Clinical investigation of characteristics of emergency telephone counseling and medical service for outpatients in the Department of Psychiatry, Nara Medical University, in fiscal 2004

Characteristics of emergency telephone counseling and medical service for outpatients in the Psychiatric Service of Nara Medical University in fiscal 2004 were investigated, and those clinical features of emergency psychiatric service of the core general hospitals in Nara Prefecture were analyzed. The total of emergency telephone counseling was 1,049 cases/year and the details consisted of mild psychiatric deterioration (31.8%), questions concerning medication (15%), and distress (of patient or caregiver) (12.8%). The majority of our responses needed for telephone counseling was brief supportive counseling (87.2%). According to the diagnostic classification of ICD-10, F2 (schizophrenia, schizotypal and delusional disorder) were most frequent (35.6%), followed by F4 (neurotic, stress-related and somatoform disorder; 23.5%), F3 (mood disorder; 19.2%), and others. The total of emergency medical services was 846 cases/year and the details consisted of psychiatric deterioration (anxiety, agitation, etc.) (36.8%), complaints related to physical symptoms (21.3%), and suicide attempts (11.7%). About 22% patients were referred for psychiatric examination from other departments in our hospital. Complaints related to physical symptoms might be one of psychiatric symptoms, but additional physical examinations (blood test, brain CT, etc.) were needed according to the circumstances for differential diagnosis of physical disease. The rate of suicide attempts was 11.7%, which may reflect the feature of a general hospital with psychiatric service. Also the availability of psychiatric service in general hospitals (21.7%) is more useful for them and consultation-liaison psychiatry is much important for one another.