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Lebin LG, Nouri PK, Kwitowski MA, Dempsey AG, Lebin JA, Nagle-Yang S. Implementation and evaluation of a proactive consultation-liaison model on an inpatient obstetric unit. Gen Hosp Psychiatry 2024; 90:124-131. [PMID: 39178701 DOI: 10.1016/j.genhosppsych.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Perinatal mental and anxiety disorders (PMADs) contribute to adverse health outcomes, though they are underrecognized and undertreated. Inpatient obstetric settings represent a unique opportunity for behavioral health engagement, including screening, brief treatment, and referrals for outpatient care. The proactive consultation-liaison (CL) model has proven effective in general hospital settings but is not well-studied in obstetric settings. This article describes the implementation and evaluation of a proactive CL model in an inpatient obstetric unit within a tertiary medical center. METHODS We implemented a multidisciplinary, proactive CL model in an inpatient obstetric unit with the purpose of identifying patients at risk for or experiencing PMADs and providing intervention and/or referral to treatment. Systematic screening of 7322 admitted patients was performed over a 17-month period to identify eligible patients for behavioral health consultation. Consultation data was retrospectively extracted from the electronic medical record. Key implementation outcomes were assessed using a RE-AIM measures (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. RESULTS 1589 initial consults were conducted by the multidisciplinary team, yielding a consult rate of 21.7 %. The majority of consults (94 %) were completed by a social worker or psychologist, with most patients identified for consultation at multidisciplinary rounds (60.7 %). The most common indications for consultation with a psychiatrist included medication management, history of bipolar disorder, and history of anxiety. All invited staff and providers participated in the model. Alternative funding sources agreed to cover the salaries of the multidisciplinary team following conclusion of pilot grant funding. CONCLUSIONS A proactive CL model implemented in an inpatient obstetric unit led to a higher consult rate (21.7 %) than is observed with traditional CL services. A multidisciplinary proactive CL model shows promise in identifying people at-risk for PMADs and providing targeted interventions to prevent PMADs and treat those with active symptoms.
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Affiliation(s)
- Lindsay G Lebin
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA.
| | - Parvaneh K Nouri
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| | - Melissa A Kwitowski
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| | - Allison G Dempsey
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
| | - Jacob A Lebin
- University of Colorado School of Medicine, Department of Emergency Medicine, 12401 East 17(th) Avenue, 7(th) floor, Aurora, CO, USA
| | - Sarah Nagle-Yang
- University of Colorado School of Medicine, Department of Psychiatry, 1890 North Revere Court, Suite, 5003, Aurora, CO, USA
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Kwitowski MA, Lebin LG, Kelleher J, Zsemlye M, Nagle-Yang S. Behavioral Health Integration on Inpatient Obstetric Units: Program Development, Strategies for Implementation, and Lessons Learned. Clin Obstet Gynecol 2024; 67:169-185. [PMID: 38281174 DOI: 10.1097/grf.0000000000000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Perinatal mood and anxiety disorders and substance use disorders are the primary causes of maternal mortality in the postpartum period and represent major public health concerns. Despite this, these conditions remain undertreated. Behavioral health integration in outpatient obstetric settings is necessary but insufficient to meet the needs of all patients. Inpatient behavioral health integration represents a promising avenue for addressing gaps in care. Results from recent program development indicate that needs assessment, stakeholder backing, collaboration with existing programs, and adaptability are key factors in successful implementation.
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Affiliation(s)
| | | | | | - Meggan Zsemlye
- Department of Obstetrics,University of Colorado School of Medicine, Aurora, Colorado
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Tops L, Coteur K, Vermandere M. Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241236038. [PMID: 38465594 PMCID: PMC10929058 DOI: 10.1177/00469580241236038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/12/2024]
Abstract
This study aims to determine the vision and mission of an academic hospital's medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital's geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU's functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU's vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient's network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.
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Affiliation(s)
- Laura Tops
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Kristien Coteur
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Academic Centre for General Practice, KU Leuven, Leuven, Belgium
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COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond. J Psychosom Res 2023; 167:111183. [PMID: 36801662 PMCID: PMC9912022 DOI: 10.1016/j.jpsychores.2023.111183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. METHODS Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. RESULTS Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. CONCLUSION Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.
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Robbins-Welty GA, Gagliardi JP. Integrated Care for Complicated Patients: A Role for Combined Training and Practice. Am J Geriatr Psychiatry 2023; 31:222-231. [PMID: 36437177 DOI: 10.1016/j.jagp.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Patients with chronic medical disease frequently have comorbid psychiatric illness, yet mental and physical healthcare is frequently siloed in the United States. Integrated behavioral healthcare models, such as medicine-psychiatry services, are feasible, improve patient outcomes, and reduce costs. The Duke University Hospital medicine-psychiatry service provides holistic patient care and serves as a model for those interested in developing combined services or training programs elsewhere. Combined residency training in psychiatry is a way to provide a workforce of physician-scientist educators adept at providing coordinated, integrated care for complex patients with comorbid illness.
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Affiliation(s)
- Gregg A Robbins-Welty
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC; Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC.
| | - Jane P Gagliardi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center (GAR-W, JPG), Durham, NC; Department of Medicine, Duke University Medical Center (GAR-W, JPG), Durham, NC
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Fernández Trujillo A, López Ortiz C, Cuñat Rodriguez O, Del Hoyo Buxo B, Parrilla FJ, Serrano-Blanco A, Berrade Zubiri JJ. History of mental disorder in an ICU and referrals to psychiatry. Med Intensiva 2022; 46:559-567. [PMID: 35637139 DOI: 10.1016/j.medine.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/15/2021] [Accepted: 03/21/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DESIGN Retrospective descriptive study. SETTING ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS Patients admitted between January 2016 and June 2018. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Severity level (APACHE II), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P < .001) and with a lower mean score on the APACHE II scale (12 vs 14, P ≤ .003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. CONCLUSIONS This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.
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Affiliation(s)
- A Fernández Trujillo
- Unidad de Cuidados Intensivos, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain.
| | - C López Ortiz
- Unidad de Agudos de Psiquiatría, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - O Cuñat Rodriguez
- MIR Psiquiatría, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - B Del Hoyo Buxo
- MIR Psiquiatría, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - F J Parrilla
- Servicio de Medicina Intensiva, Hospital del Mar, Parc de Satlut Mar, GREPAC, IMIM, Barcelona, Spain
| | - A Serrano-Blanco
- Salud Mental, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain; CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - J J Berrade Zubiri
- Unidad de Medicina Intensiva, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
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Huarcaya-Victoria J, Segura V, Cárdenas D, Sardón K, Caqui M, Podestà Á. Analysis of the care provided over a six-month period by the liaison psychiatry unit at a general hospital in Lima, Peru. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:105-112. [PMID: 35753981 DOI: 10.1016/j.rcpeng.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/05/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS In a total of 400 referrals evaluated, the average age was 58 ± 17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.
