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

{"title":"Validation of Cerebral State Monitor Frequency Power Ratios for Detection of Delirium","authors":"Robert de Burlo M.D. ,&nbsp;Alexander Robles M.D. ,&nbsp;Savannah Salazar M.D. ,&nbsp;Justine Yang M.D. ,&nbsp;Samuel MacDonald M.D. ,&nbsp;Alice Luo M.D. ,&nbsp;Orrin Myers Ph.D. ,&nbsp;William Wylie M.D. ,&nbsp;Davin K. Quinn M.D.","doi":"10.1016/j.jaclp.2025.04.001","DOIUrl":"10.1016/j.jaclp.2025.04.001","url":null,"abstract":"<div><h3>Background</h3><div>Delirium among hospitalized patients often goes undetected and is associated with increased length of stay and mortality. Cerebral state monitors<span> (CSMs) collect limited lead electroencephalography (EEG) data and have shown promise in delirium detection.</span></div></div><div><h3>Objective</h3><div>This study compares three methods of detecting delirium: EEG using an Food and Drug Administration-approved CSM, a 3-minute diagnostic<span> interview for the Confusion Assessment Method (3D-CAM), and the traditional reference standard clinical evaluation by a psychiatric consultation-liaison service.</span></div></div><div><h3>Methods</h3><div>Hospitalized patients &gt;18 years of age evaluated by the consultation-liaison service were screened for inclusion. Consent was obtained from either the patient or authorized surrogate when appropriate. Participants were screened with 3D-CAM, followed by placement of 4 frontotemporal CSM leads and collection of 5 minutes of EEG data with eyes closed. The presence or absence of a delirium diagnosis on psychiatric evaluation using Diagnostic and Statistical Manual-5 criteria the day of data collection was recorded. A MATLAB-based program (Brainstorm) was used to calculate power in each EEG frequency band.</div></div><div><h3>Results</h3><div><span>There were 75 participants, 58 with complete 3D-CAM and EEG data. Twenty-three participants were found to be delirious by clinical diagnosis. The 3D-CAM differentiated between delirious and nondelirious participants with a sensitivity of 65%, specificity of 79%, and area under the curve of 0.720. EEG power differed between delirious and nondelirious participants in the HighDelta frequency band in the left temporal (L2) lead (false discovery rate-adjusted </span><em>P</em> = 0.020) and the LowAlphaHighDelta frequency band ratio in L2 (false discovery rate-adjusted <em>P</em> = 0.039). On receiver operator curve analysis, LowAlphaHighDelta and HighDelta outperformed 3D CAM, although not significant (all <em>P</em> &gt; 0.18).</div></div><div><h3>Conclusions</h3><div>CSM frequency band power differed significantly between delirious and nondelirious patients but did not outperform 3D-CAM as a predictive test of delirium. Strengths of this study include the use of an Food and Drug Administration-approved CSM and freely available computational software and methods. Limitations include a small sample size, making the results vulnerable to skewing by outliers. Future studies should recruit larger sample sizes and explore the diagnostic utility of combined EEG variables obtained with CSMs at the bedside.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 4","pages":"Pages 302-310"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025386","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":"C-L Case Conference: Challenges of Managing Severe Opioid Use Disorder in the Hospital.","authors":"Kahlo Baniadam, Brent D Schnipke, James L Levenson, Megan Buresh, Rachna S Raisinghani, Elizabeth Ryznar","doi":"10.1016/j.jaclp.2025.06.009","DOIUrl":"10.1016/j.jaclp.2025.06.009","url":null,"abstract":"<p><p>Consultation-liaison psychiatrists are frequently consulted to assess and manage severe opioid use disorder in hospitalized patients requiring treatment for complications related to their opioid use disorder. We describe the case of a 43-year-old male with severe opioid use disorder who recently underwent bilateral amputations for his leg wounds at another hospital and left before medically advised. He subsequently presented to our hospital for pain and was admitted for ongoing infection. An understanding of the ethical considerations surrounding patient-directed discharge (previously referred to as \"against medical advice\"), appropriate opioid agonist dosing strategies, and postdischarge planning can improve outcomes for these patients, who often face significant stigma within the health care system.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499120","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":"CL Case Conference: Management of Demoralization in the Medical Setting.","authors":"Alyssa C Smith, Jonathan S Gerkin, Diana M Robinson, Emily G Holmes","doi":"10.1016/j.jaclp.2025.06.006","DOIUrl":"10.1016/j.jaclp.2025.06.006","url":null,"abstract":"<p><p>Demoralization has important implications for patients' health, but consultation-liaison psychiatrists may be less familiar with diagnosis and management due to limited inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. We present the case of a multivisceral transplant patient who experienced demoralization due to complications from her posttransplant course. We discuss the diagnosis of demoralization, including differential diagnoses to consider, followed by a discussion of management of demoralization in the inpatient setting using acceptance and commitment therapy. We then discuss the consultation-liaison psychiatrist's role in assisting with management of teams' counter-transference to difficult patient cases, including the possibility of teams experiencing their own demoralization.