PowerPoint Presentation

Alcohol Use Disorders: The Role of Liaison Psychiatry

Dr Alex ThomsonConsultant Liaison PsychiatristNorthwick Park & Central Middlesex HospitalsClinical Lead for Substance Use in Mental HealthPsychological Medicinealex.thomson@nhs.netPsychological MedicinePsychological Medicine

Psychological Medicine

Per capita alcohol consumption and alcohol-related deaths 1984-2008Source: 'Future Proof: Alcohol Consumption, Mortality and Morbidity - Key Findings' Professor Martin Plant , 2009Psychological Medicine

Psychological Medicine

Psychological Medicine

Source: Hospital Episode Statistics (HES), NHS Information Centre for Health & Social Care and Office for National Statistics mid-year population estimates for 2008. Analysed by London Regional Public Health Group and London Health Observatory.Psychological MedicineAcute Hospital Bed Days in Brent and Harrow 2008-9 BrentHarrowAlcohol-attributable Admissions

6,1183,949Alcohol-related Admissions

14,07411,487Average Daily Bed Occupancy

5542Total Costs

10.4m7.7mSource: Closing time: counting the cost of alcohol-attributable hospital admissions in London. London Health Observatory 2012

Psychological MedicineLiaison PsychiatryMental health service to patients in a general medical hospitalInpatients, outpatients & attenders at the Emergency DepartmentMuch wider scope than crisis / A&E liaison workComplex medical conditions with psychiatric symptomsCo-occurring psychiatric and medical conditionsHarmful drug or alcohol use & its complicationsMedically unexplained physical symptomsDistress due to medical conditionsSuicide or self-harmDementia, learning disability etc.Psychological MedicineNational Guidance

Every hospital should have a dedicated in-house liaison psychiatry serviceHealthcare professionals who care for people in acute alcohol withdrawal should be skilled in the assessment and monitoring of withdrawal symptoms and signsPsychological MedicineNCEPOD Report

All patients presenting to acute services with a history of potentially harmful drinking, should be referred to alcohol support servicesEach hospital should have a 7-day Alcohol Specialist Nurse Service... to provide comprehensive physical and mental assessments, Brief Interventions and access to services within 24 hours of admissionA multidisciplinary Alcohol Care Team, led by a consultant with dedicated sessions, should be established in each acute hospital and integrated across primary and secondary care.Psychological MedicineNW London Liaison Psychiatry PilotPilot Sites

Team CompositionConsultant PsychiatristsPsychiatric Liaison NursesOccupational TherapistsAlcohol Nurse SpecialistsClinical PsychologistsSpecialist PharmacistsCNWLWLMHTPsychological MedicineLiaison Psychiatry & Alcohol Use DisordersLIAISON:Primary careSecondary careCommunity mental healthAddiction servicesSocial servicesHousingCABNon-statutory agencies Victim Support24h SERVICE7 DAYS A WEEKPsychological MedicineNeuropsychiatric Complications of Alcohol DependenceWithdrawal syndromeSeizuresDelirium tremensWernickes encephalopathyCognitive impairment / KorsakoffsCentral Pontine MyelinolysisDepression/Anxiety/HallucinosisPsychological Medicine34 y.o. Male Manual WorkerDrinking 1 btl vodka / day stopped suddenlyUnwell, agitated, wanting to leaveMedicolegal advice given by Liaison PsychiatryDetained using Mental Capacity ActAdvice on delirium tremens treatment givenFull recoveryAbstinence-Orientated Advice givenReferred to community alcohol servicePsychological Medicine40 y.o. Male Shop WorkerAdmitted with 2 weeks vomitingSevere gastritisDrinking 2-4 cans beer / dayNo withdrawal symptomsHeavy whisky drinking for 1 monthDisorientated, forgetful, staggering gaitWernickes identified by Liaison PsychiatryTreated with IV Thiamine, full recoveryPsychological Medicine37 y.o. Male Repeat ED attendances with alcohol withdrawal seizuresHallucinating, disorientated, agitatedGiven high-dose chlordiazepoxide & thiaminePartial recovery for placementLiaison Psychiatry OT assessed community support networkSafe discharge home & follow-up arrangedPlacement & DTOC avoidedPsychological Medicine67 y.o. Male SalesmanAdmitted for foot operationDrinking 250ml whisky / night detox startedNo withdrawal symptoms observed/reportedReferred to Liaison PsychiatryNo need for detox meds stoppedPsychosocial intervention deliveredEducated about effects of alcohol on health and interaction with medicinesPsychological MedicineReferral CriteriaAll patients admitted to a ward receiving alcohol detoxificationPatients with alcohol-related neuropsychiatric complicationsPatients with medical/psychiatric conditions related to other drug usePsychological MedicineCurrent PathwaysHarrowBrentPsychological MedicineFuture DirectionsStaff expansionMI / IBA training for all our staffStandardised assessment and intervention packageExpand range of written infoReview Trust guidelinesTighter integration with Gastroenterology & Acute MedicineJunior doctor trainingNew admission & transfer pathwaysAudit & implementation of NICE guidancePsychological Medicine