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

英文中文

Variations in Legislation for the Care of Anorexia Nervosa Across States 厌食症护理立法。

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.2024.05.005

引用次数: 0

Impact of the COVID-19 Pandemic on the Mental Health of Patients Presenting to the Child and Adolescent Psychiatric Consultation-Liaison Service in a Large Urban Hospital COVID-19 大流行对一家大型城市医院儿童和青少年精神科咨询联络服务处就诊患者心理健康的影响。

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.2024.05.002

引用次数: 0

Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study 美国的谵妄：2023 年 "世界谵妄意识日 "流行率横断面研究结果。

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.2024.06.005

Background

Delirium is an acute brain dysfunction associated with an increased risk of mortality and future dementia.

Objectives

To describe the prevalence of clinically documented delirium in the United States on World Delirium Awareness Day 2023.

Methods

This is a sub-analysis of a prospective, cross-sectional, online, international survey. All health care settings were eligible, with the exception of operating rooms and outpatient clinics. Health care clinicians, administrators, and researchers completed the survey. The primary outcome was the prevalence of clinically documented delirium at 8:00 a.m. and 8:00 p.m. on March 15, 2023. Secondary outcomes were related to health care delivery. Descriptive statistics are reported. Differences between unit types (non-intensive care unit vs intensive care unit) were examined for all outcomes.

Results

Ninety-one hospital units reported on 1318/1213 patients. The prevalence of clinically documented delirium was 16.4% (n = 216/1318) at 8:00 a.m. and 17.9% (n = 217/1213) at 8:00 p.m. (P = 0.316) and significantly differed between age groups, reported discipline, unit, and hospital types. Significant differences were identified between non-intensive care unit and intensive care unit settings in the use of delirium-related protocols, nonpharmacologic and pharmacologic management, educational processes, and barriers to evidence-based delirium care.

Conclusions

To our knowledge, this is the first epidemiologic survey of clinically documented delirium across two time points in the United States. Delirium remains a significant burden and challenge for health care systems. The high percentage of units using delirium management protocols suggests administrator and clinician awareness of evidence-based strategies for its detection and mitigation. We provide recommendations for future studies and quality improvement projects to improve clinical recognition and management of delirium.

重要性：谵妄是一种急性脑功能障碍，与死亡率和未来痴呆症风险增加有关：描述 2023 年 "世界谵妄意识日 "当天美国有临床记录的谵妄患病率：设计：一项前瞻性、横断面、在线国际调查的子分析：除手术室和门诊部外，所有医疗机构均符合条件：主要结果和衡量标准：主要结果和测量指标：2023 年 3 月 15 日上午 8:00 和晚上 8:00 有临床记录的谵妄发生率。次要结果与医疗服务相关。报告了描述性统计数字。对所有结果进行了单位类型（非重症监护病房与重症监护病房）之间的差异检查：91个医院单位报告了1,318/1,213名患者的情况。临床记录的谵妄发生率在上午 8:00 为 16.4%（n=216/1,318），在下午 8:00 为 17.9%（n=217/1,213）（p=0.316），不同年龄组、报告学科、科室和医院类型之间存在显著差异。非重症监护病房和重症监护病房在谵妄相关协议的使用、非药物和药物管理、教育过程以及循证谵妄护理的障碍方面存在显著差异：据我们所知，这是美国首次对两个时间点上有临床记录的谵妄进行流行病学调查。谵妄仍然是医疗保健系统的一个重大负担和挑战。使用谵妄管理协议的单位比例很高，这表明管理者和临床医生都意识到了检测和缓解谵妄的循证策略。我们对未来的研究和质量改进项目提出了建议，以改善谵妄的临床识别和管理。

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引用次数: 0

Psychiatric and Substance Use Disorders and Their Association With Clinical Outcomes in Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome 糖尿病酮症酸中毒和高渗性高血糖综合征的精神障碍和药物使用障碍及其与临床结果的关系。

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.2024.02.007

Background and Objective

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the intensive care unit each year, with mortality rates up to 5–10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality.