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Affiliation(s)
- Jeff Huarcaya-Victoria
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru; Departamento Académico de Psiquiatría, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru.
| | - Victoria Segura
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Danitza Cárdenas
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Kathia Sardón
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Mónica Caqui
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Ángela Podestà
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
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Bieber ED, Philbrick KL, Shapiro JB, Karnatovskaia LV. Psychiatry's role in the prevention of post-intensive care mental health impairment: stakeholder survey. BMC Psychiatry 2022; 22:198. [PMID: 35303814 PMCID: PMC8933991 DOI: 10.1186/s12888-022-03855-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many critical illness survivors experience new or worsening mental health impairments. Psychiatry consultation services can provide a critical role in identifying, addressing, and preventing mental health challenges during and after admission to the acute medical care setting. However, psychiatry involvement in the ICU setting is lower than in other hospital settings and the conventional process in many hospitals requires other care providers to request consultation by psychiatry. Despite these differences, no studies have sought ICU provider perspectives on psychiatry consultation's current and desired role. We aimed to obtain stakeholder feedback on psychiatry's current and desired roles in the ICU, and potential benefits and drawbacks of increasing psychiatry's presence. METHODS A web-based survey obtained perspectives from 373 critical care physicians and advance practice providers, bedside nurses, physical and occupational therapists, pharmacists, and consultation-liaison psychiatry physicians and advance practice providers at a tertiary care center using multiple choice and open-ended questions. Descriptive information and content analysis of qualitative data provided information on stakeholder perspectives. RESULTS Psychiatry's primary current role was seen as assistance with management of mental health issues (38%) and suicide risk assessments (23%). 46% wished for psychiatry's increased involvement in the ICU. Perceived benefits of increased psychiatry presence in the ICU included early psychological support in parallel with medical care, identification of psychiatric factors impacting treatment, and facilitation of family understanding of the patient's mental state/delirium. An additional perceived benefit included reduction in provider burnout through processing difficult situations and decreasing family psychological distress. However, one concern included potential conflict among providers regarding treatment. CONCLUSIONS Those who work closely with the critically ill patients think that increased psychological support in the ICU would be beneficial. By contrast, psychiatry's current involvement is seen to be limited, perhaps driven by varying perceptions of what psychiatry's role is or should be.
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Affiliation(s)
- Ewa D. Bieber
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA ,grid.413808.60000 0004 0388 2248Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Kemuel L. Philbrick
- grid.66875.3a0000 0004 0459 167XDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN USA
| | - Jenna B. Shapiro
- grid.413808.60000 0004 0388 2248Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Lioudmila V. Karnatovskaia
- grid.66875.3a0000 0004 0459 167XDepartment of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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Schaefert R, Stein B, Meinlschmidt G, Roemmel N, Huber CG, Hepp U, Saillant S, Fazekas C, Vitinius F. COVID-19-Related Psychosocial Care in General Hospitals: Results of an Online Survey of Psychosomatic, Psychiatric, and Psychological Consultation and Liaison Services in Germany, Austria, and Switzerland. Front Psychiatry 2022; 13:870984. [PMID: 35815043 PMCID: PMC9270003 DOI: 10.3389/fpsyt.2022.870984] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/27/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic was accompanied by new challenges for psychosocial health care to enable the support of affected patients, their families, and staff in general hospitals. In this study, we aimed to describe the structures and procedures put in place by psychosomatic, psychiatric, and psychological consultation and liaison (CL) services in German, Austrian, and Swiss general hospitals, and to elucidate the emerging needs for cooperation, networking, and improvement. METHODS We conducted a cross-sectional online survey between December 2020 and May 2021, using a 25-item questionnaire derived from relevant literature, professional experience, and consultation with the participating professional societies. The survey was disseminated via national professional societies, relevant working and interest groups, and heads of the above-mentioned CL services. RESULTS We included responses from 98 CL services in the analyses, with a total response rate of 55% of surveyed hospital CL services; 52 responses originated from Germany, 20 from Austria, and 26 from Switzerland. A total of 77 (79%) of the 98 responding CL services reported that "COVID-19-related psychosocial care" (COVID-psyCare) was provided in their hospital. Among these, 47 CL services (61%) indicated that specific cooperation structures for COVID-psyCare had been established within the hospital. A total of 26 CL services (34%) reported providing specific COVID-psyCare for patients, 19 (25%) for relatives, and 46 (60%) for staff, with 61, 12, and 27% of time resources invested for these target groups, respectively. Regarding emerging needs, 37 (48%) CL services expressed wishes for mutual exchange and support regarding COVID-psyCare, and 39 (51%) suggested future changes or improvements that they considered essential. CONCLUSION More than three-quarters of the participating CL services provided COVID-psyCare for patients, their relatives, or staff. The high prevalence of COVID-psyCare services targeting hospital staff emphasizes the liaison function of CL services and indicates the increased psychosocial strain on health care personnel during the COVID-19 pandemic. Future development of COVID-psyCare warrants intensified intra- and interinstitutional exchange and support. TRIAL REGISTRATION ClinicalTrials.gov NCT04753242, version 11 February 2021.
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Affiliation(s)
- Rainer Schaefert
- Department of Psychosomatic Medicine, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical Private University, Nuremberg General Hospital, Nuremberg, Germany
| | - Gunther Meinlschmidt
- Department of Psychosomatic Medicine, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Noa Roemmel
- Department of Psychosomatic Medicine, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur - Zurcher Unterland, Winterthur, Switzerland
| | - Stéphane Saillant
- Department of General and Liaison Psychiatry, Neuchâtel Psychiatry Center (CNP), Neuchâtel, Switzerland
| | - Christian Fazekas
- Department of Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
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Zerbinati L, Palagini L, Balestrieri M, Belvederi Murri M, Caruso R, D'Agostino A, Ferrara M, Ferrari S, Minervino A, Milia P, Nanni MG, Pini S, Politi P, Porcellana M, Rocchetti M, Taddei I, Toffanin T, Grassi L, Bellucci J, Bergamelli E, Attilio Campagna V, Cherubini M, Folesani F, Gancitano M, Giannetti F, Giovanna G, Gullotta B, Massa L, Montardi G. Changes of consultation-liaison psychiatry practice in Italian general hospitals: A comparative 20-year multicenter study. Front Psychiatry 2022; 13:959399. [PMID: 36311528 PMCID: PMC9614237 DOI: 10.3389/fpsyt.2022.959399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Conducted under the auspices of the Italian Society of Consultation Liaison Psychiatry (SIPC) the aim of this study was to describe the characteristics of Consultation Liaison Psychiatry (CLP) activity in Italy (SIPC-2-2018) over the past 20 years by comparing with data from the first Italian nation-wide study (SIPC-1-1998). METHODS We collected data on CLP visits of 3,943 patients from 10 Italian hospitals over a period of 1 year. Data were compared with those from the SIPC-1 1998 study (4,183 participants). Patients were assessed with the same ad hoc 60-item Patient Registration Form recording information from five different areas: Sociodemographic, hospitalization-related, consultation-related, interventions and outcome. RESULTS Compared with participants from the previous study, SIPC-2-2018 participants were significantly older (d = 0.54) and hospitalized for a longer duration (d = 0.20). The current study detected an increase in the proportion of referrals from surgical wards and for individuals affected by onco-hematologic diseases. Depressive disorders still represented the most frequent psychiatric diagnosis, followed by adjustment and stress disorders and delirium/dementia. Also, CLP psychiatrists prescribed more often antidepressants (Φ = 0.13), antipsychotics (Φ = 0.09), mood stabilizers (Φ = 0.24), and less often benzodiazepines (Φ = 0.07). CONCLUSION CLP workload has increased considerably in the past 20 years in Italy, with changes in patient demographic and clinical characteristics. A trend toward increase in medication-based patient management was observed. These findings suggest that the psychiatric needs of patients admitted to the general hospital are more frequently addressed by referring physicians, although Italian CLP services still deserve better organization and autonomy.
