We present a case of a middle-aged man brought to the hospital for altered mental status and hallucinations in a background of chronic alcohol use. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include a differential for and distinguishing features of hallucinations in the setting of alcohol use, risk stratification and selection of agents for alcohol withdrawal management, and prevention of neurological injury in Wernicke-Korsakoff. Specifically, the differential diagnosis for hallucinations in alcohol withdrawal syndrome contains delirium in addition to delirium tremens as many patients do not progress to severe withdrawal syndrome. Symptom triggered protocols for alcohol withdrawal may be less reliable in general hospital settings due to limitations such as confounding medical comorbidities, and selecting an agent for management is based on clinical presentation, properties of the agents, and risk of severe symptoms.
{"title":"Consultation-Liaison Case Conference: Altered Mental Status and Hallucinations in Alcohol Use.","authors":"Ashika Bains, Deborah Meisel, Shamim Nejad, Mladen Nisavic","doi":"10.1016/j.jaclp.2025.10.333","DOIUrl":"10.1016/j.jaclp.2025.10.333","url":null,"abstract":"<p><p>We present a case of a middle-aged man brought to the hospital for altered mental status and hallucinations in a background of chronic alcohol use. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include a differential for and distinguishing features of hallucinations in the setting of alcohol use, risk stratification and selection of agents for alcohol withdrawal management, and prevention of neurological injury in Wernicke-Korsakoff. Specifically, the differential diagnosis for hallucinations in alcohol withdrawal syndrome contains delirium in addition to delirium tremens as many patients do not progress to severe withdrawal syndrome. Symptom triggered protocols for alcohol withdrawal may be less reliable in general hospital settings due to limitations such as confounding medical comorbidities, and selecting an agent for management is based on clinical presentation, properties of the agents, and risk of severe symptoms.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-05DOI: 10.1016/j.jaclp.2025.10.334
Charles Mormando, Samuel Reinfeld, Nicholas Genova, Aimy Rehim, Ilana Yel, Andrew Francis, Adeeb Yacoub
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.
{"title":"Catatonia and Delirium in a General Medical Setting: Prevalence and Naturalistic Treatment Outcome.","authors":"Charles Mormando, Samuel Reinfeld, Nicholas Genova, Aimy Rehim, Ilana Yel, Andrew Francis, Adeeb Yacoub","doi":"10.1016/j.jaclp.2025.10.334","DOIUrl":"10.1016/j.jaclp.2025.10.334","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>To assess the co-occurrence of catatonia and delirium in hospitalized general medical patients and to describe naturalistic treatment outcomes with lorazepam.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clozapine is an atypical antipsychotic for treatment-resistant schizophrenia. Despite its efficacy, it is associated with many serious side effects, including pericarditis. Clozapine-associated pericarditis may range from mild symptoms to life-threatening complications. Despite increasing case reports, a comprehensive synthesis is lacking, necessitating a systematic review.
Objective
To systematically summarize and analyze published case reports of clozapine-assoicated pericarditis with a focus on clinical presentation, diagnostic findings, treatment approaches and patient outcomes.
Methods
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in International Prospective Register of Systematic Reviews. Eight databases, including PubMed, Embase, and PsycINFO, were searched, identifying case reports published between 1980 and 2024. Inclusion criteria focused on English-language case reports diagnosing clozapine-associated pericarditis. Exclusion criteria included nonclozapine-associated pericarditis and mixed etiologies without clozapine-specific data. Data extraction included demographics, clinical presentation, diagnostic findings, management, and outcomes.
Results
The mean age was 33.56 years, with males comprising 63.9%. The most frequent presenting symptoms were chest pain (63.9%) and fever (52.8%), followed by dyspnea (50.0%) and tachycardia (44.4%). Diagnostic tests consistently indicated elevated inflammatory markers, including C-reactive protein (mean: 88.1 mg/dL) and erythrocyte sedimentation rate (mean: 72.7 mm/h). Echocardiograms confirmed pericardial effusion in 88.9% of cases. Management strategies included colchicine (16.7%) and analgesics (19.4%), with cardiac recovery achieved in all but one case. Clozapine rechallenge was attempted in 16.7% of the cases, with successful outcomes in 83.3% of these cases.
Conclusions
Clozapine-associated pericarditis is a rare but serious adverse event characterized by elevated inflammatory markers and diagnostic imaging abnormalities. Prompt recognition and tailored management, including anti-inflammatory treatment and careful rechallenge, can lead to favorable cardiac and psychiatric outcomes.
