Journal of the Academy of Consultation-Liaison Psychiatry最新文献

{"title":"Consultation-Liaison Case Conference: Assessing Psychosis in Context of Religious Beliefs.","authors":"Justin Hoffman, Mary Lynn Dell, Godfrey Pearlson, Benjamin Anderson","doi":"10.1016/j.jaclp.2025.02.005","DOIUrl":"10.1016/j.jaclp.2025.02.005","url":null,"abstract":"<p><p>We present the case of a 75-year-old female presenting with an acute mental status change during which she abruptly became nonresponsive and collapsed to the floor. History revealed years of similar episodes in the context of religious beliefs regarding demonic possession and hearing the voices of God and the Devil. Top experts in the field provide perspective and guidance for diagnosing and managing psychiatric illness involving religious themes based on their experience and a review of available literature. Key teaching points include the challenges and limitations of current diagnostic tools, the nature of religious delusions, and engagement strategies for clinicians when dealing with patients exhibiting symptoms overlapping with religious experiences.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the California End of Life Option Act at UCSF: Examining the Utility of the Mandatory Mental Health Assessment in Medical Aid in Dying","authors":"Michael T. Dinh M.D. ,&nbsp;Brieze Bell M.D. ,&nbsp;James A. Bourgeois O.D. M.D. ,&nbsp;Eric Weaver M.D. ,&nbsp;Jordie Martin M.D. ,&nbsp;David L. O'Riordan Ph.D. ,&nbsp;Michael Rabow M.D. ,&nbsp;Lawrence Kaplan D.O. ,&nbsp;Brian Anderson M.D.","doi":"10.1016/j.jaclp.2024.11.006","DOIUrl":"10.1016/j.jaclp.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>The End of Life Option Act (EOLOA) legalized medical aid in dying (MAID) in California in 2015. University of California, San Francisco Health initially implemented a policy requiring a mandatory mental health assessment of all patients seeking MAID, though this was not required by the EOLOA. State-level statistics on EOLOA are available, but less is known about outcomes at individual institutions and how institutional policy affects outcomes for patients seeking MAID.</div></div><div><h3>Objectives</h3><div>Investigators examined the factors contributing to patients' decisions to request MAID and how the mandatory mental health assessment impacted determinations of decisional capacity and access to MAID.</div></div><div><h3>Methods</h3><div>Retrospective chart review was conducted on a sample of patients who had pursued MAID or been prescribed MAID medications between June 2016 and May 2020 obtained by a combination of purposive sampling (n = 78) and systematic electronic health record sampling (n = 22). Descriptive statistics were used to examine demographic factors, neuropsychiatric diagnoses and rating scales, factors contributing to patients' decision to request MAID, and outcomes of the psychiatric evaluation process.</div></div><div><h3>Results</h3><div>Of the 78 patients in the purposive sample who had initiated EOLOA requests, 67% had MAID medications prescribed. No patient was found to lack decisional capacity due to a current psychiatric condition. Many patient records were missing relevant data including neuropsychiatric rating scale scores and factors contributing to patients' decision to request MAID. The neuropsychiatric rating scale scores and diagnoses that were present did not suggest a high prevalence of severe psychiatric illness in the sample.</div></div><div><h3>Conclusions</h3><div>The findings from this study suggest that mandatory mental health assessments for all patients requesting MAID at a single academic medical center did not identify patients who lacked decisional capacity to pursue MAID, and potentially created access barriers to seriously ill patients seeking this intervention. Generalizability of findings may be limited by the fact that mental illness burden was low in the studied sample. Results from this study contributed to changes in EOLOA institutional policy at University of California, San Francisco, including elimination of the mandatory mental health assessment for EOLOA candidates in favor of a conditional mental health assessment based on certain clinical criteria.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 172-178"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury","authors":"Yun-Hsuan Lai R.N., M.S.N. ,&nbsp;Chia-Jou Lin R.N. ,&nbsp;I-Chang Su M.D. ,&nbsp;Sheng-Wen Huang M.D. ,&nbsp;Chia-Chi Hsiao R.N. ,&nbsp;Ying-Ling Jao R.N., Ph.D. ,&nbsp;Pin-Yuan Chen M.D., Ph.D. ,&nbsp;Victoria Traynor R.N., Ph.D. ,&nbsp;Chuan-Ya Lee M.D. ,&nbsp;Ting-Jhen Chen R.N., Ph.D. ,&nbsp;Mu-Hsing Ho R.N., Ph.D. ,&nbsp;Hsiao-Yean Chiu R.N., Ph.D.","doi":"10.1016/j.jaclp.2024.12.005","DOIUrl":"10.1016/j.jaclp.2024.12.005","url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population.</div></div><div><h3>Objective</h3><div>To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury.</div></div><div><h3>Methods</h3><div>This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. <em>The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</em> criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium.