will depend on the provision of competent clinical service and high quality research of the type reported here.

Delirium and other organic mental disorders in a general hospital.

The authors analyze 133 cases of organic mental disorders (OMDs) from a total of 771 patients who were referred for psychiatric consultation from a general hospital. The cases represent a 2-year referral period which began July 1, 1980, when DSM-III criteria were instituted. Delirium and dementia are most commonly diagnosed and features of these, particularly in the geriatric population, are described. Delirium was more frequent in patients with multiple medical problems, was an indicator of poor prognosis having the highest mortality rate, and was usually undiagnosed by the referring physician.