Neuropsychiatric Assessment of Liver Transplantation Candidates: Delirium and other Psychiatric Disorders

1987 ◽  
Vol 16 (2) ◽  
pp. 101-111 ◽  
Author(s):  
Paula T. Trzepacz ◽  
Fred R. Maue ◽  
Gerald Coffman ◽  
David H. Van Thiel
Keyword(s):  
Liver Transplantation ◽  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
Hepatic Function ◽  
Psychosocial Stressors ◽  
Psychiatric Evaluation ◽  
Medical Illness ◽  
Psychiatric Diagnoses ◽  
Discriminant Analyses ◽  
Preoperative Examination

Forty consecutive liver transplantation candidates underwent a standard psychiatric evaluation as part of a multidisciplinary preoperative examination. Psychiatric diagnoses were determined using DSM-III criteria and correlations between the psychiatric diagnoses and the results of bedside cognitive examinations, biochemical measures of hepatic function, and EEG's were made. Half of the patients could not be given a specific psychiatric diagnosis despite the fact of their being in terminal stages of a severe medical illness and being stressed by the uncertainty of whether they would be accepted for possible liver transplantation. Of the twenty patients given a psychiatric diagnosis, 60 percent were found to be delirious and 35 percent had an adjustment disorder. Delirium was associated with a serum albumin less than 3.0 g/dl, grades 1 through 3 EEG dysrhythmias, a Mini Mental State score less than 24 or impairment on Trailmaking Tests. In addition, discriminant analyses were performed to determine which batteries of tests best differentiated the delirious patients. A unique pattern of psychosocial stressors was noted in these patients where the severity of overall stress and of occupational dysfunction was high in most, yet family and social relationships were reported as less affected.

scholarly journals The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology

2019 ◽  
Vol 16 (23) ◽  
pp. 4645 ◽  
Author(s):  
James J. Strain
Keyword(s):  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
Screening Tools ◽  
Medical Setting ◽  
Psychiatric Diagnoses ◽  
Liaison Psychiatry ◽  
Common Features ◽  
Biological Studies ◽  
Depression Scales ◽  
The Military

Adjustment Disorder (AD) is one of the most common psychiatric diagnoses employed. In fact, it is the most frequent diagnosis utilized for psychiatric disorders in the military and in children, and is often utilized in the consultation-liaison medical setting. However, it is acknowledged that the diagnosis is not reliable, it cannot be validated, and it has an important degree of subjective consideration in its use. Commonly used screening tools like the Hamilton and Beck Depression Scales do not give an assessment of AD. Furthermore, its use is accompanied with descriptors of depression, anxiety, mixed affects, etc., so that it crosses over several areas of psychiatric dysfunction. It does allow the placement of a patient within a psychiatric diagnosis when they do not reach criteria for a major psychiatric nomenclature. To date, biological studies have not been reported. It is not known if AD with depression is closer to the biological characteristics of depression, or AD with anxiety would have similar characteristics to that seen with major anxiety. It is also not known if AD has a biological signature that would make them an entity with common features, or if they may be more closely allied biologically with the descriptor that accompanies them. Nevertheless, AD is an important category in any psychiatric lexicon and warrants further study and biological understanding.

A System-wide Retrospective Cohort Analysis of Psychiatric Diagnoses and Persistent Symptoms Following Concussion

Neurology ◽  
2021 ◽  
Vol 98 (1 Supplement 1) ◽  
pp. S16.2-S17
Author(s):  
Diab Ali ◽  
Jose H. Posas
Keyword(s):  
Psychiatric Diagnosis ◽  
Retrospective Cohort ◽  
Longitudinal Research ◽  
Neuropsychiatric Symptoms ◽  
Cohort Analysis ◽  
Adjustment Disorder ◽  
Psychiatric Diagnoses ◽  
Psychiatric Comorbidities ◽  
Hospital System ◽  
Persistent Symptoms

