Consultation liaison psychiatry has emerged as a crucial subspecialty within modern healthcare systems, designed to integrate psychiatric expertise into the management of patients with physical illnesses. The discipline emphasises collaboration between psychiatrists and other medical specialists, ensuring that psychological and behavioural aspects of illness are not overlooked in the pursuit of physical recovery.1 In India, where psychiatric services are still developing in many regions, consultation liaison psychiatry provides an opportunity to bridge the gap between mental health and general medical care. Liaison psychiatry rests on two complementary pillars. The first is consultation, in which psychiatrists evaluate patients referred from non psychiatric departments and provide diagnostic and therapeutic recommendations. The second is liaison, which involves sustained collaboration with medical teams, educational activities, and promoting awareness of psychiatric comorbidities.2 Together, these functions aim to improve patient outcomes, reduce hospital stay durations, and optimise the use of healthcare resources.3 Despite the recognised importance of psychiatric input, referral rates in India remain disproportionately low compared to developed countries. Studies have reported that while psychiatric morbidity among hospitalised patients may range between 30–40%, actual referral rates are often below 2%.4 This discrepancy is attributed to multiple factors, including stigma surrounding mental illness, prioritisation of physical symptoms over psychological distress, and limited awareness among healthcare providers.5 In regions such as West Bengal, where psychiatric services remain concentrated within a limited number of tertiary centres such as Dr. Bidhan Chandra Roy Hospital, Haldia, the problem of underutilization becomes particularly evident. The coexistence of psychiatric and medical disorders is not only common but also clinically significant. Patients with comorbid psychiatric conditions often experience prolonged hospitalisations, higher rates of medical complications, and poorer prognoses.6 For example, depression and anxiety can negatively influence adherence to medical treatment, while delirium and substance use disorders may complicate the management of acute medical conditions. Timely psychiatric intervention can mitigate these risks, reduce healthcare costs, and improve both morbidity and mortality outcomes.7 Globally, Consultation liaison psychiatry has been recognised as an essential component of holistic healthcare. In India, however, implementation has been uneven, with many hospitals offering only on-call consultation services.8 The liaison aspect, which involves proactive collaboration and education, is often underdeveloped. This limited scope restricts consultation liaison psychiatry’s potential to transform patient care. Expanding these services in tertiary hospitals, particularly in underserved regions, is therefore urgent. The study was conducted in the Department of Psychiatry, Dr. Bidhan Chandra Roy Hospital, West Bengal, which serves as a major referral centre. The hospital caters to a diverse population, including urban, semi urban, and rural communities, and receives referrals from multiple specialities such as medicine, neurology, obstetrics, and surgery. Understanding the sociodemographic characteristics and psychiatric diagnoses of referred patients can offer valuable insights into the current state of consultation liaison psychiatry in this region. Previous studies conducted in other parts of India have highlighted depression, delirium, and somatoform disorders as common psychiatric diagnoses among referred patients.9 However, regional variations in referral patterns and diagnostic outcomes are expected due to differences in healthcare infrastructure, cultural attitudes, and awareness levels. By analysing data from the Department of Psychiatry, Dr. Bidhan Chandra Roy Hospital, West Bengal, this study aims to contribute to the growing body of literature on consultation liaison psychiatry in India and underscore the importance of strengthening psychiatric services in tertiary care settings. The present research therefore seeks to assess the sociodemographic profile and psychiatric comorbidities of patients referred to the psychiatric unit of Dr. Bidhan Chandra Roy Hospital. The findings are expected to highlight the burden of psychiatric illness among medically ill patients, identify gaps in referral practices, and emphasise the need for integrated psychiatric care. Ultimately, the study aims to advocate for expanding liaison psychiatry services in India, ensuring that mental health receives equal priority alongside physical health in clinical practice.

