European Journal of Cardiovascular Medicine

Consultation-liaison psychiatry (CLP) provides a fit vantage point for watching the changes that permit prediction of future directions in psychiatry as a medical discipline. Consultation refers to the provision of expert opinion about the diagnosis and advice on management regarding a patient's mental state and behavior by a psychiatrist

The psychiatry department has a multidimensional role in a general hospital. The department caters to patients via both indoor as well as outdoor patients. Along with these facilities it also caters to different departments   who seeks psychiatric referrals. Psychiatric morbidity among patients attending general hospitals is common, yet recognition and referral to psychiatry departments remain disproportionately low [1]. Consultation-Liaison Psychiatry (CLP) plays a critical role in bridging this gap by providing psychiatric consultation for patients admitted under non-psychiatric specialties [2].Studies from tertiary care hospitals in India have documented that only a small fraction of admitted or attending patients are referred for psychiatric evaluation. For instance, in a cross-sectional study, less than 1% of in-patients were referred to psychiatry during their hospital stay [3]. Most referrals originate from the Department of Medicine, followed by Surgery, Obstetrics and Gynecology, and Pediatrics [4]. Common reasons for referral include altered sensorium, abnormal behavior, medically unexplained somatic complaints, suspected self-harm, and anxiety [5].Among the psychiatric diagnoses assigned after consultation, depressive disorders, substance use disorders, psychotic disorders, stress- or trauma-related disorders, and neurotic or somatoform disorders are frequently observed [6]. Despite this burden, referral rates remain low, suggesting under-recognition of psychiatric morbidity, limited sensitivity towards mental health issues, or inadequate integration of psychiatric services within general hospital settings [7]. The study aimed to identify the reasons for psychiatric referrals and the hospital departments requesting them. It also examined the primary illnesses leading to admission and described the demographic profile of patients referred for psychiatric consultation.

Type of Study: Cross-sectional study

Place of Study: Nil Ratan Sircar Medical college and Hospital  at the department of psychiatry.

Study Duration: 3 months

Sample Size: 210

Inclusion Criteria:

• Psychiatric referrals sent for evaluation from other specialtie
• Psychiatric referrals who (patients or caregivers) gave consent to participate in the study

Exclusion Criteria:

• Psychiatric referrals sent for disability assessment
• Nonconsenting individuals.

Study Variables:

• Demographic Variables: Age, gender, socioeconomic status, and educational background of patients referred for psychiatric consultation.
• Clinical Variables: Primary medical or surgical illness leading to hospital admission, reason for psychiatric referral, and psychiatric diagnosis.
• Referral Variables: Department requesting psychiatric consultation, timing of referral during hospital stay, and frequency of referrals.
• Outcome Variables: Management recommendations by psychiatry, follow-up plans, and any impact on patient care or hospital stay.

Statistical Analysis:

Data were entered into Excel and subsequently analyzed using SPSS and GraphPad Prism. Continuous variables were summarized as means with standard deviations, while categorical variables were presented as counts and percentages. Comparisons between independent groups were performed using two-sample t-tests, and paired t-tests were applied for correlated (paired) data. Categorical data were compared using chi-square tests, with Fisher’s exact test applied when expected cell counts were small. A p-value of ≤ 0.05 was considered statistically significant.

Table 1: Distribution of Gender

Table 2: Distribution of Socioeconomic class

Table 3: Distribution of Departments

Table 4: Distribution of CAUSEPOST

Table 5: Distribution of primary cause of admission

In our study, the majority of participants were male, accounting for 64.3% of the total sample, while females constituted 35.7%, indicating a clear male predominance in the study population. The study population was predominantly from the upper-lower socioeconomic class (35.7%), followed by the lower-middle (23.8%) and lower (24.45%) classes. Upper-middle and upper classes comprised smaller proportions, at 14.29% and 4.76%, respectively. Among the study participants, the largest proportion were from the General Medicine department (47.5%), followed by Surgery (19.2%) and Obstetrics & Gynecology (14.6%). Smaller percentages were from Orthopedics (8%), Pediatrics (2.1%), and other departments (8.6%).The most common cause of psychiatric consultation in the study was deliberate self-harm (DSH), accounting for 37.9% of cases, followed by alcohol-related disorders (19.5%), delirium (12.8%), and insomnia (11.2%). Other causes included CVA-related psychiatric manifestations (7.6%), postpartum psychosis (4.1%), previous psychiatric medication use (5.5%), and miscellaneous causes (1.4%).The leading primary cause of hospital admission was suicidal attempt, accounting for 37.9% of cases, followed by road traffic accidents (22.5%) and dyselectrolytemia (12.3%). Admissions due to cerebrovascular accidents (5.9%), operative procedures (3.8%), and other medical causes (17.6%) constituted smaller proportions of the study population.