Methods

We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 to 2019. We identified patients admitted inpatient for DKA or HHS, then filtered by International Classification of Disease-9-CM and International Classification of Disease-10-CM codes for psychiatric diagnoses that were present in patients electronic medical record at any point in this observational period. Outcomes included the number of inpatient admissions for DKA/HHS, age of death, rates of discharging against medical advice (AMA) from any inpatient admission, and end-stage renal disease/dialysis status. Multivariate regression was conducted using R software to control for variables across patients and evaluate relationships between outcomes and concurrent psychiatric disorders. Significance was set at P < 0.05.

Results

Seven thousand seven hundred fifty-six patients were admitted for DKA or HHS, 66.9% of whom had a concurrent psychiatric disorder. Of these patients, 54.5% were male, 70.4% were White, and they had an average age of 61.6 years. This compares with 26.1% with concurrent psychiatric condition within the general diabetes population, 52.1% of whom were male, 72.1% were White, and an average age of 68.2 years. A concurrent psychiatric disorder was associated with increased odds of rehospitalization (adjusted odds ratio [aOR] = 1.62 95% confidence interval [CI] 1.35–1.95, P < 0.001), of being diagnosed with end-stage renal disease and on dialysis (aOR = 1.02 95% CI 1.002–1.035, P = 0.02), and of leaving AMA (aOR = 6.44 95% CI 4.46–9.63, P < 0.001). The average age of death for those with a concurrent psychiatric disorder had an adjusted mean difference in years of −7.5 years (95% CI −9.3 to 5.8) compared to those without a psychiatric disorder.

Conclusions

Of patients with DKA/HHS, 66.9% have a concurrent psychiatric disorder. Patients with a concurrent psychiatric disorder admitted for DKA/HHS were more likely to have multiple admissions, to leave AMA, to be on renal dialysis, and to have a lower age of mortality.

背景：糖尿病酮症酸中毒（DKA）和高渗性高血糖状态（HHS）是一种危及生命的疾病，每年有近 18 万患者被送入重症监护室，死亡率高达 5-10%。人们对并发精神障碍对 DKA/HHS 具体结果的影响知之甚少。确定这些关系为改善临床管理、治疗计划以及降低相关发病率和死亡率提供了机会：我们对马萨诸塞州一家大型医院系统在 2010 - 2019 年期间收治的成人 DKA/HHS 患者进行了回顾性分析。我们确定了因 DKA 或 HHS 而入院的患者，然后通过 ICD-9-CM、ICD-10-CM 代码筛选出患者 EMR 中在观察期内任何时间点出现的精神科诊断。结果包括因 DKA/HHS 住院的人数、死亡年龄、任何住院病例的违抗医嘱出院率 (AMA) 以及 ESRD/透析状态。使用 R 软件进行多变量回归，以控制不同患者的变量，并评估结果与并发精神疾病之间的关系。显著性以 p 为标准：7756 名患者因 DKA 或 HHS 入院，其中 66.9% 的患者同时患有精神疾病。其中 54.5% 为男性，70.4% 为白人，平均年龄为 61.6 岁。相比之下，在普通糖尿病患者中，有 26.1% 同时患有精神疾病，其中 52.1% 为男性，72.1% 为白人，平均年龄为 68.2 岁。并发精神障碍与再次住院的几率增加有关（aOR= 1.62 95%Cl 1.35 - 1.95, p结论：66.9% 的 DKA/HHS 患者并发精神障碍。因 DKA/HHS 而入院的并发精神障碍患者更有可能多次入院、离开 AMA、接受肾透析，且死亡率较低。

