Psychiatric consultation to elderly medical inpatients in a general hospital

2003 ◽  
Vol 20 (3) ◽  
pp. 80-83 ◽  
Author(s):  
Conor O'Neill ◽  
Henry O'Connell ◽  
Brian A Lawlor
Keyword(s):  
Depressive Symptoms ◽  
Psychiatric Diagnosis ◽  
Depressive Illness ◽  
Psychiatric Consultation ◽  
Referral Rates ◽  
Medical Inpatients ◽  
Icd 10 ◽  
High Degree ◽  
Models Of Service Delivery ◽  
Over Time

AbstractObjectives: To determine the reasons for referral of elderly medical inpatients for psychiatric consultation and the appropriateness of such referrals. To determine whether the provision of a consultation service is associated with increases in referral rates over time.Method: One hundred consecutive referrals seen over an 18-week period were included in the study and data on reason for referral, ICD-10 diagnosis and recommended interventions gathered prospectively. Rates of referral were calculated and compared with a similar study performed in the same location five years previously.Results: In this location the most frequent reason for referral was for assessment of depressive symptoms (47%). Referrals were generally appropriate and there was a high degree of concordance between reason for referral and psychiatric diagnosis, particularly for depressive symptoms. There was a moderate (22%) increase in referral rates in the five years since the previous study. Concordance rates between reason for referral and psychiatric diagnosis had improved considerably during this period, particularly for depressive symptoms.Conclusions: Referral rates for psychogeriatric consultation increase over time. Referrals are generally appropriate, and recognition of depressive illness improves. Psychiatric illness may still be under-recognised and increasing workload may indicate a need for more refined models of service delivery.

Depression in Primary Care 2: General Practitioners' Recognition of Major Depression in Elderly Patients

2001 ◽  
Vol 13 (3) ◽  
pp. 367-374 ◽  
Author(s):  
Daniel W. O'Connor ◽  
Richard Rosewarne ◽  
Ann Bruce
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
General Practitioners ◽  
Depressive Episode ◽  
The Elderly ◽  
Depressive Illness ◽  
Dramatic Improvement ◽  
Stratified Sample ◽  
Icd 10 ◽  
Primary Care Practitioners

Background: It is important that serious depressive illness be recognized and treated appropriately by primary care practitioners. This and the preceding article in this issue examine (a) factors responsible for older patients' decision to report depressive symptoms to their doctor and (b) general practitioners' (GPs') recognition of depression when it was present. Methods: A survey was conducted of a stratified sample of 1,021 patients aged 70+ years of 30 GPs in Melbourne, Australia, using the Canberra Interview for the Elderly, which generates rigorous ICD-10 research diagnoses. Results: GPs' ratings of depression were best predicted in descending order of importance by patients' past contact with a psychiatrist, the doctor's view that a patient did not have dementia, the number of current depressive symptoms, patients' disclosure of these symptoms, and current physical pain. Physicians' assessments of patients' mood concurred with research diagnoses in 23 of 35 (66%) cases of ICD-10 mild depressive episode and 23 of 26 (88%) cases of moderate or severe depressive episode. GPs were unaware, however, of many depressive symptoms and often rated patients as being depressed when they were not. Conclusion: The use of a simple checklist of depressive symptoms would lead to a dramatic improvement in doctors' knowledge of patients' current psychiatric status.

On changes in psychiatric diagnosis over time.

