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Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study. 左心室辅助装置(LVAD)植入术后谵妄的预后影响:一项回顾性研究。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-03 DOI: 10.1016/j.jaclp.2024.04.005
Paul Noufi, Kelley M Anderson, Nancy Crowell, Yasmine White, Ezequiel Molina, Sriram D Rao, Hunter Groninger

Background: In critically ill patients, delirium is a prognostic indicator of morbidity and mortality.

Objective: This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation.

Methods: This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared preimplantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as reintubation rate, length of stay, discharge disposition, and readmission rates.

Results: In total, 361 patients (26.7% women and 75.8% African American) received durable LVADs. Ninety-four patients (26.1%) were diagnosed with delirium during the index admission. Preimplantation demographic characteristics, past medical and psychiatric conditions, Interagency Registry for Mechanically Assisted Circulatory Support Profile, and laboratory values did not differ between the two groups with and without a diagnosis of delirium; older age (59 vs 56; P = 0.03) was associated with delirium. Delirium diagnosis was associated with higher 1-month (P = 0.007), 6-month (P = 0.004), and in-hospital mortality (P < 0.001), unplanned reintubations (P < 0.001), and a lower likelihood of discharge home (P = 0.03). Total hospital and intensive care unit length of stay were higher in patients with a diagnosis of delirium, though these results were not statistically significant. Readmission to the hospital after index admission was quicker in patients with a diagnosis of delirium, but this result was not statistically significant.

Conclusions: In this study, a diagnosis of delirium during the LVAD implantation admission was associated with higher mortality, adverse postsurgical outcomes, and unfavorable discharge dispositions. Future prospective research is needed to validate the prognostic implications of delirium in both the short and long term. Additionally, there is a need to identify modifiable risk factors associated with delirium to promote early diagnosis and implement evidence-based management strategies to enhance outcomes within this population.

导言:谵妄是危重病人发病率和死亡率的预后指标。本研究探讨了谵妄诊断对左心室辅助装置(LVAD)植入术后预后的影响:这项回顾性研究纳入了 2016 年 1 月至 2020 年 12 月期间在我院接受 LVAD 的所有成年患者。我们比较了有谵妄诊断和无谵妄诊断两组患者的植入前特征,并比较了他们的预后,包括1个月、6个月和院内死亡率,以及再插管率、住院时间(LOS)、出院处置和再入院率:共有 361 名患者(26.7% 为女性,75.8% 为非裔美国人)接受了耐用型 LVAD。94名患者(26.1%)在入院时被诊断为谵妄。植入前的人口统计学特征、既往医疗和精神状况、机械辅助循环支持机构间登记(INTERMACS)档案以及实验室值在诊断出谵妄和未诊断出谵妄的两组患者之间没有差异;年龄较大(59 岁对 56 岁;P=0.03)与谵妄有关。谵妄诊断与较高的1个月死亡率(P=0.007)、6个月死亡率(P=0.004)和院内死亡率有关(结论:谵妄诊断与较高的1个月死亡率(P=0.007)、6个月死亡率(P=0.004)和院内死亡率有关):在这项研究中,在 LVAD 植入术入院期间诊断出谵妄与较高的死亡率、不良的术后结果和不利的出院处置有关。未来需要进行前瞻性研究,以验证谵妄对短期和长期预后的影响。此外,还需要确定与谵妄相关的可改变的风险因素,以促进早期诊断并实施循证管理策略,从而改善该人群的预后。
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引用次数: 0
Changes in Serum Concentration of Antidepressants After Bariatric Surgery and Recommendations for Postbariatric Surgery Antidepressant Therapy 减肥手术后抗抑郁药血清浓度的变化以及减肥手术后抗抑郁治疗的建议。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.01.001
Daniel Maass M.D. , Drew Cumming M.D. , Haniya Raza D.O. , Ted Liao M.D. , Joyce Chung M.D. , Maryland Pao M.D.

Background

Bariatric surgery affects the absorption of medications including antidepressants, but data regarding these effects are limited.

Objectives

Our objectives were to review publicly available data regarding changes in antidepressant serum concentration following bariatric surgery in order to develop medication dosing recommendations in this patient population.

Methods

A comprehensive literature review was performed utilizing key search terms in Pubmed. Additional data were retrieved from the Food and Drug Administration and DrugBank Online resources.

