1
|
Barra BJ, Barahona M, Varela LF, Calvo P, Bastidas A, Carreño J, Pintor L. A Cross-Sectional, Retrospective, and Comparative Study between Delirium and Non-Delirium Psychiatric Disorders in a Psychogeriatric Inpatient Population Referred to Consultation-Liaison Psychiatry Unit. Medicina (B Aires) 2023; 59:medicina59040693. [PMID: 37109651 PMCID: PMC10141533 DOI: 10.3390/medicina59040693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background and objectives: Delirium is the most prevalent psychiatric disorder in inpatient older people. Its presence is associated with higher rates of institutionalization, functional disability and mortality. This study aims to evaluate delirium in a hospitalized psychogeriatric population, focusing on which factors predict the appearance of delirium, the impact it generates and the diagnostic concordance between non-psychiatric physicians and psychiatrists. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to general hospital and referred from different services to the consultation-liaison psychiatry (CLP) unit. Logistic regression was performed using delirium as the dependent variable. To estimate the concordance of the diagnoses, the Kappa coefficient was used. To assess the impact of delirium, an ordinal regression, Wilcoxon median test and Fisher’s test were performed. Results: Delirium is associated with a higher number of visits, OR 3.04 (95% CI 2.38–3.88), longer length of stay and mortality, OR 2.07 (95% CI, 1.05 to 4.10). The model to predict delirium shows that being >75 years old has an OR of 2.1 (95% CI, 1.59–2.79), physical disability has an OR of 1.66 (95% CI, 1.25–2.20), history of delirium has an OR of 10.56 (95% CI, 5.26–21.18) and no use of benzodiazepines has an OR of 4.24 (95% CI, 2.92–6.14). The concordance between the referring physician’s psychiatric diagnosis and the psychiatrist CLP unit showed a kappa of 0.30. When analysing depression and delirium, the concordance showed Kappa = 0.46. Conclusions: Delirium is a highly prevalent psychiatric disorder, but it is still underdiagnosed, with low diagnostic concordance between non-psychiatric doctors and psychiatrists from CLP units. There are multiple risk factors associated with the appearance of delirium, which must be managed to reduce its appearance.
Collapse
Affiliation(s)
- Bernardo J. Barra
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
- Mental Health Service, Clínica Universidad de los Andes, Santiago 7591047, Chile
- Department of Psychiatry, Medicine School, Universidad Andrés Bello (UNAB), Santiago 8370146, Chile;
- Correspondence: ; Tel.: +56-9-9139-9020
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Luis F. Varela
- Department of Psychiatry, Medicine School, Universidad Andrés Bello (UNAB), Santiago 8370146, Chile;
| | - Pilar Calvo
- Medicine School, University of Chile, Santiago 8330015, Chile
| | - Anna Bastidas
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
| | - Jorge Carreño
- Department of Psychiatry, Medicine School, Universidad de Santiago de Chile, Santiago 8380456, Chile
- Department of Psychiatry, Medicine School, Universidad Mayor, Santiago 8330015, Chile
| | - Luis Pintor
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
| |
Collapse
|
2
|
Xue Z, Yanwen L, Wenwen Z, Mei L, Huihui J, Hongbin L, Ying W, Ning L, Le H, Xueyang H, Yitong H, Mingxiao M. A framework for the implementation of consultation-liaison psychiatry from the characteristics of psychosomatic consultations at a general hospital in china. Int J Psychiatry Med 2023:912174231161912. [PMID: 36883233 DOI: 10.1177/00912174231161912] [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] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To understand the current situation and characteristics of consultation-liaison psychiatry (CLP) service in general hospital, to compare the results of the literature on CLP published in other hospitals in China and abroad, and to find deficiencies for the current differences. METHODS The medical records of all inpatients who had liaison consultations in the first year of the establishment of Xi'an International Medical Center Hospital, China, were collected. Statistical analysis was performed on the general demographic data, department origin, number of consultations, the reason for consultation, diagnosis of consultation, and follow-up of patients. RESULTS A total of 630 patients were enrolled in the past 1 year, of which, 45.23% were males and 54.8% were females. 89.2% of non-psychiatric departments applied for psychosomatic consultation. The percentage of middle-aged and elderly patients was 75.6%, including 61.6% of patients aged 45-74 years. The internal medicine department had the highest number of consultations (48.2%), including respiratory medicine (12.1%), neurology (12.1%), gastroenterology (12.1%), and cardiology (12.1%). For surgical patients, orthopedic patients (rehabilitation, 6.5%) comprised the majority of consults. The main reasons for requesting psychosomatic consultations included depressive symptoms (139 cases, 22.8%), anxiety symptoms (137 cases, 22.5%), sleep problems (111 cases, 18.2%), as well as hallucinations and delusions or behavioral disorders (68 cases, 11.2%), accounting for a total of 74.59% (455/630). CONCLUSION A significant gap exists between the level of CLP services in China and developed regions in Europe and the United States, mainly due to low consultation rates and referrals and imperfect CLP service.