Study design and setting: This descriptive cross-sectional study was conducted in the Department of Psychiatry, Dr. Bidhan Chandra Roy Hospital, Haldia, West Bengal. The hospital is a tertiary care centre catering to referrals from multiple medical and surgical specialities. The study was conducted over 6 months, from April 2023 to September 2023. Study population: The study included all patients referred to the psychiatry department from other hospital units during the study period. Both inpatient and outpatient referrals were considered. Patients of all age groups and both sexes were eligible for inclusion. Inclusion criteria: • Patients referred to psychiatry from non psychiatric departments (medicine, neurology, surgery, obstetrics and gynaecology, cardiology, etc.). • Patients accompanied by a reliable informant or caretaker. • Patients providing informed consent, or consent obtained from legally authorised representatives in cases where the patient was unable to provide consent. Exclusion criteria: • Patients admitted under court orders or medico legal custody. • Patients without attendants or reliable informants. • Convicted or under trial patients referred for psychiatric evaluation. Data collection: Information was collected using a self designed semi structured proforma. The proforma recorded: • Sociodemographic details (age, sex, marital status, education, occupation, family type, and residency). • Source of referral (department and mode of referral: inpatient or outpatient). • Reason for referral (clinical presentation, psychiatric clearance, or emergency). • Presenting complaints. • Final psychiatric diagnosis. Diagnostic criteria: All psychiatric diagnoses were made according to the International Classification of Diseases, Tenth Revision (ICD 10) guidelines. Procedure: Referrals were attended by psychiatry residents and faculty members on designated days of the week. Patients were clinically assessed through detailed history taking, mental status examination, and review of medical records. Where necessary, collateral information was obtained from family members or caregivers. Ethical considerations: The Institutional Ethics Committee of the Dr. Bidhan Chandra Roy Psychiatric Hospital approved the study. The study obtained written informed consent from all participants or their legally authorised representatives. Confidentiality of patient information was strictly maintained. Statistical analysis: Data were entered into Microsoft Excel and analysed using descriptive statistics. Frequencies and percentages were calculated for categorical variables, while mean and standard deviation were computed for continuous variables such as age. Results were presented in tables for clarity.

A total of 187 patients were referred to the Department of Psychiatry during the study period. Of these, 132 (70.6%) were inpatients, and 55 (29.4%) were outpatients. The sociodemographic characteristics, referral sources, reasons for consultation, and psychiatric diagnoses are presented below. The sociodemographic profile of the 187 study subjects shows a mean age of 34.8 years (SD ±11.7), with most (89.8%) below 60 years. Females made up a slightly higher proportion (54.5%) than males (45.5%). Most participants were married (66.3%), while 25.7% were unmarried, and smaller proportions were widowed (4.8%) or separated (3.2%). In terms of residency, 38.5% lived in urban areas, 26.7% in semi urban areas, and 34.8% in rural settings. Educational attainment varied, with high school education being most common (36.9%), followed by primary schooling (31.0%), graduates (25.1%), and a small proportion with postgraduate qualifications (3.2%); only 3.7% were illiterate. Occupationally, homemakers formed the largest group (36.4%), followed by business (17.1%), students (11.8%), unskilled workers (11.2%), unemployed (10.7%), skilled workers (9.6%), and clerical workers (3.2%) [Table 1]. Table 1: Sociodemographic profile of study subjects (n = 187) Variable Frequency Percentage (%) Age Mean age (SD) 34.8 (11.7) – < 60 years 168 89.8 ≥ 60 years 19 10.2 Sex Male 85 45.5 Female 102 54.5 Marital status Married 124 66.3 Unmarried 48 25.7 Widowed 9 4.8 Separated 6 3.2 Residency Urban 72 38.5 Semi urban 50 26.7 Rural 65 34.8 Education Illiterate 7 3.7 Primary school 58 31.0 High school 69 36.9 Graduate 47 25.1 Postgraduate 6 3.2 Occupation Homemaker 68 36.4 Business 32 17.1 Unskilled worker 21 11.2 Unemployed 20 10.7 Student 22 11.8 Skilled worker 18 9.6 Clerical worker 6 3.2 The source of referral analysis shows that most patients were referred from General Medicine (20.8%), followed by Neurology (9.6%) and Obstetrics & Gynaecology (8.0%). Other notable contributors included Cardiology (6.4%), Trauma Care (5.9%), and Gastroenterology (5.3%), while referrals from the ICU (4.8%) and