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引用次数: 0

Concurrent Clozapine and Amiodarone Treatment 同时使用氯氮平和胺碘酮治疗。

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.2024.06.001

引用次数: 0

Interdisciplinary Training of Agitation Management by the Proactive C-L Team Reaffirms “Service Recovery” and Maintenance of Optimism 积极主动的 C-L 团队提供的关于躁动管理的跨学科培训重申了 "服务恢复 "和保持乐观。

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.2024.05.001

引用次数: 0

Hydralazine-Induced Visual and Auditory Hallucinations in a Kidney Transplant Patient: Case Report 一名肾移植患者因肼屈嗪引起视听幻觉：病例报告。

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.2024.06.004

引用次数: 0

Reducing Pediatric Mental Health Boarding and Increasing Acute Care Access 减少儿童精神健康寄宿和增加急症护理机会

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.2024.04.001

Background

There have been notable increases in pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement in psychiatric treatment programs. Objectives: We aimed to evaluate the outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis.

Methods

Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement. Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October–December 2021 and one year later (October–December 2022). Inclusion criteria were patients ≤17 years who presented with mental health-related emergencies during the study period. Exclusion criteria were patients ≥18 years and/or patients with >100 days of admission awaiting long-term placement. Primary outcome was mean length of boarding (LOB). Secondary outcome was mean length of stay (LOS) at the hospital's acute psychiatry units.

Results

One year after full intervention implementation (October–December 2022), mean LOB decreased by 53% (4.3 vs 9.1 days, P < 0.0001) for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to October–December 2021. Additionally, mean LOS at all the 24-hour acute psychiatry treatment programs was reduced by 27% (20.0 vs 14.6 days, P = 0.0002), and more patients were able to access such programs (265/54.2% vs 221/41.9%, P < 0.0001). Across both years, youth with aggressive behaviors had 193% longer LOB (2.93 ± 1.15, 95% CI [2.23, 3.87]) than those without aggression, and youth with previous psychiatric admissions had 88% longer LOB than those without (1.88 ± 1.11, 95% CI [1.54, 2.30]).

Conclusions

The current study shows decreased LOB and improved access for youth requiring acute psychiatric treatment after comprehensive interventions and highlights challenges with placement for youth with aggressive behaviors. We recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.

近年来，美国儿科心理健康寄宿人数明显增加，青少年被安置在急诊科或内外科住院部，等待接受精神病治疗。我们旨在评估一家大型三级儿科医院在全国性儿科精神健康危机期间采取干预措施以减少寄宿人数并改善急诊精神科服务的结果。寄宿干预措施包括扩大精神科住院病床、增聘员工以加强危机稳定服务，以及在急诊科和内外科住院病房为等待安置的寄宿患者启动治疗。在 2021 年 10 月至 12 月干预措施开始实施期间和一年后（2022 年 10 月至 12 月），通过对精神健康突发事件患者的回顾性审查进行了事后评估。纳入标准为在研究期间出现精神健康相关紧急情况的年龄≤17 岁的患者。排除标准是年龄≥18 岁的患者和/或入院时间超过 100 天、等待长期安置的患者。主要结果是平均寄宿时间（LOB）。次要结果是在医院急性精神病科的平均住院时间（LOS）。干预措施全面实施一年后（2022 年 10 月至 12 月），与 2021 年 10 月至 12 月相比，出院后接受高级护理（如住院、急性住院）和中级护理（如部分住院、居家危机稳定计划）的寄宿患者的平均寄宿时间减少了 53%（4.3 天 vs 9.1 天，< 0.0001）。此外，所有24小时急诊精神病治疗项目的平均住院日减少了27%（20.0天 vs 14.6天，=0.0002），更多患者能够获得此类项目（265/54.2% vs 221/41.9%，<0.0001）。在这两年中，有攻击性行为的青少年的住院时间（2.93 ± 1.15，95% CI [2.23，3.87]）比没有攻击性行为的青少年长193%，而曾入住精神病院的青少年的住院时间（1.88 ± 1.11，95% CI [1.54，2.30]）比没有入住精神病院的青少年长88%。目前的研究表明，经过综合干预后，需要接受急性精神病治疗的青少年的等待时间缩短，获得治疗的机会增加，同时也凸显了有攻击性行为的青少年在安置方面所面临的挑战。我们建议儿科医院采取行动，投入足够的急诊精神科资源，以解决儿科精神健康寄宿问题。