Collapse
Affiliation(s)
- Zou Xue
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Liu Yanwen
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China.,Xi'an Physical Education University, Xi'an, China
| | - Zhang Wenwen
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Li Mei
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Jing Huihui
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Lu Hongbin
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Wang Ying
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Liu Ning
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Han Le
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Han Xueyang
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Hou Yitong
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China.,Xi'an Physical Education University, Xi'an, China
| | - Ma Mingxiao
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China.,Xi'an Physical Education University, Xi'an, China
| |
Collapse
|
3
|
Zapata C, Garces JJ, Duica K, Restrepo C, Ocampo MV, Velásquez-Tirado JD, Ricardo C, Trzepacz PT, Franco JG. Variables associated with concordance or discordance for delirium diagnosis between referring and consulting physicians at a Tertiary Hospital in Colombia: Prospective observational study. Medicine (Baltimore) 2022; 101:e32096. [PMID: 36626485 PMCID: PMC9750523 DOI: 10.1097/md.0000000000032096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Delirium is an acute state of impaired consciousness and a medical urgency. Its broad range of alterations in mental status make diagnosis challenging. Awareness and accurate provisional diagnosis by nonpsychiatric clinicians are important for prompt management. Because delirium symptoms overlap and mimic other neuropsychiatric conditions, a referral to a consultant psychiatrist is often needed. The aim of this study was to determine the discriminating variables that are associated with concordance or discordance for a DSM-5 delirium diagnosis made by the consultation/liaison (C/L) psychiatrist as compared to the referral diagnosis/reasons given by the referring physicians for inpatients from a Tertiary Hospital in a Latin-American country. Prospective study of a cohort of 399 consecutive patients admitted to any ward of a university hospital in Medellin-Colombia and referred by a specialist physician to the C/L Psychiatry service. Analyses for diagnostic concordance used a nested sample of 140 cases diagnosed with delirium by the psychiatrist. Two multivariate logistic models were run, for delirium diagnosis concordance and discordance between the referring physician and C/L psychiatrist. The referral diagnosis was concordant with that of Psychiatry in 90/140 patients in 64.3%, with 35.7% discordance. Increasing age (OR = 1.024) and internal medicine ward (OR = 3.0) were significantly related (Wald statistic P < .05) to concordance in the multivariate analysis whose model accuracy was 68.6%. Trauma/orthopedics ward (OR = 5.7) and SARS-CoV-2 infection (OR = 3.8) were important contributors to the model fit though not significant. Accuracy of the discordance model was 70.7%, where central nervous system (CNS) disorder (OR = 6.1) and referrals from ICU (OR = 4.9), surgery (OR = 4.6), neurology/neurosurgery (OR = 5.1) and another consultant (OR = 4.7) were significantly related (Wald statistic P < .05), while metabolic/endocrine disorder (OR = 2.7) was important for model fit, but not significant. Concordance for delirium diagnosis was higher from services where education, guidelines and working relationships with C/L Psychiatry could have contributed beneficially whereas, surprisingly, CNS disorders and neurology/neurosurgery services had higher discordance, as well as the ICU. Routine use of brief sensitive delirium assessment tools such as the DDT-Pro could enhance provisional delirium diagnosis.
Collapse
Affiliation(s)
- Carolina Zapata
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan J. Garces
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Kelly Duica
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Cristóbal Restrepo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María V. Ocampo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan D. Velásquez-Tirado
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Carmenza Ricardo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Paula T. Trzepacz
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - José G. Franco
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- * Correspondence: José G. Franco, Facultad de Medicina de la Universidad Pontificia Bolivariana (Campus Robledo), Medellín 050036, Colombia (e-mail: )
| |
Collapse
|
4
|
Resources for Patient Mental Health and Well-being after Orthopaedic Trauma. J Orthop Trauma 2022; 36:S10-S15. [PMID: 36121325 DOI: 10.1097/bot.0000000000002445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 02/02/2023]
Abstract
Orthopaedic trauma is an unanticipated life-altering experience for patients. Additionally, the prevalence of psychiatric disorders has been found to be higher in patients with trauma than in the general adult population. Symptoms of depression, anxiety, or posttraumatic stress disorder have been reported in up to 56% of patients throughout their postoperative course. Furthermore, symptoms of any one of these illnesses have been consistently associated with worse patient outcomes after treatment of traumatic orthopaedic injuries. This includes increased levels of pain and disability, postoperative complications, and, in some cases, higher rates of hospital readmission. For most patients with trauma, focus is placed on physical therapy and rehabilitation in the acute postoperative setting to help patients regain function and strength; however, more recent studies have demonstrated equal importance of the social and psychological factors involved with trauma and their impact on outcomes. Therefore, it is essential for orthopaedic surgeons and other members of the care team to be adept in the screening and treatment of psychiatric disorders. For patients struggling with these conditions, several treatment resources exist, which can be used both during their admission and after discharge. Thus, earlier recognition and intervention with appropriate treatment and referrals should be emphasized to improve outcomes. This review discusses the social and psychological impacts of orthopaedic trauma on patients' mental health and well-being and outlines numerous resources available to patients as they recover from their injuries.