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Affiliation(s)
- Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Laura Palagini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Matteo Balestrieri
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Armando D'Agostino
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Silvia Ferrari
- Section of Psychiatry, Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Milia
- Italian Society of Psychosomatic Medicine, Parma, Italy
| | - Maria Giulia Nanni
- University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matteo Porcellana
- Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy
| | - Matteo Rocchetti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Ines Taddei
- Department of Psychiatric Sciences and Psychological Medicine, University La Sapienza, 3rd Psychiatric Clinic, Rome, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | | | - Jessica Bellucci
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Emilio Bergamelli
- Psychiatric Clinic, Department of Medicine, University of Udine, Udine, Italy
| | | | - Melissa Cherubini
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
| | - Federica Folesani
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marta Gancitano
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Francesca Giannetti
- Section of Psychiatry, Department of Diagnostic-Clinical Medicine and Public Health, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Giovanna
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Benedetta Gullotta
- Department of Health Sciences, Università Degli Studi di Milano, Milano, Italy.,Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lucia Massa
- Italian Society of Psychosomatic Medicine, Parma, Italy
| | - Giulia Montardi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
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11
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Aebi NJ, Caviezel S, Schaefert R, Meinlschmidt G, Schwenkglenks M, Fink G, Riedo L, Leyhe T, Wyss K. A qualitative study to investigate Swiss hospital personnel's perceived importance of and experiences with patient's mental-somatic multimorbidities. BMC Psychiatry 2021; 21:349. [PMID: 34253168 PMCID: PMC8274261 DOI: 10.1186/s12888-021-03353-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mental-somatic multimorbidity in general hospital settings is associated with long hospital stays, frequent rehospitalization, and a deterioration of disease course, thus, highlighting the need for treating hospital patients more holistically. However, there are several challenges to overcome to address mental health conditions in these settings. This study investigated hospital personnel's perceived importance of and experiences with mental-somatic multimorbidities of patients in hospital settings in Basel, Switzerland, with special consideration of the differences between physicians and nurses. METHODS Eighteen semi-structured interviews were conducted with nurses (n = 10) and physicians (n = 8) in different hospitals located in Basel, Switzerland. An inductive approach of the framework analysis was used to develop the themes. RESULTS Four themes emerged from the data analysis: 1) the relevance of mental-somatic multimorbidity within general hospitals, 2) health professionals managing their emotions towards mental health, 3) knowledge and competencies in treating patients with mental-somatic multimorbidity, and 4) interprofessional collaboration for handling mental-somatic multimorbidity in hospital settings.The mental-somatic multimorbidities in general hospital patients was found to be relevant among all hospital professionals, although the priority of mental health was higher for nurses than for physicians. This might have resulted from different working environments or in efficient interprofessional collaboration in general hospitals. Physicians and nurses both highlighted the difficulties of dealing with stigma, a lack of knowledge of mental disorders, the emphasis place on treating somatic disorders, and competing priorities and work availability, which all hindered the adequate handling of mental-somatic multimorbidity in general hospitals. CONCLUSION To support health professionals to integrate mental health into their work, proper environments within general hospitals are needed, such as private rooms in which to communicate with patients. In addition, changes in curriculums and continuing training are needed to improve the understanding of mental-somatic multimorbidities and reduce negative stereotypes. Similarly, interprofessional collaboration between health professionals needs to be strengthened to adequately identify and treat mentally multimorbid patients. A stronger focus should be placed on physicians to improve their competencies in considering patient mental health in their daily somatic treatment care.
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Affiliation(s)
- Nicola Julia Aebi
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Seraina Caviezel
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Rainer Schaefert
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- grid.6612.30000 0004 1937 0642Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland ,grid.461709.d0000 0004 0431 1180Division of Clinical Psychology and Cognitive Behavioural Therapy, International Psychoanalytic University, Berlin, Germany ,grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Matthias Schwenkglenks
- grid.6612.30000 0004 1937 0642Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Günther Fink
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Lara Riedo
- Department of Health Canton Basel-Stadt, Division of Prevention, Basel, Switzerland
| | - Thomas Leyhe
- grid.6612.30000 0004 1937 0642University of Basel, Geriatric Psychiatry, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland ,grid.412556.10000 0004 0479 0775University of Basel, Center of Old Age Psychiatry, Psychiatric University Hospital, Basel, Switzerland
| | - Kaspar Wyss
- grid.416786.a0000 0004 0587 0574Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
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12
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Tucker MG, Hill H, Nicholson E, Moylan S. Substance Use and Psychiatric Disorders in Patients Referred to Consultation-Liaison Psychiatry Within a Regional General Hospital. Int J Ment Health Addict 2021. [DOI: 10.1007/s11469-021-00576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Fernández Trujillo A, López Ortiz C, Cuñat Rodriguez O, Del Hoyo Buxo B, Parrilla Gomez FJ, Serrano Blanco A, Berrade Zubiri JJ. History of mental disorder in an ICU and referrals to psychiatry. Med Intensiva 2021; 46:S0210-5691(21)00072-3. [PMID: 33972138 DOI: 10.1016/j.medin.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/15/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the prevalence of patients with mental disorders (MD) admitted to the ICU. To compare the clinical characteristics according to the presence of psychiatric history. To review the relevance of the consultations made to Psychiatry. DESIGN Retrospective descriptive study. SETTING ICU of the General Hospital of the Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain. PATIENTS Patients admitted between January 2016 and June 2018. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Severity level (APACHEII), reason for admission, days of admission, days of mechanical ventilation, psychiatric history and reason for psychiatric consultation. RESULTS A total of 1,247 patients were included; 194 (15.5%) met MD criteria, their mean age being younger (59 vs 68, P<.001) and with a lower mean score on the APACHEII scale (12 vs 14, P≤.003). There were 64 consultations to Psychiatry (5.1% of admissions), 59 of which were in patients with TM (92.1%). Regarding the reasons for the consultation, 22.6% were for attempted suicide, 61.3% for pharmacological adjustment, 11.3% to rule out mental disorder, and 4.8% for competence assessment. The probability of a consultation being carried out while it was indicated was 89.1%, while the probability of not carrying it out when it was not indicated was 99.4%. CONCLUSIONS This study supports the need to expand the specific recommendations for consultation to Psychiatry, beyond the assessment after a suicide attempt, since a large percentage (77.5%) of the pertinent consultations were for other reasons.
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Affiliation(s)
- A Fernández Trujillo
- Unidad de Cuidados Intensivos, Consorci Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, España.
| | - C López Ortiz
- Unidad de Agudos de Psiquiatría, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | - O Cuñat Rodriguez
- MIR Psiquiatría, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | - B Del Hoyo Buxo
- MIR Psiquiatría, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | - F J Parrilla Gomez
- Servicio de Medicina Intensiva, Hospital del Mar, Parc de Satlut Mar, GREPAC, IMIM, Barcelona, España
| | - A Serrano Blanco
- Salud Mental, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
| | - J J Berrade Zubiri
- Unidad de Medicina Intensiva, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España
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14
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Abstract
BACKGROUND Adjustment disorder requires therapeutic intervention because of its complications, which include a significant risk of suicide, but evidence-based therapeutic guidelines are not available. AREAS OF UNCERTAINTY The main problem is related to answer to the following question: What is the optimal therapeutic approach to adjustment disorder? In this respect we review all randomized controlled trials that aimed to investigate therapeutic interventions for adjustment disorder in adult populations. DATA SOURCES Comprehensive search of the electronic database PubMed (January 1980-June 2019). The review included clinical trials that aimed to investigate a psychological or pharmacological treatment for adjustment disorder in adult population and reported outcome data for therapeutic interventions. RESULTS The search identified 23 studies that fulfilled the inclusion criteria for this review. Pharmacotherapy interventions were the focus of 11 studies that used various medications and dosages including viloxazine, lormetazepam, S-adenosylmethionine, pivagabine, trazodone, clorazepate, etifoxine, lorazepam, diazepam, afobazole, and plant extracts (Kava-kava, Euphytose, and Ginkgo biloba) on a total number of 1020 patients. Psychotherapy interventions were identified in 12 studies that used mirror therapy, short-term dynamic psychotherapy, yoga meditation, body-mind-spirit technique, mindfulness, bibliotherapy (self-help manual), humor training, and cognitive behavioral therapy. CONCLUSIONS Psychotherapy seems indicated for mildly symptomatic adjustment disorder. Given the fact that adjustment disorder with severe symptoms is associated with a high risk of suicidal ideation and suicide attempts, clinicians must consider the potential benefit of using psychotropic agents such as benzodiazepines, antidepressants, or etifoxine.
