American Journal of Geriatric Psychiatry最新文献

Background: Patients who have experienced an inpatient hospitalization for heart failure are at increased risk of mortality, particularly during the months following discharge. This study described patient characteristics associated with suicide death and examined the time course of death by suicide compared to that of other types of death amongst patients with a recent medical hospitalization for heart failure.

Method: Using Department of Veterans Affairs (VA) electronic medical records from 2011 to 2020, we identified a cohort of Veterans hospitalized with a heart failure diagnosis who died after discharge. We merged the VA Mortality Database Record, a compilation of death sources and causes, with the VA electronic health record and compared characteristics of Veterans who died by suicide and by other causes.

Results: In the cohort of 348,840 Veterans, 1,097 died by suicide and 347,743 died by other causes. Compared to those who died by other causes, Veterans who died by suicide were, on average, younger, had fewer comorbidities, more likely to have a depression diagnosis, more likely to be White, and had lower prior year healthcare costs (Standardized mean differences [SMD] ranged from 0.25 to 0.46). Unadjusted analyses showed longer length of time between hospital discharge and death for those who died by suicide compared to other causes (SMD = 0.18); however, analyses adjusting for comorbidities revealed no difference in time to death between those who died by suicide versus other causes.

Conclusions: Demographic, clinical, and healthcare utilization characteristics distinguished Veterans with heart failure who died by suicide from those who died by other causes. Time to death following hospital discharge did not differ between groups when accounting for relevant factors. Comprehensive suicide screening and intervention is needed following a heart-failure hospital discharge, particularly for Veterans at elevated risk.

Objective: This study aimed to characterize patients with paraphrenia, focusing on their risk of dementia compared to patients with schizophrenia and the general population. Additionally, the study examined the risk of psychiatric disorders among the offspring of patients with paraphrenia.

Methods: We conducted a nationwide cohort study using the Danish Civil Registration System, the Danish Psychiatric Central Research Register, and the Danish National Patient Registry. Patients diagnosed with paraphrenia from 1969 to 1993 (ICD-8 code 297.19) were identified and matched with schizophrenia and an age matched reference population. Dementia risk was assessed using Cox proportional hazard models, with age as the underlying timescale. Offspring of the populations were followed for psychiatric outcomes.

Results: Patients with paraphrenia (n = 989) were predominantly older women, more often unmarried or widowed. Patients with schizophrenia and individuals in the matched reference population had a lower risk of dementia compared to patients with paraphrenia (hazard ratio [HR] = 0.60 (95% confidence interval [CI] = 0.50-0.71) and HR = 0.22 (95% CI = 0.19-0.26, respectively). Offspring of patients with paraphrenia (n = 174) exhibited a higher risk of psychiatric illness than offspring of individuals in the reference population. There was no significant difference between the risk of psychiatric illness in offspring of patients with paraphrenia and patients with schizophrenia.

Conclusion: The increased dementia risk associated with paraphrenia is contrary to the traditional description of it and may be due to earlier perhaps age based overdiagnosis of the syndrome including less characteristic clinical presentations. The increased familiar risk of psychiatric illness in offspring underscores the importance of considering familial psychiatric history in the assessment and care of these patients.

Objective: This study aimed to compare the effects of telemedicine use in management of neuropsychiatric symptoms (NPS) in patients with dementia in long-term care facilities (LTCFs) versus usual care.

Design: DETECT is a prospective randomized controlled cluster pilot study with two arms: "usual care" and "intervention arm" utilizing telemedicine for NPS management. Our study includes secondary and exploratory analyses from the DETECT study (primary analyses were the subject of a separate publication).

Setting: Nineteen LTCFs participated. Patient outcomes included total hospitalizations including emergency room admittance, psychotropic drug prescriptions, NPS based on NPI-NH, quality of life based on QolAD, and functional status based on Activity Daily Living (ADL).

Measurements: Analyses were conducted on a modified intention-to-treat population. Mixed models were used for outcome measures, considering data correlation over time and intra-LTCF correlation.

Results: One hundred forty-one patients were included: 65 in the control group and 76 in the intervention group, 99 women (70.2%) with a mean age of 86.8 years ± 6.6 (SD). No difference was identified regarding hospitalizations and psychotropic drug prescriptions in the intervention group. During exploratory analyses, telemedicine showed significant improvement in the intervention group for NPI frequency × severity score (p = 0.001), NPI distress score (p = 0.03), ADL (p = 0.006), and several quality-of-life items compared to usual care.

Conclusions: Secondary analyses form DETECT study show no difference in the use of telemedicine on management of NPS in patients with dementia in LTCFs, in terms of hospitalizations and psychotropic drug prescription. However, some exploratory analyses indicated a positive effect of Telemedicine, including severity, frequency, distress, and functional autonomy compared to usual care.