Psychiatric liaison to gynecological oncology

A psychiatric liaison to the Gynecologic Oncology Service at a major cancer center was begun in July 1991 to improve the psychosocial care. A total of 82 women were evaluated by a psychiatric consultant over a 12‐month period. Most had advanced gynecological disease with poor prognosis. Consultation requests came from the nursing staff (42%), the gynecological fellow (34%) and the attending gynecologist (24%). Reasons for consultations were: difficulty coping (45%), depression (38%), social issues (7%) and ‘other’ (10%). The initial psychosocial issues were: patient‐related problems (62%), staff issues (28%) and family/social issues (10%). The patient‐related problems were: difficulty coping (43%), depression (33%), anxiety (16%) and delirium (8%). Upon initial assessment, the women met DSM‐III‐R diagnoses of adjustment disorder (53%) with depressed mood (32%), with mixed features (12%), with anxious mood (9%), major depression (13%), delirium (12%), panic attack with agoraphobia (4%), dementia (4%), schizophrenia (4%), ‘other’ (5%). After the initial consultation 28% developed delirium. ‘Other’ consisted of two women with a history of substance dependence and borderline personality disorder, one woman with an organic mood disorder and one woman with an interpersonal problem. Psychophar‐macological, behavioral and psychotherapeutic interventions are outlined through description of several clinical case reports.