International journal of psychiatry in medicine
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Delirium is the most common neuropsychiatric complication of hospitalized AIDS patients. Typically, delirium is multifactorial in etiology and a complete evaluation to rule out all treatable, contributable medical conditions should be the first stage in the approach to a delirious AIDS patient. While a search for probable cause is underway, the next goal of treatment should be sedation. To help clinicians recognize and manage delirium in advanced HIV disease, we describe our experience with 206 AIDS patients.
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Int J Psychiatry Med · Jan 1989
Isolating the impact of psychiatric consultations in the general hospital: psychiatric comorbidities and nursing intensity.
The amount of nursing services represents a substantial portion of the total cost of hospital treatment of medical/surgical patients. Patients receiving psychiatric consultations were compared to matched patients (DRG and LOS) who did not receive psychiatric services on the intensity of their nursing service needs. ⋯ Those who received a consultation had significantly lower intensity scores prior to seeing the psychiatrist. Although patients receiving psychiatric consultations did not show a significantly greater reduction in nursing acuity relative to their baseline levels than did the matched control patients, the amount of time the psychiatrist spent with consultation patients was positively related with the change in nursing intensity post-consultation.
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Int J Psychiatry Med · Jan 1989
ReviewNeuropsychiatric manifestations of obstructive sleep apnea: a review.
Obstructive sleep apnea (OSA) may result in neuropsychiatric complications. Psychiatrists need to be alert to the possibility that patients who present to them with cognitive and/or affective disorders, who also have sleep related complaints such as snoring and significant daytime hypersomnolence, may have OSA. Clinical suspicion needs to be reinforced by obtaining a history from the bed partner. ⋯ Once the diagnosis is made, several treatment options are available. Treatment of sleep apnea usually leads to a resolution, or at least improved control, of the complicating neuropsychiatric disorder. Physicians must be aware that sedating neuroleptic or antipsychotic agents may worsen sleep apnea and, thereby, aggravate the neuropsychiatric disturbance.
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Int J Psychiatry Med · Jan 1989
Delirium after elective orthopedic surgery: risk factors and natural history.
Forty-six orthopedic patients were studied to determine the incidence, natural history, and risk factors associated with post-operative delirium. Pre-operatively, patients were given a neuropsychological screening evaluation, the Mood Adjective Checklist (MACL), the Zung Depression Scale, the Anxiety Inventory Scale, and the Health Assessment Questionnaire (HAQ). A psychiatrist interviewed each patient on post-op day four for evidence of delirium as defined by DSM III criteria. ⋯ Treatment with propranolol, scopolamine, or flurazepam (Dalmane) conferred a relative risk for delirium of 11.7 (p = 0.0028). Delirium was associated with increased post-operative complications (p = 0.01), poorer post-operative mood (p = 0.06), and an increase of about 1.5 days in length of stay (not significant). Delirious patients were significantly less likely than matched controls to improve in function at six months compared with a pre-operative baseline HAQ (t = 6.43, p less than 0.001).
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This study examines the factors influencing family physicians' patient referrals for psychotherapy. A questionnaire designed from a pilot study of the full-time family practice faculty at Wright State University was mailed to all members (154) of the voluntary family practice faculty at Wright State University with a 63 percent return rate. ⋯ The most important therapist characteristics looked for by a family physician are ability, availability, appreciation of the person as a whole, interaction skills, and experience. The article also discusses the ways in which family physicians find a psychotherapist, the feedback desired by the family physician from a psychotherapist, and type of psychotherapist discipline preferred by the family physician for handling various patient situations.