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15
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Turan Ş, Poyraz BÇ, Aksoy Poyraz C, Demirel ÖF, Tanrıöver Aydın E, Uçar Bostan B, Demirel Ö, Ali RK. Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations. Asian J Psychiatr 2021; 57:102563. [PMID: 33556918 PMCID: PMC7840407 DOI: 10.1016/j.ajp.2021.102563] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023]
Abstract
Patients hospitalized with COVID-19 are at risk of developing many neuropsychiatric disorders, due to the effects of the disease on the brain and the psychosocial pressures of having the disease. The aim of the present study was to evaluate the characteristics and outcomes of patients who were hospitalized with a diagnosis of COVID-19, who underwent psychiatric consultations. The medical records of 892 patients hospitalized due to COVID-19 and the 89 among them who requested psychiatric consultations were analyzed retrospectively. After the psychiatric consultations, patients were most frequently diagnosed with delirium (38.2 %), adjustment disorder (27.0 %), depressive disorder (19.1 %) and anxiety disorder (11.2 %). Patients with delirium had longer hospital stays (p < 0.001), were transferred more frequently to intensive care units (p < 0.001), and had higher mortality rates during their hospital stays (p < 0.001), than all other patients. The need for oxygen (p < 0.001) and mechanical ventilation (p < 0.001) was also significantly higher in delirium patients, as well as in patients who received other psychiatric diagnoses. Neuropsychiatric disorders develop in patients receiving inpatient treatments in COVID-19 wards, and these disorders negatively affect the prognosis of COVID-19. Our findings suggest that the presence of neuropsychiatric disorders in in-patients with COVID-19 might be associated with the negative outcomes of the disease.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Burç Çağrı Poyraz
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ezgi Tanrıöver Aydın
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Büşra Uçar Bostan
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Öznur Demirel
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ritvan Kara Ali
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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16
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Huarcaya-Victoria J, Segura V, Cárdenas D, Sardón K, Caqui M, Podestà Á. Analysis of the Care Provided Over a Six-Month Period by the Liaison Psychiatry Unit at a General Hospital in Lima, Peru. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30089-5. [PMID: 33735026 DOI: 10.1016/j.rcp.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/26/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS In a total of 400 referrals evaluated, the average age was 58±17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.
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Affiliation(s)
- Jeff Huarcaya-Victoria
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú; Departamento Académico de Psiquiatría, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Victoria Segura
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Danitza Cárdenas
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Kathia Sardón
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Mónica Caqui
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Ángela Podestà
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
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17
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Diagnostic Agreement between Physicians and a Consultation-Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020749. [PMID: 33477280 PMCID: PMC7830763 DOI: 10.3390/ijerph18020749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022]
Abstract
Consultation-liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000-2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen's kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.
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18
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Pilowsky JK, Elliott R, Roche MA. Pre-existing mental health disorders in patients admitted to the intensive care unit: A systematic review and meta-analysis of prevalence. J Adv Nurs 2021; 77:2214-2227. [PMID: 33426719 DOI: 10.1111/jan.14753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/15/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
AIMS To determine the reported prevalence rate of pre-existing mental health disorders in patients admitted to adult ICUs and identify the most commonly occurring types of these disorders. DESIGN Systematic review and meta-analysis. DATA SOURCES Five electronic databases were searched from 1 January 2000 -15 April 2020. Google Scholar was used to perform forwards citation searching. METHODS This review was conducted in line with the PRISMA guidelines and protocol registered with PROSPERO CRD42020181818. Meta-analyses were performed using the quality effects model to calculate weighted pooled prevalence estimates and heterogeneity was tested using the I2 statistic. RESULTS Seven articles were included in the final review and meta-analysis (143,179 participants). Identified prevalence rates varied considerably, ranging from 6.2-28.0%, reflecting variation in each study's clinical context, as well as different patient selection and identification methodologies. The pooled prevalence rate of all pre-existing mental health disorders was 19.4% (95% CI 8.9-32.6%). Depression was the most common subtype, accounting for an estimated 60.5% (95% CI 54.4-66.5%) of identified mental health disorders. All analyses showed significant heterogeneity with I2 > 95%. CONCLUSION Approximately 19% of adult ICU patients have a history of a mental health disorder, most commonly depression. Further research is needed to improve the accuracy of this estimate as well as determine the best identification method. IMPACT This study has demonstrated that patients with pre-existing mental health disorders, particularly depression, constitute a significant subgroup in ICU. Given that the presence of a pre-existing mental health disorder appears to confer an increased mortality risk following ICU discharge, clinicians need to be made aware of this group of patients to provide additional support. Further research is needed to more accurately quantify this vulnerable group and establish methods to enable clinicians to readily identify and refer these patients for appropriate follow-up treatment.
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Affiliation(s)
- Julia K Pilowsky
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Rosalind Elliott
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Nursing and Midwifery Directorate, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Michael A Roche
- School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Mental Health Drug and Alcohol Services, Northern Sydney Local Health District, North Ryde, NSW, Australia
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19
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McLoughlin C, McLoughlin A, Jain S, Abdalla A, Cooney J, MacHale S. The suburban-city divide: an evaluation of emergency department mental health presentations across two centres. Ir J Med Sci 2021; 190:1523-1528. [PMID: 33392979 DOI: 10.1007/s11845-020-02496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the characteristics of mental health presentations to the emergency department in two different hospital settings. METHODS This was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre. The authors collected data on gender, age, employment, housing, clinical presentation, time of assessment and admissions, over a 1-month period. RESULTS The total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29 years, compared with 28/104 (27%) of suburban presenters (P value 0.0134). A higher number of presenters were aged over 60 in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) (P value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting (P < 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period, 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted in the inner-city centre and 13/104 (12.5%) patients admitted in the suburban centre (P value 0.002). CONCLUSIONS A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs, who are seen out of hours. This prompts consideration of expanding both ED and community services to comprise a more multidisciplinary-resourced, 24/7 care model.
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Affiliation(s)
| | | | | | - Ahad Abdalla
- Limerick University Hospital Group, Limerick, Ireland
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20
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Proactive C-L Psychiatry Beyond Academic Hospital Settings: A Pilot Study of Effectiveness in a Suburban Community Hospital. PSYCHOSOMATICS 2020; 61:688-697. [DOI: 10.1016/j.psym.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022]
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21
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Ferrari S, Mattei G, Marchi M, Galeazzi GM, Pingani L. Is Consultation-Liaison Psychiatry 'Getting Old'? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207389. [PMID: 33050480 PMCID: PMC7601334 DOI: 10.3390/ijerph17207389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.