Collapse
|
5
|
Kim H, Khanna R, Olver J, Norman TR. Diagnostic agreement and concordance between consultation-liaison psychiatry and non-psychiatric (medical and surgical) doctors: changes within junior doctor's terms. Australas Psychiatry 2022; 30:60-63. [PMID: 35086341 DOI: 10.1177/10398562211037338] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether diagnostic agreement and concordance between non-psychiatric (medical and surgical) doctors and consultation-liaison psychiatry changes within junior doctors' terms. METHOD This was a retrospective cohort analysis of referrals from medical and surgical units to a consultation-liaison psychiatry service. Diagnostic agreement was calculated across all diagnoses and expressed as a percentage. Diagnostic concordance (expressed using Cohen's Kappa) was calculated for the two most common diagnoses of depression and delirium. Diagnostic agreement and concordance in the first two weeks (Timepoint A) were compared to those in the last two weeks (Timepoint B) of junior doctors' terms. RESULTS Around half the referrals (Timepoint A = 48.1%, Timepoint B = 54.0%) were excluded as no diagnosis was listed.Diagnostic agreement over all diagnoses was 31.7% (Timepoint A) and 29.9% (Timepoint B) and was not statistically different. Diagnostic concordance for depression increased from fair to moderate but was not statistically significant. Diagnostic concordance for delirium was substantial for both timepoints and were not statistically different. CONCLUSIONS No statistically significant change in diagnostic accuracy over a junior doctors' term was found in this study.
Collapse
Affiliation(s)
- Hannah Kim
- Consultant Psychiatrist, Peninsula Health, Frankston, VIC, Australia
| | - Rahul Khanna
- Consultant Psychiatrist, Austin Health, Heidelberg, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - James Olver
- Consultant Psychiatrist, Austin Health, Heidelberg VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Trevor R Norman
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
6
|
Sharma AK, Elbuluk AM, Gkiatas I, Kim JM, Sculco PK, Vigdorchik JM. Mental Health in Patients Undergoing Orthopaedic Surgery: Diagnosis, Management, and Outcomes. JBJS Rev 2021; 9:01874474-202107000-00013. [PMID: 34297704 DOI: 10.2106/jbjs.rvw.20.00169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Mental health and psychosocial factors play a critical role in clinical outcomes in orthopaedic surgery. » The biopsychosocial model of disease defines health as a product of physiology, psychology, and social factors and, traditionally, has not been as emphasized in the care of musculoskeletal disease. » Improvement in postoperative outcomes and patient satisfaction is incumbent upon the screening, recognition, assessment, and possible referral of patients with high-risk psychosocial factors both before and after the surgical procedure.
Collapse
Affiliation(s)
- Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ameer M Elbuluk
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Julia M Kim
- Clinical Psychology, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Huang MC, Lin YS, Liu HC, Yang TW, Chiu CC. Challenge of caring for patients with severe mental illness during the COVID-19 epidemic in Taiwan. Asian J Psychiatr 2021; 55:102488. [PMID: 33271480 PMCID: PMC7678457 DOI: 10.1016/j.ajp.2020.102488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ming-Chyi Huang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Song-De Road, Taipei, 110, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Yi-Shen Lin
- Department of Nephrology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tong-De Road, Taipei, 115, Taiwan
| | - Hsing-Cheng Liu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Song-De Road, Taipei, 110, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Tien-Wei Yang
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Song-De Road, Taipei, 110, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan
| | - Chih-Chiang Chiu
- Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309, Song-De Road, Taipei, 110, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, 110, Taiwan.
| |
Collapse
|
9
|
AlSalem M, AlHarbi MA, Badeghiesh A, Tourian L. Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians: A retrospective chart review. Medicine (Baltimore) 2020; 99:e23708. [PMID: 33371117 PMCID: PMC7748330 DOI: 10.1097/md.0000000000023708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC).We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate.Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team.Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians' knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions.
Collapse
Affiliation(s)
- Moayyad AlSalem
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | | | | | | |
Collapse
|
10
|
Gabet M, Grenier G, Cao Z, Fleury MJ. Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study. BMC Health Serv Res 2020; 20:854. [PMID: 32917199 PMCID: PMC7488576 DOI: 10.1186/s12913-020-05708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. Method Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. Results Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. Conclusions Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.
Collapse
Affiliation(s)
- Morgane Gabet
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada.,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada. .,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
| |
Collapse
|
11
|
Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
| |
Collapse
|
12
|
Hercus C, Hudaib AR. Delirium misdiagnosis risk in psychiatry: a machine learning-logistic regression predictive algorithm. BMC Health Serv Res 2020; 20:151. [PMID: 32106845 PMCID: PMC7045404 DOI: 10.1186/s12913-020-5005-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Delirium is a frequent diagnosis made by Consultation-Liaison Psychiatry (CLP). Numerous studies have demonstrated misdiagnosis prior to referral to CLP. Few studies have considered the factors underlying misdiagnosis using multivariate approaches. OBJECTIVES To determine the number of cases referred to CLP, which are misdiagnosed at time of referral, to build an accurate predictive classifier algorithm, using input variables related to delirium misdiagnosis. METHOD A retrospective observational study was conducted at Alfred Hospital in Melbourne, collecting data from a record of all patients seen by CLP for a period of 5 months. Data was collected pertaining to putative factors underlying misdiagnosis. A Machine Learning-Logistic Regression classifier model was built, to classify cases of accurate delirium diagnosis vs. misdiagnosis. RESULTS Thirty five of 74 new cases referred were misdiagnosed. The proposed predictive algorithm achieved a mean Receiver Operating Characteristic (ROC) Area under the curve (AUC) of 79%, an average 72% classification accuracy, 77% sensitivity and 67% specificity. CONCLUSIONS Delirium is commonly misdiagnosed in hospital settings. Our findings support the potential application of Machine Leaning-logistic predictive classifier in health care settings.
