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      A history of liaison psychiatry in the UK

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          Abstract

          Aims and method To record the development of liaison psychiatry in the UK and to summarise the current levels of activity. We also highlight the challenges the specialty may face if it is to develop further. History since the 1970s is reviewed by early pioneers and those involved in the present day, with a focus on the key role played by members of the Royal College of Psychiatrists.

          Results We describe the development of training guidelines, the publication of joint documents with other Royal Colleges, establishing international collaborations and defining service specifications. We emphasise the importance of collaboration with other medical organisations, and describe successes and pitfalls.

          Clinical implications Much has been achieved but challenges remain. Liaison psychiatry has a potentially important role in improving patient care. It needs to adapt to the requirements of the current National Health Service, marshal evidence for cost-effectiveness and persuade healthcare commissioners to fund services that are appropriate for the psychological needs of general hospital patients.

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          Most cited references8

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          Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial.

          Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care.
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            The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome.

            Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established. Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibitor (SSRI) antidepressant, paroxetine, or routine care by a gastroenterologist and general practitioner. Primary outcome measures of abdominal pain, health-related quality of life, and health care costs were determined after 3 months of treatment and 1 year later. A total of 257 subjects (81% response rate) from 7 hospitals were recruited; 59 of 85 patients (69%) randomized to psychotherapy and 43 of 86 (50%) of the paroxetine group completed the full course of treatment. Both psychotherapy and paroxetine were superior to treatment as usual in improving the physical aspects of health-related quality of life (SF-36 physical component score improvement, 5.2 [SEM, 1.26], 5.8 [SEM, 1.0], and -0.3 [SEM, 1.17]; P < 0.001), but there was no difference in the psychological component. During the follow-up year, psychotherapy but not paroxetine was associated with a significant reduction in health care costs compared with treatment as usual (psychotherapy, $976 [SD, $984]; paroxetine, $1252 [SD, $1616]; and treatment as usual, $1663 [SD, $3177]). For patients with severe IBS, both psychotherapy and paroxetine improve health-related quality of life at no additional cost.
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              Functional (conversion) neurological symptoms: research since the millennium.

              Functional neurological symptoms (FNS) are commonly encountered but have engendered remarkably little academic interest. 'UK-Functional Neurological Symptoms (UK-FNS)' was an informal inaugural meeting of UK based clinicians in March 2011 with a variety of research and clinical interests in the field. This narrative review reflects the content of the meeting, and our opinion of key findings in the field since the turn of the millennium.
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                Author and article information

                Journal
                BJPsych Bull
                BJPsych Bull
                pbrcpsych
                BJPsych Bulletin
                Royal College of Psychiatrists
                2056-4694
                2056-4708
                August 2016
                : 40
                : 4
                : 199-203
                Author notes
                Correspondence to Christopher Bass ( christopher.bass@ 123456oxfordhealth.nhs.uk )

                Peter Aitken, Director of Research and Development, Devon Partnership NHS Trust, Honorary Associate Professor, University of Exeter Medical School, and Chair, Faculty of Liaison Psychiatry, Royal College of Psychiatrists. Geoffrey Lloyd, Emeritus Consultant Liaison Psychiatrist, Royal Free Hospital, London. Richard Mayou, Emeritus Professor of Psychiatry, Oxford University, Nuffield College, Oxford. Christopher Bass, Consultant in Liaison Psychiatry, John Radcliffe Hospital, Oxford. Michael Sharpe, Professor of Psychological Medicine, Psychological Medicine Research, University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford.

                Article
                10.1192/pb.bp.116.053728
                4967779
                27512589
                f72f3591-255a-49ca-8a50-e1ef1dbb10f0
                © 2016 The Authors

                This is an open-access article published by the Royal College of Psychiatrists and distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 January 2016
                : 13 April 2016
                : 21 April 2016
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