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Cheung J, Chan CY, Cheng HY. The Effectiveness of Interventions on Improving the Mental Health Literacy of Health Care Professionals in General Hospitals: A Systematic Review of Randomized Controlled Trials. J Am Psychiatr Nurses Assoc 2024; 30:465-479. [PMID: 37615199 DOI: 10.1177/10783903231194579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
BACKGROUND Suboptimal mental health literacy levels among general hospital health care professionals negatively impact the care coordination of patients with physical-mental comorbidity. AIMS This review is to examine the evidence on the effectiveness of interventions to improve the mental health literacy of general hospital health care professionals. METHODS A systematic search of literature was conducted in 13 electronic databases with manual searching of reference lists from 1980 to 2021. Studies were screened by pre-set eligibility criteria, that is, participants who were general hospital health care professionals taking care of adult patients, the interventions aimed at improving any components of participants' mental health literacy, comparisons were alternative active intervention or no intervention, and the primary outcomes were any aspects of mental health literacy. RESULTS Eight randomized controlled trials (N = 1,732 participants) were included in this review. Evidence indicated that mental health literacy interventions with educational components can improve components of the health care professionals' mental health literacy, in terms of mental health knowledge and mental illness-related attitudes/stigma. In addition, few studies evaluated all components of participants' mental health literacy. CONCLUSIONS Based on the available evidence, educational interventions had a positive effect on components of general hospital health care professionals' mental health literacy. Health care organizations should provide educational programs to enhance general hospital health care professionals' mental health literacy. Further studies are needed to explore interventions that target all components of general hospital staff's mental health literacy and to evaluate its impact on the psychiatric consultation-liaison service utilization in general hospitals, as well as patient outcomes.
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Affiliation(s)
- Janice Cheung
- Janice Cheung, RN, RN(Psy), BN(Hons), MSc (Mental Health Nursing), The Chinese University of Hong Kong, Hong Kong SAR, China; Tuen Mun Hospital, Hong Kong SAR, China
| | - Cheuk Yin Chan
- Cheuk Yin Chan, RN(Psy), BNM(Hons), MSc(Mental Health Nursing), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Yu Cheng
- Ho Yu Cheng, RN, RN(Psy), BN(Hons), PgD(Psychiatric/Mental Health Nursing), PhD, The Chinese University of Hong Kong, Hong Kong SAR, China
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2
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Barra BJ, Barahona M, Varela LF, Calvo P, Bastidas A, Carreño J, Pintor L. A Cross-Sectional, Retrospective, and Comparative Study between Delirium and Non-Delirium Psychiatric Disorders in a Psychogeriatric Inpatient Population Referred to Consultation-Liaison Psychiatry Unit. Medicina (B Aires) 2023; 59:medicina59040693. [PMID: 37109651 PMCID: PMC10141533 DOI: 10.3390/medicina59040693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/24/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Background and objectives: Delirium is the most prevalent psychiatric disorder in inpatient older people. Its presence is associated with higher rates of institutionalization, functional disability and mortality. This study aims to evaluate delirium in a hospitalized psychogeriatric population, focusing on which factors predict the appearance of delirium, the impact it generates and the diagnostic concordance between non-psychiatric physicians and psychiatrists. Material and methods: This is an observational, cross-sectional, retrospective, and comparative study. We obtained data from a sample of 1017 patients (≥65 years) admitted to general hospital and referred from different services to the consultation-liaison psychiatry (CLP) unit. Logistic regression was performed using delirium as the dependent variable. To estimate the concordance of the diagnoses, the Kappa coefficient was used. To assess the impact of delirium, an ordinal regression, Wilcoxon median test and Fisher’s test were performed. Results: Delirium is associated with a higher number of visits, OR 3.04 (95% CI 2.38–3.88), longer length of stay and mortality, OR 2.07 (95% CI, 1.05 to 4.10). The model to predict delirium shows that being >75 years old has an OR of 2.1 (95% CI, 1.59–2.79), physical disability has an OR of 1.66 (95% CI, 1.25–2.20), history of delirium has an OR of 10.56 (95% CI, 5.26–21.18) and no use of benzodiazepines has an OR of 4.24 (95% CI, 2.92–6.14). The concordance between the referring physician’s psychiatric diagnosis and the psychiatrist CLP unit showed a kappa of 0.30. When analysing depression and delirium, the concordance showed Kappa = 0.46. Conclusions: Delirium is a highly prevalent psychiatric disorder, but it is still underdiagnosed, with low diagnostic concordance between non-psychiatric doctors and psychiatrists from CLP units. There are multiple risk factors associated with the appearance of delirium, which must be managed to reduce its appearance.
