General hospital psychiatry
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Gen Hosp Psychiatry · Mar 2015
ReviewPostoperative cognitive dysfunction after liver transplantation.
Postoperative cognitive dysfunction (POCD) in liver transplant (LT) recipients is defined as a "more than expected" postoperative deterioration in cognitive domains, including short-term and long-term memory, mood, consciousness and circadian rhythm. It is diagnosed, after exclusion of other neurological complications, by using specific neuropsychological tests that need preoperative baseline. The aim of this systematic review was to assess the prevalence of POCD after LT and to analyze patients' symptoms, type and timing of assessment used. ⋯ Future studies should be focused on detecting preoperative and intraoperative factors associated to POCD in order to carry out appropriate strategies aimed at reducing this disabling health condition. Relationship between POCD and long-term outcome needs to be investigated.
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Gen Hosp Psychiatry · Mar 2015
Review Meta Analysis Comparative StudySchizophrenia and the risk of fractures: a systematic review and comparative meta-analysis.
People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness. ⋯ People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly, there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls-prevention strategies.
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Gen Hosp Psychiatry · Mar 2015
ReviewThe implementation of mindfulness in healthcare systems: a theoretical analysis.
Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. ⋯ In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way.
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Gen Hosp Psychiatry · Jan 2015
Case ReportsCatatonia in resource-limited settings: a case series and treatment protocol.
The catatonic syndrome ("catatonia") is characterized by motor and motivation dysregulation and is associated with a number of neuropsychiatric and medical disorders. It is recognizable in a variety of clinical settings. We present observations from the treatment of four individuals with catatonia in Haiti and Rwanda and introduce a treatment protocol for use in resource-limited settings. ⋯ Catatonia can be effectively and inexpensively treated in resource-limited settings. Identification and management of catatonia are critical for the health and safety of patients with this syndrome. Familiarity with the clinical features of catatonia is essential for health professionals working in any setting. To facilitate early recognition of this treatable disorder, catatonia should feature more prominently in global mental health discourse.
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Gen Hosp Psychiatry · Jan 2015
Review Case ReportsPsychiatric consequences of intraoperative awareness: short review and case series.
Intraoperative awareness is an unwanted outcome that consists of an explicit recall of events during a surgical procedure performed under general anesthesia. Despite its relatively infrequent occurrence, intraoperative awareness is of significant concern due to frequent adverse psychiatric sequelae. We present three patients who developed posttraumatic sequelae following an episode of awareness under anesthesia and discuss the importance of early detection and specific care.