Journal of the Academy of Consultation-Liaison Psychiatry最新文献

英文中文

Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study 美国的谵妄：2023 年 "世界谵妄意识日 "流行率横断面研究结果。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-09-01 DOI: 10.1016/j.jaclp.2024.06.005

Background

Delirium is an acute brain dysfunction associated with an increased risk of mortality and future dementia.

Objectives

To describe the prevalence of clinically documented delirium in the United States on World Delirium Awareness Day 2023.

Methods

This is a sub-analysis of a prospective, cross-sectional, online, international survey. All health care settings were eligible, with the exception of operating rooms and outpatient clinics. Health care clinicians, administrators, and researchers completed the survey. The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. and 8:00 p.m. on March 15, 2023. Secondary outcomes were related to health care delivery. Descriptive statistics are reported. Differences between unit types (non-intensive care unit vs intensive care unit) were examined for all outcomes.

Results

Ninety-one hospital units reported on 1318/1213 patients. The prevalence of clinically documented delirium was 16.4% (n = 216/1318) at 8:00 a.m. and 17.9% (n = 217/1213) at 8:00 p.m. (P = 0.316) and significantly differed between age groups, reported discipline, unit, and hospital types. Significant differences were identified between non-intensive care unit and intensive care unit settings in the use of delirium-related protocols, nonpharmacologic and pharmacologic management, educational processes, and barriers to evidence-based delirium care.

Conclusions

To our knowledge, this is the first epidemiologic survey of clinically documented delirium across two time points in the United States. Delirium remains a significant burden and challenge for health care systems. The high percentage of units using delirium management protocols suggests administrator and clinician awareness of evidence-based strategies for its detection and mitigation. We provide recommendations for future studies and quality improvement projects to improve clinical recognition and management of delirium.

重要性：谵妄是一种急性脑功能障碍，与死亡率和未来痴呆症风险增加有关：描述 2023 年 "世界谵妄意识日 "当天美国有临床记录的谵妄患病率：设计：一项前瞻性、横断面、在线国际调查的子分析：除手术室和门诊部外，所有医疗机构均符合条件：主要结果和衡量标准：主要结果和测量指标：2023 年 3 月 15 日上午 8:00 和晚上 8:00 有临床记录的谵妄发生率。次要结果与医疗服务相关。报告了描述性统计数字。对所有结果进行了单位类型（非重症监护病房与重症监护病房）之间的差异检查：91个医院单位报告了1,318/1,213名患者的情况。临床记录的谵妄发生率在上午 8:00 为 16.4%（n=216/1,318），在下午 8:00 为 17.9%（n=217/1,213）（p=0.316），不同年龄组、报告学科、科室和医院类型之间存在显著差异。非重症监护病房和重症监护病房在谵妄相关协议的使用、非药物和药物管理、教育过程以及循证谵妄护理的障碍方面存在显著差异：据我们所知，这是美国首次对两个时间点上有临床记录的谵妄进行流行病学调查。谵妄仍然是医疗保健系统的一个重大负担和挑战。使用谵妄管理协议的单位比例很高，这表明管理者和临床医生都意识到了检测和缓解谵妄的循证策略。我们对未来的研究和质量改进项目提出了建议，以改善谵妄的临床识别和管理。

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引用次数: 0

Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome 糖尿病酮症酸中毒和高渗性高血糖综合征的精神障碍和药物使用障碍及其与临床结果的关系。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-09-01 DOI: 10.1016/j.jaclp.2024.02.007

Background and Objective

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5–10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality.

Methods

We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05.

Results

Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35–1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002–1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46–9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of −7.5 years (95% CI −9.3 to 5.8) compared to those without a psychiatric disorder.

Conclusions

Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality.

背景：糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS）是一种危及生命的疾病，每年有近 18 万患者被送入重症监护室，死亡率高达 5-10%。人们对并发精神障碍对 DKA/HHS 具体结果的影响知之甚少。确定这些关系为改善临床管理、治疗计划以及降低相关发病率和死亡率提供了机会：我们对马萨诸塞州一家大型医院系统在 2010 - 2019 年期间收治的成人 DKA/HHS 患者进行了回顾性分析。我们确定了因 DKA 或 HHS 而入院的患者，然后通过 ICD-9-CM、ICD-10-CM 代码筛选出患者 EMR 中在观察期内任何时间点出现的精神科诊断。结果包括因 DKA/HHS 住院的人数、死亡年龄、任何住院病例的违抗医嘱出院率 (AMA) 以及 ESRD/透析状态。使用 R 软件进行多变量回归，以控制不同患者的变量，并评估结果与并发精神疾病之间的关系。显著性以 p 为标准：7756 名患者因 DKA 或 HHS 入院，其中 66.9% 的患者同时患有精神疾病。其中 54.5% 为男性，70.4% 为白人，平均年龄为 61.6 岁。相比之下，在普通糖尿病患者中，有 26.1% 同时患有精神疾病，其中 52.1% 为男性，72.1% 为白人，平均年龄为 68.2 岁。并发精神障碍与再次住院的几率增加有关（aOR= 1.62 95%Cl 1.35 - 1.95, p结论：66.9% 的 DKA/HHS 患者并发精神障碍。因 DKA/HHS 而入院的并发精神障碍患者更有可能多次入院、离开 AMA、接受肾透析，且死亡率较低。

