scholarly journals Acute myocardial infarction in several mental illness: a nationwide analysis of prevalence, management strategies and outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Mohamed ◽  
M Rashid ◽  
S Farooq ◽  
N Siddiqui ◽  
P Parwani ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Major Depression ◽  
Clinical Outcomes ◽  
Management Strategies ◽  
The United States ◽  
Increased Risk ◽  
Organic Psychoses ◽  
To Receive ◽  
Invasive Management

Abstract Background Severe mental illness (SMI) is associated with an increased risk of cardiovascular disease and mortality. However, it is unclear whether SMI patients are just as likely to receive guideline-recommended therapy for AMI as those without mental illness. Purpose To examine national-level estimates of the prevalence, management strategies and in-hospital clinical outcomes of SMI patients presenting with AMI. Methods All AMI hospitalisations from the United States National Inpatient Sample were included, stratified by mental health status in to 5 groups: no-SMI, Schizophrenia, “Other non-organic psychoses” (ONOP), Bipolar Disorder and Major Depression. Multivariable logistic regression modelling was performed to examine the association between SMI subtypes and receipt of invasive management and subsequent in-hospital clinical outcomes, expressed as adjusted odds ratios (aOR) and 95% confidence intervals (CI). Results Out of 6,968,777 AMI hospitalisations between 2004 and 2014, a total of 439,544 (6.5%) had an SMI diagnosis. The prevalence of SMI amongst the ACS population doubled over the study period (from 4.5% in 2004 to 9.5% in 2014), primarily due to an increase in Major Depression and Bipolar Disorder diagnoses. All SMI subtypes were less likely to receive coronary angiography and PCI, with the Schizophrenia group being at least odds of either procedure (aOR 0.46 95% CI 0.45, 0.48 and aOR 0.57 95% CI 0.55, 0.59, respectively). Although patients with Schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared to those without SMI, only Schizophrenia patients were associated with increased odds of mortality (aOR 1.10 95% CI 1.04, 1.16), while ONOP were the only group at increased odds of stroke (aOR 1.53 95% CI 1.42,1.65) following multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared to those without SMI (aOR 1.11 95% CI 1.04,1.17). Conclusion Patients with SMI are less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. Schizophrenia and “other non-organic psychoses” are the only SMI subtypes associated with adverse clinical outcomes after AMI. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population. Odds of management and clinical outcomes Funding Acknowledgement Type of funding source: None

scholarly journals The association between osteoarthritis and invasive treatment and clinical outcomes in 6.5 million patients presenting with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Parmar ◽  
M Mohamed ◽  
R Wilkie ◽  
M Mamas
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adverse Events ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Management Strategies ◽  
Lower Likelihood ◽  
To Receive ◽  
Invasive Management

Abstract Background People with osteoarthritis (OA) have an increased risk of cardiovascular disease, including acute myocardial infarction (AMI). Despite OA being the most common joint condition and the fastest increasing major health condition, there is limited information on the management strategies and subsequent outcomes of OA patients presenting with AMI. Purpose To describe the association between OA and invasive management strategies (including coronary angiography (CA), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG)) and clinical outcomes. Methods We analysed all hospitalisations for AMI between 2004 and 2015 recorded in the National Inpatient Sample (NIS), the largest inpatient electronic health record database in the United States. The proportion of patients receiving CA, PCI, and CABG were compared between patients with and without OA, as were the proportions of in-hospital adverse events including major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, cardiac complications and acute stroke), in-hospital mortality, stroke, and major bleeding. Multivariate logistic regression modelling with adjustment for potential confounders (demographics, medical history, and comorbidities) was performed to examine associations between OA and in-hospital clinical outcomes; results are expressed as adjusted odds ratios (AdjOR) with 95% confidence intervals (95% CI). Results A total of 6,561,940 people were hospitalised for AMI between January 2004 and September 2015, of which 444,217 (6.8%) had a concurrent diagnosis of OA. On average, those with OA were older (median: 77 vs. 67 years), more likely to be female (55.7% vs. 38.6%), and less likely to receive CA (55.3% vs. 65.2%), PCI (33.3% vs. 43.6%), and CABG (7.4% vs. 8.5%) (Figure 1A, p<0.001 for all). After adjustment for confounders, OA was associated with a lower likelihood of receiving CA (AdjOR 0.89; 95% CI 0.87, 0.90), PCI (0.85; 0.84, 0.87), and CABG (0.92; 0.90, 0.94). With reference to outcomes, OA was associated with lower likelihood of in-hospital adverse events (MACCE: AdjOR 0.71; 95% CI 0.69, 0.72; in-hospital mortality: 0.69; 0.67, 0.71; stroke: 0.81; 0.77, 0.85; and major bleeding: 0.73; 0.70, 0.75) (Figure 1B, p<0.001 for all). Conclusion In a national cohort of AMI hospitalisations, patients with OA were less likely to receive invasive management compared to those without OA. However, they were also less likely to experience adverse events. Further work is required to investigate treatment disparities in this increasingly prevalent patient group when presenting with AMI. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Like father like daughter: sex-specific parent-of-origin effects in the transmission of liability for psychotic symptoms to offspring

