Comobid Medical and Psychiatric Disorders: Clinical and Economic Impact and Systems of Care
Department of Psychiatry, Nippon Medical School Musashi Kosugi Hospital
Psychiatric disorders are more commonly seen in the general medical outpatient and inpatient settings than in community samples. This group is at particular risk for resistance to general medical and psychiatric treatment, increased complications of disease, high use of health care services, and disability. Several randomized, controlled studies have shown that integrated medical and psychiatric treatment is clinically and economically effective. For this reason, "integrated" physical and mental-health primary care models and inpatient models should receive greater attention as we attempt to improve the quality of care and health outcomes for patients with comorbid medical and psychiatric disorders. Because there are too few consultating psychiatrists to deliver services to the many medically ill patients with psychiatric disorders, we should consider new efficient and effective proactive approaches in the future rather than relying on the current reactive psychiatric consultation system. For cost-effective treatment in these budget- and manpower-limited environments, a multidisciplinary team approach, which coordinates psychiatric service delivery under specially trained psychiatrists, should be used. Specially trained psychiatrists should be multidisciplinary team leaders who support and encourage interventions by other behavioral health specialists with selected skills.
日医大医会誌 2008; 4(4), 175-180
consultation-liaison psychiatry, general hospital psychiatry, patient care team, Mental Health Services/organization & administration/utilization
Yasuhiro Kishi, Department of Psychiatry, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan