General hospital psychiatry
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In response to the spiraling anger and frustration voiced by the emergency room (ER) medical staff and the observed negative interactions between the alcohol-dependent patient and the ER staff, the author completed a 6-month retrospective review of all patients evaluated by the ER service with a complaint of alcohol abuse, chronic alcoholism, or requesting detoxification. As a result of that study, an ER-based comprehensive approach to the management of this population was proposed. Utilizing an existing Connecticut state statute, a specific approach to manage the skid-row alcoholic arriving repeatedly in the ER was developed. I report on this ER-based model and an approach to "capturing" the skid-row alcoholic.
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The authors analyze 133 cases of organic mental disorders (OMDs) from a total of 771 patients who were referred for psychiatric consultation from a general hospital. The cases represent a 2-year referral period which began July 1, 1980, when DSM-III criteria were instituted. Delirium and dementia are most commonly diagnosed and features of these, particularly in the geriatric population, are described. Delirium was more frequent in patients with multiple medical problems, was an indicator of poor prognosis having the highest mortality rate, and was usually undiagnosed by the referring physician.