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Affiliation(s)
- Silvia Ferrari
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Giorgio Mattei
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
- Department of Economics “Marco Biagi”, University of Modena and Reggio Emilia, Via Jacopo Berengario 51, 41121 Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Luca Pingani
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
- Department of Health Professions, Azienda USL–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-0522-522077
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Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd010530.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patricia Casey
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Divina Pillay
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Lorna Wilson
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Andreas Maercker
- Department of Psychology; University of Zurich; Zurich Switzerland
| | - Angela Rice
- Library and Information Service; Mater Misericordiae University Hospital; Dublin Ireland
| | - Brendan Kelly
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
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Wittink MN, Cross W, Goodman J, Jackson H, Lee HB, Olivares T, Maeng DD, Caine ED. Taking the Long View in an Inpatient Medical Unit: A Person-Centered, Integrated Team Approach for Patients With Severe Mental Illnesses. Psychiatr Serv 2020; 71:885-892. [PMID: 32362225 DOI: 10.1176/appi.ps.201900385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patients with severe mental illnesses and related conditions, such as substance misuse and suicide attempts, are among the highest utilizers of acute inpatient medical services. The objective of this study was to assess the impact of a specialized medical unit that uses a comprehensive biopsychosocial model to care for patients with severe mental illnesses. METHODS The study used administrative data to compare patients with severe mental illnesses admitted to a specialized unit with patients admitted to medically similar acute (non-intensive care) medical units in a tertiary academic medical center. With controls for sociodemographic variables, illness severity, and medical complexity, multivariate regression analyses compared utilization outcomes for patients from the specialized unit with outcomes from comparison units. RESULTS Patients on the specialized unit (N=2,077) were younger, had more mental disorder diagnoses, and were more likely to have less severe general medical illness and less medical complexity than patients from comparison units (N=12,824). Analyses of a subsample of patients with complex behavioral health diagnoses indicated that those on the specialized unit had a shorter average stay, higher odds of discharge to home, and lower odds of 30-day readmission, compared with those on comparison units. CONCLUSIONS Specialized units targeted to the needs of patients with serious mental illnesses can provide a moment of engagement when vulnerable patients are likely to benefit from more coordinated care. Findings suggest that a specialized unit that capitalizes on this moment of engagement and uses a biopsychosocial model of care can improve utilization outcomes.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Wendi Cross
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Jacqueline Goodman
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Heather Jackson
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Hochang B Lee
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Telva Olivares
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Daniel D Maeng
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
| | - Eric D Caine
- Department of Psychiatry (Wittink, Cross, Jackson, Lee, Olivares, Maeng, Caine), Department of Family Medicine (Wittink), Department of Pediatrics (Cross), and Department of Medicine (Olivares), University of Rochester Medical Center (Goodman), Rochester, New York
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24
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Hino K, Nomoto M, Endo E, Watanabe A, Sakamoto O, Takahashi Y. Effect of a Psychiatric Department Liaison Team on Patient Treatment and Outcomes. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200628-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Scratch SE, Stevens SA, King G, Schwellnus H, Searl N, McPherson AC. Mental Health Care in Pediatric Rehabilitation Hospitals: A Biopsychosocial, Collaborative, and Agency-based Service Integration Approach. Dev Neurorehabil 2020; 23:359-367. [PMID: 31790617 DOI: 10.1080/17518423.2019.1687600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Canadian hospitals are not currently prepared to meet the psychosocial needs of children with disabilities as services are rooted in a biomedical care model. Objective: To describe a practical and holistic framework for pediatric rehabilitation hospitals to meet the health care needs of children and their families. Method: An environmental scan was conducted of best practice guidelines, policy documents, and models of integrated mental health care. Recommendations from clinical guidelines and national strategy documents were incorporated to develop a service integration approach. Results: An agency-based approach was used to develop a two-phase biopsychosocial framework. In framework Phase I, reactive care is provided to mental health concerns. In Phase II, there is a shift to proactive care and mental health wellbeing. Conclusions: Emphasis is placed on capacity building of clinical staff into best practices for mental health care. Implementation needs and consideration for uptake of the framework are also discussed.
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Affiliation(s)
- Shannon E Scratch
- Bloorview Research Institute , Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Department of Pediatrics, University of Toronto , Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto , Toronto, Canada
| | - Sara A Stevens
- Bloorview Research Institute , Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Gillian King
- Bloorview Research Institute , Toronto, Canada.,Occupational Science and Occupational Therapy, University of Toronto , Toronto, Canada
| | - Heidi Schwellnus
- Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada.,Occupational Science and Occupational Therapy, University of Toronto , Toronto, Canada
| | - Nancy Searl
- Holland Bloorview Kids Rehabilitation Hospital , Toronto, Canada
| | - Amy C McPherson
- Bloorview Research Institute , Toronto, Canada.,Department of Pediatrics, University of Toronto , Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
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26
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Gao YN, Marcangelo M. Association of Early Treatment With Chronicity and Hazard of Hospitalization After New Adjustment Disorder. Am J Psychother 2020; 73:50-56. [PMID: 31994408 DOI: 10.1176/appi.psychotherapy.20190019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to examine the effect of early treatment with psychotherapy or psychoactive medications on later hospitalizations for patients with a new diagnosis of adjustment disorder. METHODS Commercial claims data from Truven Health MarketScan were used. Patient-level propensity score matching was performed, and the authors fit an inverse probability of treatment weighting to a Cox proportional hazard model. RESULTS Early receipt of psychoactive medication instead of psychotherapy was associated with an increased hazard of later psychiatric hospitalization (hazard ratio [HR]=2.61, 95% confidence interval [CI]=2.07-3.28) and overall hospitalization (HR=1.12, 95% CI=1.04-1.21). Specifically, benzodiazepines were associated with increased hazard of later psychiatric hospitalization (HR=1.59, 95% CI=1.02-2.51), which did not differ from medications overall. In contrast, early receipt of psychotherapy was associated with a small decrease in the hazard of later psychiatric hospitalization (HR=0.85, 95 % CI=0.73-0.99) but had no effect on overall hospitalizations. CONCLUSIONS Early medication treatment for adjustment disorder was associated with greater overall and psychiatric hospitalization compared with no early medication treatment. This study suggests that an observed provider preference to use medications to treat patients who have comorbid physical illness may have deleterious long-term effects.
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Affiliation(s)
- Y Nina Gao
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, and New York State Psychiatric Institute, New York (Gao); Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago (Marcangelo)
| | - Michael Marcangelo
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, and New York State Psychiatric Institute, New York (Gao); Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago (Marcangelo)
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Liaison psychiatry in low & middle income countries: Experiences at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. Asian J Psychiatr 2020; 48:101889. [PMID: 31812928 DOI: 10.1016/j.ajp.2019.101889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022]
Abstract
AIMS AND METHODS Our study investigated the pattern of referrals made to psychiatric services from the general wards of Aga Khan University Hospital (AKUH). Data on all cases referred between years 2015 to 2016 was collected retrospectively from the medical records. Information included socio-demographic details, reason for referral, past psychiatric history, treatment, management suggested and outcome of referral. SPSS version 19.0 was used for data entry and analyzing. RESULTS During the study period 1166 cases were referred for psychiatric consultations of which 995 were analyzed. The results show an almost equal distribution of females and males. Most referrals were from Internal Medicine. The most common reason for referral was behavioral problem and the most common psychiatric diagnosis made was delirium. CLINICAL IMPLICATIONS Review of the service has identified areas that need improvement such as late referrals, problems with documentation, and issues in following through with the recommended management and will help us improve the existing services.
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Predictors of Disagreement Between Diagnoses From Consult Requesters and Consultation-Liaison Psychiatry. J Nerv Ment Dis 2019; 207:1019-1024. [PMID: 31790047 DOI: 10.1097/nmd.0000000000001018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We evaluated disagreement between reported symptoms and a final diagnosis of depression, anxiety, withdrawal, psychosis, or delirium through regression models assessing individual and combined diagnoses. Highest disagreement rates were reported for services classified as others (88.2%), general surgery (78.5%), and bone marrow transplant (77.7%). Disagreement rates varied widely across different diagnoses, with anxiety having the highest disagreement rate (63.3%), whereas psychosis had the lowest disagreement rate (10.6%). When evaluating kappa coefficients, the highest agreement occurred with diagnoses of withdrawal and psychosis (0.66% and 0.51%, respectively), whereas anxiety and depression presented the lowest values (0.31% and 0.11%, respectively). The best-performing predictive model for most outcomes was random forest, with the most important predictors being specialties other than the ones focused on single systems, older age, lack of social support, and the requester being a resident. Monitoring disagreement rates and their predictors provides information that could lead to quality improvement and safety programs.