2018 ◽  
Vol 10 (1) ◽  
pp. 100-107 ◽  
Author(s):  
A. Aylott ◽  
A. Zwicker ◽  
L. E. MacKenzie ◽  
J. Cumby ◽  
L. Propper ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Major Depression ◽  
Psychotic Symptoms ◽  
Same Sex ◽  
Mixed Effect ◽  
Increased Risk ◽  
Opposite Sex ◽  
Parent Of Origin ◽  
Origin Effects

AbstractChildren of parents with major mood and psychotic disorders are at increased risk of psychopathology, including psychotic symptoms. It has been suggested that the risk of psychosis may be more often transmitted from parent to opposite-sex offspring (e.g., from father to daughter) than to same-sex offspring (e.g., from father to son). To test whether sex-specific transmission extends to early manifestations of psychosis, we examined sex-specific contributions to psychotic symptoms among offspring of mothers and fathers with depression, bipolar disorder and schizophrenia. We assessed psychotic symptoms in 309 offspring (160 daughters and 149 sons) aged 8–24 years (mean=13.1, s.d.=4.3), of whom 113 had a mother with schizophrenia, bipolar disorder or major depression and 43 had a father with schizophrenia, bipolar disorder or major depression. In semi-structured interviews, 130 (42%) offspring had definite psychotic symptoms established and confirmed by psychiatrists on one or more assessments. We tested the effects of mental illness in parents on same-sex and opposite-sex offspring psychotic symptoms in mixed-effect logistic regression models. Psychotic symptoms were more prevalent among daughters of affected fathers and sons of affected mothers than among offspring of the same sex as their affected parent. Mental illness in the opposite-sex parent increased the odds of psychotic symptoms (odds ratio (OR)=2.65, 95% confidence interval (CI) 1.43–4.91, P=0.002), but mental illness in the same-sex parent did not have a significant effect on psychotic symptoms in offspring (OR=1.13, 95% CI 0.61–2.07, P=0.697). The opposite-sex-specific parent-of-origin effects may suggest X chromosome-linked genetic transmission or inherited chromosomal modifications in the etiology of psychotic symptoms.

scholarly journals Stopping 5-aminosalicylates in patients with ulcerative colitis starting biologic therapy does not increase the risk of adverse clinical outcomes: analysis of two nationwide population-based cohorts

Gut ◽  
2018 ◽  
Vol 68 (6) ◽  
pp. 977-984 ◽  
Author(s):  
Ryan C Ungaro ◽  
Berkeley N Limketkai ◽  
Camilla Bjørn Jensen ◽  
Kristine Højgaard Allin ◽  
Manasi Agrawal ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
The United States ◽  
Health Claims ◽  
Sensitivity Analyses ◽  
Clinical Event ◽  
Clinical Events ◽  
Increased Risk ◽  
National Databases