General Surgery (4.3%) were comparatively fewer. Pediatric and Dermatology departments each accounted for 3.7% of referrals, with Nephrology and ENT contributing 3.2% each. Chest Medicine (2.7%), Plastic Surgery (2.1%), Rheumatology (1.1%), and Urology (1.1%) represented the lowest referral rates. Additionally, 9.1% of cases were referred from other departments not listed individually (Table 2). Table 2: Source of referral among study subjects Department Frequency Percentage (%) General Medicine 39 20.8 Neurology 18 9.6 Obstetrics & Gynaecology 15 8.0 Cardiology 12 6.4 Trauma Care 11 5.9 Gastroenterology 10 5.3 ICU 9 4.8 General Surgery 8 4.3 Pediatrics 7 3.7 Dermatology 7 3.7 Nephrology 6 3.2 ENT 6 3.2 Chest Medicine 5 2.7 Plastic Surgery 4 2.1 Rheumatology 2 1.1 Urology 2 1.1 Others 17 9.1 The reasons for psychiatric consultation among the study subjects reveal that suicidal attempts (16.6%) were the most frequent cause for referral, underscoring the critical role of psychiatric evaluation in self harm cases. Anxiety symptoms (11.7%), history of psychiatric medication (11.2%), and behavioural abnormalities/irrelevant speech (10.7%) also accounted for a substantial proportion of referrals, reflecting the wide spectrum of psychiatric presentations encountered in hospital settings. Medically unexplained symptoms (9.1%) and altered sensorium/restlessness (8.0%) were other common triggers, highlighting the overlap between psychiatric and medical conditions. Substance related issues such as alcohol use disorder (6.4%) and multiple substance abuse (1.6%) contributed notably, while postpartum abnormal behaviour (4.8%) and depressive features (3.7%) represented specific clinical scenarios requiring psychiatric input. A smaller but significant proportion of referrals were for pre surgical clearance, including renal transplant (3.2%) and gender reassignment surgery (1.6%) [Table 3]. Table 3: Reasons for psychiatric consultation Reason for referral Frequency Percentage (%) Suicidal attempts 31 16.6 Anxiety symptoms 22 11.7 History of psychiatric medication 21 11.2 Behavioural abnormality/irrelevant speech 20 10.7 Medically unexplained symptoms 17 9.1 Altered sensorium/restlessness 15 8.0 Alcohol use disorder 12 6.4 Postpartum abnormal behaviour 9 4.8 Depressive features 7 3.7 Clearance for renal transplant 6 3.2 Clearance for gender reassignment surgery 3 1.6 Multiple substance abuse 3 1.6 The final psychiatric diagnoses among the study subjects reveal that depressive episodes (13.4%) were the most common, followed by delirium (9.1%) and somatoform disorders (7.5%), highlighting the predominance of mood and organic psychiatric conditions in hospital referrals. Substance related disorders such as alcohol dependence syndrome (6.4%) and multiple drug use disorder (1.1%) were also present, reflecting the burden of addiction in this population. Severe mental illnesses, including bipolar affective disorder (4.8%), schizophrenia (3.2%), and acute transient psychotic disorder (2.1%), were identified, alongside neurocognitive disorders such as dementia (4.3%). Anxiety related conditions, including mixed anxiety and depressive disorder (4.3%) and adjustment disorder (3.7%), contributed notably, while less frequent diagnoses included dissociative disorder (2.7%), personality disorders (2.7%), and impulse control disorders such as trichotillomania (1.1%). Interestingly, a small proportion of referrals were linked to sexual dysfunction (erectile dysfunction, 1.6%) and conduct disorder (2.1%). Importantly, 5.3% of patients were found to have no psychiatric diagnosis, underscoring the challenge of differentiating psychiatric from medical presentations in consultation liaison settings (Table 4). Table 4: Final psychiatric diagnoses (ICD 10) Diagnosis Frequency Percentage (%) Depressive episode 25 13.4 Delirium 17 9.1 Somatoform disorder 14 7.5 Alcohol dependence syndrome 12 6.4 Bipolar affective disorder 9 4.8 Dementia (unspecified) 8 4.3 Mixed anxiety and depressive disorder 8 4.3 Adjustment disorder 7 3.7 Schizophrenia 6 3.2 Dissociative (conversion) disorder 5 2.7 Personality disorders (emotionally unstable/dissocial) 5 2.7 Acute transient psychotic disorder 4 2.1 Conduct disorder 4 2.1 Erectile dysfunction 3 1.6 Trichotillomania/impulse control disorder 2 1.1 Multiple drug use disorder 2 1.1 Nil psychiatric diagnosis 10 5.3 The gender wise distribution of psychiatric diagnoses highlights distinct patterns. Organic disorders (F00–F09) were more common among males (69.2%) than females (30.8%), while substance use disorders (F10–F19) were exclusively diagnosed in males (100%), underscoring the male predominance in addiction related conditions. In contrast, mood disorders (F30–F39) were significantly more frequent in females (68.3%) compared to males (31.7%), and neurotic, stress