Journal of the Academy of Consultation-Liaison Psychiatry最新文献_第6页

Antenatal Psychiatric Hospitalization: Factors Associated With Newborns' Custody Under Child Protective Services 产前精神病住院治疗：产前精神病住院：新生儿在儿童保护服务机构（CPS）监护下的相关因素》。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-11-01 DOI: 10.1016/j.jaclp.2024.03.004

Tyler Torrico M.D. , Emily Fitzsimmons M.D. , Shrey Patel M.D. , Juan Lopez M.D. , Ranjit Padhy M.D. , Muhammad.T. Salam M.D., Ph.D. , Sara Abdijadid M.D.

Background

Psychiatric illness during pregnancy is associated with adverse obstetric outcomes, but investigations into its impact on parenting capacity are limited. Child Protective Services (CPS) contact disproportionately impacts families marginalized by poverty, mental health disorders, and substance use disorders. Recently, there have been investigations into the significance of psychiatric illness and nonmental health-related factors that predict CPS custody arrangements.

Objective

To identify clinical factors associated with newborns' custody under CPS for mothers with antenatal psychiatric hospitalization.

Methods

We conducted a retrospective review of electronic medical records over a 10-year period (2012–2021) for patients who were pregnant during their inpatient psychiatric hospitalizations. We followed 81 patients (18 to 43 years old) who delivered within the hospital. The study endpoint was whether the newborn was placed under CPS custody. For the purposes of this study, psychiatric illness was categorized by the presence or absence of psychotic symptoms. We utilized logistic regressions to investigate the associations of these demographic and clinical factors with the study outcome of CPS custody.

Results

For the entire study population, 64.2% of newborns had CPS custody arrangements. In multivariate analysis, after adjusting for potential confounders, patients with psychotic symptoms were at increased odds of having CPS custody arrangements (odds ratio = 8.43; 95% confidence interval 2.16-32.85) compared with patients without psychotic symptoms. Furthermore, multivariate analyses revealed that patients with a history of homelessness also had a higher risk (odds ratio = 6.59; 95% confidence interval: 1.24-35.13) of CPS custody arrangements for their newborns than those without a history of homelessness.

Conclusions

The results of this study suggest that among pregnant and psychiatrically hospitalized patients, those with psychotic symptoms are significantly more likely to have CPS custody arrangements compared to those without psychotic symptoms. However, it is important to note that psychotic symptoms were not definitive for the inability to parent appropriately. In fact, nearly 25% of the study population who had psychotic symptoms were able to successfully transition home with their newborns as mothers. This emphasizes the importance of optimizing the management of psychotic symptoms, particularly among those who have children or plan to have children. The findings of this study also highlight the chronic impacts that those who have struggled with homelessness may experience, including parenting capacity after homelessness resolves.

背景：孕期精神疾病与不良的产科结果有关，但有关其对养育能力影响的调查却很有限。儿童保护服务机构（CPS）对因贫困、精神障碍和药物使用障碍而被边缘化的家庭造成了极大的影响。最近，有人调查了精神病和与精神健康无关的因素对 CPS 监护安排的影响：我们对 10 年内（2012-2021 年）精神病住院期间怀孕的患者的电子病历进行了回顾性审查。我们对 81 名在医院分娩的患者（18 至 43 岁）进行了跟踪调查。研究终点是新生儿是否被置于 CPS 监护之下。在本研究中，精神病是根据是否存在精神病症状来分类的。我们利用逻辑回归法来研究这些人口统计学和临床因素与 CPS 监护这一研究结果之间的关联：在整个研究人群中，有 64.2% 的新生儿被 CPS 监管。在多变量分析中，在调整了潜在的混杂因素后，与无精神病症状的患者相比，有精神病症状的患者被CPS监护的几率更高（几率比[OR]=8.43；95%置信区间[95% CI] 2.16-32.85）。此外，多变量分析显示，有无家可归史的患者与无无家可归史的患者相比，其新生儿被CPS监护的风险也更高（OR=6.59；95% CI：1.24-35.13）：本研究结果表明，在孕妇和精神病住院患者中，与无精神病症状者相比，有精神病症状者更有可能被安排接受 CPS 监护。然而，值得注意的是，精神病症状并不是无法适当养育子女的决定性因素。事实上，在有精神病症状的研究人群中，有近 25% 的人能够作为母亲成功地将新生儿送回家。这强调了优化精神病症状管理的重要性，尤其是对那些有孩子或计划要孩子的人。这项研究的结果还强调了那些曾在无家可归中挣扎的人可能会经历的长期影响，包括无家可归问题解决后的养育能力。

