1998 Volume 38 Issue 2 Pages 127-134
In this article, the authors, based on their investigations of the actual conditions in a general hospital, discuss the present state and the tasks of consulation-liaison activity from a relation-centered aspect. They believe that is the important core aspect of the activity.The investigations proved that patient-staff and/or intra-staff interpersonal relations problems ("relational problems") played a significant role in approximately 40% of the consultations studied. These problems occurred significantly less frequently in patients admitted following a self-injury and more frequently in patients admitted to medical wards, and those referred due to adjustment disorders related to their physical disorder or admission stress itself. This was also found to be true in patients with personality disorders, organic mental disorders in which strange speech and behavior patterns were apt to be misunder-stood as being caused by their personality, and psyco-socially initiated physical smptoms such as somatoform disorders and psychosomatic diseases.Clinically, relational problems appeared in the following situations : disturbances in the patient-staff relationship (44.2%), psychological distresses of members of the ward staff due to relational problems (37.2%), psychological and/or psychosomatic distresses of patients due to relational problems (16.3%) and intra-staff problems (2.3%).These problems were attributable to the following factors : personality problems of the patients (34.9%), organic mental disorders such as delirium and dementia (23.3%), inappropriate patient treatment by members of the ward staff (18.6%), patient adjustment disorders related to their physical disorder or admission stress itself (14%), and insufficient understanding and cooperation of the patients' family members (9.3%).The consultants utilized a solely patient-oriented approach in 10% of the cases, a strictly staff-oriented approach in 30%m and a combined-approach in 40%. In 20% of the cases, they could not, or did not, intervene. Some improvement was achieved in 60.1% of the consultation cases that had relational problems.Finally, the authors stress the importance of both devising a clinical setting which will effectively manage relational problems, and providing suitable training of consultants based on the psychodynamic aspect of assessment and treatment.