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Implementing Motivational Interviewing for Substance Misuse on Medical Inpatient Units: a Randomized Controlled Trial. J Gen Intern Med 2019; 34:2520-2529. [PMID: 31468342 PMCID: PMC6848470 DOI: 10.1007/s11606-019-05257-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/28/2019] [Accepted: 07/11/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse. OBJECTIVE To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients. DESIGN Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057). PARTICIPANTS Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital. INTERVENTIONS Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition). MAIN MEASURES Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse. KEY RESULTS 20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge's g = 1.49) and 3.0% (Hedge's g = 1.26) in the respective workshop only and apprenticeship conditions (p < 0.001). Motivational interviews in the consult condition were performed with more fundamental motivational interviewing adherence and competence than the other conditions. Most statements made by patients during the interviews favored reducing substance misuse, with no differences between conditions. CONCLUSIONS Providers' ability to place an order to have experts from the consultation-liaison service deliver a motivational interview was a more effective implementation strategy than a workshop or apprenticeship method for ensuring motivational interviewing is available to medical inpatients who misuse substances. TRIAL REGISTRY NCT01825057.
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Lobo A, Rabanaque I, Blanch J, Campos R, Ezquiaga E, Farré JM, Gómez-Reino I, Marco C, Navío M, Ochoa E, Parramón G, Ventura T, Aguilar EJ, Artal J, Cuesta M, Devolx VM, Espárrago G, Franco MA, Hernández Fleta JL, Martínez Jambrina JJ, Ortega MÁ, Palomo J, Pérez Costillas L, Roca M. The development of psychosomatic and Liaison Psychiatry units in Spain: A national enquiry. J Psychosom Res 2019; 125:109784. [PMID: 31421327 DOI: 10.1016/j.jpsychores.2019.109784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/03/2019] [Accepted: 07/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Lobo
- Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Instituto de Investigación Sanitaria Aragón IIS-A, Spain.
| | - Isabel Rabanaque
- Instituto de Investigación Sanitaria Aragón IIS-A, Universidad de Zaragoza, Zaragoza, Spain.
| | - Jordi Blanch
- Coordinador del Centro de Salud Mental de Adultos del Instituto Clínic de Neurociencias, Barcelona, Spain.
| | | | | | | | | | - Carlos Marco
- Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Mercedes Navío
- Oficina Regional de Coordinación de Salud Mental, Madrid, Spain.
| | - Enriqueta Ochoa
- Hospital Universitario Ramón y Cajal (IRYCIS), Universidad de Alcalá, Madrid, Spain.
| | - Gemma Parramón
- Hospital Universitari de la Vall d'Hebrón, Barcelona, Spain.
| | | | | | - Jesús Artal
- Hospital Marqués de Valdecilla, Santander, Spain.
| | | | | | | | | | | | | | | | - Javier Palomo
- Hospital Universitario de Donostia, San Sebastián, Spain.
| | | | - Miquel Roca
- Hospital Juan March de Mallorca, Palma de Mallorca, Spain.
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Fegan J, Doherty AM. Adjustment Disorder and Suicidal Behaviours Presenting in the General Medical Setting: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162967. [PMID: 31426568 PMCID: PMC6719096 DOI: 10.3390/ijerph16162967] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/16/2022]
Abstract
Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies.
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Affiliation(s)
- Joanne Fegan
- Department of Psychiatry, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Anne M Doherty
- Department of Psychiatry, University Hospital Galway, H91 YR71 Galway, Ireland.
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Chadda RK, Deb KS, Mahapatra A, Gupta R. Referral patterns in a consultation liaison psychiatry service in India: A comparison with the Western world. Gen Hosp Psychiatry 2019; 59:76-77. [PMID: 30745228 DOI: 10.1016/j.genhosppsych.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/14/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Rakesh Kumar Chadda
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India.
| | - Koushik Sinha Deb
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ananya Mahapatra
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rishi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi 110029, India
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Bui M, Thom RP, Hurwitz S, Levy-Carrick NC, O'Reilly M, Wilensky D, Talmasov D, Blanchfield B, Vaidya V, Kakoza R, Klompas M, Stanley E, Gitlin D, Massaro A. Hospital Length of Stay With a Proactive Psychiatric Consultation Model in the Medical Intensive Care Unit: A Prospective Cohort Analysis. PSYCHOSOMATICS 2019; 60:263-270. [DOI: 10.1016/j.psym.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 11/17/2022]
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Caarls PJ, van Schijndel MA, Kromkamp M, Wierdsma AI, Osse RJ, van der Hoeven G, Hoogendijk WJG, van Busschbach JJ. Need analysis for a new high acuity medical psychiatry unit: which patients are considered for admission? BMC Health Serv Res 2019; 19:139. [PMID: 30819164 PMCID: PMC6394074 DOI: 10.1186/s12913-019-3967-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study aims were: to estimate the proportion of patients with an indication for admission to a new high acuity Medical Psychiatric Unit (MPU), to explore the reasons for MPU-admission according to different health disciplines, and to check for differences in patient characteristics. The results of this study are to be utilized in the proposed establishment of a high-acuity MPU in a University Medical Center. Such a unit currently does not exist at Erasmus MC. METHODS Hospital in-patients were included if they received psychiatric consultation from the Psychiatric Consultative Service (PCS). As part of the study protocol, psychiatrists, other medical specialists, and nurses determined the need for admission to the proposed MPU. Patient groups were compared with respect to diagnoses, socio-demographic characteristics and patient routing. RESULTS One hundred and fifty-one patients were included, 43% had an indication for MPU-admission, for the other patients PCS involvement was sufficient. There was agreement on suicide attempts as a reason for MPU-admission. For psychiatrists, the need for further diagnostic evaluation was a common reason for MPU admission, while other medical specialists more often emphasized the need for safety measures. Patients with an unplanned hospital admission had a higher chance of MPU eligibility (OR = 2.72, 95% CI 1.10-6.70). The main psychiatric diagnoses of MPU-eligible patients were organic disorders (including delirium), mood disorders, and disorders related to substance abuse. The most common diagnoses found were similar to those in previous research on MPU populations. CONCLUSION Different medical disciplines have different views on the advantages of MPUs, while all see the need for such facilities. The proposed MPU should be able to accommodate patients directly from the Emergency Unit, and the MPU should provide specialized diagnostic care in an extra safe environment.
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Affiliation(s)
- P J Caarls
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - M A van Schijndel
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.,Rijnstate Hospital, Department of Psychiatry, Wagnerlaan 55, 6815 AD, Arnhem, The Netherlands
| | - M Kromkamp
- University Medical Center Utrecht, Department of Psychiatry, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A I Wierdsma
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - R J Osse
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - G van der Hoeven
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - W J G Hoogendijk
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - J J van Busschbach
- Erasmus MC, University Medical Center Rotterdam, Department of Psychiatry, s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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Sánchez-González R, Rodríguez-Urrutia A, Monteagudo-Gimeno E, Vieta E, Pérez-Solá V, Herranz-Villanueva S, Pintor-Pérez L. Clinical features of a sample of inpatients with adjustment disorder referred to a consultation-liaison psychiatry service over 10 years. Gen Hosp Psychiatry 2018; 55:98-99. [PMID: 30107936 DOI: 10.1016/j.genhosppsych.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Roberto Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Amanda Rodríguez-Urrutia
- Consultation-Liaison Psychiatry Unit, Department of Psychiatry, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Eila Monteagudo-Gimeno
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Víctor Pérez-Solá
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Sandra Herranz-Villanueva
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain
| | - Luis Pintor-Pérez
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain
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L’addictologie de liaison : outils et spécificités. Encephale 2018; 44:354-362. [DOI: 10.1016/j.encep.2017.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
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Brunn M, Golombek U, Strain J, Diefenbacher A. Personality disorders in patients referred to consultation-liaison psychiatry: Characteristics and medical treatment in a large general hospital. THE EUROPEAN JOURNAL OF PSYCHIATRY 2018. [DOI: 10.1016/j.ejpsy.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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O'Donnell ML, Metcalf O, Watson L, Phelps A, Varker T. A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults. J Trauma Stress 2018; 31:321-331. [PMID: 29958336 DOI: 10.1002/jts.22295] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/10/2022]
Abstract
Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.