Results

A total of twelve published articles were included in addition to the publicly available data from the Food and Drug Administration and DrugBank. The serum concentration of antidepressants following bariatric surgery demonstrated considerable variability between and within drug classes due to unique pharmacokinetic features, drug preparation, and formulation. Recommendations were developed from published data regarding changes in serum concentration and drug-specific pharmacokinetic data.

Conclusions

To our knowledge, this is the first study to propose medication dose-adjustment recommendations for patients on antidepressants undergoing bariatric surgery. We were limited by the relatively small amount of data available and recommend monitoring patients and use of clinical judgment along with this guidance.

目的我们的目标是回顾有关减肥手术后抗抑郁药血清浓度变化的公开数据,以便为这一患者群体制定用药剂量建议 方法:利用 Pubmed 上的关键搜索关键词进行了全面的文献回顾。从 FDA 和 DrugBank 在线资源中检索了其他数据:结果:除了从 FDA 和 DrugBank 获取的公开数据外,还收录了 12 篇已发表的文章。由于独特的药代动力学特征、药物制备和配方,减肥手术后抗抑郁药的血清浓度在药物类别之间和药物类别内部都存在相当大的差异。根据已公布的血清浓度变化数据和特定药物的药代动力学数据提出了建议:据我们所知,这是第一项针对接受减肥手术的抗抑郁药物患者提出药物剂量调整建议的研究。我们受到可用数据量相对较少的限制,建议对患者进行监测,并在使用本指南的同时使用临床判断。
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引用次数: 0
Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System 要求在 MS-DRG 系统中将谵妄与急性脑病相提并论。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.02.004
Mark A. Oldham M.D. , Thomas Heinrich M.D. , James Luccarelli M.D., D.Phil.

Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics.

The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services’ guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per DSM-5-TR), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness.

The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.

自 2007 年以来,医疗保险严重程度诊断相关组分类系统在确定医院报销和几项护理质量价值指标时,更倾向于急性脑病的计费代码,而不是谵妄代码,尽管这两组诊断代码之间存在广泛的重叠。中毒性和代谢性脑病代码被指定为主要并发症或合并症,而因果关系明确的谵妄代码被指定为并发症或合并症,因此报销额度较低,对价值指标的影响也较小。作者牵头向美国医疗保险和医疗补助服务中心提交了一份申请,要求将因果性谵妄与中毒性和代谢性脑病一起列为主要并发症或合并症。谵妄之所以值得重新分类,是因为它符合美国医疗保险和医疗补助服务中心重新评估医疗保险严重程度诊断相关组严重程度的指导原则。谵妄:(1) 与痴呆(DSM-5-TR 规定的主要神经认知障碍)这一永久性疾病有双向关系;(2) 反映不同人群的脆弱性;(3) 影响不同级别的医疗保健系统;(4) 使术后恢复复杂化;(5) 使患者接受更高级别的护理;(6) 阻碍患者参与护理;(7) 有几项最新的治疗指南;(8) 通常表明神经元/脑损伤;(9) 是绝症的常见表现形式。利用 2019 年全国住院病人抽样调查对该提案的影响进行了探讨,结果表明,增加谵妄的复杂性指定将导致符合条件的出院病例中少于 1%的病例被增加编码。谵妄的对等性对于提高人们对谵妄的临床和经济成本的认识至关重要。认识到谵妄的影响将促进谵妄的预防和筛查工作,从而减轻谵妄对患者、家庭和医疗系统造成的严重后果。
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引用次数: 0
A Tremor Classification Primer for the Consultation-Liaison Psychiatrist 为会诊联络精神科医生编写的震颤分类入门指南。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.03.007
Drew Cumming M.D., Mirza Baig M.D., David L. Perez M.D., M.M.Sc.
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引用次数: 0
Examining the Features of Neuroleptic Malignant Syndrome in Anti-NMDA Receptor Encephalitis: A Case-Control Study 研究抗 nmda 受体脑炎中神经性恶性综合征的特征:一项病例对照研究。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2023.12.002
Jesus Ramirez-Bermudez M.D., Ph.D. , Miguel Restrepo-Martinez M.D. , Mariana Espinola-Nadurille M.D., M.P.H. , Victoria Martinez-Angeles M.D. , Juan Carlos Lopez-Hernandez M.D. , Laura E. Hernandez-Vanegas M.D. , Francisco Martinez-Carrillo M.D. , Ramiro Ruiz-Garcia M.D. , Veronica Rivas-Alonso M.D. , Jose Flores-Rivera M.D. , Thomas A. Pollak M.R.C.Psych., Ph.D.

