Diamonds in the coalface: new research in consultation-liaison psychiatry.

Ilchef, Ralf

PURPOSE OF REVIEW Consultation-liaison psychiatry deals with patients who manifest both psychological and somatic symptoms and involves a close and collaborative interaction with other medical specialities. While it is a clinically rich area, resource constraints and service requirements have meant that it has perhaps contributed a little below its weight in academic terms. This review, although far from exhaustive, seeks to present some themes of recent research in this fascinating discipline. RECENT FINDINGS The need to demonstrate the utility, and ensure the funding, of a service that is all too often regarded as 'non-core' by both mental health services and general hospitals remains constant. Useful work is being done in streamlining data collection, accurately measuring disability and improving outcomes for these complex and resource-intensive patients. Recent reviews have helped to clarify our understanding of medication-induced depression, the treatment options in self-harm, the place of psychosocial interventions in oncology, and the relationship between depression and heart disease among other areas. SUMMARY Consultation-liaison psychiatry is a fascinating and underresearched field. Important work remains to be done in service delivery, diagnosis, treatment and outcome, as well as medical ethics and systems research. Although our knowledge is progressing, many existing studies are underpowered and multisite collaborations are necessary. Our patients carry an enormous burden of ill health and require the services of skilled clinicians, advocates and treatment brokers.