Collapse
|
13
|
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.
Collapse
|
14
|
Fleury MJ, Grenier G, Farand L. Satisfaction with Emergency Departments and Other Mental Health Services among Patients with Mental Disorders. ACTA ACUST UNITED AC 2019; 14:43-54. [PMID: 31017865 PMCID: PMC7008685 DOI: 10.12927/hcpol.2019.25793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background Few studies have investigated satisfaction with emergency departments (EDs) among patients with mental health (MH) issues. This study evaluated the use of and satisfaction with EDs and other MH services among 328 patients with MH disorders, as well as specific characteristics of patient satisfaction and dissatisfaction. Methods A mixed-methods study was conducted in four EDs located in different administrative healthcare regions of Quebec (Canada). Results Patients were highly satisfied with staff attitudes in EDs and other MH services (i.e., hospital in-patient services, outpatient services, community organizations). Major sources of dissatisfaction were the information received in EDs concerning community services and the physical environment or climate in EDs and other MH services. Conclusion Dissatisfaction with services may be reduced by extending hours of operation in MH services; promoting collaboration between psychiatrists, family physicians and other primary care providers; further integrating EDs with other healthcare services; and improving the characteristically austere and restrictive atmosphere in EDs.
Collapse
Affiliation(s)
- Marie-Josée Fleury
- Professor, Department of Psychiatry, McGill UniversityResearcher, Douglas Mental Health University Institute Research CentreMontreal, QC
| | - Guy Grenier
- Research AssociateDouglas Mental Health University Institute Research CentreMontreal, QC
| | - Lambert Farand
- Associate ProfessorDepartment of Health Administration, Policy and EvaluationSchool of Public Health, University of MontrealMontreal, QC
| |
Collapse
|
15
|
Brinkers M, Pfau G, Schneemilch C. [Aspects of liaison psychiatry care of patients in a university pain clinic]. Schmerz 2019; 32:115-120. [PMID: 29352375 DOI: 10.1007/s00482-018-0267-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Owing to a rise of psychosomatic comorbidities, the treatment of psychological disorders, which may negatively impact prognosis and therapy, is increasingly becoming a focus of attention for pain outpatient clinics. AIM This study investigates and discusses the advantages of liaison psychiatric care in a university pain clinic. METHODS In this retrospective study, we investigated all patients who presented to an anaesthesiologically led pain clinic between January and June 2014. The psychiatric history was taken by the liaison psychiatrist of the pain clinic. RESULTS In the period investigated, 485 patients were treated as outpatients. A psychiatric diagnosis was present 351 patients (72.4%). The distribution of the diagnoses was comparable with that of a consultation service. Adaptation and affective disorders dominated. The patients were preferentially treated with new generation antidepressants. CONCLUSION The constant presence of a liaison psychiatrist allows for timely, specialised care of pain patients in terms of a multimodal therapeutic approach.
Collapse
Affiliation(s)
- M Brinkers
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - G Pfau
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - C Schneemilch
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland
| |
Collapse
|
16
|
Hoyer C, Schmidt HL, Kranaster L, Alonso A. Impact of psychiatric comorbidity on the severity, short-term functional outcome, and psychiatric complications after acute stroke. Neuropsychiatr Dis Treat 2019; 15:1823-1831. [PMID: 31308675 PMCID: PMC6614829 DOI: 10.2147/ndt.s206771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND PURPOSE The comorbidity of psychiatric disorders and cerebrovascular disease appears to be complex with underlying bidirectional influences. Hitherto, research has focused mainly on the evaluation of stroke risk in particular psychiatric disorders; only a few studies have assessed their role in the acute natural history of stroke. The aim of this study was to provide a perspective on psychiatric premorbidity and its impact on stroke severity, psychiatric complications during the initial treatment phase, and the short-term functional outcome of stroke. PATIENTS AND METHODS We retrospectively studied the impact of a predocumented psychiatric diagnosis (PDPD) on stroke severity, short-term functional outcome, and psychiatric complications in a sample of 798 patients consecutively admitted for acute ischemic or hemorrhagic stroke by performing a chart review. Group comparisons (PDPD vs non-PDPD) with adjustment for covariates were carried out either using multivariate analysis of variance or logistic regression analysis. RESULTS More severe strokes (ie, mean National Institute of Health Stroke Scale score on admission 10.1±7.9 vs 7.5±7.4; F(10,796)=18.5, p<0.0001) and higher prevalence of poor outcome (73.7 vs 54.9%; OR: 2.6, standard error: 0.5, z=4.82, p<0.0001) was found in patients with a documented psychiatric diagnosis at the time of stroke, as well as a higher rate of psychiatric complications during the initial treatment phase (46.7 vs 28.9%; OR: -0.78, z=4.59, p<0.0001). CONCLUSION Our data have clinical implications in that they call for identification of psychiatric premorbidity or comorbidity through careful history-taking and particularly close monitoring for psychiatric complications with respect to their potentially negative impact on outcome after stroke.
