Psychosomatics
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Traumatic brain injury (TBI) is an increasingly common cause of behavioral and emotional dysregulation among hospitalized patients. While consultation-liaison psychiatrists are often called to help manage these behaviors, acute pharmacological management guidelines are limited. ⋯ The pharmacological management of agitated patients immediately following a TBI is still an area of much-needed research, as there is limited data-driven guidance in the literature.
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We sought to determine how delirium subtyped by arousal affected 6-month function and cognition in acutely ill older patients. ⋯ Delirium with normal arousal, as opposed to delirium with decreased or increased arousal, was the only arousal subtype significantly associated with worsening 6-month function and cognition. Subtyping delirium by arousal may have important prognostic value.
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Pulmonary hypertension is a highly disabling condition characterized by a progressive increase in pulmonary arterial pressure. Even though pulmonary hypertension may cause great emotional distress, research examining the determinants of patients' emotional well-being has been scarce and has mostly focused on the role of disease-related factors. ⋯ Patients with considerably different levels of disease severity may develop clinically-significant depressive and anxiety symptomatology. This suggests that there is not a perfect correspondence between the level of disease severity and the repercussions thereof across patients. Accordingly, these results suggest that emotional well-being may be better explained by taking into consideration patients' life circumstances, as these may modulate the repercussions of having pulmonary hypertension. The results also showed that anxiety symptoms constituted an extra burden to patients' QoL. The higher prevalence in this sample of clinically-significant symptoms of anxiety, compared to that of depression, suggest that feelings of fear and uncertainty may require special attention among patients with pulmonary hypertension.
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The California End of Life Option Act (EOLOA), which legalized physician-assisted death (PAD), became effective in 2016. The EOLOA does not require a mental health consultation in all cases nor does it state the standards for the mental health assessment. University of California, San Francisco Medical Center (UCSFMC) policy makers decided to require a mental health assessment of all patients seeking PAD under the EOLOA. ⋯ The local adoption of the California EOLOA by UCSFMC requires a mental health assessment of all patients requesting EOL services at UCSF. The clinical guideline for these assessments was locally developed, informed by the literature on EOL in other jurisdictions where it has already been available.