related disorders (F40–F48) also showed a strong female predominance (77.4%). Similarly, behavioural syndromes (F50–F59) and personality disorders (F60–F69) were more common in females (61.5% and 58.3%, respectively) than in males. Interestingly, schizophrenia and related disorders (F20–F29) demonstrated a relatively balanced distribution, with a slight female predominance (63.6%) [Table 5]. Table 5: Psychiatric diagnosis versus gender ICD 10 Category Female n (%) Male n (%) Total Organic disorders (F00–F09) 12 (30.8) 27 (69.2) 39 Substance use disorders (F10–F19) 0 (0) 12 (100) 12 Schizophrenia and related (F20–F29) 7 (63.6) 4 (36.4) 11 Mood disorders (F30–F39) 28 (68.3) 13 (31.7) 41 Neurotic, stress related (F40–F48) 24 (77.4) 7 (22.6) 31 Behavioral syndromes (F50–F59) 8 (61.5) 5 (38.5) 13 Personality disorders (F60–F69) 7 (58.3) 5 (41.7) 12

Consultation liaison psychiatry has long been recognised as a vital subspecialty that integrates psychiatric care into general hospital settings. This study at Dr. Bidhan Chandra Roy Psychiatric Hospital highlights the sociodemographic profile and psychiatric comorbidities among referred patients, and the findings align with earlier Indian and international literature. In our study, most referrals were female, married, and under 60 years of age. Similar demographic trends have been reported in previous Indian studies, where women were more frequently referred for psychiatric evaluation, particularly for mood and neurotic disorders.10 However, some earlier reports noted a male predominance, especially in substance use and organic psychiatric conditions.11 This variation may reflect regional sociocultural differences and healthcare seeking behaviours. General medicine was the leading source of referrals, followed by neurology and obstetrics/gynaecology. This pattern is consistent with earlier studies from tertiary hospitals in India, where physicians in general medicine often encounter psychiatric symptoms such as depression, anxiety, and medically unexplained complaints.12 Neurology referrals are also common due to overlapping presentations of dissociative disorders and seizure like episodes with neurological conditions.13 The relatively lower referral rates from surgical departments, as observed in our study, have also been noted in earlier literature, suggesting under-recognition of psychiatric morbidity in surgical patients.14 Suicidal attempts emerged as the most frequent reason for referral, followed by anxiety symptoms and behavioural abnormalities. This finding aligns with the implications of the Mental Healthcare Act 2017, which mandates psychiatric evaluation in cases of self harm or attempted suicide.15 Previous studies, however, reported altered sensorium and substance use disorders as leading causes of referral, indicating that referral patterns may vary depending on institutional protocols and regional health priorities.16 Depression and delirium were the most common psychiatric diagnoses in our study. Earlier Indian studies also reported high rates of depression among medically ill patients, underscoring its impact on treatment adherence and recovery.1 Delirium, often associated with acute medical conditions and ICU admissions, has consistently been identified as a major psychiatric diagnosis in consultation liaison settings.17 Somatoform disorders, which were relatively less frequent in our study, have been reported as predominant diagnoses in other centres, reflecting differences in patient populations and referral practices.18 Gender differences in psychiatric diagnoses were evident, with organic and substance related disorders more common in men, while mood and neurotic disorders predominated in women. This pattern is consistent with earlier findings, where cultural and social factors influenced the manifestation and recognition of psychiatric illness.19 Overall, the study reinforces the importance of consultation liaison psychiatry in tertiary care hospitals. Despite the evident burden of psychiatric morbidity, referral rates remain low compared to international standards.14 Expanding liaison services, training medical staff to recognise psychiatric symptoms, and reducing stigma are essential steps toward integrated patient care. Limitations This study has several limitations. First, it was conducted over a short duration of four months, which may not capture seasonal or long term variations in referral patterns. Second, data collection was limited to specific days of the week, potentially excluding some referrals. Third, the study was restricted to a single tertiary care hospital in West Bengal, limiting the generalizability of findings to other regions. Finally, the cross sectional design precludes assessment of long term outcomes or the impact of psychiatric interventions on patient prognosis.

