The essential role of the psychiatrist as consultant and educator of primary care physicians is increasing in importance as the American health care system faces fundamental restructuring. In a recent workshop during the annual meeting of the American Psychiatric Association, a number of prominent consultation-liaison psychiatrists reviewed major developments in consultation-liaison psychiatry during the past decade and looked toward the future. This book is based on these presentations, but it is not simply a proceedings book. A number of additional experts have contributed important chapters, and all the chapters based on the presentations are expanded and updated. Thus, this book reviews the current state of consultation-liaison psychiatry and anticipates future challenges. It also informs the reader about the state-of-the-art knowledge and skills in consultation-liaison psychiatry as of 1994. This book should be a valuable up-to-date overview/refresher for both consultation­ liaison psychiatrists and general psychiatrists who wish to update and formulate his/her consultant role. It should be especially valuable for psychiatric residents for whom the role as consultant to primary physicians assumes increasing importance, and for primary physicians and medical students who are interested in learning about commonly encountered complex biopsychosocial problems of their patients and integrating these dimensions in patient care. I am grateful to Mary Safford and Eileen Bermingham of Plenum for their help with the preparation and production of this book. I am also thankful to Anita Shaw for her secretarial help. Hoyle Leigh, M. D.

INTRODUCTION: Consultation-Liaison Psychiatry on the Threshold of a New Century.- Legal and Ethical Changes in Consultation Psychiatry.- Chronic Pain.- Chronic Pain and Addiction.- Psychiatric Consultation with Chemically Dependent Patients.- The Dementia Syndrome in Consultation Psychiatry.- Psychotherapy Solutions in the Medical Setting.- Physical Factors affecting Psychiatric Condition: A Proposal for a Future DSM.- Training in Medical Psychiatry.- Consultation-Liaison in Child Psychiatry: Continuity and Change in the Past Decade.- Consultation-Liaison 1980-90-The Hawaii Experience.- Consultation-Liaison Funding: Issues for Service and Training.- Computerization and Consultation-Liaison Psychiatry in the 1990's.- A Computerized Database System for Psychiatric and Consultation Records.- Databasing in CLP Psychiatry.- Contributors.