General hospital psychiatry
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Gen Hosp Psychiatry · Jul 1996
Multicenter StudyAlcoholism and psychiatric comorbidity in general hospital inpatients.
A substantial psychiatric comorbidity has been observed in alcohol patients from specialized alcoholism and substance abuse treatment centers. However, hardly any results have yet been reported from general hospital inpatients. We report results from a survey of a representative sample of 400 general hospital inpatients (200 medical, 200 surgical) which was carried out not only to assess the prevalence of alcoholism but also the rates of additional psychiatric disorders. ⋯ Of these patients, lifetime alcoholism was associated with 41.3% lifetime psychiatric comorbidity, current alcoholism with 44.4% current comorbidity. Organic brain syndromes were diagnosed predominantly, followed by depressive disorders and phobias. With the exception of the high rate of organic brain disorders, the rates of other comorbid psychiatric disorders in the general hospital seem to resemble those of the general population rather than those from alcoholism treatment facilities.
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Gen Hosp Psychiatry · May 1996
Acute intoxication and substance abuse among patients presenting to a psychiatric emergency service.
It is common for patients to arrive at the Psychiatric Emergency Service (PES) under the influence of a variety of drugs. The purpose of this study was to 1) determine what impact there was on the PES of patients who arrive after engaging in substance abuse within the 24 hours prior to arrival; and 2) describe some of the parameters associated with substance abuse and mental illness in the PES setting. Consecutive evaluations done at the PES during the study month were reviewed retrospectively utilizing the extensive material collected in the screening chart. ⋯ However, they have much less need for psychiatric hospitalization. In contrast, the patients presenting with psychosis also have a high rate of behavior management needs, but these patients are very likely to be hospitalized. These findings suggest that an important role for the PES is a "filter" to triage patients to the appropriate treatment setting and that this role is fulfilled when the PES is able to provide sufficient time and resources for evaluation and/or stabilization.
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Gen Hosp Psychiatry · Nov 1995
The reliability of depression diagnosis in chronic low back pain. A pilot study.
The variability in estimated rates of major depressive disorder (MDD) in chronic pain samples may be accounted for by sample and methodological differences. Most studies rely on a single measure of depression and lack independent or repeated measures. This study investigated the prevalence of psychiatric disorders in a convenience sample of 18 patients disabled by low back pain (LBP) referred to, evaluated, and treated in a comprehensive pain rehabilitation program specifically designed to restore work readiness and return to work. ⋯ Both the SCID and Pain Medicine Evaluation accurately diagnosed the MDD cases they identified; 9 of 13 MDD cases (69%) were precipitated by a physical factor other than their pain. Three episodes of MDD were ruled out by confounding. These findings are discussed in relation to their implications for assessing pain patients for psychiatric comorbidity.
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Gen Hosp Psychiatry · Sep 1995
Delirium in critical care unit patients admitted through an emergency room.
Two hundred thirty-eight patients admitted consecutively to a critical care unit through an emergency room were assessed prospectively for the presence of delirium. Thirty-eight patients (16%) developed delirium. Delirium occurred with equal frequency in all disease categories. ⋯ In this population, serious medical disease is a better predictor of the development of delirium than the presence of abnormal brain imaging which required medical intervention. Although delirious patients have longer lengths of stay, the presence of delirium does not predict higher mortality, as has been reported in other populations. This could be because delirious patients admitted to the critical care unit through the emergency room have fewer premorbid medical problems predisposing them to poor outcome.