The present study conducted at Dr. Bidhan Chandra Roy Psychiatric Hospital demonstrates that psychiatric comorbidities are highly prevalent among patients referred from non psychiatric departments. Depression and delirium were the most frequent diagnoses, while suicidal attempts emerged as the leading reason for referral. The majority of referrals originated from general medicine, reflecting the tendency of patients and families to seek help from physicians rather than psychiatrists due to stigma and limited awareness. Gender differences were evident, with substance related and organic disorders more common in men, while mood and neurotic disorders predominated in women. These findings are consistent with earlier Indian studies and highlight the influence of sociocultural factors on referral patterns and psychiatric morbidity. Despite the significant burden of psychiatric illness, referral rates remain low compared to international standards. This underutilization underscores the need to strengthen consultation liaison psychiatry services in tertiary care hospitals. Expanding liaison models, training medical staff to recognise psychiatric symptoms, and reducing stigma can improve early detection and management of psychiatric illness. In conclusion, consultation liaison psychiatry is essential for bridging the gap between physical and mental health care. By integrating psychiatric services into general hospital practice, patient outcomes can be enhanced, healthcare resources optimised, and holistic care ensured. The findings from West Bengal emphasise the urgent need to expand and strengthen liaison psychiatry services across India.

1. Grover S. State of Consultation-Liaison Psychiatry in India: Current status and vision for future. Indian J Psychiatry. 2011;53(3):202-13. 2. Lipowski ZJ. Current trends in consultation-liaison psychiatry. Can J Psychiatry. 1983;28(5):329-38. 3. Wood R, Wand AP. The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. J Psychosom Res. 2014;76(3):175-92. 4. Goyal SG, Sagar R, Sharan P. Sociodemographic profile and psychiatric diagnosis of patients referred to consultation liaison psychiatric services of general hospital psychiatric unit at a tertiary care center. J Ment Health Hum Behav. 2017;22(1):45 9. 5. Bhogale GS, Katte RM, Heble SP, Sinha UK, Patil BA. Psychiatric referrals in multispeciality hospital. Indian J Psychiatry. 2000;42(2):188-94. 6. Tekkalaki B, Tripathi A, Arya A, Nischal A. A descriptive study of pattern of psychiatric referrals and effect of psychiatric intervention in consultation liaison set up in a tertiary care center. Indian J Soc Psychiatry. 2017;33(2):165 70. 7. Patra P, Divinakumar KJ, Prakash J, Patra B, Chakraborty R. Clinico-psycho-social profile of patients brought under consultation-liaison psychiatry care in a large tertiary care referral hospital. Ind Psychiatry J. 2017;26(1):24-7. 8. Grover S, Avasthi A. Consultation-liaison psychiatry services: A survey of medical institutes in India. Indian J Psychiatry. 2018;60(3):300-6. 9. Mudgal V, Rastogi P, Niranjan V, Razdan R. Pattern, clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital: a descriptive study. Gen Psychiatr. 2020;33(4):e100177. 10. Jain A, Mutalik NR. Clinical Characteristics and Gender Differences in Suicide Attempters: A Hospital-based Cross sectional Study. Ind J Priv Psychiatry 2021;15(1):32-7. 11. Kaur D, Verma R, Ajinkya S, et al. Patterns of Consultation-liaison Psychiatry among Inpatients at a Tertiary Care Hospital. Ind J Priv Psychiatry 2020;14(1):35-40. 12. Gurram S, Macharapu R, M V, M PK. A study of psychiatric referrals from other specialties at a tertiary care center. Arch Ment Health. 2018;19(2):129 35. 13. Crimlisk HL, Bhatia K, Cope H, David A, Marsden CD, Ron MA. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ. 1998;316(7131):582-6. 14. Keertish N, Sathyanarayana MT, Kumar BG, Singh N, Udagave K. Pattern of psychiatric referrals in a tertiary care teaching hospital in southern India. J Clin Diagn Res. 2013;7(8):1689-91. 15. Vadlamani LN, Gowda M. Practical implications of Mental Healthcare Act 2017: Suicide and suicide attempt. Indian J Psychiatry. 2019;61(Suppl 4):S750-S755. 16. White W, Bloch S. Psychiatric referrals in a general hospital. Med J Aust. 1970;1(19):950-4. 17. Levenson JL, Hamer RM, Rossiter LF. Relation of psychopathology in general medical inpatients to use and cost of services. Am J Psychiatry. 1990;147(11):1498-503. 18. Parkar SR, Sawant NS. Liaison psychiatry and Indian research. Indian J Psychiatry. 2010;52(Suppl 1):S386-8. 19. Kaur D, Verma R, Ajinkya S, Ghildiyal R. Patterns of Consultation-liaison Psychiatry among Inpatients at a Tertiary Care Hospital. Ind J Priv Psychiatry 2020;14(1):35-40.