Psychosomatics
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Opioid use disorders are a growing public health problem in the United States. Most women who are opioid-dependent are of childbearing age, and management of opioid dependence during pregnancy poses unique challenges. Assessment includes evaluation for addiction, withdrawal syndromes, and comorbid psychiatric diagnoses. Consultation-liaison (C-L) psychiatrists may also be involved in acute pain management, perinatal medication management, buprenorphine induction, and stabilization. For the past four decades, the standard of care has included methadone maintenance, but the increasing use of buprenorphine creates new treatment issues and opportunities. ⋯ In this review, the authors summarize known and emerging management strategies for opioid dependence in pregnancy pertinent to C-L psychiatrists.
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Identify the frequency with which pediatric care teams recognize delirium in patients referred for psychiatric consultation, whether their diagnosis is substantiated by the involved consultant, and whether this diagnosis is documented in the discharge problem list. ⋯ Delirium was not noted or mentioned in 88.7% of delirious patients referred for psychiatric consultation, potentially because it was never diagnosed by pediatrics. There is a low documentation rate of this condition on the discharge problem list, even in those children so diagnosed by pediatrics. These findings highlight the important role of the consultation psychiatrist as an educator as well as a diagnostician.
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Delirium, dementia and depression are the most prevalent mental disorders in elderly patients, and are associated with higher mortality. ⋯ These results suggest that elderly inpatients with delirium seen by a psychiatric consultation service have significantly higher mortality than elderly inpatients with depression, and that mortality is significantly associated with older age and length of hospital stay.
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To establish the role of psychiatrists and mental disorder in assisted dying practices in countries and states where such practices are legal. ⋯ No country has a blanket policy of mandatory psychiatric review but the specialty contributes in circumstances of exclusive mental disorder or when there is doubt regarding capacity and sound judgement. The absence of a mandatory role for psychiatrists means that reversible psychopathology may be missed. As a result, the patient's decision to end his/her life may be more informed by treatable mental disorder than by his/her lifelong preferences.
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Despite modern antiretroviral treatment, HIV-associated distal neuropathic pain (DNP) remains one of the most prevalent and debilitating complications of HIV disease. Neuropathic pain is often accompanied by depressed mood, and both pain and depression have been associated with decreased health-related quality of life (HRQOL) well-being. The relative contribution of depression and pain to worse life quality has not been addressed, however, even though a better understanding might sharpen intervention strategies. ⋯ These results suggest that interventions to improve HRQOL well-being in individuals with HIV-associated DNP may need to address not only pain intensity but mood state as well.