ObjectiveTo evaluate the epidemiologic features of psychiatric comorbidities following mild traumatic brain injury (MTBI, or concussion) in a state-wide hospital system cohort over a 10-year period.BackgroundThe epidemiology of neuropsychiatric symptoms and diagnoses following concussion are poorly understood. Despite the rebirth of post-concussion syndrome (PCS) as persistent post-concussion symptoms (PPCS), entailing diverse and complex somatic, cognitive, and emotional components with significant potential overlap or confounding of psychiatric comorbidities, there is scarce characterization of the incidence of such comorbidities following concussion. The study of demographic factors as they relate to psychiatric diagnoses following concussion remains in infancy.Design/MethodsWe conducted an observational retrospective cohort study of all patients who received a diagnosis of concussion within Ochsner Health (OH) over a 10-year period. System-wide electronic medical records were evaluated using ICD-10 codes to collect data on patients with a diagnosis of MTBI or concussion, as compared to patients with no diagnosis of concussion over the same period. Data on subpopulations corresponding to psychiatric diagnostic outcomes following diagnosis of concussion were collected and evaluated to determine timeline-related incidences of outcomes, as well as on demographic and morbid features corresponding to each outcome. These included age, sex, race, ethnicity, household income, neurologic and psychiatric history, cause of concussion, and presence of loss of consciousness.ResultsWe report incidence, demographic, and morbid factor data on patients with a diagnosis of concussion, and as related to outcomes following diagnosis of concussion, including: (1) new diagnosis of PCS, (2) meeting PPCS Berlin Sport Concussion Consensus criteria, (3) new unclassified neuropsychiatric symptoms, (4) any new psychiatric diagnosis, (5) new psychiatric diagnosis excluding PCS, (6) new anxiety, dissociative, stress-related, or somatoform disorder diagnosis, (7) new reaction to severe stress or adjustment disorder diagnosis, and (8) new PTSD diagnosis.ConclusionsWe call for multidisciplinary awareness, screening, and longitudinal research of patients with concussion.

scholarly journals Sociodemographic profile and Psychiatric diagnosis in attempted suicide

2017 ◽  
Vol 5 (1) ◽  
pp. 22-25
Author(s):  
B. Kafle ◽  
Y. Bagale ◽  
M. Dhungana
Keyword(s):  
Psychiatric Diagnosis ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Demographic Data ◽  
Adjustment Disorder ◽  
Psychiatric Evaluation ◽  
Age Group ◽  
Medical College ◽  
Major Emergencies ◽  
Suicide Attempted

 Introduction: The presence of a mental disorder is an important risk factor for suicide. Attempted suicide is one of the major emergencies in psychiatry. Suicide attempts are considered to be the best predictors of an eventual completed suicide. Data of patients presenting with attempted suicide is scanty in Nepal.Objective: The aim of the study was to explore the socio-demographic and psychiatric diagnosis of the patients with suicidal attemptMethod: The study population included those patients who were admitted and being managed for attempted suicide and brought for psychiatric evaluation during the period of one year (1st July 2015- 30 June 2016) at Devdaha Medical College and research institute, Nepal. Each patient underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Details including socio-demographic data, psychiatric diagnosis, was tabulated and analyzed using SPSS-16.Result: Among the total patients (N=75), 68% were in the age group 20-39 years. Majority of the cases were female (78.7%). 53.3% cases were married and majority were from Hindu religion. Most common method of attempted suicide was by poisoning and was by intake of Organophosphorous. Adjustment disorder(44%) and Depression(24%) were the most common psychiatric diagnosis. Marital dispute (22.7%) and family dispute (17.3%) and were the most common psychosocial precipitant.Conclusion: Attempted suicide is widely prevalent on younger age group. It is usually by poisoning and the use of Organophosphorus compound is most common in our setting and is commonly associated with adjustment disorder. Hence, psychiatric care is essential for these patients.

Pediatric Referrals to Psychiatry: III. Is the Psychiatrist's Opinion Heard?

1978 ◽  
Vol 8 (3) ◽  
pp. 295-301 ◽  
Author(s):  
Arthur P. Froese
Keyword(s):  
Psychiatric Diagnosis ◽  
Medical Service ◽  
Psychiatric Evaluation ◽  
Psychiatric Diagnoses ◽  
Discharge Diagnosis ◽  
Psychophysiological Disorders

At least one psychiatric diagnosis was made for 205 of 220 children whose psychiatric evaluation had been requested by the medical service. Only 78 of 242 psychiatric diagnoses given the 205 patients were reflected correctly in the medical discharge diagnoses. In addition, seven of fifteen patients considered to be “normal” by the consulting psychiatrist had a psychiatric or mixed medical-psychiatric diagnoses included in the discharge diagnoses. Psychophysiological disorders, psychoses and special symptom diagnoses were likely to be correctly reflected in the discharge diagnoses, while depression and adjustment reaction were not. Possible reasons why the psychiatrist's diagnostic opinion is not correctly reflected in the discharge diagnosis in over one-half of the referrals are discussed. Pediatricians may be reluctant to label their patients “neurotic” for life, or may consider the problem transient—that is, only a “passing phase.” But these theories are discounted by the fact that seven patients considered to be emotionally normal when assessed by the psychiatrist were discharged with a psychiatric or mixed medical-psychiatric diagnosis.