</div></div><div><h3>Results</h3><div>A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the <em>Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</em> criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (<em>P</em> = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (<em>P</em> &lt; 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively.</div></div><div><h3>Conclusion</h3><div>The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 130-138"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive, Behavioral, and Functional Outcomes of Suspected Mild Traumatic Brain Injury in Community-Dwelling Older Persons Without Mild Cognitive Impairment or Dementia","authors":"Dylan X. Guan HBSc ,&nbsp;Matthew E. Peters M.D. ,&nbsp;G Bruce Pike Ph.D. ,&nbsp;Clive Ballard M.D. ,&nbsp;Byron Creese Ph.D. ,&nbsp;Anne Corbett Ph.D. ,&nbsp;Ellie Pickering M.Sc. ,&nbsp;Pamela Roach Ph.D. ,&nbsp;Eric E. Smith M.D., M.P.H. ,&nbsp;Zahinoor Ismail M.D.","doi":"10.1016/j.jaclp.2024.12.004","DOIUrl":"10.1016/j.jaclp.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury is associated with greater risk and earlier onset of dementia.</div></div><div><h3>Objective</h3><div>This study investigated whether later-life changes in subjective cognition and behavior – potential markers of Alzheimer disease – could be observed in cognitively unimpaired older persons with a history of suspected mild traumatic brain injury (smTBI) earlier in life and whether changes in cognition and behavior mediated the link between smTBI and daily function.</div></div><div><h3>Methods</h3><div>Data for 1392 participants from the Canadian Platform for Research Online to Investigate Health, Quality of Life, Cognition, Behaviour, Function, and Caregiving in Aging were analyzed. A validated self-reported brain injury screening questionnaire was used to determine the history of smTBI. Outcomes were measured using the Everyday Cognition scale (for subjective cognitive decline [SCD]), Mild Behavioral Impairment (MBI) Checklist, and Standard Assessment of Global Everyday Activities (for function). Inverse probability of treatment weighted logistic and negative binomial regressions were used to model smTBI (exposure) associations with SCD and MBI statuses, and Everyday Cognition-II and MBI Checklist total scores, respectively. Mediation analyses were conducted using bootstrapping.</div></div><div><h3>Results</h3><div>History of smTBI was linked to higher odds of SCD (odds ratio = 1.45, 95% confidence interval: [1.14−1.84]) or MBI (odds ratio = 1.75, 95% confidence interval: [1.54−1.98]), as well as 24% (95% confidence interval: [18%−31%]) higher Everyday Cognition-II and 52% (95% confidence interval: [41%−63%]) higher MBI Checklist total scores. Finally, SCD and MBI mediated approximately 45% and 56%, respectively, of the association between smTBI history and poorer function, as indicated by higher Standard Assessment of Global Everyday Activities total scores.</div></div><div><h3>Conclusions</h3><div>smTBI at any point in the life course is linked to poorer cognition and behavior even in community-dwelling older persons without MCI or dementia. Older persons with smTBI may benefit from early dementia risk assessment using tools that measure changes in cognition and behavior. Interventions for declining cognition and behavior may also be beneficial in this population to address functional impairment.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 118-129"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Psychiatry Units: A Delphi Consensus Approach to Defining Essential Characteristics","authors":"Susan L. Padrino M.D. ,&nbsp;Aubrey C. Chan M.D., Ph.D. ,&nbsp;Maarten van Schijndel M.D., Ph.D. ,&nbsp;Marsha N. Wittink M.D., M.B.E.","doi":"10.1016/j.jaclp.2024.09.004","DOIUrl":"10.1016/j.jaclp.2024.09.004","url":null,"abstract":"<div><div>Medical psychiatry units (MPUs), also known as complexity intervention units, represent an important innovation for integrating medical and behavioral health care in the hospital setting, thereby reducing the need for sequential medical and psychiatric hospitalization. As US hospitals face an increased demand for mental health services, interest in the MPU model is gaining momentum. However, there is no shared definition for what constitutes an MPU, and significant variation exists among units across the United States that have been designated as an MPU. The lack of a unified definition for MPUs results in significant variability and poses challenges for creating new MPUs and studying existing MPUs. To address this gap, the Medical-Psychiatry Unit Consortium recruited a panel of MPU experts to conduct a consensus study. The consortium used a survey to assess the relative importance of various characteristics of MPUs within the following categories: structural organization, environment and design, spectrum of care, staffing, and culture of care.