Collapse
Affiliation(s)
- Carolin Hoyer
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hanna Luise Schmidt
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Angelika Alonso
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
17
|
Baten V, Busch H, Busche C, Schmid B, Heupel‐Reuter M, Perlov E, Brich J, Klöppel S. Validation of the Brief Confusion Assessment Method for Screening Delirium in Elderly Medical Patients in a German Emergency Department. Acad Emerg Med 2018; 25:1251-1262. [PMID: 29738102 DOI: 10.1111/acem.13449] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/17/2018] [Accepted: 04/26/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. METHODS We implemented the bCAM into practice in a German interdisciplinary high-volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. RESULTS Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrolled. The bCAM showed 93.8% specificity (95% confidence interval [CI] = 90.0%-96.5%) and 65.2% sensitivity (95% CI = 49.8%-78.7%). Positive and negative likelihood ratios were 10.5 and 0.37, respectively, while the odds ratio was 28.4. Delirium was missed in 10 of 16 cases, since the bCAM did not indicate altered levels of consciousness and disorganized thinking. The level of agreement with the criterion standard increased for patients with low cognitive performance. CONCLUSION This was the first study evaluating the bCAM for a German ED and when performed by EPs during routine work. The bCAM showed good specificity, but only moderate sensitivity. Nevertheless, application of the bCAM most likely improves the delirium detection rate in German EDs. However, it should only be applied by trained physicians to maximize diagnostic accuracy and hence improve the bCAM's sensitivity. Future studies should refine the bCAM.
Collapse
Affiliation(s)
- Verena Baten
- Department of Neurology and Neuroscience Medical Center University of Freiburg FreiburgGermany
- Department of Emergency Medicine University Hospital of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Hans‐Jörg Busch
- Department of Emergency Medicine University Hospital of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Caroline Busche
- Department of Emergency Medicine University Hospital of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Bonaventura Schmid
- Department of Emergency Medicine University Hospital of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | - Miriam Heupel‐Reuter
- Center of Geriatrics and Gerontology Freiburg Medical Center University of Freiburg Freiburg Germany
| | - Evgeniy Perlov
- Department of Psychiatry and Psychotherapy Faculty of Medicine University of Freiburg FreiburgGermany
- Clinic for Psychiatry Luzern St. UrbanSwitzerland
| | - Jochen Brich
- Department of Neurology and Neuroscience Medical Center University of Freiburg FreiburgGermany
| | - Stefan Klöppel
- Department of Psychiatry and Psychotherapy Faculty of Medicine University of Freiburg FreiburgGermany
- Center for Geriatric Medicine and Gerontology Faculty of Medicine University of Freiburg FreiburgGermany
- University Hospital of Old Age Psychiatry and Psychotherapy University of Bern Bern Switzerland
| |
Collapse
|
18
|
Pezzia C, Pugh JA, Lanham HJ, Leykum LK. Psychiatric consultation requests by inpatient medical teams: an observational study. BMC Health Serv Res 2018; 18:336. [PMID: 29739414 PMCID: PMC5941586 DOI: 10.1186/s12913-018-3171-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background We describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams’ subsequent consultation practices. Methods We observed morning rounds for nine inpatient medical teams for approximately month-long periods, for a total of 1941 observations. We compared discussions of patients admitted for behavioral health related medical conditions between those who did and did not receive a psychiatric consultation, developing categories to describe factors influencing consultation or other management. Results Out of 536 patients, 40 (7.5%) received a psychiatry consult. Evaluation of a known concern (i.e., substance use, affective disorder, or suicidal ideation) was the most common reason for referral (41.7%). Requests for medication review were second (30.6%). Thirty patients with concomitant behavioral and medical health issues did not receive a psychiatry consult. Cirrhosis with active substance use was the most common medical diagnosis (15), followed by alcohol withdrawal (9). Conclusions Four primary themes emerged from our data: positive identification of behavioral health issues by physicians, medication management as a primary reason for referral, patient preference in physician decision-making, and poor management of substance abuse. Our results identify two potential areas where skills-building for inpatient physicians could have a positive impact: management of medication and of substance abuse management.