Frequency of and Determinants for Psychotropic Drug Use in an Institution for the Mentally Retarded

1990 ◽  
Vol 156 (4) ◽  
pp. 525-530 ◽  
Author(s):  
Olav M. Linaker
Keyword(s):  
Drug Use ◽  
General Population ◽  
Psychotropic Drug ◽  
Small Proportion ◽  
Psychiatric Diagnosis ◽  
Anticonvulsant Drug ◽  
Mentally Retarded ◽  
Significant Trend ◽  
Disruptive Behaviour ◽  
Psychiatric Diagnoses

The frequency of psychotropic and anticonvulsant drug use in 168 institutionalised mentally retarded adults was studied. Use of neuroleptics and anticonvulsants was more frequent and use of hypnotics and antidepressants less frequent than in the general population. Neuroleptics were given to 49% of the population. Clients with no psychiatric diagnosis consumed less neuroleptics than those with such a diagnosis, and there was a non-significant trend for those with a more serious diagnosis (e.g. schizophrenia) to take a higher dosage. The degree of disruptive behaviour and the availability of a physician were related to dosage of neuroleptics. The various psychiatric diagnoses given could explain only a small proportion of the variance in dosage.

scholarly journals Sociocultural Context of Suicidal Behaviour in the Sundarban Region of India

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
A. N. Chowdhury ◽  
S. Banerjee ◽  
A. Brahma ◽  
A. Hazra ◽  
M. G. Weiss
Keyword(s):  
Psychiatric Diagnosis ◽  
Suicidal Behaviour ◽  
Adjustment Disorder ◽  
Community Action ◽  
Easy Access ◽  
Social Stressors ◽  
Young Females ◽  
Detailed Assessment ◽  
Self Harm

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their “intention to die,” and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

scholarly journals Adolescent units: a need for change?

2003 ◽  
Vol 27 (8) ◽  
pp. 292-294 ◽  
Author(s):  
Tim Calton ◽  
Jon Arcelus
Keyword(s):  
Mental Health ◽  
Psychiatric Diagnosis ◽  
Adjustment Disorder ◽  
General Purpose ◽  
Clinical Implications ◽  
Violent Behaviour ◽  
Mental Health Act

Aims and MethodTo describe the characteristics and diagnoses of patients admitted to a general adolescent psychiatric in-patient unit. We describe the age, gender and psychiatric diagnosis of the patient, as well as whether the patient exhibited violent behaviour in the ward, whether he/she needed to be transferred to a different service and whether he/she was admitted under a section of the Mental Health Act 1983.ResultsPatients were evenly distributed in terms of gender, with most being 14–16 years old. Diagnoses were varied with adjustment disorder predominating, but could be separated into four main groups. Levels of violence were high, being associated with detention under the Mental Health Act 1983, and often resulted in transfer to another service.Clinical ImplicationsThe needs of certain adolescents admitted to a general-purpose adolescent unit may not be best met in this environment. Current services must change to meet the needs of their patients. There may be a need for greater specialisation.

Pink and blue: the role of gender in psychiatric diagnosis

2018 ◽  
Vol 45 (4) ◽  
pp. 271-274
Author(s):  
George Gillett
Keyword(s):  
Sexual Orientation ◽  
Diagnostic Criteria ◽  
Psychiatric Diagnosis ◽  
Personal Characteristics ◽  
Psychiatric Diagnoses ◽  
Qualitative And Quantitative ◽  
Diagnostic Bias ◽  
Gender Based ◽  
Changing Attitudes

Why are the diagnostic criteria of some psychiatric disorders standardised by gender while others are not? Why standardise symptom questionnaires by gender but not other personal characteristics such as ethnicity, socioeconomic class or sexual orientation? And how might our changing attitudes towards gender, born from scientific research and changing societal narratives, alter our opinion of these questions? This paper approaches these dilemmas by assessing the concept of diagnosis in psychiatry itself, before analysing two common approaches to the study of psychiatric diagnosis; the naturalist and constructivist views. The paper assesses the relative merits and significance of each, before turning its attention to the nature of gender and its relevance to psychiatry. The paper introduces a framework to approach gender-based diagnostic bias and concludes by drawing a distinction between qualitative and quantitative standardisation, arguing that gender standardisation of psychiatric diagnoses is ethically justified in the former but not the latter.