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Affiliation(s)
- Meaghan L O'Donnell
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Olivia Metcalf
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Loretta Watson
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrea Phelps
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord 2018; 227:243-253. [PMID: 29107817 DOI: 10.1016/j.jad.2017.10.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. METHODS Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. RESULTS This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. LIMITATIONS Publications without an English abstract were not included. CONCLUSIONS Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.
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Affiliation(s)
- Rahel Bachem
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 699780, Israel.
| | - Patricia Casey
- University College Dublin, School of Medicine, Mater Misericordiae Hospital, 62/63 Eccles Street, Dublin 7, Ireland
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Deter HC, Kruse J, Zipfel S. History, aims and present structure of psychosomatic medicine in Germany. Biopsychosoc Med 2018; 12:1. [PMID: 29434655 PMCID: PMC5795290 DOI: 10.1186/s13030-017-0120-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
Combining its two traditions of integrated psychosomatics in internal medicine and focusing on psychotherapeutic/psychiatric methods in many clinical fields, German psychosomatic medicine has developed well over the last decades. It benefits from its institutional independence and the progressive changes in health care. Clinically, disorder-oriented psychotherapy is a core method integrated with other modes of therapy. As a conceptual base for empirical research, non-reductionist accounts of the interactions of (sick) persons with their environment are most important. Germany has developed a model of Psychosomatic Medicine that has conceptualized and integrated psychotherapeutic methods into clinical practice and realized one way to practice bio-psycho-social medicine in the health care system of the country.
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Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Johannes Kruse
- Clinic for Psychosomatic Medicine and Psychotherapy, German Association of Psychosomatic Medicine and Psychotherapy (DGPM), University Gießen und Marburg GmbH, Giessen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, German College of Psychosomatic Medicine (DKPM), Tuebingen, Germany
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González M, Carreño M. PSIQUIATRÍA DE ENLACE Y MEDICINA DE ENLACE, NUEVOS ALCANCES. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Graziane JA, Gopalan P, Cahalane J. Telepsychiatry Consultation for Medical and Surgical Inpatient Units. PSYCHOSOMATICS 2017; 59:62-66. [PMID: 28918164 DOI: 10.1016/j.psym.2017.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/09/2017] [Accepted: 08/10/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND Telepsychiatry is becoming more commonplace in the provision of psychiatric care. Most commonly used in the outpatient setting, there is little information available in the literature as to the use of telepsychiatry for inpatient medical/surgical consultation. OBJECTIVE We review the University of Pittsburgh Medical Center's telepsychiatry consultation program that provides consultation to an outlying community-based rural hospital. METHODS This article examines the 69 telepsychiatry consultations that were performed from November 2014 through February 2016, looking at the patients served, common consultation questions, and patterns of diagnoses and recommendations. RESULTS The median age of individuals undergoing telepsychiatry evaluations was 67 years, and the most common reason for consultation was for delirium. Over half of the patients consulted had a primary diagnosis of delirium, dementia, or a cognitive disorder not otherwise specified, using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses. In most patients, additional laboratory studies or imaging or both were requested and medication changes recommended (initiation, dose changes, and discontinuation). CONCLUSION This report provides one of the first detailed views of the use of telepsychiatry in a remote inpatient medical setting. Findings will guide education to primary teams and will shape the development of future telepsychiatry interventions.
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Affiliation(s)
- Julie A Graziane
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA; Department of Psychiatry, Penn State College of Medicine, Pennsylvania Psychiatric Institute, Harrisburg, PA.
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA
| | - Jack Cahalane
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA
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[Bio-psycho-socio or psychotherapeutic medicine - actual development of psychosomatics in clinical practice]. Wien Med Wochenschr 2017; 168:52-61. [PMID: 28744775 DOI: 10.1007/s10354-017-0582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
In Germany a model of Psychosomatic Medicine has developed, which integrated several psychotherapeutic methods in clinical practice. The concept, which focused on disease mechanisms in the human body and the interaction between diseased individuals and their environment became a basic psychosomatic research strategy and was imlemented in medical care. In this paper the result of a psychosomatic development in clinical health care and research and possible deficiences are described. Perspectives of development and future tasks of Psychosomatic Medicine will be reviewed.
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Poli R, Carreca A, Colmegna F, Ferraris S, Gagliardi E, Tamborini S, Toscano M. The practice of consultation psychiatry in Italy: A multi-centre study. J Psychosom Res 2017; 96:32-34. [PMID: 28545790 DOI: 10.1016/j.jpsychores.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/10/2017] [Accepted: 03/11/2017] [Indexed: 10/20/2022]
Affiliation(s)
- R Poli
- ASST Cremona DSM Cremona, via Largo Priori n.1, Cremona, Italy.
| | - A Carreca
- UOC Mental Health, 7 ASP Palermo, Italy
| | - F Colmegna
- Department of Mental Health ASST, Monza, Italy
| | | | - E Gagliardi
- Department of Mental Health ASST, Cremona, Italy
| | - S Tamborini
- Department of Mental Health ASST, Cremona, Italy
| | - M Toscano
- Department of Mental Health ASST, Cremona, Italy; Department of Mental Health ASST, Rhodense, Italy
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The European Network on Psychosomatic Medicine (ENPM) - history and future directions. Biopsychosoc Med 2017; 11:3. [PMID: 28149323 PMCID: PMC5267402 DOI: 10.1186/s13030-016-0086-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/08/2016] [Indexed: 11/24/2022] Open
Abstract
Background Within national and international societies of psychosomatic medicine the idea has emerged of bringing together and coordinating psychosomatic, behavioural, psychological and medical actions with common interests throughout Europe as a way to increase their scientific and political influence. Methods It was felt that there was a strong need and opportunity of a common and unifying forum for scientific exchange. Results It was considered desirable to exchange scientific thoughts and experiences in an open minded and boundless way, among individuals and societies, between disciplines and across borders. The course of ideas and discussions within the group of European psychosomatic scientists over 12 years is presented as an effort to combine strengths and actions supporting clinical psychosomatic research and medical practice in Europe. The fields of psycho-cardiology, quality in primary care, psycho-oncology, gastrointestinal psychosomatics, C/L Psychiatry, and Psychosomatics are examples of such positive developments. Discussion Several historic ideas are mentioned and the aims and advantages of the newly founded European Association of Psychosomatic Medicine are discussed. The advantages and virtues of a more powerful common European organisation of Psychosomatic Medicine and Psychiatric Consultation-Liaison are compared to continuing our work within the present Psychosomatic/Psychiatric and Behavioural fields. Conclusion Psychosomatic and Behavioural Medicine have reached a strong position in Europe. There are studies in which the medical speciality is on equal terms with psychosomatic medicine representatives. There is a continuous need for scientific conferences, for teaching, and for better practice with patients. This could be coordinated by a network. Much energy and time is lost in isolated societies and countries. We want to focus our resources in scientific projects within the boundaries of a scientific network with the primary aim of developing psychosomatic scientific exchange.
