Psychosomatics
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The authors identified the added cost attributable to postoperative delirium in patients undergoing elective surgery. The authors evaluated patients (n = 500) before their elective surgery, assessing cognitive functioning, medical conditions, medication usage, and other information regarding their health status. Using DSM-IV criteria, the authors assessed patients for delirium on Postoperative Days 1-4. ⋯ Delirium is an extremely costly disorder, both to the patient in terms of morbidity and mortality and to the medical facility. A prolonged LOS increases charges to third party payors and reduces return to physicians and hospitals when delirium develops. Careful presurgical screening and targeted postoperative interventions may help contain LOS and costs while affording greater physical, emotional, and cognitive health to patients hospitalized for elective surgery.
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There is limited discussion of maternal competency in the consultation-liaison psychiatry literature. As awareness and reporting of child abuse is increasing, maternal ability to care for newborns is more often called into question. Maternal risk factors for harm and neglect have been identified, and positive signs of maternal ability have also been recognized as important to appraise. ⋯ The competency exam by the psychiatrist requires a sensitive and nonjudgmental inquiry into maternal behavior and thoughts. The authors present a case study of an inpatient maternal competency consultation that illustrates some of the dilemmas encountered. Future directions should include more involvement by psychiatrists in preventive efforts and interventions that focus on pregnant women at risk in prenatal clinics and in the community.