</div><div>After two rounds of a modified Delphi process, consensus was achieved with regard to which characteristics are necessary or preferred vs. not necessary or harmful. The necessary or preferred characteristics include those that would be expected on a general medical unit, such as having cardiac telemetry monitoring capabilities, as well as characteristics typical of a psychiatric unit, such as locked unit doors, locked cabinets for patient belongings, and common area or milieu. Overall, this suggests that an ideal MPU combines the ability to provide acute medical care with acute psychiatric care. Notably, staffing and culture of care emerged as categories with the highest ranking of necessary characteristics, outweighing environment, design, or the breadth of services offered. These findings suggest that MPU experts feel teamwork and having a shared mission are critical components of effective MPUs and highlight the importance of staff recruitment and training.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 152-161"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dexmedetomidine in the Intensive Care Unit for Extreme Aggression in a Child With Catatonia","authors":"Samuel Warn M.D. ,&nbsp;Barrington Hwang M.D. ,&nbsp;Joshua Smith M.D.","doi":"10.1016/j.jaclp.2024.12.006","DOIUrl":"10.1016/j.jaclp.2024.12.006","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 183-185"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Use of the Cultural Formulation Interview for Assessment and Management of a Migrant Patient With Anorexia Nervosa","authors":"Christine Huynh B.S. ,&nbsp;Nana Park M.D. ,&nbsp;Nia Harris M.D. ,&nbsp;Diana Punko M.D., M.S.","doi":"10.1016/j.jaclp.2025.01.001","DOIUrl":"10.1016/j.jaclp.2025.01.001","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 186-187"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consultation Liaison Case Conference: Inpatient Psychiatric Consultation for Patients With Sickle Cell Disease","authors":"Lauren E. Fields M.D. ,&nbsp;Elizabeth Leimbach M.D. ,&nbsp;Adrienne D. Mishkin M.D., M.P.H., M.B.E., F.A.P.A. ,&nbsp;C. Patrick Carroll M.D. ,&nbsp;Elizabeth J. Prince D.O.","doi":"10.1016/j.jaclp.2024.09.005","DOIUrl":"10.1016/j.jaclp.2024.09.005","url":null,"abstract":"<div><div>We present the fictional case of a 29-year-old man with sickle cell disease referred to psychiatry for evaluation of depression during an acute pain episode. Consultation-liaison psychiatrists with expertise in sickle cell disease provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the high prevalence of mood and cognitive disorders in this population, as well as pertinent issues related to chronic pain, opioids, and stigma.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 162-171"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catatonia: The Phoenix Rises Again and Is Here to Stay","authors":"Mark A. Oldham M.D., F. A. C. L. P.","doi":"10.1016/j.jaclp.2025.03.433","DOIUrl":"10.1016/j.jaclp.2025.03.433","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 2","pages":"Pages 115-117"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unnecessary Use of Medications for Alcohol Withdrawal Among Hospitalized Patients: A Retrospective Study of Phosphatidylethanol Testing in Patients With Suspected Alcohol Use Disorder.","authors":"Pooja R Sarkar, Amber N Edinoff, Joji Suzuki","doi":"10.1016/j.jaclp.2025.02.003","DOIUrl":"10.1016/j.jaclp.2025.02.003","url":null,"abstract":"<p><strong>Objectives: </strong>Alcohol withdrawal is frequently encountered in hospital settings, but the decision to treat the withdrawal with pharmacotherapy is often made without knowing if treatment is even necessary. Testing for phosphatidylethanol (PEth), results of which correlate well with recent alcohol consumption, may allow hospital teams to avoid treating alcohol withdrawal unnecessarily. To investigate PEth values of those suspected of alcohol withdrawal syndrome (AWS) among hospital inpatients, we conducted a retrospective study to determine the prevalence of hospitalized patients who received pharmacotherapy for withdrawal who also demonstrated PEth values suggesting minimal recent drinking.</p><p><strong>Methods: </strong>This retrospective study examined the electronic health records of hospitalized adult patients suspected of recent heavy alcohol use for whom PEth tests were ordered. PEth tests were ordered at the time to inform treatment decisions such as the provision of naltrexone or referral to ongoing psychosocial treatments, but not to inform the decision to treat AWS given that results would only be available 3 or more days later. Hospital inpatients, excluding emergency room encounters, for whom PEth was ordered at 2 affiliated academic hospitals from January 2021 to April 2024 were included.</p><p><strong>Results: </strong>The included cohort was composed of 73 individual encounters. Among the 45 (62%) encounters where pharmacotherapy for AWS was administered, 14 (31%) had PEth values (≤200 ng/ml) inconsistent with heavy alcohol use.</p><p><strong>Conclusions: </strong>Results suggest that a substantial proportion of hospital inpatients may have received pharmacotherapy for AWS despite PEth levels inconsistent with recent heavy alcohol use. If PEth results are available in real-time, results could help clinicians decide if pharmacotherapy is warranted. Further study of PEth testing and its role in the care of hospitalized patients is recommended.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}