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Singh I, Fernando P, Griffin J, Edwards C, Williamson K, Chance P. Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport). Clin Interv Aging 2016; 12:29-36. [PMID: 28053514 PMCID: PMC5192058 DOI: 10.2147/cia.s104278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Hospitals are currently admitting an increasing number of older people, and more than one-third could have an underlying mental health problem. The existing Older Adult Mental Health (OAMH) liaison service was increasingly unable to meet the escalating needs of older and frail patients. Therefore, the service was modernized and enhanced on an “invest-to-save” principle to provide a prompt holistic assessment for older adults with mental health problems. The objective of this study was a service evaluation to appraise clinical outcome, minimize the length of stay, and measure the predictors of adverse outcomes to streamline this enhanced service. Materials and methods Patient demographics, social care needs, comorbidity burden (Charlson comorbidity index, CCI), and functional status (Barthel index, BI) were recorded from November 2014 to February 2015. Frailty status (frailty index, FI) was measured by an index (Rockwood index) of accumulated deficits. The outcomes were compared with the previous OAMH liaison service data over the same period a year earlier. Results The new Rapid Assessment Interface and Discharge service assessed 339 patients compared to 179 by the previous liaison team over the 4-month period. Mean age was 82.18±8.04 years, with 60% women; preadmission BI was 14.96±4.35, and admission BI was 11.38±5.73 (P<0.001, paired t-test); mean CCI was 1.66±1.53, and mean FI was 0.34±0.99, and 80% were on polypharmacy. The direct discharges from front door were increased by 7%. The mean hospital stay reduced from 35 to 20 days in acute site and from 108 to 47 days in long-stay wards. The cost benefits were based on the mean reduction in hospital stay (41.8 days) and admission reduction (2.2 days), leading to a total annualized bed savings of 44 days. FI was the most highly significant factor between patient groups with a good and poor outcome (P=0.00003, independent groups t-test, t=−4.38, df 98). Conclusion Prompt mental health assessments for acutely unwell frail older people are not only cost effective but also improve clinical outcomes.
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Affiliation(s)
- Inderpal Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
| | - Priya Fernando
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
| | - Jane Griffin
- Royal Gwent Hospital, Aneurin Bevan University Board
| | - Chris Edwards
- Royal Gwent Hospital, Aneurin Bevan University Board
| | - Kathryn Williamson
- Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales, UK
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Chen KY, Evans R, Larkins S. Why are hospital doctors not referring to Consultation-Liaison Psychiatry? - a systemic review. BMC Psychiatry 2016; 16:390. [PMID: 27829386 PMCID: PMC5103418 DOI: 10.1186/s12888-016-1100-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Consultation-Liaison Psychiatry (CLP) is a subspecialty of psychiatry that provides care to inpatients under non-psychiatric care. Despite evidence of benefits of CLP for inpatients with psychiatric comorbidities, referral rates from hospital doctors remain low. This review aims to understand barriers to CLP inpatient referral as described in the literature. METHODS We searched on Medline, PsychINFO, CINAHL and SCOPUS, using MESH and the following keywords: 1) Consultation-Liaison Psychiatry, Consultation Liaison Psychiatry, Consultation Psychiatry, Liaison Psychiatry, Hospital Psychiatry, Psychosomatic Medicine, the 2) Referral, Consultation, Consultancy and 3) Inpatient, Hospitalized patient, Hospitalized patient. We considered papers published between 1 Jan 1965 and 30 Sep 2015 and all articles written in English that contribute to understanding of barriers to CLP referral were included. RESULTS Thirty-five eligible articles were found and they were grouped thematically into three categories: (1) Systemic factors; (2) Referrer factors; (3) Patient factors. Systemic factors that improves referrals include a dedicated CLP service, active CLP consultant and collaborative screening of patients. Referrer factors that increases referrals include doctors of internal medicine specialty and comfortable with CLP. Patients more likely to be referred tend to be young, has psychiatric history, live in an urban setting or has functional psychosis. CONCLUSION This is the first systematic review that examines factors that influence CLP inpatient referrals. Although there is research in this area, it is of limited quality. Education could be provided to hospital doctors to better recognise mental illness. Collaborative screening of vulnerable groups could prevent inpatients from missing out on psychiatric care. CLP clinicians should use the knowledge gained in this review to provide quality engagement with referrers.
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Affiliation(s)
- Kai Yang Chen
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811, Australia. .,Townsville Hospital and Health Service, 100 Angus Smith Drive, Townsville, QLD 4814, Australia.
| | - Rebecca Evans
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
| | - Sarah Larkins
- James Cook University, 1 James Cook Drive, Townsville, QLD 4811 Australia
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Laderman M, Mate KS. Behavioral Health Integration in Acute Medical Settings: An Opportunity to Improve Outcomes and Reduce Costs. Jt Comm J Qual Patient Saf 2016; 42:331-6. [DOI: 10.1016/s1553-7250(16)42046-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Mukaetova-Ladinska EB. Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People's Care. Geriatrics (Basel) 2016; 1:E7. [PMID: 31022802 PMCID: PMC6371160 DOI: 10.3390/geriatrics1010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/16/2016] [Accepted: 02/26/2016] [Indexed: 11/16/2022] Open
Abstract
A large number of people admitted to medical wards have co-morbid mental health problems, and these predominantly include depression, dementia and delirium. An additional one third of medically ill patients remain in hospitals with undetected and, therefore, undiagnosed mental health problems. The comorbidity of mental and physical illnesses leads to poor health outcomes, prolonged inpatient stays and use of inpatient resources, involvement of various affiliated health services, introduction of medications and discharge to long-term facilities, including residential and nursing 24-h care, increased both readmission rates and mortality. The establishment of Liaison psychiatry services to meet the needs for people with mental health problems admitted to medical wards is a priority for many acute health Trusts. This has an economical background in terms of cost-savings, especially in relation to the older adults, with decreasing readmission rates and quicker hospital discharges. In the current review, we address the latest policies regarding Liaison psychiatry services; especially those for older people with dementia and delirium, and discuss their future shaping.
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Anderson C, Tauch D, Quante A. Diagnosis and Treatment Procedures for Patients With Anxiety Disorders by the Psychiatric Consultation Liaison Service in a General Hospital in Germany: A Retrospective Analysis. Prim Care Companion CNS Disord 2016; 17:15m01805. [PMID: 26835174 DOI: 10.4088/pcc.15m01805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/11/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To investigate the population of patients with anxiety disorders in a general hospital in Germany who required treatment by a consultation psychiatrist. METHOD A retrospective investigation of psychiatric consultations concerning 119 patients with anxiety disorders (DSM-IV criteria) from January 1, 2011, to December 31, 2012, was conducted in a general hospital of the Charité Berlin, Berlin, Germany. The frequency of different anxiety disorders, the distribution of anxiety disorders among the departments of the general hospital, and the recommended treatment procedure were investigated. RESULTS The largest group of patients with anxiety symptoms presented panic attacks. Many of these patients sought treatment in the emergency department of the hospital primarily due to their anxiety symptoms. Within the group of somatically ill patients, panic attacks were prominent, especially in patients with cardiac or respiratory diseases. Treatment procedures comprised pharmacologic and psychotherapeutic interventions. Benzodiazepines and psychoeducation were common acute treatments; antidepressants, pregabalin, and psychotherapy were recommended for long-term treatment. CONCLUSIONS Many patients who primarily suffer from symptoms of anxiety seek treatment in a general hospital, especially in the emergency department. It is therefore very important for the individual patient as well as the health care system that the correct treatment is initiated. The consultation-liaison psychiatric service within a general hospital is important to ensure the best possible diagnostic procedures as well as treatment for patients with anxiety disorders.
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Affiliation(s)
- Christina Anderson
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Deborah Tauch
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany
| | - Arnim Quante
- Department of Psychiatry and Psychotherapy, Charité-Campus Benjamin Franklin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Friedrich von Bodelschwingh Hospital, Berlin, Germany
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