1978 ◽  
Vol 33 (11) ◽  
pp. 1017-1031 ◽  
Author(s):  
Jeffrey D. Blum
Keyword(s):  
Psychiatric Diagnosis ◽  
Over Time

Stability and Fluctuation of Personality Disorder Features in Daily Life

2018 ◽  
Author(s):  
Aidan G.C. Wright ◽  
Leonard Simms
Keyword(s):  
Personality Disorder ◽  
Daily Life ◽  
Daily Diary ◽  
Personality Pathology ◽  
Dynamic Processes ◽  
Diary Study ◽  
Daily Diary Study ◽  
Symptom Exacerbation ◽  
High Degree ◽  
Over Time

Very little is known about the daily stability and fluctuation of personality pathology. To address this gap in knowledge, we investigated the naturalistic manifestation of personality pathology over the course of 100 days. A group of individuals (N=101) diagnosed with any personality disorder (PD) completed a daily diary study over 100 consecutive days (Mdn = 94 days, Range = 33-101 days). Participants completed daily ratings of 30 manifestations of personality pathology. Patterns of stability and variability over the course of the study were then examined. Results indicated that individual PD manifestations and domains of PD manifestations were variable across days and differed widely in their frequency. Additionally, individual averages and level of variability in PD domains were highly stable across months, individual averages of PD domains were predicted by baseline dispositional ratings of PD traits with a high degree of specificity, and daily variability PD domains was associated with elevated levels of PD traits. This pattern of findings suggests that dynamic processes of symptom exacerbation and diminution that are stable in mean level and variability in expression over time characterizes personality pathology. Further, dispositional ratings are significant predictors of average daily expression of PD features.

scholarly journals Customary physical activity and odds of depression: a systematic review and meta-analysis of 111 prospective cohort studies

2021 ◽  
pp. bjsports-2020-103140
Author(s):  
Rodney K Dishman ◽  
Cillian P McDowell ◽  
Matthew Payton Herring
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Depressive Symptoms ◽  
Cohort Studies ◽  
Prospective Cohort ◽  
Observational Studies ◽  
Meta Analysis ◽  
Vigorous Physical Activity ◽  
Prospective Cohort Studies ◽  
Over Time

ObjectiveTo explore whether physical activity is inversely associated with the onset of depression, we quantified the cumulative association of customary physical activity with incident depression and with an increase in subclinical depressive symptoms over time as reported from prospective observational studies.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, PsycINFO, PsycARTICLES and CINAHL Complete databases, supplemented by Google Scholar.Eligibility criteriaProspective cohort studies in adults, published prior to January 2020, reporting associations between physical activity and depression.Study appraisal and synthesisMultilevel random-effects meta-analysis was performed adjusting for study and cohort or region. Mixed-model meta-regression of putative modifiers.ResultsSearches yielded 111 reports including over 3 million adults sampled from 11 nations in five continents. Odds of incident cases of depression or an increase in subclinical depressive symptoms were reduced after exposure to physical activity (OR, 95% CI) in crude (0.69, 0.63 to 0.75; I2=93.7) and adjusted (0.79, 0.75 to 0.82; I2=87.6) analyses. Results were materially the same for incident depression and subclinical symptoms. Odds were lower after moderate or vigorous physical activity that met public health guidelines than after light physical activity. These odds were also lower when exposure to physical activity increased over time during a study period compared with the odds when physical activity was captured as a single baseline measure of exposure.ConclusionCustomary and increasing levels of moderate-to-vigorous physical activity in observational studies are inversely associated with incident depression and the onset of subclinical depressive symptoms among adults regardless of global region, gender, age or follow-up period.

Prevalence of Psychiatric Diagnoses and Psychiatric Consultation Service Utilization on Inpatient Medical Units

2021 ◽  
pp. 107839032110055
Author(s):  
Bianca Reis ◽  
Jenny Hsin-Chun Tsai
Keyword(s):  
Health Care ◽  
Psychiatric Disorders ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Adult Patients ◽  
Psychiatric Diagnoses ◽  
Psychiatric Consultation ◽  
Consultation Service ◽  
Icd 10 ◽  
Delivery Models