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引用次数: 0

Medical Psychiatry Units: A Delphi Consensus Approach to Defining Essential Characteristics. 内科精神科病房：采用德尔菲共识法确定基本特征。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-10-05 DOI: 10.1016/j.jaclp.2024.09.004

Susan L Padrino, Aubrey C Chan, Maarten van Schijndel, Marsha N Wittink

Medical psychiatry units (MPUs), also known as complexity intervention units, represent an important innovation for integrating medical and behavioral health care in the hospital setting, thereby reducing the need for sequential medical and psychiatric hospitalization. As US hospitals face an increased demand for mental health services, interest in the MPU model is gaining momentum. However, there is no shared definition for what constitutes an MPU, and significant variation exists among units across the United States that have been designated as an MPU. The lack of a unified definition for MPUs results in significant variability and poses challenges for creating new MPUs and studying existing MPUs. To address this gap, the Medical-Psychiatry Unit Consortium recruited a panel of MPU experts to conduct a consensus study. The consortium used a survey to assess the relative importance of various characteristics of MPUs within the following categories: structural organization, environment and design, spectrum of care, staffing, and culture of care. After two rounds of a modified Delphi process, consensus was achieved with regard to which characteristics are necessary or preferred vs. not necessary or harmful. The necessary or preferred characteristics include those that would be expected on a general medical unit, such as having cardiac telemetry monitoring capabilities, as well as characteristics typical of a psychiatric unit, such as locked unit doors, locked cabinets for patient belongings, and common area or milieu. Overall, this suggests that an ideal MPU combines the ability to provide acute medical care with acute psychiatric care. Notably, staffing and culture of care emerged as categories with the highest ranking of necessary characteristics, outweighing environment, design, or the breadth of services offered. These findings suggest that MPU experts feel teamwork and having a shared mission are critical components of effective MPUs and highlight the importance of staff recruitment and training.

精神科医疗单元（MPUs），又称复杂性干预单元，是在医院环境中整合医疗和行为保健的一项重要创新，从而减少了医疗和精神科连续住院的需求。随着美国医院对心理健康服务的需求不断增加，人们对 MPU 模式的兴趣也日益高涨。然而，对于什么是 MPU 并没有一个共同的定义，美国各地被指定为 MPU 的单位之间也存在着很大的差异。缺乏对 MPU 的统一定义导致了巨大的差异，为创建新的 MPU 和研究现有 MPU 带来了挑战。为了填补这一空白，医疗-精神病学单位联盟招募了一个由多学科综合单位专家组成的小组来开展一项共识研究。联合会通过一项调查来评估多学科综合病房在以下类别中各种特征的相对重要性：结构组织、环境和设计、护理范围、人员配备和护理文化。经过两轮修改后的德尔菲程序，就哪些特征是必要的或首选的，哪些特征是不必要的或有害的达成了共识。必要或首选的特征包括普通医疗单元应有的特征，如具备心电遥测监控功能，以及精神科单元的典型特征，如单元门上锁、病人物品柜上锁、公共区域或环境上锁。总体而言，这表明理想的重症监护病房应兼具提供急症医疗护理和急症精神病护理的能力。值得注意的是，人员配备和护理文化是必要特征中排名最高的类别，超过了环境、设计或所提供服务的广度。这些研究结果表明，多学科综合病房专家认为团队合作和共同的使命是有效的多学科综合病房的重要组成部分，并强调了人员招聘和培训的重要性。

