Doctors are increasingly aware of the importance of developing good
communication skills and of attending to their patients’ psychological
symptoms. This second joint report of the Royal College of Physicians and Royal
College of Psychiatrists aims to highlight the importance of addressing the
psychological dimension of medical practice and to foster the development of
services designed to improve the psychological care of medical patients. The
latter target is best achieved by establishing a multidisciplinary liaison psychiatry
service in every general hospital.
Although most people adjust well to the limitations imposed by their illness, a
significant proportion find that their coping mechanisms are overwhelmed. The
high prevalence of psychiatric disorders in general hospital patients is now well
established. Depression, anxiety disorders, delirium and substance misuse are
particularly common, and deliberate self-harm accounts for approximately
140,000 presentations to hospitals in England and Wales each year. Physicians
need to be able to identify these problems, to arrange basic psychological care
and to know when to refer patients to specialist psychiatric and psychological
services. Depression and other psychiatric disorders have often been regarded as
inevitable and understandable responses to illness and therefore not amenable to
treatment. This opinion is no longer sustainable. Patients with significant
and persistent psychological symptoms respond well to psychological or
pharmacological treatments. Therapeutic interventions are also effective for
managing patients with problems of alcohol misuse, those who present after
episodes of self-harm and those who somatise their problems.