OBJECTIVE This practice improvement project sought to determine the prevalence of psychiatric diagnoses among patients admitted to a community hospital’s inpatient medical units and which diagnoses were serviced by the hospital’s psychiatric consultation service. METHOD Electronic medical record data on adult patients of five medical units admitted with a psychiatric condition between October 1, 2019, and December 31, 2019, were used. Psychiatric ICD-10 ( International Classification of Diseases, 10th Revision) codes and diagnosis names extracted were categorized into seven major diagnostic groups. A total of 687 adult patients with 82 psychiatric ICD-10 codes were analyzed using descriptive statistics. RESULTS Substance-related and addictive disorders were the most prevalent psychiatric diagnoses. Ninety-six percent ( n = 658) of patients residing on medical floors with psychiatric disorders were hospitalized for a principal medical problem. Seventy-three cases received psychiatric consultations during their stay. Sixty percent ( n = 44) of those cases had psychiatric disorders from two or more diagnostic categories. CONCLUSIONS Multidisciplinary, team-based health care delivery models that include a psychiatric nurse can provide an effective approach to treat patients in community hospitals with multiple psychiatric and medical comorbidities. Hospitals could take a significant role in providing substance use disorder treatment and equipping medical nurses with training to competently care for patients with psychiatric disorders on medical units. Further research into the prevalence and impact of patients with co-occurring and multiple psychiatric diagnoses in community hospitals is needed to implement effective health care delivery models and provide appropriate treatment options in the community.

scholarly journals Longitudinal Effects of Motivation and Physical Activity on Depressive Symptoms among College Students

2021 ◽  
Vol 18 (10) ◽  
pp. 5121
Author(s):  
Jie Zhang ◽  
Xiangli Gu ◽  
Xiaoxia Zhang ◽  
Jihye Lee ◽  
Mei Chang ◽  
...  
Keyword(s):  
College Students ◽  
Depressive Symptoms ◽  
Leisure Time ◽  
Perceived Competence ◽  
Repeated Measure ◽  
Depression Symptoms ◽  
Task Values ◽  
Competence Beliefs ◽  
Over Time ◽  
And Task

High prevalence of depression and physical inactivity have been consistently reported among college students, especially in females. Guided by Lubans et al.’s conceptual framework, the primary purpose of this study was to examine the longitudinal relationships of PA motivation with leisure-time PA and depressive symptoms among college students over one academic year. Employing a longitudinal repeated measure design, 1004 college students in China were recruited in this study (28.3% males and 71.7% females; M age = 18.93 ± 0.64 years; 18–22 years old). Participants completed previously validated questionnaires assessing PA motivation (perceived competence beliefs and task values toward PA), leisure-time PA participation, and depressive symptoms in Fall 2016 (Time 1) and Fall 2017 (Time 2). Both male and female college students showed a significant increase of depressive symptoms from freshmen to sophomores (p < 0.05). The regression models indicated that perceived competence beliefs and task values toward PA were significant predictors of depressive symptoms at Time 2 (p < 0.05) after controlling for Time 1 measures in males and females, respectively. Physically active college students consistently demonstrated higher PA motivation, and they displayed fewer depressive symptoms compared to inactive peers over time (p < 0.05). The findings suggest sex-specified motivational intervention strategies and PA promotion programs/opportunities are needed to reduce depression symptoms among college students over time.

The Role of Leisure Activities on Partnered Men’s and Women’s Types of Depressive Symptoms Over Time

2021 ◽  
pp. 1-23
Author(s):  
Preston C. Morgan ◽  
Michelle Washburn-Busk ◽  
M. Hunter Stanfield ◽  
Jared A. Durtschi
Keyword(s):  
Depressive Symptoms ◽  
Leisure Activities ◽  
Over Time

The course of depression in the elderly: a longitudinal community-based study in Australia

1997 ◽  
Vol 27 (1) ◽  
pp. 119-129 ◽  
Author(s):  
A. S. HENDERSON ◽  
A. E. KORTEN ◽  
P. A. JACOMB ◽  
A. J. MACKINNON ◽  
A. F. JORM ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Decline ◽  
Service Use ◽  
Community Sample ◽  
The Elderly ◽  
Activity Levels ◽  
Sample Attrition ◽  
Poor Social Support ◽  
Icd 10 ◽  
Depressive States

