Aripiprazole in the Treatment of Delirium

Objective: Delirium is a common condition frequently seen in consultation-liaison psychiatry. It is especially common among medically compromised patients, and is an indicator of the severity of the medical illness. In addition, it is associated with a higher morbidity, mortality, and longer hospitalization. Traditionally, haloperidol has been used to treat agitation as it may occur in delirium. However, atypical antipsychotics are being increasingly used to treat delirium. Method: In this article, we will describe two cases of delirium successfully treated with aripiprazole. Results: Both patients had significant improvement in their delirium as measured by the delirium rating scale. Conclusion: Aripiprazole appears to be effective in reducing the symptoms of delirium.

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Medical Disorders in the Schizophrenic Patient

The International Journal of Psychiatry in Medicine ◽

10.2190/ttya-a89t-2yt9-uk2a ◽

1995 ◽

Vol 25 (2) ◽

pp. 137-172 ◽

Cited By ~ 31

Author(s):

Victor Vieweg ◽

James Levenson ◽

Anand Pandurangi ◽

Joel Silverman

Keyword(s):

Schizophrenic Patient ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Response To Treatment ◽

Medical Setting ◽

Medical Illness ◽

Liaison Psychiatry ◽

Medical Disorders ◽

Consultation Liaison Psychiatry

Objective: The primary purpose of this review of medical disorders in the schizophrenic patient is to provide the clinician interested in Consultation/ Liaison psychiatry and psychosomatic issues a comprehensive and current review of the subject. Method: The authors used the Index Medicus and Medline to find recent review articles and research articles related to medical disorders in the schizophrenic patient. Also, the authors described their clinical experience in Consultation/Liaison psychiatry working with schizophrenic patients in a large, tertiary-care academic medical center. Results: The authors divided their review into: 1) mortality and morbidity in schizophrenia, 2) differential diagnosis, 3) specific comorbidity management problems, 4) caring for schizophrenics on medical/surgical wards, and 5) antipsychotic drugs in the medical setting. Schizophrenia remains an important subject for Consultation/Liaison psychiatrists. Conclusions: Schizophrenia and its protean manifestations confound the care of the medical patient. The psychosis of schizophrenia may impair the patient's capacity to recognize or articulate emerging medical illness, or to respond to therapeutic interventions. The psychiatrist caring for and consulting on patients with medical illnesses bears major responsibility for understanding the complex interface of schizophrenia and medical illnesses. Psychiatrists need to educate our medical and surgical colleagues how schizophrenia alters the usual presentation, clinical course, and response to treatment of common medical and surgical illnesses.

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Relationship between Etiology and Phenomenologic Profile in Delirium

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/089198879801100305 ◽

1998 ◽

Vol 11 (3) ◽

pp. 146-149 ◽

Cited By ~ 44

Author(s):

David J. Meagher ◽

Donal O'Hanlon ◽

Edmond O'Mahony ◽

Patricia R. Casey ◽

Paula T. Trzepacz

Keyword(s):

Rating Scale ◽

Liaison Psychiatry ◽

Symptom Profiles ◽

Symptom Profile ◽

Consultation Liaison Psychiatry ◽

Mood Lability ◽

Perceptual Changes ◽

The Relationship ◽

Treatment Responsiveness

This study describes the symptom profile of 46 patients with delirium seen as consecutive referrals to a consultation-liaison psychiatry service. The relationship between symptoms rated on the Delirium Rating Scale (DRS) and delirium subtypes defined according to three putative etiologic groups are described. The relationship between etiologic groups and motoric subtype of the delirium episode is also described. Drug-related cases had the highest total DRS score and higher scores than the anticholinergic group for perceptual changes, delusions, psychomotor disturbance, and mood lability. Drug-related cases had higher scores than both the anticholinergic and infectious/electrolyte group for changes in sleep-wake cycle and fluctuation of symptoms. Those from the anticholinergic etiologic group were more likely to fit the hypoactive motoric subtype. Although our findings are tentative, etiologic categories may present with different symptom profiles, which may be associated with differing treatment responsiveness and course.