ObjectiveThe benefit of continuing 5-aminosalicylate (5-ASA) in patients with ulcerative colitis (UC) who initiate anti-tumour necrosis factor-alpha (anti-TNF) biologics is unknown. We aimed to compare clinical outcomes in patients with UC already on 5-ASA who started anti-TNF and then either stopped or continued 5-ASA.DesignOur primary outcome was any adverse clinical event defined as a composite of new corticosteroid use, UC-related hospitalisation or surgery. We used two national databases: the United States (US) Truven MarketScan health claims database and the Danish health registers. Patients with UC who started anti-TNF after having been on oral 5-ASA for at least 90 days were included. Patients were classified as stopping 5-ASA if therapy was discontinued within 90 days of starting anti-TNF. We performed multivariable Cox regression models controlling for demographics, clinical factors and healthcare utilisation. Adjusted HRs (aHR) with 95% CI are reported comparing stopping 5-ASA with continuing 5-ASA.ResultsA total of 3589 patients with UC were included (2890 US and 699 Denmark). Stopping 5-ASA after initiating anti-TNF was not associated with an increased risk of adverse clinical events in the U.S. cohort (aHR 1.04; 95% CI 0.90 to 1.21, p=0.57) nor in the Danish cohort (aHR 1.09; 95% CI 0.80 to 1.49, p=0.60). Results were similar in sensitivity analyses investigating concomitant immunomodulator use and duration of 5-ASA treatment before initiating anti-TNF.ConclusionIn two national databases, stopping 5-ASA in patients with UC starting anti-TNF therapy did not increase the risk of adverse clinical events. These results should be validated in a prospective clinical trial.

scholarly journals Physiological and molecular correlates of the screwworm fly attraction to wound and animal odors

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Paul V. Hickner ◽  
Omprakash Mittapalli ◽  
Anjana Subramoniam ◽  
Agustin Sagel ◽  
Wes Watson ◽  
...  
Keyword(s):  
Expression Patterns ◽  
Management Strategies ◽  
Florida Keys ◽  
The United States ◽  
Screwworm Fly ◽  
Control Programs ◽  
Olfactory Responses ◽  
Synthetic Chemicals ◽  
Increased Risk ◽  
Monitoring Traps

AbstractThe screwworm fly, Cochliomyia hominivorax (Coquerel), was successfully eradicated from the United States by the sterile insect technique (SIT). However, recent detection of these flies in the Florida Keys, and increased risk of introductions to the other areas warrant novel tools for management of the flies. Surveillance, a key component of screwworm control programs, utilizes traps baited with rotting liver or a blend of synthetic chemicals such as swormlure-4. In this work, we evaluated the olfactory physiology of the screwworm fly and compared it with the non-obligate ectoparasitic secondary screwworm flies, C. macellaria, that invade necrotic wound and feed on dead tissue. These two species occur in geographically overlapping regions. C. macellaria, along with other blowflies such as the exotic C. megacephala, greatly outnumber C. hominivorax in the existing monitoring traps. Olfactory responses to swormlure-4 constituents between sex and mating status (mated vs unmated) in both species were recorded and compared. Overall, responses measured by the antennograms offered insights into the comparative olfactory physiology of the two fly species. We also present detailed analyses of the antennal transcriptome by RNA-Sequencing that reveal significant differences between male and female screwworm flies. The differential expression patterns were confirmed by quantitative PCR. Taken together, this integrated study provides insights into the physiological and molecular correlates of the screwworm’s attraction to wounds, and identifies molecular targets that will aid in the development of odorant-based fly management strategies.

scholarly journals Dental visits in Medicaid-enrolled youth with mental illness: an analysis of administrative claims data

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Erica L. Stockbridge ◽  
Eleena Dhakal ◽  
Stacey B. Griner ◽  
Abiah D. Loethen ◽  
Joseph F. West ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Oral Health ◽  
Dental Care ◽  
Service Use ◽  
Claims Data ◽  
The United States ◽  
Administrative Claims ◽  
Dental Visits ◽  
Administrative Claims Data

Abstract Background State Medicaid plans across the United States provide dental insurance coverage to millions of young persons with mental illness (MI), including those with attention deficit hyperactivity disorder (ADHD), depression, anxiety, bipolar disorder, and schizophrenia. There are significant oral health challenges associated with MI, and providing dental care to persons with MI while they are young provides a foundation for future oral health. However, little is known about the factors associated with the receipt of dental care in young Medicaid enrollees with MI. We aimed to identify mental and physical health and sociodemographic characteristics associated with dental visits among this population. Methods We retrospectively analyzed administrative claims data from a Medicaid specialty health plan (September 2014 to December 2015). All enrollees in the plan had MI and were ≥ 7 years of age; data for enrollees aged 7 to 20 years were analyzed. We used two-level, mixed effects regression models to explore the relationships between enrollee characteristics and dental visits during 2015. Results Of 6564 Medicaid-enrolled youth with MI, 29.0% (95% CI, 27.9, 30.1%) had one or more visits with a dentist or dental hygienist. Within youth with MI, neither anxiety (Adjusted odds ratio [AOR] = 1.15, p = 0.111), post-traumatic stress disorder (AOR = 1.31, p = 0.075), depression (AOR = 1.02, p = 0.831), bipolar disorder (AOR = 0.97, p = 0.759), nor schizophrenia (AOR = 0.83, p = 0.199) was associated with dental visits in adjusted analyses, although having ADHD was significantly associated with higher odds of dental visits relative to not having this condition (AOR = 1.34, p < 0.001). Age, sex, race/ethnicity, language, and education were also significantly associated with visits (p < 0.05 for all). Conclusions Dental utilization as measured by annual dental visits was lower in Medicaid-enrolled youth with MI relative to the general population of Medicaid-enrolled youth. However, utilization varied within the population of Medicaid-enrolled youth with MI, and we identified a number of characteristics significantly associated with the receipt of dental services. By identifying these variations in dental service use this study facilitates the development of targeted strategies to increase the use of dental care in – and consequently improve the current and long-term wellbeing of – the vulnerable population of Medicaid-enrolled youth with MI.