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Affiliation(s)
- Bernardo J. Barra
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
- Mental Health Service, Clínica Universidad de los Andes, Santiago 7591047, Chile
- Department of Psychiatry, Medicine School, Universidad Andrés Bello (UNAB), Santiago 8370146, Chile;
- Correspondence: ; Tel.: +56-9-9139-9020
| | - Maximiliano Barahona
- Department of Orthopaedic Surgery, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
| | - Luis F. Varela
- Department of Psychiatry, Medicine School, Universidad Andrés Bello (UNAB), Santiago 8370146, Chile;
| | - Pilar Calvo
- Medicine School, University of Chile, Santiago 8330015, Chile
| | - Anna Bastidas
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
| | - Jorge Carreño
- Department of Psychiatry, Medicine School, Universidad de Santiago de Chile, Santiago 8380456, Chile
- Department of Psychiatry, Medicine School, Universidad Mayor, Santiago 8330015, Chile
| | - Luis Pintor
- Department of Psychiatry, Hospital Clinic i Provincial of Barcelona, University of Barcelona, 08036 Barcelona, Spain (L.P.)
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), University of Barcelona, 08036 Barcelona, Spain
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3
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Xue Z, Yanwen L, Wenwen Z, Mei L, Huihui J, Hongbin L, Ying W, Ning L, Le H, Xueyang H, Yitong H, Mingxiao M. A framework for the implementation of consultation-liaison psychiatry from the characteristics of psychosomatic consultations at a general hospital in china. Int J Psychiatry Med 2023:912174231161912. [PMID: 36883233 DOI: 10.1177/00912174231161912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To understand the current situation and characteristics of consultation-liaison psychiatry (CLP) service in general hospital, to compare the results of the literature on CLP published in other hospitals in China and abroad, and to find deficiencies for the current differences. METHODS The medical records of all inpatients who had liaison consultations in the first year of the establishment of Xi'an International Medical Center Hospital, China, were collected. Statistical analysis was performed on the general demographic data, department origin, number of consultations, the reason for consultation, diagnosis of consultation, and follow-up of patients. RESULTS A total of 630 patients were enrolled in the past 1 year, of which, 45.23% were males and 54.8% were females. 89.2% of non-psychiatric departments applied for psychosomatic consultation. The percentage of middle-aged and elderly patients was 75.6%, including 61.6% of patients aged 45-74 years. The internal medicine department had the highest number of consultations (48.2%), including respiratory medicine (12.1%), neurology (12.1%), gastroenterology (12.1%), and cardiology (12.1%). For surgical patients, orthopedic patients (rehabilitation, 6.5%) comprised the majority of consults. The main reasons for requesting psychosomatic consultations included depressive symptoms (139 cases, 22.8%), anxiety symptoms (137 cases, 22.5%), sleep problems (111 cases, 18.2%), as well as hallucinations and delusions or behavioral disorders (68 cases, 11.2%), accounting for a total of 74.59% (455/630). CONCLUSION A significant gap exists between the level of CLP services in China and developed regions in Europe and the United States, mainly due to low consultation rates and referrals and imperfect CLP service.
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Affiliation(s)
- Zou Xue
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Liu Yanwen
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China.,Xi'an Physical Education University, Xi'an, China
| | - Zhang Wenwen
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Li Mei
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Jing Huihui
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Lu Hongbin
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Wang Ying
- Department of Psychosomatic Medicine, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Liu Ning
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Han Le
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Han Xueyang
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China
| | - Hou Yitong
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China.,Xi'an Physical Education University, Xi'an, China
| | - Ma Mingxiao
- Department of Adolescent Mental Health, Mental Hospital, 555086Xi'an International Medical Center, Hospital of Northwest University, Xi'an, China.,Xi'an Physical Education University, Xi'an, China
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4
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Zapata C, Garces JJ, Duica K, Restrepo C, Ocampo MV, Velásquez-Tirado JD, Ricardo C, Trzepacz PT, Franco JG. Variables associated with concordance or discordance for delirium diagnosis between referring and consulting physicians at a Tertiary Hospital in Colombia: Prospective observational study. Medicine (Baltimore) 2022; 101:e32096. [PMID: 36626485 PMCID: PMC9750523 DOI: 10.1097/md.0000000000032096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Delirium is an acute state of impaired consciousness and a medical urgency. Its broad range of alterations in mental status make diagnosis challenging. Awareness and accurate provisional diagnosis by nonpsychiatric clinicians are important for prompt management. Because delirium symptoms overlap and mimic other neuropsychiatric conditions, a referral to a consultant psychiatrist is often needed. The aim of this study was to determine the discriminating variables that are associated with concordance or discordance for a DSM-5 delirium diagnosis made by the consultation/liaison (C/L) psychiatrist as compared to the referral diagnosis/reasons given by the referring physicians for inpatients from a Tertiary Hospital in a Latin-American country. Prospective study of a cohort of 399 consecutive patients admitted to any ward of a university hospital in Medellin-Colombia and referred by a specialist physician to the C/L Psychiatry service. Analyses for diagnostic concordance used a nested sample of 140 cases diagnosed with delirium by the psychiatrist. Two multivariate logistic models were run, for delirium diagnosis concordance and discordance between the referring physician and C/L psychiatrist. The referral diagnosis was concordant