Collapse
Affiliation(s)
- Carla Pezzia
- Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA. .,Department of Human Sciences in the Contemporary World, University of Dallas, 1845 East Northgate Drive, Irving, TX, 75062, USA.
| | - Jacqueline A Pugh
- Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA
| | - Holly J Lanham
- Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA.,McCombs School of Business, University of Texas At Austin, 2110 Speedway, Austin, TX, 78705, USA
| | - Luci K Leykum
- Department of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,South Texas Veterans Health Care System, 7400 Merton Minter, San Antonio, TX, 78229, USA
| |
Collapse
|
19
|
Which orthopaedic trauma patients need psychiatry consultation? A single institution pilot survey study. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Wilkins KM, Blazek MC, Brooks WB, Lehmann SW, Popeo D, Wagenaar D. Six Things All Medical Students Need to Know About Geriatric Psychiatry (and How To Teach Them). ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:693-700. [PMID: 28255854 DOI: 10.1007/s40596-017-0691-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/15/2017] [Indexed: 06/06/2023]
Affiliation(s)
| | - Mary C Blazek
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | | | - Susan W Lehmann
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dennis Popeo
- New York University School of Medicine, New York, NY, USA
| | - Deborah Wagenaar
- Michigan State University Colleges of Human and Osteopathic Medicine, East Lansing, MI, USA
| |
Collapse
|
21
|
Otani VHO, Otani TZDS, Freirias A, Calfat ELDB, Aoki PS, Cordeiro Q, Kanaan RAA, Cross S, Liersch-Sumskis S, Uchida RR. Misidentification of mental health symptoms in presence of organic diseases and delirium during psychiatric liaison consulting. Int J Psychiatry Clin Pract 2017; 21:215-220. [PMID: 28326870 DOI: 10.1080/13651501.2017.1301483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation. METHODS Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks. RESULTS A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 - 95% CI 2.01, 4.5) and delirium (OR 3.92 - 2.4, 6.39). CONCLUSIONS Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.
Collapse
Affiliation(s)
| | | | - Andrea Freirias
- a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil
| | | | | | - Quirino Cordeiro
- a Department of Mental Health , Santa Casa Medical School , São Paulo , Brazil
| | - Richard A A Kanaan
- b Chair of Psychiatry, Austin Health , University of Melbourne , Melbourne , Australia
| | - Sean Cross
- c Maudsley Simulation, South London & Maudsley Foundation NHS Trust , Lambeth Hospital , London , UK
| | - Susan Liersch-Sumskis
- d School of Nursing, Faculty of Science, Medicine and Health University of Wollongong , Wollongong , Australia
| | | |
Collapse
|
22
|
Grover S, Sahoo S, Aggarwal S, Dhiman S, Chakrabarti S, Avasthi A. Reasons for referral and diagnostic concordance between physicians/surgeons and the consultation-liaison psychiatry team: An exploratory study from a tertiary care hospital in India. Indian J Psychiatry 2017; 59:170-175. [PMID: 28827863 PMCID: PMC5547857 DOI: 10.4103/psychiatry.indianjpsychiatry_305_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Very few studies have evaluated the reasons for referral to consultation-liaison (CL) psychiatry teams. AIM This study aimed to evaluate the psychiatric morbidity pattern, reasons for referral and diagnostic concordance between physicians/surgeons and the CL psychiatry team. MATERIALS AND METHODS Two hundred and nineteen psychiatric referrals made to the CL psychiatry team were assessed for reason for referral and diagnostic concordance in terms of reason of referral and psychiatric diagnosis made by the CL psychiatry team. RESULTS In 57% of cases, a specific psychiatric diagnosis was mentioned by the physician/surgeon. The most common specific psychiatric diagnoses considered by the physician/surgeon included depression, substance abuse, and delirium. Most common psychiatric diagnosis made by the CL psychiatric services was delirium followed by depressive disorders. Diagnostic concordance between physician/surgeon and psychiatrist was low (κ < 0.3) for depressive disorders and delirium and better for the diagnosis of substance dependence (κ = 0.678) and suicidality (κ = 0.655). CONCLUSIONS The present study suggests that delirium is the most common diagnosis in referrals made to CL psychiatry team, and there is poor concordance between the psychiatric diagnosis considered by the physician/surgeon and the psychiatrist for delirium and depression; however, the concordance rates for substance dependence and suicidal behavior are acceptable.
Collapse
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnajeet Sahoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivali Aggarwal
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shallu Dhiman
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
23
|
Lamont S, Stewart C, Chiarella M. Documentation of Capacity Assessment and Subsequent Consent in Patients Identified With Delirium. JOURNAL OF BIOETHICAL INQUIRY 2016; 13:547-555. [PMID: 27468831 DOI: 10.1007/s11673-016-9741-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Delirium is highly prevalent in the general hospital patient population, characterized by acute onset, fluctuating levels of consciousness, and global impairment of cognitive functioning. Mental capacity, its assessment and subsequent consent are therefore prominent within this cohort, yet under-explored. AIM This study of patients with delirium sought to determine the processes by which consent to medical treatment was attempted, how capacity was assessed, and any subsequent actions thereafter. METHOD A retrospective documentation review of patients identified as having a delirium for the twelve months February 2013 to January 2014 was undertaken. Inclusion and exclusion criteria were used; demographic and descriptive data collected. A total of n=1153 patients were identified with n=310 meeting inclusion criteria. RESULT A random sample of one hundred patients were subsequently reviewed. One third of patients (n=33) had documentation relating to consent, while four patients had documentation relating to capacity. Median delirium duration was three days, with treatment refusal occurring in twenty-two patients and "duty of care" being used as an apparent beneficent related treatment framework in twelve patients. CONCLUSIONS While impaired decision-making was indicated, the review was unable to indicate what patient characteristics flag the need for capacity assessment. Documentation relating to consent processes (whether patient or substitute) appeared deficient for this cohort.
