Annals of Clinical Psychiatry最新文献

Background: Delirium is a major source of morbidity in the inpatient hospital setting. This study examined differences between patients with delirium present prior to hospital admission and those with hospitalacquired delirium in several health outcomes.

Methods: A total of 12,529 patients on 2 inpatient units were included in this retrospective cohort study. Outcomes were assessed using chart review. Other variables were compared across groups and included in multivariate models predicting discharge location within the hospitalacquired delirium group.

Results: Of 709 patients with delirium, 83% had pre-admission prevalent and 17% had post-admission incident delirium. Compared with patients with preexisting delirium, patients with hospital-acquired delirium had greater hospital durations and mortality and were more likely to receive ICU care, more likely to receive multiple classes of medications, and less likely to be discharged home without home health services. Multivariate analysis in the hospital-acquired delirium group found that several variables independently predicted discharge location.

Conclusions: Patients with hospital-acquired delirium had worse hospital outcomes and a more complicated hospital course than those with preexisting delirium. Administration of various medications, several demographic variables, and some hospital-related variables were independently associated with worse outcomes within the hospital-acquired delirium group. These results demonstrate that patients with hospitalacquired delirium are a vulnerable subgroup deserving special attention.

Background: We aimed to confirm the association between slow brain wave activity typically described as "diffuse slowing" on standard electroencephalogram (EEG) and patient outcomes, including mortality.

Methods: This retrospective study was conducted with patient chart data from March 2015 to March 2017 at a tertiary care academic hospital in the midwestern United States. In total, 1,069 participants age ≥55 years on an inpatient floor or ICU received a standard 24-hour EEG. The primary outcome was all-cause mortality at 30, 90, 180, and 365 days. Secondary outcomes were time to discharge, and discharge to home.

Results: Having diffuse slowing on standard EEG was significantly associated with 30-, 90-, 180-, and 365-day mortality compared with patients who had normal EEG findings, after controlling for age, sex, and Charlson Comorbidity Index score. When controlling for these factors, patients with diffuse slowing had a significant longer time to discharge and were significantly less likely to discharge to home. Our findings showed that a standard EEG finding of diffuse slowing for inpatients age ≥55 years is associated with poor outcomes, including greater mortality.

Conclusions: This study suggested that the finding of diffuse slowing on EEG may be an important clinical marker for predicting mortality in geriatric inpatients.

Background: The management of major neurocognitive disorder (MNCD), formerly known as dementia, is of increasing concern as the elderly population continues to grow. Doll therapy (DT) is a controversial method observed in clinical practice that has both promising benefits and potential ethical concerns. To date, little research has been done on this therapy.

Methods: A PubMed search was performed using the keywords "dementia," "elderly," "dolls," "doll therapy," and "Alzheimer's disease." A list of pertinent articles was assembled, with irrelevant articles excluded. References from these articles were also reviewed and additional articles were included in the final list.

Results: Research on the utility of DT for patients with MNCD is limited. Current literature suggests that DT may be beneficial in decreasing the use of pharmacologic interventions and alleviating symptoms such as agitation and anxiety. However, most studies consisted of small, unrepresentative sample populations.

Conclusions: Preliminary studies favor DT as an effective management strategy for behavioral symptoms of MNCD. However, the few existing randomized controlled trials are limited in size and demographics. Further research involving larger, more diverse study samples with more male patients is needed. Additionally, the exact parameters to guide this therapy have not been established and require investigative study.

Background: Neuroimaging, especially diffusion tensor imaging (DTI), has emerged as a helpful tool in assessing and characterizing white matter (WM) integrity. The resultant early treatment from early diagnosis is crucial because treatment is often more efficacious. Borderline personality disorder (BPD) is a challenging disorder to diagnose and treat, and has been reported to have various neurobiologic abnormalities. We conducted a search of the literature to review WM pathology findings in BPD.

Methods: A search was conducted to identify systematic reviews and meta-analyses published from January 2000 to September 2019 that assessed WM integrity in BPD.

Results: Four studies were included. One study demonstrated no difference in WM between BPD and healthy controls. Another study found decreased fractional anisotropy (FA) within the corpus callosum (CC) and orbitofrontal regions. A subsequent randomized controlled trial reported a decrease in FA within the fornix, CC, and right superior/anterior corona radiata with associated increase in radial diffusivity in the left anterior thalamic radiation. The fourth study found a decrease in the axial diffusivity within the cingulum, inferior longitudinal fasciculus, and inferior frontoccipital fasciculus.

Conclusions: Our review concludes that BPD is associated with measurable WM pathology. Methods such as DTI might emerge as useful tools in the management of BPD. More controlled studies are needed to validate our conclusions.

Background: Patients with schizophrenia, bipolar disorder, and major depressive disorder (MDD) have increased infections. We explored the association between recent antimicrobial exposure and acute psychiatric illness.

Methods: We performed a retrospective chart review of 267 acutely ill patients age 18 to 65. There were 92 patients with schizophrenia, 42 with bipolar disorder, 61 with MDD, and 72 with alcohol use disorders (hospitalized controls). Recent antimicrobial exposure was defined as occurring within 3 days of psychiatric hospitalization.

Results: The prevalence of recent antimicrobial exposure was significantly increased in acutely ill patients with schizophrenia (16%), bipolar disorder (21%), and MDD (18%) compared with patients who had alcohol use disorders (4%, P ≤ .01 for each). After controlling for potential confounders, participants with schizophrenia or mood disorders were 5 to 7 times more likely to have recent antimicrobial exposure than participants with alcohol use disorders (schizophrenia: odds ratio [OR] = 4.5, 95% confidence interval [CI] 1.0-21.0, P = .053; bipolar disorder: OR = 6.9, 95% CI 1.3-35.7, P = .022; MDD: OR = 5.7, 95% CI 1.2-28.3, P = .032). Among participants with mood disorders, the association was stronger for participants with depression and affective psychosis compared with participants with alcohol use disorders.

Conclusions: We found an increased prevalence of recent antimicrobial exposure in acutely ill patients with schizophrenia and mood disorders. The findings provide additional evidence that infections are relevant to acute psychiatric illness.

Background: Use of kratom is increasing in the United States due to its perceived safety as a botanical product. This review provides salient information about kratom for the practicing clinician.

Methods: We conducted a literature search of MedLine, UpToDate, and Google using the terms "kratom" and "Mitragyna speciosa" for articles published within the last 10 years.

Results: We reviewed > 500 articles. Kratom is derived from the Mitragyna speciosa plant of Southeast Asia. It has grown in popularity within the United States due to its dual effects of acting as a stimulant at low doses and acting as an opioid-like substance at higher dosages. The 2 major active ingredients in kratom, mitragynine and 7-OH mitragynine, act as partial agonists at the mu-opioid receptor. While adverse consequences are normally mild, there are several potentially serious adverse effects, including respiratory depression, especially with chronic, high-dose usage. Furthermore, in case reports, concomitant use of kratom with other substances has been linked to seizures. Unfortunately, an increasing number of deaths have been linked to kratom usage. Six states have made it illegal to possess or sell kratom.

Conclusions: Kratom is an emerging drug of abuse in the United States. Its use is increasing in individuals who may seek to experience an opioidlike "high" as well as to help reduce withdrawal effects from other opioids.