Background

Anti–N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. Symptomatic treatment with antipsychotics is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis.

Methods

This case-control study included patients who received antipsychotics before referral to the National Institute of Neurology and Neurosurgery of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, and hyperthermia. A logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions.

Results

A total sample of 112 patients with definite ANMDARE were included in the study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics.

Conclusions

Our study supports previous observations about the high frequency of autonomic dysfunction, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels in patients with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.

背景:抗N-甲基-D-天冬氨酸受体脑炎(ANMDARE)是一种神经免疫性疾病,免疫治疗常能改善病情。在精神症状占主导地位的早期阶段,使用抗精神病药物进行对症治疗很常见,但这些药物的使用与包括神经性恶性综合征(NMS)在内的严重副作用有关。观察到对抗抑郁药的不良反应,引起对 NMS 的怀疑,已被列为可能患有自身免疫性精神病的一个标准:这项病例对照研究纳入了在转诊至墨西哥国家神经病学与神经外科研究所(National Institute of Neurology and Neurosurgery of Mexico)之前接受过抗精神病药物治疗并被诊断为明确患有 ANMDARE 的患者,以及在转诊之前未接受过抗精神病药物治疗的 ANMDARE 患者。两组患者均测量了神经系统和全身特征,这些特征用于衡量抗精神病药物不良反应,从而引起对 NMS 的怀疑,其中包括运动障碍、自主神经不稳定、全身僵硬、肌酸磷酸激酶浓度升高和高热。采用逻辑回归分析确定既往使用过抗精神病药物与 NMS 类反应发生之间的关系:研究共纳入了112名确诊的ANMDARE患者。其中 50 名患者在转诊至我院前曾接受过抗精神病药物治疗。在这组患者中,有 36 名患者(72%)最初被归类为出现不良反应,引起了对 NMS 的怀疑,其特征如下:运动障碍(64%)、自主神经不稳定(58%)、全身僵硬(52%)、肌酸磷酸激酶浓度升高(50%)和高热(14%)。六名患者符合 NMS 标准(12%)。与临床评估前未服用抗精神病药物的患者进行比较后发现,在运动失调、自律神经不稳定、全身僵硬、肌酸磷酸激酶浓度升高或高热的发生率方面,组间差异并不明显。在不同的抗精神病药物中,与未服用抗精神病药物的患者相比,只有氟哌啶醇与全身僵直有显著相关性:我们的研究证实了之前关于抗 NMDAR 脑炎患者在服用抗精神病药物后频繁出现自主神经功能紊乱、高热、心动过速、全身僵硬和 CPK 水平升高的观察结果。尽管如此,我们的研究并不表明非典型抗精神病药物与这些神经系统症状的出现之间存在因果关系,因为在未接受抗精神病药物治疗的患者群体中,这些症状也同样频繁出现。
{"title":"Examining the Features of Neuroleptic Malignant Syndrome in Anti-NMDA Receptor Encephalitis: A Case-Control Study","authors":"Jesus Ramirez-Bermudez M.D., Ph.D. ,&nbsp;Miguel Restrepo-Martinez M.D. ,&nbsp;Mariana Espinola-Nadurille M.D., M.P.H. ,&nbsp;Victoria Martinez-Angeles M.D. ,&nbsp;Juan Carlos Lopez-Hernandez M.D. ,&nbsp;Laura E. Hernandez-Vanegas M.D. ,&nbsp;Francisco Martinez-Carrillo M.D. ,&nbsp;Ramiro Ruiz-Garcia M.D. ,&nbsp;Veronica Rivas-Alonso M.D. ,&nbsp;Jose Flores-Rivera M.D. ,&nbsp;Thomas A. Pollak M.R.C.Psych., Ph.D.","doi":"10.1016/j.jaclp.2023.12.002","DOIUrl":"10.1016/j.jaclp.2023.12.002","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Anti–N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. </span>Symptomatic treatment with </span>antipsychotics<span> is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis.</span></p></div><div><h3>Methods</h3><p><span>This case-control study included patients who received antipsychotics before referral to the National Institute of Neurology and </span>Neurosurgery<span><span><span> of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of </span>creatine phosphokinase, and hyperthermia. A </span>logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions.</span></p></div><div><h3>Results</h3><p>A total sample of 112 patients with definite ANMDARE were included in the study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics.</p></div><div><h3>Conclusions</h3><p><span>Our study supports previous observations about the high frequency of autonomic dysfunction<span>, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels </span></span>in patients<span> with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms<span>, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.</","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139049770","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
Current State of Consultation-Liaison Psychiatry in China and Future Directions 中国会诊联络精神病学的现状和未来方向。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.04.002
Wenhao Jiang M.D., Ph.D., Yonggui Yuan M.D., Ph.D.