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引用次数: 0

Consultation Liaison Case Conference: Inpatient Psychiatric Consultation for Patients With Sickle Cell Disease. 咨询联络病例会议：镰状细胞病患者的住院精神病咨询。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-10-05 DOI: 10.1016/j.jaclp.2024.09.005

Lauren E Fields, Elizabeth Leimbach, Adrienne D Mishkin, C Patrick Carroll, Elizabeth J Prince

We present the fictional case of a 29-year-old man with sickle cell disease referred to psychiatry for evaluation of depression during an acute pain episode. Consultation-liaison psychiatrists with expertise in sickle cell disease provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the high prevalence of mood and cognitive disorders in this population, as well as pertinent issues related to chronic pain, opioids, and stigma.

我们介绍了一个虚构的病例：一名 29 岁的镰状细胞病患者在一次急性疼痛发作中因抑郁而被转诊到精神科进行评估。具有镰状细胞病专业知识的会诊联络精神科医生根据他们的经验和对现有文献的回顾，为这个常见的临床病例提供了指导。教学要点包括该人群中情绪和认知障碍的高发病率，以及与慢性疼痛、阿片类药物和耻辱感相关的问题。

引用次数: 0

Evaluating the Proactive C-L Model: Insights and Unanswered Questions From the UK HOME Study 评估积极主动的 C-L 模型：英国 HOME 研究的启示和未解之谜。

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.2024.09.001

Mark A. Oldham M.D., F.A.C.L.P. , Patrick Triplett M.D. , Hochang B. Lee M.D., F.A.C.L.P.

The HOME Study is the largest and among the most important trials in the history of consultation-liaison psychiatry, and its study team is to be commended for this landmark study. In this article, we provide context for the HOME Study and consider several aspects of the study critical to understanding the nature of the intervention and interpreting its results. First, we compare the model of proactive integrated consultation-liaison psychiatry as implemented in the HOME Study with versions of proactive consultation-liaison psychiatry as commonly practiced in the US. Key distinctions of proactive integrated consultation-liaison psychiatry include a direct assessment of all study arm participants by a consultation-liaison psychiatrist rather than the use of initial screening for acute psychiatric issues, the unique inclusion of an occupational therapist as a member of the proactive integrated consultation-liaison psychiatry team, and patient-level randomization as opposed to unit-based approaches as commonly practiced in the US. Next, we consider several characteristics of the HOME Study sample relevant to its generalizability. These include an average age of 82 years, limited ethnic and racial diversity, and a high prevalence of both cognitive and functional impairment. Third, we review how study methodology informs study interpretation. These include early trial termination due to COVID, which limits power to detect a 1-day reduction in hospital, a mean 3.5-day delay from hospital admission to study enrollment, and the exclusion of patients who had already received a psychiatric consultation, which likely reduced the acuity of mental health issues addressed in this study. Despite these considerations, the HOME Study is a truly remarkable contribution to the literature, and its results will be discussed for years to come. In view of the aging global population, the HOME Study set about to tackle an especially ambitious and forward-looking question by focusing exclusively on older hospitalized adults. Like all good studies, this trial raises many important questions. As the first randomized trial of proactive consultation-liaison psychiatry of any form, the HOME Study is an encouragement to the field to consider the range of potential benefits of providing proactive, integrated mental health care to medical and surgical inpatients with mental health needs.