General medical disorders with psychiatric implications

2015 ◽  
Author(s):  
Erik J. Garcia ◽  
Warren J. Ferguson
Keyword(s):  
Mental Illness ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Prior History ◽  
Medical Illness ◽  
Medical Conditions ◽  
Presenting Symptoms ◽  
Medical Disorders ◽  
Increased Risk ◽  
History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

scholarly journals Association of severe mental illness with stroke outcomes and process-of-care quality indicators: nationwide cohort study

2021 ◽  
pp. 1-8
Author(s):  
Kelly Fleetwood ◽  
Sarah H. Wild ◽  
Daniel J. Smith ◽  
Stewart W. Mercer ◽  
Kirsty Licence ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Cohort Study ◽  
Major Depression ◽  
Severe Mental Illness ◽  
Quality Indicators ◽  
Care Quality ◽  
Process Of Care ◽  
Vascular Events ◽  
Stroke Outcomes

Background Severe mental illness (SMI) is associated with increased stroke risk, but little is known about how SMI relates to stroke prognosis and receipt of acute care. Aims To determine the association between SMI and stroke outcomes and receipt of process-of-care quality indicators (such as timely admission to stroke unit). Method We conducted a cohort study using routinely collected linked data-sets, including adults with a first hospital admission for stroke in Scotland during 1991–2014, with process-of-care quality indicator data available from 2010. We identified pre-existing schizophrenia, bipolar disorder and major depression from hospital records. We used logistic regression to evaluate 30-day, 1-year and 5-year mortality and receipt of process-of-care quality indicators by pre-existing SMI, adjusting for sociodemographic and clinical factors. We used Cox regression to evaluate further stroke and vascular events (stroke and myocardial infarction). Results Among 228 699 patients who had had a stroke, 1186 (0.5%), 859 (0.4%), 7308 (3.2%) had schizophrenia, bipolar disorder and major depression, respectively. Overall, median follow-up was 2.6 years. Compared with adults without a record of mental illness, 30-day mortality was higher for schizophrenia (adjusted odds ratio (aOR) = 1.33, 95% CI 1.16–1.52), bipolar disorder (aOR = 1.37, 95% CI 1.18–1.60) and major depression (aOR = 1.11, 95% CI 1.05–1.18). Each disorder was also associated with marked increased risk of 1-year and 5-year mortality and further stroke and vascular events. There were no clear differences in receipt of process-of-care quality indicators. Conclusions Pre-existing SMI was associated with higher risks of mortality and further vascular events. Urgent action is needed to better understand and address the reasons for these disparities.

scholarly journals Adenoviral Respiratory Infection-Associated Mortality in Children: A Retrospective Case Series

2020 ◽  
Author(s):  
Michael C. Spaeder ◽  
Claire Stewart ◽  
Matthew P. Sharron ◽  
Julia R. Noether ◽  
Natalia Martinez-Schlurman ◽  
...  
Keyword(s):  
Respiratory Infection ◽  
Medical Condition ◽  
Case Series ◽  
The United States ◽  
Chronic Medical Condition ◽  
Icu Admission ◽  
Increased Risk ◽  
Immunocompromised State ◽  
To Receive ◽  
Viral Respiratory