Collapse
Affiliation(s)
- Scott Lamont
- Prince of Wales Hospital, Level 1 East Wing, Edmund Blackett Building, Sydney, NSW, 2031, Australia.
| | - Cameron Stewart
- Sydney Law School, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Mary Chiarella
- Sydney Nursing School, The University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Canuto A, Gkinis G, DiGiorgio S, Arpone F, Herrmann FR, Weber K. Agreement between physicians and liaison psychiatrists on depression in old age patients of a general hospital: influence of symptom severity, age and personality. Aging Ment Health 2016; 20:1092-8. [PMID: 26155954 DOI: 10.1080/13607863.2015.1063103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Comorbid depressive episodes are common among general hospital inpatients. However, existing evidence shows that depression is often poorly recognized in patients aged over 60 years. The aim of the study was first to determine the degree of agreement between primary care physicians' and liaison psychiatrists' evaluation of depression, and second, to analyze how patients' clinical presentation and personality traits influence this degree of agreement. METHODS Agreement was defined as the matching of the physicians' initial referral for depressive mood and the actual diagnosis of a major depressive disorder evaluated by the consultation-liaison service in 148 inpatients aged 60+ years. Nature and severity of psychiatric symptoms were rated on the HoNOS65+ scale and patients' personality traits were assessed with the Big Five Inventory. RESULTS Forty percent of the patients referred for depressive mood were indeed diagnosed with major depression. Agreement between physicians and psychiatrists was most likely in patients with more severe depressive symptoms and younger age. In contrast, risk for non-agreement was increased for patients with more open personalities, yet lower levels of neuroticism, who were referred for depressive mood even though they presented another or even no psychiatric disorder. CONCLUSION These data reveal that the detection of late-life depression in general hospitals may be critically influenced by age, symptoms severity and personality traits.
Collapse
Affiliation(s)
- Alessandra Canuto
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - Georgios Gkinis
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - Sergio DiGiorgio
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - Francesca Arpone
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| | - François R Herrmann
- b Department of Internal Medicine, Rehabilitation and Geriatrics , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Thônex , Switzerland
| | - Kerstin Weber
- a Division of liaison psychiatry and crisis intervention , University Hospitals of Geneva and Faculty of Medicine of the University of Geneva , Geneva , Switzerland
| |
Collapse
|
26
|
Weinberg DS, Narayanan AS, Boden KA, Breslin MA, Vallier HA. Psychiatric Illness Is Common Among Patients with Orthopaedic Polytrauma and Is Linked with Poor Outcomes. J Bone Joint Surg Am 2016; 98:341-8. [PMID: 26935455 DOI: 10.2106/jbjs.15.00751] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Psychiatric disorders are common, and their functional consequences may be underappreciated by non-mental health-care providers. There exist limited data regarding the frequency of psychiatric illness in patients who sustain orthopaedic polytrauma. The purpose of this study was to describe the prevalence of psychiatric illness in patients with orthopaedic polytrauma, to determine whether psychiatric illnesses were identified and were accommodated by trauma providers, and, finally, to investigate any associations between postoperative complications and psychiatric illness. METHODS Three hundred and thirty-two skeletally mature patients with surgically treated axial and/or femoral fractures and injuries to other body systems (Injury Severity Score of ≥ 16 points) were identified from a database at a Level-I trauma center. These included 238 men and ninety-four women with a mean value (and standard deviation) of 39 ± 16 years for age and 27 ± 12 points for the Injury Severity Score. Records were reviewed for preexisting diagnoses of psychiatric disorders. The inpatient courses and discharge recommendations regarding treatment of psychiatric illness were analyzed. Complications in the six-month postoperative period were determined by an independent committee. RESULTS Preexisting psychiatric disorders were identified in 130 patients (39.2%), including depression in seventy-four patients (22.3%) and substance abuse in fifty-six patients (16.9%). Patients managed by an orthopaedic surgery service were less likely to receive their home psychiatric medications while hospitalized (p = 0.001) and were less likely to receive instructions for psychiatric follow-up at discharge (p = 0.087). Postoperative complications occurred in sixty-six patients (19.9%) overall; depression was an independent predictor of increased complications, with an odds ratio of 2.956 (95% confidence interval, 1.502 to 5.816). CONCLUSIONS Psychiatric illness was common among individuals who sustained orthopaedic polytrauma, and patients with depression had more complications. This study highlights the need for greater attention to mental health disorders in this population.