with that of Psychiatry in 90/140 patients in 64.3%, with 35.7% discordance. Increasing age (OR = 1.024) and internal medicine ward (OR = 3.0) were significantly related (Wald statistic P < .05) to concordance in the multivariate analysis whose model accuracy was 68.6%. Trauma/orthopedics ward (OR = 5.7) and SARS-CoV-2 infection (OR = 3.8) were important contributors to the model fit though not significant. Accuracy of the discordance model was 70.7%, where central nervous system (CNS) disorder (OR = 6.1) and referrals from ICU (OR = 4.9), surgery (OR = 4.6), neurology/neurosurgery (OR = 5.1) and another consultant (OR = 4.7) were significantly related (Wald statistic P < .05), while metabolic/endocrine disorder (OR = 2.7) was important for model fit, but not significant. Concordance for delirium diagnosis was higher from services where education, guidelines and working relationships with C/L Psychiatry could have contributed beneficially whereas, surprisingly, CNS disorders and neurology/neurosurgery services had higher discordance, as well as the ICU. Routine use of brief sensitive delirium assessment tools such as the DDT-Pro could enhance provisional delirium diagnosis.
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Affiliation(s)
- Carolina Zapata
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan J. Garces
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Kelly Duica
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Cristóbal Restrepo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - María V. Ocampo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Juan D. Velásquez-Tirado
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Carmenza Ricardo
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Paula T. Trzepacz
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - José G. Franco
- Grupo de Investigación en Psiquiatría de Enlace (GIPE), Facultad de Medicina, Universidad Pontificia Bolivariana, Medellín, Colombia
- * Correspondence: José G. Franco, Facultad de Medicina de la Universidad Pontificia Bolivariana (Campus Robledo), Medellín 050036, Colombia (e-mail: )
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5
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Huarcaya-Victoria J, Segura V, Cárdenas D, Sardón K, Caqui M, Podestà Á. Analysis of the care provided over a six-month period by the liaison psychiatry unit at a general hospital in Lima, Peru. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:105-112. [PMID: 35753981 DOI: 10.1016/j.rcpeng.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/05/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS In a total of 400 referrals evaluated, the average age was 58 ± 17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.
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Affiliation(s)
- Jeff Huarcaya-Victoria
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru; Departamento Académico de Psiquiatría, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru.
| | - Victoria Segura
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Danitza Cárdenas
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Kathia Sardón
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Mónica Caqui
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Ángela Podestà
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
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6
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Ghosal MK, Ray AK. Assessment of Psychiatric Disorders in Consultation-Liaison Setting. Indian J Psychiatry 2022; 64:S211-S227. [PMID: 35602358 PMCID: PMC9122156 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Malay Kumar Ghosal
- Department of Psychiatry, Medical College, Kolkata, West Bengal, India E-mail:
| | - Anindya Kumar Ray
- Department of Psychiatry, Medical College, Kolkata, West Bengal, India E-mail:
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7
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Gautam S, Gautam M, Jain A, Yadav K. Overview of practice of Consultation-Liaison Psychiatry. Indian J Psychiatry 2022; 64:S201-S210. [PMID: 35602371 PMCID: PMC9122154 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_1019_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/05/2022] [Accepted: 01/15/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shiv Gautam
- Department of Psychiatry, Gautam Hospital and Institute of Behavioural Sciences, Jaipur, Rajasthan, India
| | - Manaswi Gautam
- Gautam Hospital and Research Center, Jaipur, Rajasthan, India
| | - Akhilesh Jain
- Department of Psychiatry, ESI Model Hospital, Jaipur, Rajasthan, India E-mail:
| | - Kuldeep Yadav
- Department of Psychiatry, ESI Model Hospital, Jaipur, Rajasthan, India E-mail:
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8
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Kim H, Khanna R, Olver J, Norman TR. Diagnostic agreement and concordance between consultation-liaison psychiatry and non-psychiatric (medical and surgical) doctors: changes within junior doctor's terms. Australas Psychiatry 2022; 30:60-63. [PMID: 35086341 DOI: 10.1177/10398562211037338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether diagnostic agreement and concordance between non-psychiatric (medical and surgical) doctors and consultation-liaison psychiatry changes within junior doctors' terms. METHOD This was a retrospective cohort analysis of referrals from medical and surgical units to a consultation-liaison psychiatry service. Diagnostic agreement was calculated across all diagnoses and expressed as a percentage. Diagnostic concordance (expressed using Cohen's Kappa) was calculated for the two most common diagnoses of depression and delirium. Diagnostic agreement and concordance in the first two weeks (Timepoint A) were compared to those in the last two weeks (Timepoint B) of junior doctors' terms. RESULTS Around half the referrals (Timepoint A = 48.1%, Timepoint B = 54.0%) were excluded as no diagnosis was listed.Diagnostic agreement over all diagnoses was 31.7% (Timepoint A) and 29.9% (Timepoint B) and was not statistically different. Diagnostic concordance for depression increased from fair to moderate but was not statistically significant. Diagnostic concordance for delirium was substantial for both timepoints and were not statistically different. CONCLUSIONS No statistically significant change in diagnostic accuracy over a junior doctors' term was found in this study.