居家研究 "是会诊联络精神病学历史上规模最大、最重要的试验之一，其研究团队因这项具有里程碑意义的研究而备受赞誉。在本文中，我们将介绍 "居家 "研究的背景，并对该研究中对理解干预的性质和解释其结果至关重要的几个方面进行探讨。首先，我们将 "居家研究 "中实施的主动综合咨询-联络精神病学模式与美国通常实施的主动咨询-联络精神病学模式进行比较。前瞻性综合会诊-联络精神病学的主要区别包括：由会诊-联络精神病学医生对所有研究组参与者进行直接评估，而不是对急性精神病问题进行初步筛查；将职业治疗师作为前瞻性综合会诊-联络精神病学团队的成员之一；患者层面的随机化，而不是美国通常采用的以单位为基础的方法。接下来，我们将考虑 "居家 "研究样本中与可推广性相关的几个特点。这些特点包括：平均年龄 82 岁、种族和民族多样性有限、认知和功能障碍发生率高。第三，我们回顾了研究方法如何影响研究解释。这些因素包括：由于 COVID 导致试验提前结束，从而限制了检测住院时间减少 1 天的能力；从入院到加入研究的平均延迟时间为 3.5 天；排除了已经接受过精神科咨询的患者，这可能降低了本研究中精神健康问题的严重性。尽管有这些考虑因素，但 "居家 "研究确实为文献做出了卓越的贡献，其结果也将在未来数年内得到讨论。鉴于全球人口老龄化的趋势，"居家 "研究专门针对住院的老年人，着手解决一个雄心勃勃且具有前瞻性的问题。与所有优秀的研究一样，这项试验也提出了许多重要问题。作为首例任何形式的主动咨询-联络精神病学随机试验，"居家 "研究鼓励该领域考虑为有心理健康需求的内科和外科住院患者提供主动、综合的心理健康护理可能带来的一系列益处。

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引用次数: 0

Depressed and Nowhere to Go for Help: Using Telepsychiatry and Intramuscular Ketamine to Treat a Suicidal Patient With Huntington's Disease in the General Hospital 抑郁无处求助：在综合医院使用远程精神病学和肌肉注射氯胺酮治疗有自杀倾向的亨廷顿病患者。

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.2024.03.008

引用次数: 0

Myoclonus, Uremia, and Delirium in a Liver Transplant Recipient: A Case Report and Literature Review 一名肝移植受者的肌阵挛、尿毒症和谵妄：病例报告与文献综述

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.2024.07.004

Ernest Okwuonu M.D., Yelizaveta Sher M.D.

Background

Consultation-liaison (CL) psychiatrists are frequently asked to consult on various abnormal movements (1). CL psychiatrists can be instrumental in aiding the primary teams to identify and manage these movement disorders. In this manuscript, we provide an illustrative case of a patient presenting with myoclonus and offer a review on this important topic. Myoclonus accompanied by delirium represents a rare post-transplant complication and can be associated with heightened morbidity and mortality. The incidence of this complication in solid organ transplant recipients is scarcely documented, and its pathophysiology remains inadequately understood. Potential etiologies in the intensive care unit are numerous and likely multifactorial. The literature lacks detailed descriptions of the correlation and association between myoclonus and uremia. Management of this condition requires a multimodal approach, focusing on resolving underlying metabolic disturbances and providing symptomatic treatment.

Objective

This manuscript describes the clinical presentation of myoclonus in a liver transplant recipient accompanied by delirium and precipitated by uremia. We aim to highlight the diagnostic and therapeutic complexities, help providers distinguish myoclonus from other movement disorders, and aid appropriate management.

Methods and Results

We present a case of acute myoclonus in an elderly female liver transplant recipient precipitated by uremia and improved after continuous renal replacement treatment. In addition, we conducted a systematic review utilizing EMBASSE and PubMed of reported cases of myoclonus, delirium, and/or encephalopathy accompanied by uremia. We included 12 manuscripts in our review and discussed their findings.

Conclusions

CL psychiatrists are frequently consulted for a range of movement disorders in the intensive care unit, including myoclonus. Accurate diagnosis and identification of contributing etiologies are critical in these cases. Management typically involves addressing the underlying disorder, such as using dialysis for uremia, alongside symptomatic treatment with benzodiazepines to mitigate the frequency and amplitude of myoclonus. This approach helps to alleviate both the physical burden and psychological distress associated with the condition. This case underscores the pivotal role of the CL psychiatrist within a complex multidisciplinary team, contributing to diagnostic precision and optimization of management strategies for movement disorders.