scholarly journals HOUT-29. THE INFLUENCE OF PSYCHIATRIC ILLNESS ON OUTCOME AND CANCER CARE RECEIVED IN PATIENTS WITH GLIOMAS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi118-vi118
Author(s):  
Palak Patel ◽  
Terry Li ◽  
Janice Chou ◽  
Amie Patel ◽  
Sylvia Crispino ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Cancer Care ◽  
Psychiatric Illness ◽  
Adjustment Disorder ◽  
Tumor Diagnosis ◽  
Panic Attacks ◽  
Psychiatric Diagnoses ◽  
Increased Risk ◽  
Psychiatric Conditions

Abstract BACKGROUND Data related to the prevalence of different psychiatric disorders and their impact on survival and compliance in patients with glioma is scarce and mostly anecdotal. We aimed to study the prevalence of psychiatric disorders in glioma patients and the possible influence on compliance with cancer care and outcome. METHODS We performed a retrospective, observational study and compared compliance with medical care and outcome in patients who had or did not have a psychiatric illness at time of diagnosis. Kaplan-Meier method was used to compare survival between groups. RESULTS We identified 22 subjects (M=13, F=9) with intracranial glioma with psychiatric diagnosis and 22 matched control subjects (M=13, F=9) without psychiatric illness. Psychiatric diagnoses included depression (12%), anxiety disorder (6%), Adjustment disorder & substance use problems (2% each), bipolar disorder (1%) and panic attacks (1%). Psychiatric diagnoses were predating tumor diagnosis in 9/22 (41%) subjects and occurred around tumor diagnosis in 11/22 (50%) patients. The time of diagnosis with psychiatric illness was unknown in 2/22 (9%) of cases. Tumor diagnoses were glioblastoma in 50%, anaplastic astrocytoma in 9%, anaplastic oligodendroglioma in 13%, oligodendroglioma in 4%, and astrocytoma in 9% of cases. MedianOS was not reached for cases with psychiatric illness (not reached due to censoring) but was 4.2 years (95% CI 1.1 – 7.4) in controls (p=0.263). Subjects with psychiatric illness had an increased risk (OR 7.5, 95% CI 0.81 -68.8) of poor compliance with cancer care (medication, clinic and MRI follow-up compliance) compared to controls (p=0.046). CONCLUSION A variety of psychiatric conditions were observed in patients with glioma and presence of psychiatric illness may influence compliance with treatment and follow-up. Studies with larger population and longer follow-up are warranted to clarify true association between psychiatric conditions and compliance and survival.

scholarly journals The albumin–bilirubin score as a predictor of outcomes in Japanese patients with PBC: an analysis using time-dependent ROC

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Takanori Ito ◽  
Masatoshi Ishigami ◽  
Hikaru Morooka ◽  
Kenta Yamamoto ◽  
Norihiro Imai ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Roc Analysis ◽  
Japanese Patients ◽  
Hepatic Function ◽  
Time Dependent ◽  
Prognostic Scores ◽  
Primary Biliary Cholangitis ◽  
Simple Method ◽  
Mayo Score

Abstract The albumin–bilirubin (ALBI) score is calculated using only serum albumin and bilirubin levels, and was developed as a simple method to assess hepatic function. In this study, a total of 409 patients with primary biliary cholangitis (PBC) were enrolled between March 1990 and October 2018. The predictive performances of the ALBI score and other well-established prognostic scores were compared using time-dependent receiver operating characteristic (ROC) analysis. During the follow-up period, 60 patients died, 45 due to liver-related diseases and 15 due to non-liver-related diseases, and 16 patients underwent liver transplantation. Time-dependent ROC analysis showed that the ALBI score has higher the areas under the ROC curves (AUROCs) than the Child–Pugh (C–P) score at each time point; AUROCs at 3, 5, and 10 years after the start of follow-up were 0.94, 0.91, and 0.90 for the ALBI score, and 0.89, 0.88, and 0.82 for the C–P score, respectively. The ALBI score showed the highest AUROCs within 2 years after the start of observation; beyond 2 years, however, the Mayo score had better prognostic ability for mortality and liver transplantation. The ALBI score/grade, derived from objective blood tests, and the Mayo score were superior prognostic tools in PBC patients.

Sign in / Sign up

Export Citation Format

Share Document