This article provides an overview of the history and current status of consultation-liaison psychiatry (CLP) in China and its development within the Chinese Society of Psychosomatic Medicine. Over the past decade, various CLP practice models have been developed to meet the diverse needs of different regions in China. Notably, the Chinese Multidisciplinary Integrated Centers of Psychosomatic Medicine have been established as regional hubs throughout the country. Additionally, this article delves into the role of Chinese traditional medicine in the practice of CLP in China. Finally, several projects involving CLP-based multidisciplinary collaboration are highlighted. We hope this article offers a bird's-eye view of CLP in China and opens a window for future collaboration with CLP initiatives in other countries.

本文概述了中国会诊联络精神病学(CLP)的历史和现状,以及它在中国心身医学会内的发展情况。在过去的十年中,为了满足中国不同地区的不同需求,各种CLP实践模式应运而生。值得注意的是,中国多学科综合心身医学中心已作为区域中心在全国各地建立起来。此外,本文还深入探讨了中国传统医学在中国中医药实践中的作用。最后,本文重点介绍了几个基于中电的多学科合作项目。我们希望这篇文章能让读者鸟瞰中国的中电联,并为未来与其他国家的中电联项目合作打开一扇窗。
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引用次数: 0
Cushing Disease Psychosis Identified as Postoperative Psychosis 被认定为术后精神病的库欣病精神病。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.01.008
Bilal A. Bari M.D., Ph.D., Paavani Reddy M.D., Bryce A. Wininger M.D.
{"title":"Cushing Disease Psychosis Identified as Postoperative Psychosis","authors":"Bilal A. Bari M.D., Ph.D.,&nbsp;Paavani Reddy M.D.,&nbsp;Bryce A. Wininger M.D.","doi":"10.1016/j.jaclp.2024.01.008","DOIUrl":"10.1016/j.jaclp.2024.01.008","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673638","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
Effectiveness and Safety of Intravenous Medications for the Management of Acute Disturbance (Agitation and Other Escalating Behaviors): A Systematic Review of Prospective Interventional Studies 静脉注射药物治疗急性骚动(躁动和其他行为升级)的有效性和安全性:前瞻性干预研究的系统回顾。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.01.004
Megan Castro M.Sc. , Matt Butler M.D. , Alysha Naomi Thompson B.Sc. , Siobhan Gee Ph.D. , Sotiris Posporelis M.D.

Acute disturbance is a broad term referring to escalating behaviors secondary to a change in mental state, such as agitation, aggression, and violence. Available management options include de-escalation techniques and rapid tranquilization, mostly via parenteral formulations of medication. While the intramuscular route has been extensively studied in a range of clinical settings, the same cannot be said for intravenous (IV); this is despite potential benefits, including rapid absorption and complete bioavailability. This systematic review analyzed existing evidence for effectiveness and safety of IV medication for management of acute disturbances. It followed a preregistered protocol (PROSPERO identification CRD42020216456) and is reported following the guidelines set by Preferred Reporting Items for Systematic Review and Meta-Analysis. APA PsycINFO, MEDLINE, and EMBASE databases were searched for eligible interventional studies up until May 30th, 2023. Data analysis was limited to narrative synthesis since primary outcome measures varied significantly. Results showed mixed but positive results for the effectiveness of IV dexmedetomidine, lorazepam, droperidol, and olanzapine. Evidence was more limited for IV haloperidol, ketamine, midazolam, chlorpromazine, and valproate. There was no eligible data on the use of IV clonazepam, clonidine, diazepam, diphenhydramine, propranolol, ziprasidone, fluphenazine, carbamazepine, or promethazine. Most studies reported favorable adverse event profiles, though they are unlikely to have been sufficiently powered to pick up rare serious events. In most cases, evidence was of low or mixed quality, accentuating the need for further standardized, large-scale, multi-arm randomized controlled trials with homogeneous outcome measures. Overall, this review suggests that IV medications may offer an effective alternative parenteral route of administration in acute disturbance, particularly in general hospital settings.