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引用次数: 0

Annual Meeting Content Analysis: Leveraging Annual Meetings to Promote Diversity, Equity, Inclusion, and Belonging in the Academy of Consultation-Liaison Psychiatry 年会内容分析：利用年会促进咨询联络精神病学学会的多样性、公平性、包容性和归属感。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-07-01 DOI: 10.1016/j.jaclp.2024.02.003

Background

There is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education. Although professional medical organizations' annual meetings play an instrumental role in continuing medical education for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for consultation-liaison psychiatrists.

Objective

To examine the ACLP annual meeting titles using Content Analysis.

Methods

We examined the publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. National DEI leaders from ACLP's DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting’s content was independently coded by 2 members of the DEI subcommittee with discrepancies adjudicated by 2 additional members. Descriptive statistics were used to characterize the content of the annual meeting.

Results

Of the 2615 annual meeting titles from 2010 to 2021 that were analyzed, 2531 were not coded to have DEI themes. Three percent (n = 84) of titles were coded to have a DEI theme as follows: Culture/diversity (n = 20, 24%), bias/disparities (n = 17, 20%), race/racism (n = 17, 20%), social justice (n = 12, 14%), gender/sexism (n = 10, 12%), and LGBTQ+ (n = 8, 10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021) with an increase in DEI content in 2021 (n = 24, 17%).

Conclusions

Although professional medical organizations like the ACLP are poised to leverage their continuing medical education platforms embedded in annual meeting programming to train consultation-liaison psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI-focused educational programming for their annual meetings.

背景：在学术医学的各个方面，包括通过继续医学教育（CME）来促进多样性、公平性和包容性（DEI）的需求与日俱增。尽管专业医学组织的年会在医生的继续医学教育（CME）中发挥着重要作用，但目前还没有研究描述专业医学组织年会计划中的 DEI 内容，包括咨询联络精神病学学会（ACLP），该学会是咨询联络（C-L）精神病学家的主要专业组织：我们研究了 2010 年至 2021 年 ACLP 网站上公开的 ACLP 年会内容标题。来自 ACLP DEI 小组委员会的国家 DEI 领导人反复生成了涵盖广泛的 DEI 相关主题的关键词。每次年会内容均由 DEI 分会的两名成员独立编码，并由另外两名成员对差异进行裁定。描述性统计用于描述年会内容的特征：在分析的 2010-2021 年的 2615 个年会标题中，有 2531 个未被编码为 DEI 主题。3%（n=84）的标题被编码为具有 DEI 主题，具体如下：文化/多样性（n=20，24%）、偏见/差异（n=17，20%）、种族/种族主义（n=17，20%）、社会公正（n=12，14%）、性别/性别歧视（n=10，12%）和 LGBTQ+ （n=8，10%）。每年DEI标题的频率从1%（2010年、2018年）到17%（2021年）不等，2021年DEI内容有所增加（n=24，17%）：尽管像 ACLP 这样的专业医疗组织已准备好利用其嵌入年会计划的继续医学教育平台，对 CL 精神科医师进行有关 DEI 主题的培训，但我们的研究结果表明，还需要做更多的工作，为其年会开发和推广以 DEI 为重点的教育计划。

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引用次数: 0

Patient and Medical Unit Staff Experiences of Proactive and Integrated Consultation-Liaison Psychiatry in The HOME Study: A Qualitative Investigation 在 "居家研究"（The HOME Study）中，病人和医疗单位员工对主动和综合咨询联络精神病学的体验：一项定性调查。

IF 2.7 4区心理学 Q2 PSYCHIATRY

Journal of the Academy of Consultation-Liaison Psychiatry

Pub Date : 2024-07-01 DOI: 10.1016/j.jaclp.2024.03.005

Background

Consultation-liaison (C-L) psychiatry services aim to help general hospital staff provide better care for their patients. Recently, many inpatient C-L psychiatry services have adopted proactive and integrated approaches to achieve this aim. Despite these developments, there have been no interview-based studies of patients' and staff members' experiences of the new approaches.