背景：会诊联络（CL）精神科医生经常被要求对各种异常运动进行会诊(1)。会诊联络精神科医生可以帮助基层团队识别和处理这些运动障碍。在本手稿中，我们提供了一例肌阵挛患者的病例，并对这一重要课题进行了综述。肌阵挛伴有谵妄是一种罕见的移植后并发症，可导致发病率和死亡率升高。这种并发症在实体器官移植（SOT）受者中的发生率鲜有记录，其病理生理学也仍未得到充分了解。重症监护室（ICU）中的潜在病因很多，而且很可能是多因素造成的。文献中缺乏肌阵挛与尿毒症之间相关性和关联性的详细描述。治疗这种病症需要采取多模式方法，重点是解决潜在的代谢紊乱并提供对症治疗：本手稿描述了一名肝移植受者因尿毒症诱发肌阵挛并伴有谵妄的临床表现。我们旨在强调诊断和治疗的复杂性，帮助医疗人员区分肌阵挛和其他运动障碍，并帮助进行适当的治疗：我们介绍了一例女性老年肝移植受者因尿毒症诱发急性肌阵挛的病例，该病例在持续接受肾脏替代治疗后病情有所好转。此外，我们还利用 EMBASSE 和 PubMed 对尿毒症伴发肌阵挛、谵妄和/或脑病的病例进行了系统性回顾。我们在综述中收录了 12 篇手稿，并对其研究结果进行了讨论：包括肌阵挛在内的一系列重症监护室运动障碍病例经常会咨询 CL 精神科医生。在这些病例中，准确诊断和确定诱因至关重要。处理方法通常包括解决潜在的疾病，例如使用透析治疗尿毒症，同时使用苯二氮卓类药物对症治疗，以减轻肌阵挛的频率和幅度。这种方法有助于减轻患者的身体负担和心理压力。本病例强调了 CL 精神科医生在复杂的多学科团队中的关键作用，有助于运动障碍的精确诊断和管理策略的优化。

{"title":"Myoclonus, Uremia, and Delirium in a Liver Transplant Recipient: A Case Report and Literature Review","authors":"Ernest Okwuonu M.D., Yelizaveta Sher M.D.","doi":"10.1016/j.jaclp.2024.07.004","DOIUrl":"10.1016/j.jaclp.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Consultation-liaison (CL) psychiatrists are frequently asked to consult on various abnormal movements (1). CL psychiatrists can be instrumental in aiding the primary teams to identify and manage these movement disorders. In this manuscript, we provide an illustrative case of a patient presenting with myoclonus and offer a review on this important topic. Myoclonus accompanied by delirium represents a rare post-transplant complication and can be associated with heightened morbidity and mortality. The incidence of this complication in solid organ transplant recipients is scarcely documented, and its pathophysiology remains inadequately understood. Potential etiologies in the intensive care unit are numerous and likely multifactorial. The literature lacks detailed descriptions of the correlation and association between myoclonus and uremia. Management of this condition requires a multimodal approach, focusing on resolving underlying metabolic disturbances and providing symptomatic treatment.</div></div><div><h3>Objective</h3><div>This manuscript describes the clinical presentation of myoclonus in a liver transplant recipient accompanied by delirium and precipitated by uremia. We aim to highlight the diagnostic and therapeutic complexities, help providers distinguish myoclonus from other movement disorders, and aid appropriate management.</div></div><div><h3>Methods and Results</h3><div>We present a case of acute myoclonus in an elderly female liver transplant recipient precipitated by uremia and improved after continuous renal replacement treatment. In addition, we conducted a systematic review utilizing EMBASSE and PubMed of reported cases of myoclonus, delirium, and/or encephalopathy accompanied by uremia. We included 12 manuscripts in our review and discussed their findings.</div></div><div><h3>Conclusions</h3><div>CL psychiatrists are frequently consulted for a range of movement disorders in the intensive care unit, including myoclonus. Accurate diagnosis and identification of contributing etiologies are critical in these cases. Management typically involves addressing the underlying disorder, such as using dialysis for uremia, alongside symptomatic treatment with benzodiazepines to mitigate the frequency and amplitude of myoclonus. This approach helps to alleviate both the physical burden and psychological distress associated with the condition. This case underscores the pivotal role of the CL psychiatrist within a complex multidisciplinary team, contributing to diagnostic precision and optimization of management strategies for movement disorders.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 5","pages":"Pages 471-481"},"PeriodicalIF":2.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794072","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}