{"title":"Clozapine-Associated Pericarditis: A Systematic Review","authors":"Aliu Opeyemi Yakubu MD , Olorungbami Kolade Anifalaje MD , Moses Gregory Effiong MD , Oluwakemi Eunice Olalude MD , Maryam Abubakar MD , Francess Oluwaferanmi Adeyemi MD","doi":"10.1016/j.jaclp.2025.07.004","DOIUrl":"10.1016/j.jaclp.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Clozapine is an atypical antipsychotic for treatment-resistant schizophrenia. Despite its efficacy, it is associated with many serious side effects, including pericarditis. Clozapine-associated pericarditis may range from mild symptoms to life-threatening complications. Despite increasing case reports, a comprehensive synthesis is lacking, necessitating a systematic review.</div></div><div><h3>Objective</h3><div>To systematically summarize and analyze published case reports of clozapine-assoicated pericarditis with a focus on clinical presentation, diagnostic findings, treatment approaches and patient outcomes.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in International Prospective Register of Systematic Reviews. Eight databases, including PubMed, Embase, and PsycINFO, were searched, identifying case reports published between 1980 and 2024. Inclusion criteria focused on English-language case reports diagnosing clozapine-associated pericarditis. Exclusion criteria included nonclozapine-associated pericarditis and mixed etiologies without clozapine-specific data. Data extraction included demographics, clinical presentation, diagnostic findings, management, and outcomes.</div></div><div><h3>Results</h3><div>The mean age was 33.56 years, with males comprising 63.9%. The most frequent presenting symptoms were chest pain (63.9%) and fever (52.8%), followed by dyspnea (50.0%) and tachycardia (44.4%). Diagnostic tests consistently indicated elevated inflammatory markers, including C-reactive protein (mean: 88.1 mg/dL) and erythrocyte sedimentation rate (mean: 72.7 mm/h). Echocardiograms confirmed pericardial effusion in 88.9% of cases. Management strategies included colchicine (16.7%) and analgesics (19.4%), with cardiac recovery achieved in all but one case. Clozapine rechallenge was attempted in 16.7% of the cases, with successful outcomes in 83.3% of these cases.</div></div><div><h3>Conclusions</h3><div>Clozapine-associated pericarditis is a rare but serious adverse event characterized by elevated inflammatory markers and diagnostic imaging abnormalities. Prompt recognition and tailored management, including anti-inflammatory treatment and careful rechallenge, can lead to favorable cardiac and psychiatric outcomes.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 6","pages":"Pages 492-501"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jaclp.2025.10.324
Morgan Brasfield , Dimitry Davydow , Christopher Morrow , Adam Staffaroni , Gregory Pontone , Chiadi Onyike , Breton Asken , Morgan Brasfield
{"title":"78. Is Neurofilament Light Chain a Viable Biomarker to Aid Consultation-Liaison Psychiatrists in Differentiating Behavioral Variant Frontotemporal Dementia from Primary Psychiatric Disorders? A Systematic Review of the Literature","authors":"Morgan Brasfield , Dimitry Davydow , Christopher Morrow , Adam Staffaroni , Gregory Pontone , Chiadi Onyike , Breton Asken , Morgan Brasfield","doi":"10.1016/j.jaclp.2025.10.324","DOIUrl":"10.1016/j.jaclp.2025.10.324","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Pages S40-S41"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jaclp.2025.10.273
Elisabeth Dietrich , Maureen Cassady , Zoii Barnes-Scott , Bonnie Blanchfield , Nomi Levy-Carrick , Sejal Shah , Melissa Bui
{"title":"27. WEBB FELLOW: Proactive Psychiatric Consultation in the Medical Intensive Care Setting: A Retrospective Review of the Financial and Clinical Impact of This Model of Care","authors":"Elisabeth Dietrich , Maureen Cassady , Zoii Barnes-Scott , Bonnie Blanchfield , Nomi Levy-Carrick , Sejal Shah , Melissa Bui","doi":"10.1016/j.jaclp.2025.10.273","DOIUrl":"10.1016/j.jaclp.2025.10.273","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Page S14"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"29. WEBB FELLOW: \"Dying Insane:” the End-Of-Life Experiences of Psychiatrically Hospitalized Insanity Acquittees, a Case Series","authors":"Gregg Robbins-Welty , Ariana Hustled , Haseeb Haroon , Nicole Wolfe","doi":"10.1016/j.jaclp.2025.10.275","DOIUrl":"10.1016/j.jaclp.2025.10.275","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Page S15"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jaclp.2025.10.293
Simran Ailani , Jessica Poster , Haitham Salem
{"title":"47. Zap the Gap: Why Psychiatry Residency Desperately Needs an “Interventional” Jolt","authors":"Simran Ailani , Jessica Poster , Haitham Salem","doi":"10.1016/j.jaclp.2025.10.293","DOIUrl":"10.1016/j.jaclp.2025.10.293","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Pages S24-S25"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jaclp.2025.10.329
Alice Li , Alvin Gordián Arroyo , Kristen Jacobson
{"title":"83. Psychiatric Consults in Hispanic/Latinx Patients With Limited English Proficiency: A Retrospective Chart Review","authors":"Alice Li , Alvin Gordián Arroyo , Kristen Jacobson","doi":"10.1016/j.jaclp.2025.10.329","DOIUrl":"10.1016/j.jaclp.2025.10.329","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Page S43"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jaclp.2025.10.301
Kimberly Bond , Tremayne Koochin , Baadal Vacchani , Gkeemia Gibson , Celeste Peay , Joseph Dragonetti
{"title":"55. Indications, Safety, and Evidence Base for Intravenous Antipsychotics: A Scoping Review","authors":"Kimberly Bond , Tremayne Koochin , Baadal Vacchani , Gkeemia Gibson , Celeste Peay , Joseph Dragonetti","doi":"10.1016/j.jaclp.2025.10.301","DOIUrl":"10.1016/j.jaclp.2025.10.301","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Pages S28-S29"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jaclp.2025.10.279
Randi Libbon , Mackenzie Moore , Meagan Watson , Jared Woodward , Laura Strom , Thida Thant
{"title":"33. Group Psychotherapy for the Treatment of Functional Seizures","authors":"Randi Libbon , Mackenzie Moore , Meagan Watson , Jared Woodward , Laura Strom , Thida Thant","doi":"10.1016/j.jaclp.2025.10.279","DOIUrl":"10.1016/j.jaclp.2025.10.279","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 ","pages":"Page S17"},"PeriodicalIF":2.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145500067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号