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Psychopathology in patients with psoriasis: a cross-sectional clinical study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195927 ◽

2019 ◽

Vol 8 (1) ◽

pp. 307

Author(s):

Kumari Padma ◽

Sagar Subhash Nanaware ◽

Aruna Yadihal ◽

P. John Mathai

Keyword(s):

Psychiatric Disorders ◽

Rating Scale ◽

Psychiatric Symptoms ◽

Psychiatric Morbidity ◽

Self Esteem ◽

Liaison Psychiatry ◽

Chi Square ◽

Cross Sectional ◽

Chi Square Test ◽

Consultation Liaison Psychiatry

Background: Psoriasis is associated with a variety of psychological problems including poor self-esteem, sexual dysfunction, anxiety and depressive disorder and suicidal ideation. There are reports that patients with psoriasis may have significant psychiatric morbidity. The objective of the study is to evaluate the frequency of psychiatric disorders, frequency and nature of psychiatric symptoms in patients with psoriasis.Methods: 100 patients with psoriasis were evaluated and included for the study. Comprehensive Psychopathological Rating Scale (CPRS) is used for assessment of psychiatric symptoms and MINI Plus for assessing psychiatric disorders. Chi-square test was used to compare the proportions.Results: Patients with psoriasis had high frequency of psychiatric morbidity and was found to be 42%.Conclusions: Patients with psoriasis have more psychopathology and higher psychiatric morbidity which may further imply justifiable consultation liaison psychiatry in other speciality fields like Dermatology.

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Consultation-liaison psychiatry

Psychiatric Ethics ◽

10.1093/med/9780198839262.003.0025 ◽

2021 ◽

pp. 599-618

Author(s):

Tomer T. Levin ◽

Christopher J. Ryan

Keyword(s):

Large Scale ◽

Population Level ◽

Medical Illness ◽

Ethical Challenges ◽

Medical Outcomes ◽

Liaison Psychiatry ◽

Psychiatric Illnesses ◽

Decision Making Capacity ◽

Consultation Liaison Psychiatry ◽

Boundary Issues

Ethics in consultation-liaison (C-L) psychiatry involves the intersection of medical illness and psychiatry. Because it is now clear that psychiatric illnesses and substance use also worsen medical outcomes, the field has broadened to a population level, overlapping with primary care. This brings distributive justice to the fore, as large-scale psychiatric screening requires adequate resources to treat identified populations. Ethical challenges masquerading as psychiatric problems or psychiatric issues masquerading as ethical dilemmas are common. Boundary issues, confidentiality, privacy, multiple loyalties in C-L settings, autonomy, decision-making capacity, and end-of-life conflict are frequent areas of ethical concern for the C-L psychiatrist.

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Diagnostic Agreement between Physicians and a Consultation–Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020749 ◽

2021 ◽

Vol 18 (2) ◽

pp. 749

Author(s):

Mattia Marchi ◽

Federica Maria Magarini ◽

Giorgio Mattei ◽

Luca Pingani ◽

Maria Moscara ◽

...

Keyword(s):

General Hospital ◽

Depressive Disorders ◽

Psychiatric Morbidity ◽

Clinical Signs ◽

Kappa Statistics ◽

Comorbid Depression ◽

Liaison Psychiatry ◽

Consultation Liaison Psychiatry ◽

Psychiatric Conditions ◽

Diagnostic Concordance

Consultation–liaison psychiatry (CLP) manages psychiatric care for patients admitted to a general hospital (GH) for somatic reasons. We evaluated patterns in psychiatric morbidity, reasons for referral and diagnostic concordance between referring doctors and CL psychiatrists. Referrals over the course of 20 years (2000–2019) made by the CLP Service at Modena GH (Italy) were retrospectively analyzed. Cohen’s kappa statistics were used to estimate the agreement between the diagnoses made by CL psychiatrist and the diagnoses considered by the referring doctors. The analyses covered 18,888 referrals. The most common referral reason was suspicion of depression (n = 4937; 32.3%), followed by agitation (n = 1534; 10.0%). Psychiatric diagnoses were established for 13,883 (73.8%) referrals. Fair agreement was found for depressive disorders (kappa = 0.281) and for delirium (kappa = 0.342), which increased for anxiety comorbid depression (kappa = 0.305) and hyperkinetic delirium (kappa = 0.504). Moderate agreement was found for alcohol or substance abuse (kappa = 0.574). Referring doctors correctly recognized psychiatric conditions due to their exogenous etiology or clear clinical signs; in addition, the presence of positive symptoms (such as panic or agitation) increased diagnostic concordance. Close daily collaboration between CL psychiatrists and GH doctors lead to improvements in the ability to properly detect comorbid psychiatric conditions.

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How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients

BMJ Open ◽

10.1136/bmjopen-2020-041214 ◽

2021 ◽

Vol 11 (4) ◽

pp. e041214

Author(s):

Kevin Glynn ◽

Frank McKenna ◽

Kevin Lally ◽

Muireann O’Donnell ◽

Sandeep Grover ◽

...

Keyword(s):

Palliative Care ◽

Rating Scale ◽

Symptom Burden ◽

Systemic Infection ◽

International Study ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Liaison Psychiatry ◽

Cross Sectional ◽

Hypoactive Delirium

ObjectivesTo investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.DesignCross-sectional study.SettingInternational study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measuresHyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.ResultsHypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).ConclusionsThis study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.

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