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引用次数: 0

Interdisciplinary Training of Agitation Management by the Proactive C-L Team Reaffirms “Service Recovery” and Maintenance of Optimism 积极主动的 C-L 团队提供的关于躁动管理的跨学科培训重申了 "服务恢复 "和保持乐观。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-09-01 DOI: 10.1016/j.jaclp.2024.05.001

引用次数: 0

Concurrent Clozapine and Amiodarone Treatment 同时使用氯氮平和胺碘酮治疗。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-09-01 DOI: 10.1016/j.jaclp.2024.06.001

引用次数: 0

Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access 减少儿童精神健康寄宿和增加急症护理机会

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-09-01 DOI: 10.1016/j.jaclp.2024.04.001

Background

There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. Objectives: We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis.

Methods

Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October–December 2021 and one year later (October–December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units.

Results

One year after full intervention implementation (October–December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October–December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P = 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93 ± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88 ± 1.11, 95% CI [1.54, 2.30]).

Conclusions

The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.

近年来，美国儿科心理健康寄宿人数明显增加，青少年被安置在急诊科或内外科住院部，等待接受精神病治疗。我们旨在评估一家大型三级儿科医院在全国性儿科精神健康危机期间采取干预措施以减少寄宿人数并改善急诊精神科服务的结果。寄宿干预措施包括扩大精神科住院病床、增聘员工以加强危机稳定服务，以及在急诊科和内外科住院病房为等待安置的寄宿患者启动治疗。在 2021 年 10 月至 12 月干预措施开始实施期间和一年后（2022 年 10 月至 12 月），通过对精神健康突发事件患者的回顾性审查进行了事后评估。纳入标准为在研究期间出现精神健康相关紧急情况的年龄≤17 岁的患者。排除标准是年龄≥18 岁的患者和/或入院时间超过 100 天、等待长期安置的患者。主要结果是平均寄宿时间（LOB）。次要结果是在医院急性精神病科的平均住院时间（LOS）。干预措施全面实施一年后（2022 年 10 月至 12 月），与 2021 年 10 月至 12 月相比，出院后接受高级护理（如住院、急性住院）和中级护理（如部分住院、居家危机稳定计划）的寄宿患者的平均寄宿时间减少了 53%（4.3 天 vs 9.1 天，< 0.0001）。此外，所有24小时急诊精神病治疗项目的平均住院日减少了27%（20.0天 vs 14.6天，=0.0002），更多患者能够获得此类项目（265/54.2% vs 221/41.9%，<0.0001）。在这两年中，有攻击性行为的青少年的住院时间（2.93 ± 1.15，95% CI [2.23，3.87]）比没有攻击性行为的青少年长193%，而曾入住精神病院的青少年的住院时间（1.88 ± 1.11，95% CI [1.54，2.30]）比没有入住精神病院的青少年长88%。目前的研究表明，经过综合干预后，需要接受急性精神病治疗的青少年的等待时间缩短，获得治疗的机会增加，同时也凸显了有攻击性行为的青少年在安置方面所面临的挑战。我们建议儿科医院采取行动，投入足够的急诊精神科资源，以解决儿科精神健康寄宿问题。

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引用次数: 0

Hydralazine-Induced Visual and Auditory Hallucinations in a Kidney Transplant Patient: Case Report 一名肾移植患者因肼屈嗪引起视听幻觉：病例报告。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-09-01 DOI: 10.1016/j.jaclp.2024.06.004

引用次数: 0

Broca's Aphemia, Not Aphasia: Focal Frontal Seizures Misdiagnosed as Functional Neurological (Conversion) Mutism. 布罗卡缺血症，而非失语症：局灶性额叶癫痫被误诊为功能性神经（转换）缄默症。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-08-30 DOI: 10.1016/j.jaclp.2024.08.005

Xavier F Jimenez, Maria Vasconez Narvaez, Fred A Lado

引用次数: 0

Serotonin Toxicity Associated With Electroconvulsive Therapy: A Case Report. 与电休克疗法相关的羟色胺中毒：病例报告。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-08-28 DOI: 10.1016/j.jaclp.2024.08.002

Kylie Calderon, Melissa K Cutshaw, Elana Horwtiz, Ryan D Slauer, Ryan A Duffy

引用次数: 0

"I'm Not Crazy": Responding to Perceived Mental Health Stigma. "我没疯"--对心理健康污名化的回应。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-08-17 DOI: 10.1016/j.jaclp.2024.08.001

John R Peteet

引用次数: 0

Electroconvulsive Therapy in Managing Intractable Psychosis in Hereditary Aceruloplasminemia-Associated Neurodegeneration: A Case Report. 电休克疗法用于治疗遗传性醋浆蛋白血症相关神经变性的顽固性精神病：病例报告。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-07-27 DOI: 10.1016/j.jaclp.2024.07.006

Vicky Wang, Hannah Chew, Kathy Niu

引用次数: 0

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Journal of the Academy of Consultation-Liaison Psychiatry

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