Background. We report the outcome of depressive states after 3-4 years in a community sample of the elderly.Methods. A sample of 1045 persons aged 70+ years in 1990–1 was re-interviewed after 3·6 years.Results. Mortality (21·7%) and refusal or non-availability (10·4%) were higher in those who initially had had a diagnosis or symptoms of depression. Of those with an ICD-10 depressive episode in 1990–1, 13% retained that diagnosis. Of those who were not depressed initially only 2·5% had become cases. Depression was unrelated to age or apolipoprotein E genotype. The best predictors of the number of depressive symptoms at follow-up was the number at Wave 1, followed by deterioration in health and in activities of daily living, high neuroticism, poor current health, poor social support, low current activity levels and high service use. Depressive symptoms at Wave 1 did not predict subsequent cognitive decline or dementia.Conclusions. Non-random sample attrition is unavoidable. ICD-10 criteria yield more cases than other systems, while continuous measures of symptoms confer analytical advantages. Risk factors for depressive states in the elderly have been further identified. The prognosis for these states is favourable. At the community level, depressive symptoms do not seem to predict cognitive decline, as they do in referred series.

scholarly journals Serial Analysis of the Gut and Respiratory Microbiome in Cystic Fibrosis in Infancy: Interaction between Intestinal and Respiratory Tracts and Impact of Nutritional Exposures

mBio ◽  
2012 ◽  
Vol 3 (4) ◽  
Author(s):  
J. C. Madan ◽  
D. C. Koestler ◽  
B. A. Stanton ◽  
L. Davidson ◽  
L. A. Moulton ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Respiratory Tract ◽  
Microbial Communities ◽  
Effective Means ◽  
Significant Proportion ◽  
Gut Colonization ◽  
Pulmonary Damage ◽  
Chronic Colonization ◽  
High Degree ◽  
Over Time

ABSTRACT Pulmonary damage caused by chronic colonization of the cystic fibrosis (CF) lung by microbial communities is the proximal cause of respiratory failure. While there has been an effort to document the microbiome of the CF lung in pediatric and adult patients, little is known regarding the developing microflora in infants. We examined the respiratory and intestinal microbiota development in infants with CF from birth to 21 months. Distinct genera dominated in the gut compared to those in the respiratory tract, yet some bacteria overlapped, demonstrating a core microbiota dominated by Veillonella and Streptococcus. Bacterial diversity increased significantly over time, with evidence of more rapidly acquired diversity in the respiratory tract. There was a high degree of concordance between the bacteria that were increasing or decreasing over time in both compartments; in particular, a significant proportion (14/16 genera) increasing in the gut were also increasing in the respiratory tract. For 7 genera, gut colonization presages their appearance in the respiratory tract. Clustering analysis of respiratory samples indicated profiles of bacteria associated with breast-feeding, and for gut samples, introduction of solid foods even after adjustment for the time at which the sample was collected. Furthermore, changes in diet also result in altered respiratory microflora, suggesting a link between nutrition and development of microbial communities in the respiratory tract. Our findings suggest that nutritional factors and gut colonization patterns are determinants of the microbial development of respiratory tract microbiota in infants with CF and present opportunities for early intervention in CF with altered dietary or probiotic strategies. IMPORTANCE While efforts have been focused on assessing the microbiome of pediatric and adult cystic fibrosis (CF) patients to understand how chronic colonization by these microbes contributes to pulmonary damage, little is known regarding the earliest development of respiratory and gut microflora in infants with CF. Our findings suggest that colonization of the respiratory tract by microbes is presaged by colonization of the gut and demonstrated a role of nutrition in development of the respiratory microflora. Thus, targeted dietary or probiotic strategies may be an effective means to change the course of the colonization of the CF lung and thereby improve patient outcomes.

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