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486913","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":"Examining the Moderating Effect of Sex on the Association Between Asthma and Age of Onset in Bipolar Disorder and Schizophrenia.","authors":"Ian M Michel, Manuel Gardea-Reséndez, Mete Ercis, Javier Ortiz-Orendain, Dina N Ali, Vanessa K Pazdernik, Alessandro Miola, Tamahara Gonzalez-Campos, Bostan Siralp, Joseph Bisoglio, Peggy M Gruhlke, J Michael Bostwick, Alastair J McKean, Jennifer L Vande Voort, Aysegul Ozerdem, Mark A Frye","doi":"10.1016/j.jaclp.2025.06.002","DOIUrl":"10.1016/j.jaclp.2025.06.002","url":null,"abstract":"<p><strong>Background: </strong>Asthma, characterized by chronic inflammatory burden, may increase the risk of developing bipolar disorder (BD) and schizophrenia (SZ). Emerging evidence suggests that sex differences can further influence the presentation and course of these conditions.</p><p><strong>Objective: </strong>To investigate the impact of antecedent asthma diagnosis on the clinical trajectory and age at first episode of mania (FEM) or psychosis (FEP) in individuals and explore sex differences in these associations.</p><p><strong>Methods: </strong>We identified patients with FEM or FEP within the Rochester Epidemiology Project. Patient demographics, psychiatric antecedents, and prior medical diagnoses were collected. Antecedent asthma diagnoses were extracted using International Classification of Diseases-10 codes via the Rochester Epidemiology Project records-linkage system.</p><p><strong>Results: </strong>Among 201 patients with FEM (n = 72) or FEP (n = 129), 50 (24.9%) had a prior diagnosis of asthma. There was no difference in asthma prevalence by diagnosis (24.8% BD vs. 25.0% SZ; P = 0.976) or sex (male 22.4% vs. female 31.5%, P = 0.189). Patients with asthma were more likely to have an antecedent psychiatric disorder prior to their first episode (P = 0.008), particularly depressive disorders (P = 0.006). A significant interaction effect was found between sex and asthma on age at first episode, with females with asthma experiencing a significantly earlier illness onset (F [1197] = 8.20, P = 0.006). These findings remained significant in sensitivity analyses excluding patients without at least one year of follow-up prior to the first episode.</p><p><strong>Conclusions: </strong>Antecedent asthma was prevalent in our cohort and associated with increased psychiatric illness burden and an earlier age of onset in females with BD or SZ. These findings highlight important comorbidity patterns to consider in the antecedent illness trajectory and the need for further research into the inflammatory and sex-specific mechanisms underlying serious mental illness.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CL Case Conference: Treatment Over Objection in the General Hospital.","authors":"Natasha R Pillai, Adira Hulkower, Shane Gallagher, Cyril Abraham, Rubiahna Vaughn","doi":"10.1016/j.jaclp.2025.05.006","DOIUrl":"10.1016/j.jaclp.2025.05.006","url":null,"abstract":"<p><p>We present the case of a 65-year-old female with schizophrenia admitted to the general hospital for a urinary tract infection complicated by psychotropic nonadherence and severe agitation. Treatment over objection (TOO) for urinary tract infection and underlying severe mental illness was granted by the court. However, treatment was delayed by staff discomfort and unfamiliarity with TOO and further complicated by the patient's ongoing psychosis and agitation. The multidisciplinary team provides commentary and guidance on the management of this commonly encountered scenario. Key teaching points include the ethical dilemmas of TOO, goals of TOO, and difficulties implementing TOO in the general hospital from both physician and nursing perspectives. We discuss the logistical barriers hindering implementation of TOO in the general hospital setting, the pivotal role of the consultation-liaison psychiatrist, and provide a general guide for implementing TOO in the general hospital.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182258","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":"Dual Orexin Receptor Antagonists for Delirium: A Scoping Review and Feasibility Trial of Daridorexant.","authors":"Mark A Oldham, Heather L Lander, Joy J Choi, Marjorie S Gloff, Peter A Knight, Jacob W Nadler","doi":"10.1016/j.jaclp.2025.05.003","DOIUrl":"10.1016/j.jaclp.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>No medication is currently approved either for the prevention or treatment of delirium despite its tremendous clinical impact. Sleep-wake disturbances offer a promising target for delirium therapeutics, with a growing body of literature suggesting a potential role of dual orexin receptor antagonists (DORAs).</p><p><strong>Objective: </strong>This report provides a scoping review of the literature on DORAs for delirium and the results of a feasibility trial of daridorexant to prevent delirium after heart surgery.