Validation of Psychiatric Liaison and Consultation Practices in the COVID-19 Ward of Kawasaki Medical School General Medical Center
Background: The global outbreak of coronavirus disease 2019 (COVID-19) in 2020 significantly affected our hospital, prompting the establishment of a dedicated ward for managing patients with COVID-19 in March 2020. In April 2020, we established the “Mental Health Support Team for COVID-19” (referred to as the “Mental Support Team”) to address various psychiatric symptoms in patients with COVID-19, including delirium, anxiety, depression, and dementia. The team conducted regular ward rounds and provided consultation-liaison psychiatry services. The aim of this case study was to examine the consultation-liaison psychiatry services provided by our Mental Support Team. Methods: This study included patients with COVID-19 who were admitted to our hospital and referred for a psychiatric consultation between April 1, 2020, and April 30, 2023. Consultations were conducted through a video conferencing platform. The participants’ age, sex, prominent symptoms, psychiatric diagnosis, and severity of COVID-19 were retrospectively analyzed. Results: Of the 464 patients who were hospitalized owing to COVID-19, 63 (14%) underwent a psychiatric consultation during the study period. Among the study patients, 81% were aged 60 years or older. The most common psychiatric diagnosis was delirium, accounting for 44% of the cases, followed by adjustment disorder (28%) and anxiety disorder (20%). In terms of the severity of COVID-19, 46% of the patients in the psychiatric consultation group had moderate Ⅱand severe disease, and this was significantly higher than that observed in the overall hospitalized patient group (30%) (P = 0.032). In addition, among patients who received a psychiatric consultation, an improvement in psychiatric symptoms was observed in 76.9% of patients diagnosed with delirium and 83.3% of those diagnosed with adjustment or anxiety disorder. Conclusion: Psychiatric consultations were mainly effective in treating delirium in older patients and adjustment and anxiety disorders in younger patients, and a certain degree of symptomatic improvement was observed. The results also suggest that telemedicine using video calls can be an effective means of psychiatric liaison in situations where infection control measures are required. The development and utilization of these approaches will strengthen the psychiatric medical system in preparation for future pandemics.