Objective

To gain an in-depth understanding of patients' and medical unit staff members' experiences of a proactive and integrated C-L psychiatry service for older medical inpatients (Proactive Integrated C-L Psychiatry [PICLP]).

Methods

We conducted an interview-based qualitative study with thematic analysis. The participants were patients and staff who had experienced PICLP during The HOME Study, a randomized trial that evaluated PICLP in 24 medical units of three UK general hospitals.

Results

We conducted 97 interviews: 43 with patients or their proxies (family members who were interviewed on behalf of patients with significant cognitive impairment) and 54 with staff members of all relevant disciplines. Patients and staff both described how PICLP was a helpful addition to medical care and discharge planning. It enhanced the medical unit team's ability to address psychological, psychiatric, and social needs and provide patient-centered care. They welcomed proactive biopsychosocial assessments and the broader perspective that these offered on patients' complex problems. They also valued the integration of C-L psychiatrists into the unit teams and their daily contact with them. For patients, it fostered a therapeutic relationship and helped them to be more engaged in decisions about their medical care and discharge planning. For staff, it enabled ready access to psychiatric expertise and training opportunities. The few reported experiences of PICLP being unhelpful were mainly about the greater number of clinicians involved in patients' care and a lack of clarity about professional roles in the integrated team.

Conclusions

We found that older inpatients and medical unit staff experienced PICLP as both acceptable and generally helpful. Our findings add to the existing evidence for the benefits of proactive and integrated C-L psychiatry services.

背景：精神科会诊-联络（C-L）服务旨在帮助综合医院的员工为病人提供更好的护理。最近，许多住院病人精神科会诊服务都采用了积极主动的综合方法来实现这一目标。尽管取得了这些进展，但目前还没有以访谈为基础的研究来了解病人和员工对新方法的体验：目的：深入了解患者和医疗单位员工对针对老年住院患者的积极主动的综合 C-L 精神科服务（Proactive Integrated C-L Psychiatry，PICLP）的体验：我们开展了一项以访谈为基础的定性研究，并进行了主题分析。参与研究的人员是在 "居家研究"（HOME Study）期间体验过 PICLP 的患者和员工。"居家研究 "是一项随机试验，在英国三家综合医院的 24 个医疗单位对 PICLP 进行了评估：我们进行了 97 次访谈，其中 43 次访谈的对象是患者或其代理人（代表有严重认知障碍的患者接受访谈的家属），54 次访谈的对象是所有相关学科的工作人员。患者和工作人员都描述了 PICLP 如何对医疗护理和出院规划起到了有益的补充作用。它提高了医疗单位团队解决心理、精神和社会需求的能力，并提供了以病人为中心的护理。他们欢迎积极主动的生物心理社会评估，以及这些评估为解决病人的复杂问题提供的更广阔视角。他们还非常重视 C-L 精神科医生融入病房团队以及与他们的日常接触。对病人来说，这促进了治疗关系，有助于他们更多地参与有关医疗护理和出院规划的决策。对员工而言，这使他们能够随时获得精神科专业知识和培训机会。少数报告称PICLP无益的经历主要是参与患者护理的临床医生人数较多，以及综合团队中的专业角色不够明确：我们发现，老年住院患者和医疗单位的工作人员都认为PICLP是可以接受的，而且总体上是有帮助的。我们的研究结果补充了现有的证据，证明了积极主动的综合老年精神病学服务的益处。

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