</p><p><strong>Methods: </strong>We conducted a scoping review according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) for Scoping Reviews guidelines for peer-reviewed reports of DORAs for delirium. Next, we report sample characteristics and results for the feasibility aims from our single-site, double-blind, randomized placebo-controlled feasibility trial of daridorexant 50 mg given the first three nights after heart surgery to prevent delirium.</p><p><strong>Results: </strong>Our scoping review includes 30 reports: 4 case reports/series, 1 clinical effectiveness project, 22 retrospective cohort studies, and 3 clinical trials. This literature is authored almost exclusively by teams from Japan. Most publications are on suvorexant. Although published data suggest a potential role for DORAs to prevent delirium, they remain inconclusive. We demonstrate the feasibility of our study (n = 11). In this preliminary trial, daridorexant-arm subjects had a numerically lower mean delirium symptom burden on postoperative days 1-3.</p><p><strong>Conclusions: </strong>The evidence in support of DORAs for delirium calls for adequately powered efficacy trials. We also emphasize the importance of considering the pharmacokinetics of DORAs for delirium to maximize potential benefit and minimize the risk of next-morning sedation.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to ‘Scoping Review on Educational Programs for Medical Professionals on the Management of Acute Agitation’ [Journal of the Academy of Consultation-Liaison Psychiatry volume 64 Issue 5 (2023) 457–467]","authors":"Idris Leppla M.D. ,&nbsp;William Tobolowsky M.D. ,&nbsp;Sanam Patel B.S. ,&nbsp;Artin Mahdanian M.D. ,&nbsp;Katie Lobner M.L.I.S. ,&nbsp;Christine Caufield-Noll M.L.I.S. ,&nbsp;I. Lucia Ponor M.D., M.B.A. ,&nbsp;Durga Roy M.D., M.S., F.A.C.L.P.","doi":"10.1016/j.jaclp.2025.03.003","DOIUrl":"10.1016/j.jaclp.2025.03.003","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Page 275"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796958","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 D.O. ,&nbsp;Amber N. Edinoff M.D. ,&nbsp;Joji Suzuki M.D.","doi":"10.1016/j.jaclp.2025.02.003","DOIUrl":"10.1016/j.jaclp.2025.02.003","url":null,"abstract":"<div><h3>Objectives</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 224-229"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","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}

{"title":"A Case of Avoidant / Restrictive Food Intake Disorder in an Adult With Schizophrenia and Obsessive-Compulsive Disorder","authors":"Raissa Li BS,&nbsp;Varsha Radhakrishnan MD","doi":"10.1016/j.jaclp.2025.01.005","DOIUrl":"10.1016/j.jaclp.2025.01.005","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 268-269"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076556","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":"Developing a Clinical Workflow for Early Recognition and Diagnosis of Autoimmune Encephalitis in Patients Presenting With Atypical Psychosis","authors":"Grace Russo M.D. ,&nbsp;Lucy Jia M.D. ,&nbsp;Carla Y. Kim B.A. ,&nbsp;Konstantin Stojanovic M.D. ,&nbsp;Sarah F. Wesley M.D. ,&nbsp;George H. Denfield M.D. ,&nbsp;Paula Askalsky M.D. ,&nbsp;Gad Noy M.D. ,&nbsp;Kiran T. Thakur M.D.","doi":"10.1016/j.jaclp.2025.02.001","DOIUrl":"10.1016/j.jaclp.2025.02.001","url":null,"abstract":"<div><h3>Background and Objective</h3><div>Atypical psychosis is often difficult to diagnose and treat, and delays in identifying the underlying etiology can worsen patient outcomes. We present a novel clinical workflow for patients presenting to the emergency department with features of atypical psychosis to standardize the diagnostic process with the goal of earlier recognition and diagnosis of autoimmune encephalitis.</div></div><div><h3>Methods</h3><div>Through literature review and multidisciplinary discussions, we developed a clinical workflow to direct patient management and diagnostic testing using the following identified “red” and “yellow” flags of atypical psychosis: unexplained seizures, focal neurologic deficits, autonomic instability, movement disorder in the absence of antipsychotics, hyponatremia, age greater than 40 years, psychosis refractory to 2 appropriate treatment trials, infectious or systemic prodrome, and history of malignancy. We then reviewed electronic medical records to assess the disposition and outcomes of patients who underwent the workflow.</div></div><div><h3>Results</h3><div>From January 2022 to September 2023, 38 patients presenting with atypical psychosis were assessed using our new workflow in the Comprehensive Psychiatric Emergency Program. Most patients (23/38) entered the workflow due to one yellow flag, and age greater than 40 years was the most frequent flag feature (31/38). Ultimately, 57.9% (22/38) were diagnosed with primary psychiatric disorders, while 15.8% (6/38) had primary neurological diagnoses, including 3 immune-mediated cases. A survey of neurology and psychiatry team members showed the workflow was generally viewed as straightforward and effective.</div></div><div><h3>Conclusions</h3><div>Our novel clinical workflow facilitated early neurologic consultation and management of patients presenting with atypical psychosis, identifying both immune-mediated and nonimmune-mediated neurologic disorders.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 251-260"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460529","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}