Collapse
Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | | | - Kaeleen A Boden
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Mary A Breslin
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Heather A Vallier
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
27
|
Gillies D, Buykx P, Parker AG, Hetrick SE. Consultation liaison in primary care for people with mental disorders. Cochrane Database Syst Rev 2015; 2015:CD007193. [PMID: 26384252 PMCID: PMC6463953 DOI: 10.1002/14651858.cd007193.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Approximately 25% of people will be affected by a mental disorder at some stage in their life. Despite the prevalence and negative impacts of mental disorders, many people are not diagnosed or do not receive adequate treatment. Therefore primary health care has been identified as essential to improving the delivery of mental health care. Consultation liaison is a model of mental health care where the primary care provider maintains the central role in the delivery of mental health care with a mental health specialist providing consultative support. Consultation liaison has the potential to enhance the delivery of mental health care in the primary care setting and in turn improve outcomes for people with a mental disorder. OBJECTIVES To identify whether consultation liaison can have beneficial effects for people with a mental disorder by improving the ability of primary care providers to provide mental health care. SEARCH METHODS We searched the EPOC Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), and bibliographic databases: MEDLINE, EMBASE, CINAHL and PsycINFO, in March 2014. We also searched reference lists of relevant studies and reviews to identify any potentially relevant studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared consultation liaison to standard care or other service models of mental health care in the primary setting. Included participants were people attending primary care practices who required mental health care or had a mental disorder, and primary care providers who had direct contact with people in need of mental health care. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of identified studies against the inclusion criteria and extracted details including the study design, participants and setting, intervention, outcomes and any risk of bias. We resolved any disagreements by discussion or referral to a third author. We contacted trial authors to obtain any missing information.We collected and analysed data for all follow-up periods: up to and including three months following the start of treatment; between three and 12 months; and more than 12 months following the start of therapy.We used a random-effects model to calculate the risk difference (RD) for binary data and number needed to treat for an additional beneficial outcome (NNTB), if differences between groups were significant. The mean difference (MD) or standardised mean difference (SMD) was calculated for continuous data. MAIN RESULTS There were 8203 citations identified from database searches and reference lists. We included 12 trials with 2605 consumer participants and more than 905 primary care practitioner participants. Eleven trials compared consultation liaison to standard care and one compared consultation liaison to collaborative care, with a case manager co-ordinating mental health care. People with depression were included in eight trials; and one trial each included people with a variety of disorders: depression, anxiety and somatoform disorders; medically unexplained symptoms; and drinking problems. None of the included trials reported separate data for children or older people.There was some evidence that consultation liaison improved mental health up to three months following the start of treatment (two trials, n = 445, NNTB 8, 95% CI 5 to 25) but there was no evidence of its effectiveness between three and 12 months. Consultation liaison also appeared to improve consumer satisfaction (up to three months: one trial, n = 228, NNTB 3, 95% CI 3 to 5; 3 to 12 months: two trials, n = 445, NNTB 8, 95% CI 5 to 17) and adherence (3 to 12 months: seven trials, n = 1251, NNTB 6, 95% CI 4 to 13) up to 12 months. There was also an improvement in the primary care provider outcomes of providing adequate treatment between three to 12 months (three trials, n = 797, NNTB 7, 95% CI 4 to 17) and prescribing pharmacological treatment up to 12 months (four trials, n = 796, NNTB 13, 95% CI 7 to 50). There was also some evidence that consultation liaison may not be as effective as collaborative care in regards to symptoms of mental disorder, disability, general health status, and provision of treatment.The quality of these findings were low for all outcomes however, apart from consumer adherence from three to 12 months, which was of moderate quality. Eight trials were rated a high risk of performance bias because consumer participants were likely to have known whether or not they were allocated to the intervention group and most outcomes were self reported. Bias due to attrition was rated high in eight trials and reporting bias was rated high in six. AUTHORS' CONCLUSIONS There is evidence that consultation liaison improves mental health for up to three months; and satisfaction and adherence for up to 12 months in people with mental disorders, particularly those who are depressed. Primary care providers were also more likely to provide adequate treatment and prescribe pharmacological therapy for up to 12 months. There was also some evidence that consultation liaison may not be as effective as collaborative care in terms of mental disorder symptoms, disability, general health status, and provision of treatment. However, the overall quality of trials was low particularly in regards to performance and attrition bias and may have resulted in an overestimation of effectiveness. More evidence is needed to determine the effectiveness of consultation liaison for people with mental disorders particularly for those with mental disorders other than depression.
Collapse
Affiliation(s)
- Donna Gillies
- Western Sydney Local Health District ‐ Mental HealthCumberland HospitalLocked Bag 7118ParramattaNSWAustralia2124
| | - Penny Buykx
- University of SheffieldSchool of Health and Related Research (ScHARR)Regents CourtSheffieldSouth YorkshireUKS1 4DA
- Monash University School of Rural HealthPO Box 666BendigoVictoriaAustralia3552
| | - Alexandra G Parker
- University of MelbourneOrygen Youth Health Research Centre, Centre for Youth Mental HealthLocked Bag 10, 35 Poplar RoadParkvilleMelbourneVICAustralia3054
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health and The Centre of Youth Mental Health, University of Melbourne35 Poplar RoadParkvilleMelbourneVictoriaAustralia3054
| | | |
Collapse
|
28
|
Tang W, Lu J, Ungvari GS, Wong K, Kwan P. Anxiety symptoms in patients with frontal lobe epilepsy versus generalized epilepsy. Seizure 2012; 21:457-60. [DOI: 10.1016/j.seizure.2012.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/26/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022] Open
|