引用次数: 0

Proactive Psychiatry: Innovating the Delivery of Consultation-Liaison Services in a Pediatric Hospital 积极主动的精神病学：创新儿科医院的咨询联络服务。

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.2024.07.005

Elizabeth Schindler D.O. , Katherine Winner M.D. , Ramzi W. Nahhas Ph.D. , Gianni Maione M.D. , Aisha Jamison M.D. , Kelly Blankenship D.O.

Background

The benefits of a proactive consultation-liaison psychiatry service have been well documented in the adult population, including decreased length of stay (LOS), increased satisfaction among physicians, and enhanced collaborative care. However, there is no available research on the effectiveness of this model in pediatric hospitals.

Objective

This study compared patients aged 5–18 years on a general medical floor receiving a proactive psychiatry consult to concurrent controls receiving no consult and to historical controls receiving traditional reactive consults.

Methods

New admissions to two pediatric general medical hospital teams were reviewed on weekday mornings to identify those with active psychiatric concerns. Adjusted negative binomial regression was used to compare the primary outcome of hospital LOS between the proactive (n = 65), concurrent control (n = 63), and reactive historical control (n = 45) groups. Patient satisfaction, hospitalist satisfaction, and recommendation concordance (degree to which psychiatry recommendations were implemented by the primary team) were also compared between groups as secondary outcome measures.

Results

After adjusting for age, sex, race, insurance type, reason for consult, and medical diagnosis, concurrent control patients had 14% (P = 0.295) longer mean LOS than proactive consults, and historical controls had twice (P < 0.001) the mean LOS of those with proactive consults. Response rate for patient satisfaction scores was low, but responses were modestly more favorable among patients who received proactive consultation-liaison services. Based on nine paired pediatric hospitalist presurveys and postsurveys, follow-up surveys were statistically significantly more favorable after a proactive psychiatry consult service was introduced. Concordance of recommendations was observed to be higher for proactive consults than concurrent controls for diagnoses and nonmedication (other) recommendations.

Conclusions

The positive impact of a proactive consultation-liaison psychiatry consultation model was observed in a pediatric hospital and was associated with a lower LOS than concurrent controls and historical reactive consults, higher hospitalist satisfaction among paired responses, and greater concordance of diagnosis and other non-medication recommendations.

背景：积极主动的会诊-联络（C-L）精神病学服务在成年人群中的益处已得到充分证实，包括缩短住院时间、提高医生满意度以及加强协作护理。然而，目前还没有关于这种模式在儿科医院有效性的研究：本研究比较了在综合医疗楼层接受主动精神病咨询的 5-18 岁患者与同时接受无咨询的对照组以及接受传统反应性咨询的历史对照组：方法：在工作日上午对两家儿科综合医院团队的新入院患者进行审查，以确定哪些患者有精神方面的问题。调整后的负二项回归用于比较主动咨询组（65 人）、同期对照组（63 人）和反应性历史对照组（45 人）的主要结果--住院时间。患者满意度、住院医生满意度和建议一致性（主要团队执行精神科建议的程度）也作为次要结果指标在各组之间进行了比较：结果：在对年龄、性别、种族、保险类型、就诊原因和医疗诊断进行调整后，并发对照组患者的平均住院时间比主动就诊患者长 14% (p = 0.295)，而历史对照组患者的平均住院时间是主动就诊患者的两倍 (p < 0.001)。患者满意度评分的回复率较低，但接受主动C-L服务的患者的回复率略高。根据九份儿科住院医生前后配对调查显示，在引入主动精神科会诊服务后，随访调查的满意度在统计学上明显更高。据观察，在诊断和非药物治疗（其他）建议方面，主动咨询的建议一致性要高于同期对照组：结论：在一家儿科医院观察到了主动式 C-L 精神科会诊模式的积极影响，与同期对照组和历史反应性会诊相比，主动式会诊的住院时间更短；在配对回复中，住院医生的满意度更高；诊断和其他非用药建议的一致性更高。