急性骚乱是一个广义的术语,指因精神状态改变而继发的行为升级,如激动、攻击和暴力。现有的处理方法包括降级技术和快速镇静,主要是通过肠外药物制剂。虽然肌肉注射途径已在一系列临床环境中得到广泛研究,但静脉注射(IV)却并非如此;尽管静脉注射具有快速吸收和完全生物利用度等潜在优势。本系统性综述分析了静脉注射药物治疗急性精神障碍的有效性和安全性的现有证据。该研究遵循了预先注册的方案(PROSPERO 鉴定 CRD42020216456),并按照《系统性综述和荟萃分析的首选报告项目》(PRISMA)规定的指南进行报告。检索了 APA PsycINFO、MEDLINE 和 EMBASE 数据库中截至 2023 年 5 月 30 日符合条件的介入性研究。由于主要结果指标差异很大,因此数据分析仅限于叙述性综合。结果显示,静脉注射右美托咪定、劳拉西泮、屈哌利多和奥氮平的疗效参差不齐,但都具有积极意义。关于静脉注射氟哌啶醇、氯胺酮、咪达唑仑、氯丙嗪和丙戊酸钠的证据则较为有限。关于静脉注射氯硝西泮、氯尼丁、地西泮、苯海拉明、普萘洛尔、齐拉西酮、氟奋乃静、卡马西平或异丙嗪的使用,没有符合条件的数据。大多数研究都报告了良好的不良反应情况,不过这些研究的研究力量可能不足以发现罕见的严重事件。在大多数情况下,证据的质量较低或参差不齐,因此需要进一步开展标准化、大规模、多臂随机对照试验,并采用同质的结果测量方法。总之,本综述表明,静脉注射药物可为急性骚乱患者提供另一种有效的肠外给药途径,尤其是在综合医院环境中。
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引用次数: 0
Advancing Biopsychosocial Model and Achieving Optimal Health by Incorporating Integrative Medicine into Consultation Liaison Psychiatry Care 将中西医结合纳入精神病学咨询联络护理,推进生物心理社会模式,实现最佳健康状态。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.05.003
Madeleine A. Becker M.D., M.A., F.A.C.L.P., A.B.O.I.M., Daniel A. Monti M.D., M.B.A.
{"title":"Advancing Biopsychosocial Model and Achieving Optimal Health by Incorporating Integrative Medicine into Consultation Liaison Psychiatry Care","authors":"Madeleine A. Becker M.D., M.A., F.A.C.L.P., A.B.O.I.M.,&nbsp;Daniel A. Monti M.D., M.B.A.","doi":"10.1016/j.jaclp.2024.05.003","DOIUrl":"10.1016/j.jaclp.2024.05.003","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064762","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
A Survey of Consultation Liaison Psychiatrists on the Assessment of Maternal Capacity 关于产妇行为能力评估的咨询联络精神科医生调查。
IF 2.3 4区 心理学 Q2 Psychology Pub Date : 2024-05-01 DOI: 10.1016/j.jaclp.2024.02.005
Laura Renee Warning B.S., Nicholas David Hollman M.P.H., B.S., Ondria Chris Gleason M.D.
{"title":"A Survey of Consultation Liaison Psychiatrists on the Assessment of Maternal Capacity","authors":"Laura Renee Warning B.S.,&nbsp;Nicholas David Hollman M.P.H., B.S.,&nbsp;Ondria Chris Gleason M.D.","doi":"10.1016/j.jaclp.2024.02.005","DOIUrl":"10.1016/j.jaclp.2024.02.005","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013743","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
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Journal of the Academy of Consultation-Liaison Psychiatry
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