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

Background: Catatonia is prevalent in the general hospital yet remains under-recognized. Of particular interest is the relationship between delirium and catatonia as recent studies have shown catatonia may co-occur with delirium. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision posits that catatonia does not exist in delirium, although studies have questioned this exclusion.

Objective: To assess the co-occurrence of catatonia and delirium in hospitalized general medical patients and to describe naturalistic treatment outcomes with lorazepam.

Methods: Data from a naturalistic quality improvement project were retrospectively analyzed. All consecutive admissions to 4 general medical units at the University Hospital at Stony Brook were screened within 48 h using the Bush-Francis Catatonia Screening Instrument and the Confusion Assessment Method. The diagnostic threshold on the Bush-Francis Catatonia Screening Instrument was set to 4 signs to increase specificity. The Bush-Francis Catatonia Rating Scale was utilized to monitor severity of positive screens. The quality improvement project included 718 consecutive patient admissions that are reviewed and analyzed in this report.

Results: Approximately 2.2% of the 718 patients met criteria for catatonia. Of the patients with catatonia, 93% also met criteria for co-occurring delirium. The prevalence of delirium in the sample was 24.8%, and 8.4% of patients with delirium also had catatonia. Of those with catatonia and delirium, 43.8% received treatment for catatonia with benzodiazepines. Of those treated, the clinical features of catatonia and delirium remitted in 43% of cases, whereas the signs of catatonia responded to treatment (>50% reduction in Bush-Francis Catatonia Rating Scale) in 57% of cases. All 16 cases of catatonia had 5 or more signs of catatonia, while the majority of the remaining 702 patients had 0-2 signs.

Conclusions: These data provide further evidence that catatonia coexists with delirium, and may respond to lorazepam. We found a bimodal distribution in the number of catatonic signs, suggesting catatonia may be a distinct syndrome among medical patients. Our results suggest that prospective treatment studies are warranted.

Background: Anorexia nervosa (AN) in older adults presents with medical complexity, psychiatric comorbidity, and diagnostic ambiguity, often overlapping with depression, cognitive decline, or anorexia of aging. A literature base dominated by case reports limits practical guidance for consultation-liaison (C-L) psychiatry.

Objective: To describe key clinical features of AN in older adults, integrating systems-level barriers that shape diagnosis, care transitions, and prognosis.

Methods: We describe 2 late-life AN cases and conducted a systematic review of studies including adults aged ≥60 years with AN defined by the Diagnostic and Statistical Manual of Mental Disorders. Two reviewers independently screened and extracted data and appraised quality using Joanna Briggs Institute tools. Extracted variables included demographics, Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, psychiatric and medical comorbidities, care setting, and outcomes. We used narrative synthesis with descriptive statistics like n/N, %, median (interquartile range), and ranges to summarize case reports. The AN course was categorized as late-onset (≥60 years), chronic diagnosed, chronic undiagnosed, or recurrence.

Results: Forty publications met criteria: 31 case reports/series, eight cross-sectional studies, and one cohort. Cross-sectional studies showed 3-6% prevalence of disordered eating behaviors with rare AN. Across 47 individually described patients, most were women in their early seventies with severe undernutrition and multimorbidity. Care most commonly occurred on medical units. Nutritional rehabilitation (e.g., supervised meals, enteral feeding) was the most common intervention. Outcomes were mixed, with many patients achieving weight gain, but mortality remained substantial. System-level barriers, such as insurance coverage and access constraints, were not reported in the literature but were prominent in our 2 cases.

Conclusions: In older adults, AN is rare in population samples but severe when clinically detected. The review highlights diagnostic complexity, medical risk, limited psychotherapy/medication detail, and systems barriers central to consultation-liaison practice. Consultation-liaison psychiatrists play a key role in identifying and coordinating treatment for this complex population.

Demoralization has important implications for patients' health, but consultation-liaison psychiatrists may be less familiar with diagnosis and management due to limited inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. We present the case of a multivisceral transplant patient who experienced demoralization due to complications from her posttransplant course. We discuss the diagnosis of demoralization, including differential diagnoses to consider, followed by a discussion of management of demoralization in the inpatient setting using acceptance and commitment therapy. We then discuss the consultation-liaison psychiatrist's role in assisting with management of teams' counter-transference to difficult patient cases, including the possibility of teams experiencing their own demoralization.

Background: Heart failure (HF) affects over 6 million US adults, especially older individuals, and is a leading cause of hospitalization with high readmission rates. Psychological distress, particularly depression, is common and linked to negative outcomes.

Objective: This study explored illness perceptions and psychosocial experiences in patients with HF, with attention to differences by etiology and sex.

Methods: This was a qualitative research study of patients with HF that collected information through semistructured phone interviews and a mailed survey assessing demographic and mental health history. From February 2021 to May 2022, thirty-five patients were recruited and completed the interview. All interviews were audio-recorded, transcribed, and coded using NVivo.

Results: The mean participant age was 71.8 years (standard deviation 11.1), with 22 (63%) males. Eight had a history of depression, and 5 reported anxiety; most linked their symptoms partly to HF. Three major psychosocial themes emerged: (1) Living with Heart Failure, (2) Emotional Experience and Coping, and (3) Personal and CommunitySupport. Emotional responses included depression, anxiety, anger, and frustration. Although many reported strong family support, caregiver stress was noted. Women showed higher rates of depression, anxiety, and antidepressant use, with differences also seen by illness etiology.

Conclusions: This qualitative analysis found that patients with HF adapt to a "new normal" through lifestyle changes, with 4 key themes emerging. Variability within each theme suggests that a one-size-fits-all approach to assessing and managing psychosocial distress may be insufficient, highlighting opportunities for more individualized care in primary and specialty settings.