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引用次数: 0

Assessment of Decision-Making Capacity in 97 Hospitalized Patients With Cancer: A Call for Standardization 评估九十七名住院癌症患者的决策能力：呼吁标准化

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.2024.05.004

Hospitalized patients with cancer face pivotal decisions that will affect their cancer care trajectory and quality of life, but frequently lack decision making capacity (DMC). Standardization is conspicuously missing for inpatient oncology teams and for consultation-liaison psychiatrists performing DMC assessments for patients with cancer. This study sought to characterize a single institutional experience of psychiatric consultations to assess DMC. We conducted a retrospective chart review of 97 consecutive psychiatric consultations for DMC from 2017 to 2019. Demographic, hospital-based, and psychiatry consult differences were assessed based on the reasons for DMC evaluation (uncertainty, patient refusal, and emergency) and whether patients had decisional capacity. Out of 97 consultations, 56 (59%) hospitalized patients with cancer were unable to demonstrate capacity. Consultations came from medical services almost exclusively. Only 5% of primary teams documented their own DMC evaluation. Only 22% of DMC evaluation by consultation-liaison psychiatrists documented four determinates of DMC. Few commented on reversibility or tenuousness of DMC, and the identification of agents/surrogates; however, psychiatry consultants were more likely to follow up on patients without DMC. One-third of patients died in the hospital and two-thirds of patients were deceased 3 months after the consult. Given the substantial heterogeneity in the documentation of DMC evaluations in this retrospective chart review, we call for more rigor and standardization in documentation of DMC evaluations.

住院癌症患者面临着影响其癌症治疗轨迹和生活质量的关键决定，但他们往往缺乏决策能力（DMC）。住院肿瘤团队和咨询联络精神科医生在为癌症患者进行 DMC 评估时明显缺乏标准化。本研究试图描述一家机构在进行精神科会诊以评估 DMC 方面的经验。我们对 2017 年至 2019 年连续 97 次 DMC 精神科会诊进行了回顾性病历审查。根据 DMC 评估的原因（不确定性、患者拒绝和紧急情况）以及患者是否具有决策能力，评估了人口统计学、医院和精神科会诊的差异。在 97 例咨询中，56 例（59%）住院癌症患者无法证明其行为能力。会诊几乎全部来自医疗服务机构。只有 5% 的初级团队记录了自己的 DMC 评估。只有 22% 的会诊联络精神科医生在 DMC 评估中记录了 DMC 的四个决定因素。很少有人对 DMC 的可逆性或不稳定性以及代理人/替代人的识别发表评论；然而，精神科顾问更有可能对没有 DMC 的患者进行随访。三分之一的患者在住院期间死亡，三分之二的患者在会诊 3 个月后死亡。鉴于此次回顾性病历审查中对 DMC 评估的记录存在很大差异，我们呼吁对 DMC 评估的记录应更加严格和标准化。

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引用次数: 0

Psychiatric Explanations of Poor Oral Intake: A Clinically Focused Review 口腔摄入不足的精神病学解释：临床重点回顾。

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.2024.08.006

Eliane Grace A.B. , Beth Heaney D.N.P., P.M.H.N.P. , Alexandra France M.D. , Tanya Bruckel M.D. , Mark A. Oldham M.D.

Background

Poor oral intake (POI) among medical-surgical inpatients can cause malnutrition and delay recovery due to medical consequences and the need for more invasive nutritional support. Many psychiatric conditions can cause POI; however, the role that psychiatric conditions play in POI has received limited attention to date.

Objective

This review aggregates available information on POI due to psychiatric conditions and provides a framework for the clinical approach to these conditions in hospitalized adult patients.