AbstractViral respiratory infections are a leading cause of illness and hospitalization in young children worldwide. Case fatality rates in pediatric patients with adenoviral lower respiratory tract infection requiring intensive care unit (ICU) admission have been reported between 7 and 22%. We investigated the demographics and clinical characteristics in pediatric mortalities associated with adenoviral respiratory infection at 12 academic children's hospitals in the United States. There were 107 mortality cases included in our study, 73% of which had a chronic medical condition. The most common chronic medical condition was immunocompromised state in 37 cases (35%). The incidences of pediatric acute respiratory distress syndrome (78%) and multiple organ dysfunction syndrome (94%) were profound. Immunocompetent cases were more likely to receive mechanical ventilation within the first hour of ICU admission (60 vs. 14%, p < 0.001) and extracorporeal membrane oxygenation (27 vs. 5%, p = 0.009), and less likely to receive continuous renal replacement therapy (20 vs. 49%, p = 0.002) or have renal dysfunction (54 vs. 78%, p = 0.014) as compared with immunocompromised cases. Immunocompromised cases were more likely to have bacteremia (57 vs. 16%, p < 0.001) and adenoviremia (51 vs. 17%, p < 0.001) and be treated with antiviral medications (81 vs. 26%, p < 0.001). We observed a high burden of nonrespiratory organ system dysfunction in a cohort of pediatric case fatalities with adenoviral respiratory infection. The majority of cases had a chronic medical condition associated with an increased risk of complications from viral respiratory illness, most notably immunocompromised state. Important treatment differences were noted between immunocompromised and immunocompetent cases.

scholarly journals Evaluating the Impact of Pharmacists on Clinical Outcomes and Adherence in Patients with Mental Illness: A Literature Review

2020 ◽  
Vol 2 (01) ◽  
Author(s):  
Dalia Mekeel
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Clinical Trials ◽  
Literature Review ◽  
Clinical Outcomes ◽  
The United States ◽  
Psychotropic Medications ◽  
Depression Symptoms ◽  
Free Text

Purpose: The purpose of this literature review is to investigate the role of pharmacists in improving clinical outcomes and adherence to psychotropic medications in patients with mental illness. The majority of patients tend to stop taking their medications due to the delayed effects or adverse events. It has been established that pharmacists have a positive effect on patients’ clinical outcomes in different chronic disease states other than mental illness. There is also a stigma associated with how comfortable pharmacists are on counseling patients about psychotropic medications. This literature review will evaluate the level of pharmacists’ involvement in treating patients with mental illness as well as strategies used to achieve persistence and compliance with therapy. Methods: A PubMed search was conducted to identify articles related to mental illness and pharmacists. MeSH terms included “antidepressants”, “adherence”, “pharmacists”, and “bipolar disorder”. A free-text search was conducted using the same terms and to search for the most updated American Psychiatric Association practice guidelines. The National Institute of Mental Health database was searched for current mental health statistics in the United States. Collectively, 62 results returned for the MeSh search. This review included studies on adults with mental disorders who were evaluated by pharmacists for adherence and clinical outcomes between the years of 1995-2019. The results of five clinical trials assessing the role of pharmacists in adherence to psychotropic medications will be discussed in this literature review. Results: The clinical trials included in this review showed a statistically significant increase in adherence to psychotropic medications associated with pharmacists’ interventions. The results were not statistically significant for the clinical outcomes in most studies but presented positive improvements in the inpatient and outpatient settings. Canales et al. results showed that patients receiving pharmacists’ interventions in the inpatient setting had >30% improved clinical outcomes measured by different rating scales. The results of Valenstein et al. study conducted at Veteran Affairs clinics were statistically significant for adherence improvement presented by a 25% increase in medication possession ratio. Aljumah et al. clinical trial had a 18% increase in adherence associated with pharmacist interventions. The EMDADER-TAB trial resulted in a statistically significant decrease in ER visits, significant improvement of the depression symptoms, and overall improvement of severity of symptoms. Conclusion: Mental illness should be treated as any other medical condition that requires interventions whenever clinical outcomes are not optimal. Pharmacists have the skills to evaluate clinical symptoms of different psychiatric disorders as well as the knowledge on therapeutic treatments necessary for the optimization of medication use.

General medical disorders with psychiatric implications

2017 ◽  
Author(s):  
Erik J. Garcia ◽  
Warren J. Ferguson
Keyword(s):  
Mental Illness ◽  
Psychiatric Symptoms ◽  
The United States ◽  
Prior History ◽  
Medical Illness ◽  
Medical Conditions ◽  
Presenting Symptoms ◽  
Medical Disorders ◽  
Increased Risk ◽  
History Of

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.

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