Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 54

I ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS
provided by human imagination at the cost of both patients and
practitioners. The human imagination is defined as the image-
making faculty within the individual and its clinical implications are
laid out by drawing on sources in medicine, philosophy, dynamic
psychiatry, and mystical theology. The method is phenomeno-
logical, i.e. the imagination is explored as a structure of experience
presenting itself to consciousness. Its clinical function will be
examined by using examples from clinical work and the history of
psychological healing in Nordic countries. It is concluded that the
imagination is a powerful alliance to the psychiatrist/therapist, if
and only if,? he/she is skilled enough to make use of it in clinic.
S - XXV / 1 Saturday 16/8, 11:00-12:30
Models for the organization of consultation-liaison
psychiatry in the general hospital
Lars Wahlström, MD, överlakare, Psychiatric Dept., Huddinge University Hospital,
S-141 86 Stockholm, Sweden
lars. wahlstrom@slpo.sll.se
Background: Different models of consultation-liaison (C-L) psychi-
atric work have consequences as to which patient populations are
targeted, for research as well as for the prestige of psychiatry in the
somatic specialties. If C-L psychiatry is to play a role in the future,
the organization of aclivities has to be compatible with the complex
problems facing the C-L psychiatrist.
Metliod: A reflection based upon a recent questionnaire sludy of
the organization of C-L services in Sweden and comparison with
the ECLW collaborative study.
Results: Tliere is no common model for how to organize C-L
psychiatric activities.
Conclusion: The following themes will be touched upon:
• The basic importance of personal relations, continuity and
accessibility.
• Probably most units in the Nordic counlries are affiliated
with the psychiatric departments. What are the advantages
and disadvantages of this compared to an affiliation with the
general hospital deparlments or a completely independent
status?
• Which are the consequences of, on the one hand integration,
or, on the other hand, a separation of emergency and elective
activities?
• Perspectives on financing.
S-XXV/2 Friday 16/8,11:00-12:30
Working with consultation-liaison psychiatry in a
neurology clinic
Giirun Kydcn. MD, Psykiatriska kliniken, SLPO, Huddinge Universitetssjukhus,
Psykiatriska kliniken, M56, S-141 86 Stockholm, Sweden
goran. ryden@slpo.sll.se
During the last year, 2002, the psychiatric consultation unil received
64 referrals from the neurologic clinic. 16% of these were solved
without seeing the patient; 68% resulted in one consultation. Only
a few cases were seen more than 3 times. About one third were
emergency referrals.
The most common reasons for referral were depression (25%),
anxiety, suicide risk evaluation, psychosis, and somatization. Direct
pharmacologic issues were more uncommon. Only one case con-
tained a wish that the patient should be taken over. Compared to
the total amount of referrals from the whole of Huddinge Univer-
sity Hospital, the neurologist seems to use the psychiatrist in the
evaluation of the patient’s problem as whole and presumed ele-
ments of somatization and less in direct wishes for different kinds of
administrative help.
Among the preliminary diagnoses that were evaluated by the
psychiatrist depression was most common (20%) The organic dis-
orders, including delirium states and dementia, were diagnosed in
19%, anxiety in 15% and maladaptive stress disorder in 10%.
Somatization is a common symptom but surprisingly few patients
had a somatoform disorder. Another unexpected finding was that
the difference in diagnostic distribution compared to the hospital as
a whole was almost ignorable. GAF was at average 46,4 with con-
siderable difference between the wards (from 35 to 56 at average).
Crucial elements for consultation-liaison work seem to be colle-
gial relations lo doctors and nurses at the wards, continuity and that
the psychiatrist is easily available.
Two cases are presented as examples of how the consultative work
is assessed; one patient with cerebral abscess and panic disorder and
one patient with cerebral paralysis and pathologic laughter.
S - XXV / 3 Friday 16/8, 11:00-12:30
Debriefing - is it useful in crisis intervention?
0ivind Ekcberg. Professor, Department of Behavioural Sciences in Medicine, PO
Box 1111 Blindern, NO-0317 Oslo. Norway. Erlend Hem.
oivind.ekebers@basalmed.uio.no
Background: Traumatic events are an important source of psycho-
logical morbidity. Psychological interventions such as debriefing
have been increasingly used to treal psychological trauma. How-
ever, in 1998, a systematic Cochrane review concluded that single
session individual debriefing did not reduce psychological distress
nor prevent the onset of PTSD. The implication of this is not that
psychological debriefing per se is ineffective. A major problem in
previous research is that debriefing has been used for different
interventions, e.g. in terms of number of sessions and individual or
group treatment. An inclusion criterion in the Cochrane review is
individual one-session intervention. Tliis kind of intervention is
contrary to most clinical thinking: First, assess the trauma. Second,
offer treatment accordingly. During the presentation, clinical cases
will be presented to illustrate the relationship between the degree
of trauma, intervention and outcome.
Conclusion: A flexible and individual strategy is recommended.
Future studies of debriefing should utilise individualised designs
including screening of psychopathology before intervention, if any,
is offered. To assess the effect of one session of debriefing, only
subjects who are likely to benefit from such a limited intervention
should be included. Accordingly, those who are at greatest risk for
PTSD should have more extensive interventions.
54 LæKNABLAÐIÐ / FYLGiRIT 48 2003/89