Methods

We searched PubMed and EMBASE for reviews of POI due to psychiatric causes, but no relevant publications were identified. Diagnostic criteria for relevant conditions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and Rome IV were reviewed, as were C-L psychiatry textbooks and relevant society websites. This review was further supplemented by a case conference at the authors' institution.

Results

We have divided results into five sections for clinical utility: (1) the need to rule out medical causes of POI; (2) unpleasant somatic experiences, including psychotropic causes; (3) mood, psychotic, catatonic, and neurocognitive disorders that can present with POI; (4) eating and feeding disorders; and (5) personal and interpersonal explanations of POI. Within each section, we review how to identify and manage each condition, specifically considering the effects of treatment on oral intake.

Conclusions

The clinical management of POI varies based on cause. For instance, psychostimulants can cause POI due to inappetence; however, they can treat POI due to abulia by improving motivation. The fact that such a broad range of psychiatric conditions can cause POI calls for a systematic clinical approach that considers the categories of potential causes. We also identified a need for prospective studies focused on the management of POI due to psychiatric conditions, as the literature on this topic is limited to case reports, case series, and retrospective cohort studies.

背景：内外科住院病人口腔摄入不足（POI）会导致营养不良，并因医疗后果和需要更多侵入性营养支持而延迟康复。许多精神疾病都可导致口腔摄入不足，但迄今为止，精神疾病在口腔摄入不足中所起的作用受到的关注有限：本综述汇集了有关精神疾病引起的急性营养不良的现有信息，并为住院成人患者的临床治疗提供了一个框架：方法：我们在 PubMed 和 EMBASE 中检索了有关精神疾病引起的 POI 的综述，但未发现相关出版物。我们还查阅了 DSM-5-TR 和 Rome IV 中相关病症的诊断标准，以及 C-L 精神病学教科书和相关学会网站。此外，作者所在机构还召开了一次病例讨论会，进一步补充了这一回顾：出于临床实用性考虑，我们将结果分为五个部分：（1）需要排除POI的医学和精神药物原因；（2）导致POI的不愉快躯体体验；（3）可能出现POI的情绪、精神、紧张和神经认知障碍；（4）进食和喂养障碍；以及（5）POI的个人和人际解释。在每一部分中，我们将回顾如何识别和处理每种情况，特别是考虑治疗对口腔摄入量的影响：POI的临床治疗因病因而异。例如，精神刺激剂可能会导致不思饮食引起的 POI；但是，精神刺激剂可以通过改善动机来治疗因食量不足引起的 POI。事实上，如此广泛的精神疾病都可能引起 POI，这就要求我们采用一种系统的临床方法，对潜在病因进行分类考虑。我们还发现，由于有关这一主题的文献仅限于病例报告、系列病例和回顾性队列研究，因此有必要开展前瞻性研究，重点关注精神病引起的 POI 的管理。

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引用次数: 0

Consultation-Liaison Case Conference: Assessment and Management of a Physician With Thoughts of Suicide 会诊-联络病例会议：对一名有自杀念头的医生的评估和管理

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.2024.05.006

We present the case of a physician who engages with a peer response team and discloses suicidal ideation while himself seeing patients in the hospital. Top experts in consultation-liaison psychiatry provide guidance for this clinical case based on their experience and a review of the available literature. Key teaching topics include a general approach to suicide risk assessment, peer response programs for healthcare workers, and ethical and clinical considerations in treating colleagues. Consultation-liaison psychiatrists should be familiar with suicide risk management, take a pro-active approach to addressing modifiable risk factors, and keep in mind unique challenges of treating colleagues referred for care.

我们介绍了一名医生在医院为病人看病时与同伴反应小组接触并透露自杀意念的案例。咨询联络精神病学领域的顶级专家根据他们的经验和对现有文献的回顾，为这一临床案例提供了指导。主要的教学主题包括自杀风险评估的一般方法、医护人员的同伴反应计划以及治疗同事时的伦理和临床考虑因素。咨询联络精神科医生应熟悉自杀风险管理，采取积极主动的方法来应对可改变的风险因素，并牢记治疗转诊同事的独特挑战。

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