Pub Date : 2024-05-03DOI: 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.
{"title":"Prognostic Implications of Delirium After Left Ventricular Assist Device Implantation: A Retrospective Study.","authors":"Paul Noufi, Kelley M Anderson, Nancy Crowell, Yasmine White, Ezequiel Molina, Sriram D Rao, Hunter Groninger","doi":"10.1016/j.jaclp.2024.04.005","DOIUrl":"10.1016/j.jaclp.2024.04.005","url":null,"abstract":"<p><strong>Background: </strong>In critically ill patients, delirium is a prognostic indicator of morbidity and mortality.</p><p><strong>Objective: </strong>This study investigates the impact of a delirium diagnosis on outcomes after left ventricular assist device (LVAD) implantation.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868729","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}
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。
{"title":"Changes in Serum Concentration of Antidepressants After Bariatric Surgery and Recommendations for Postbariatric Surgery Antidepressant Therapy","authors":"Daniel Maass M.D. , Drew Cumming M.D. , Haniya Raza D.O. , Ted Liao M.D. , Joyce Chung M.D. , Maryland Pao M.D.","doi":"10.1016/j.jaclp.2024.01.001","DOIUrl":"10.1016/j.jaclp.2024.01.001","url":null,"abstract":"<div><h3>Background</h3><p>Bariatric surgery affects the absorption of medications including antidepressants, but data regarding these effects are limited.</p></div><div><h3>Objectives</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","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":"139465709","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 : 2024-05-01DOI: 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.
{"title":"Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System","authors":"Mark A. Oldham M.D. , Thomas Heinrich M.D. , James Luccarelli M.D., D.Phil.","doi":"10.1016/j.jaclp.2024.02.004","DOIUrl":"10.1016/j.jaclp.2024.02.004","url":null,"abstract":"<div><p>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.</p><p>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 <em>DSM-5-TR</em>), (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.</p><p>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.</p></div>","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":"140177705","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 : 2024-05-01DOI: 10.1016/j.jaclp.2024.03.007
Drew Cumming M.D., Mirza Baig M.D., David L. Perez M.D., M.M.Sc.
{"title":"A Tremor Classification Primer for the Consultation-Liaison Psychiatrist","authors":"Drew Cumming M.D., Mirza Baig M.D., David L. Perez M.D., M.M.Sc.","doi":"10.1016/j.jaclp.2024.03.007","DOIUrl":"10.1016/j.jaclp.2024.03.007","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":"140319876","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 : 2024-05-01DOI: 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. , 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.","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}
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.
{"title":"Current State of Consultation-Liaison Psychiatry in China and Future Directions","authors":"Wenhao Jiang M.D., Ph.D., Yonggui Yuan M.D., Ph.D.","doi":"10.1016/j.jaclp.2024.04.002","DOIUrl":"10.1016/j.jaclp.2024.04.002","url":null,"abstract":"<div><p>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.</p></div>","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":"140763839","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 : 2024-05-01DOI: 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., Paavani Reddy M.D., 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}
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.
{"title":"Effectiveness and Safety of Intravenous Medications for the Management of Acute Disturbance (Agitation and Other Escalating Behaviors): A Systematic Review of Prospective Interventional Studies","authors":"Megan Castro M.Sc. , Matt Butler M.D. , Alysha Naomi Thompson B.Sc. , Siobhan Gee Ph.D. , Sotiris Posporelis M.D.","doi":"10.1016/j.jaclp.2024.01.004","DOIUrl":"10.1016/j.jaclp.2024.01.004","url":null,"abstract":"<div><p>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.</p></div>","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":"https://www.sciencedirect.com/science/article/pii/S2667296024000120/pdfft?md5=019eb3cc3b08be235ec15baa455e62d8&pid=1-s2.0-S2667296024000120-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 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., 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}
Pub Date : 2024-05-01DOI: 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., Nicholas David Hollman M.P.H., B.S., 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}