We showed that male patients formed the majority of our study population (64.3%), reflecting a gender-related predisposition or higher healthcare-seeking behavior among men. A substantial proportion of participants belonged to the lower socioeconomic strata, particularly the upper-lower (35.7%), lower-middle (23.8%), and lower (24.45%) classes, suggesting socioeconomic vulnerability as a contributing factor for hospital admissions. Most admissions were from the General Medicine department (47.5%), followed by Surgery (19.2%) and Obstetrics & Gynecology (14.6%), highlighting the predominance of medical conditions in this cohort. Notably, deliberate self-harm (37.9%) and suicidal attempts (37.9%) were the leading causes for psychiatric consultation and hospital admission, respectively, emphasizing the significant burden of mental health crises and the need for targeted psychosocial interventions. Other important causes included alcohol-related disorders (19.5%), delirium (12.8%), insomnia (11.2%), dyselectrolytemia (12.3%), cerebrovascular accidents (5.9%), and operative procedures (3.8%), underscoring the importance of comprehensive medical and psychiatric evaluation in admitted patients. In similar study Desai et al. (2017) observed that the majority of psychiatry referrals originated from the Medicine department, with substance use disorders being among the most common reasons for consultation [8]. Jaswal et al. (2023) reported similar patterns, highlighting deliberate self-harm and suicidal attempts as major causes for psychiatric referral, along with high proportions of referrals from medical and surgical units [9]. Gupta et al. (2020) noted that abnormal behavior and intentional self-harm accounted for the majority of psychiatric referrals among inpatients, supporting our observation of mental health crises as a leading cause of hospital admission [10]. Furthermore, Das et al. (2008) highlighted that intentional self-harm was a frequent reason for psychiatry referral, with depression and substance-related disorders being the most common psychiatric diagnoses [11].

We concluded that highlights a clear pattern in psychiatric referrals within a tertiary care hospital in Eastern India, with males and patients from lower socioeconomic strata constituting the majority, indicating potential gender and socioeconomic influences on healthcare access and psychiatric vulnerability. Most referrals originated from General Medicine, followed by Surgery and Obstetrics & Gynecology, reflecting the predominance of medical illnesses in psychiatric consultations. Deliberate self-harm and suicide attempts were the leading causes, emphasizing the critical need for early identification and psychosocial interventions. Additionally, alcohol-related disorders, delirium, insomnia, dyselectrolytemia, cerebrovascular accidents, and postoperative conditions were significant contributors, underscoring the importance of integrated medical and psychiatric care. These findings advocate for proactive mental health screening and targeted support in hospital settings.

1.       Desai ND, Shah SN, Shah SH, Sharma E, Zankat D. Patterns of psychiatric referrals in a tertiary care hospital: An overview of consultation-liaison psychiatry. Natl J Integr Res Med. 2016;7(2):56–60.

2.       Grover S, Avasthi A, Bhateja G, Nehra R. Consultation-liaison psychiatry in India: Past, present, and future. Indian J Psychiatry. 2015;57(4):347–354.

3.       Patil R, Das A, Mukherjee A. Pattern of psychiatric referrals in a tertiary care teaching hospital in eastern India. Asian J Psychiatr. 2017;25:134–138.

4.       Reddy S, Chandrashekar CR. Profile of psychiatric referrals in general hospital: A review. Indian J Psychiatry. 1998;40:21–25.

5.       Gautam S, Nijhawan M, Gautam M. Consultation-liaison psychiatry: Clinical profile of referrals in a tertiary care hospital. Indian J Psychiatry. 2000;42(3):279–282.

6.       Sharma A, Grover S, Bhansali A. Psychiatric morbidity in medically ill inpatients: A descriptive study. Indian J Psychiatry. 2010;52(4):345–350.

7.       Ramesh A, Shaji KS. Under-recognition of psychiatric morbidity in general hospitals: Challenges for liaison psychiatry. J Postgrad Med. 2013;59:221–226.

8.       Desai N, Shah SN, Shah SH, Sharma E, Zankat D. Patterns of psychiatric referrals in a tertiary care hospital: An overview of consultation-liaison psychiatry. NJIRM. 2017;8(2):28–33.

9.       Jaswal S, Garg H, Kaur A. Pattern of psychiatry referrals in a tertiary hospital teaching set-up. Mathews J Psychiatry. 2023;7(1):1–6.

10.    Gupta R, Sharma S, et al. Pattern, clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital: A descriptive study. Asian J Psychiatry. 2020;53:102213.

11.    Das PP, Grover S, Avasthi A, et al. Intentional self-harm seen in psychiatric referrals in a tertiary care hospital. Indian J Psychiatry. 2008;50(2):107–112.