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Affiliation(s)
- Hannah Kim
- Consultant Psychiatrist, Peninsula Health, Frankston, VIC, Australia
| | - Rahul Khanna
- Consultant Psychiatrist, Austin Health, Heidelberg, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - James Olver
- Consultant Psychiatrist, Austin Health, Heidelberg VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Trevor R Norman
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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Abstract
Delirium is the most common psychiatric diagnoses encountered in patients with various medical-surgical illnesses, in all the treatment set-ups, with relatively higher incidence and prevalence in the intensive care units. As delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. This study aims to assess the research output involving patients of delirium from India. A comprehensive search was undertaken using Medline (PubMed) and other databases. Search words included were “delirium,” “delirious,” “delirium tremens” AND “India.” No filters were used. Internet and hand searches yielded 305 articles. Out of these articles, 151 had the terms “delirium,” “delirious,” “delirium tremens” in the title and these were included for the review. Additionally, 14 articles were included for the review, although these did not have these terms in the title, but delirium was one of the major outcome parameters in these studies. Majority of the papers were original articles (
n
= 81), and these were followed by, case reports (
n
= 58), review articles (
n
= 10), letter to the editor (not as case reports but as a communication;
n
= 13), editorials (
n
= 2) and one clinical practice guideline. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with occasional studies focusing on effectiveness of various pharmacological interventions. There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of nonpharmacological interventions, and evaluation of prevention strategies. It is the need of the hour to carry out more studies to further our understanding of delirium in the Indian context.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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10
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Huarcaya-Victoria J, Segura V, Cárdenas D, Sardón K, Caqui M, Podestà Á. Analysis of the Care Provided Over a Six-Month Period by the Liaison Psychiatry Unit at a General Hospital in Lima, Peru. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(20)30089-5. [PMID: 33735026 DOI: 10.1016/j.rcp.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/26/2020] [Accepted: 10/05/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Consultation-liaison psychiatry is a branch of clinical psychiatry that enables psychiatrists to carry out a series of activities within a general hospital. The number of liaison psychiatry units around the world has increased significantly, and Peru is no exception. However, this development is heterogeneous and unknown, so recent study reports are required to reveal the characteristics and details of the clinical care services provided by these units. AIM To describe and report the socio-demographic and clinical characteristics of patients evaluated in the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital in Lima, Peru, and to analyse the symptomatic and syndromic nature of the identified conditions. METHODS Cross-sectional descriptive study. Referrals to the Liaison Psychiatry Unit of the Guillermo Almenara Irigoyen National Hospital between May and October 2019 were studied, and a factor analysis of the symptoms was conducted. RESULTS In a total of 400 referrals evaluated, the average age was 58±17.09 years and 61.5% of the patients were women. The rate of psychiatric consultation was 2.73%. Internal medicine (13.9%) was the service that most frequently requested a psychiatric consultation. The disorder most frequently diagnosed was anxiety (44%), and the symptoms most frequently found were depression (45.3%), insomnia (44.5%), and anxiety (41.3%). The most used treatments were antidepressants (44.3%). The exploratory factor analysis of the symptoms showed three syndromic components: delirium, depression, and anxiety. CONCLUSIONS The typical patient of this sample is a woman in her late 50s, suffering from a non-psychiatric medical illness, and with anxiety disorders as the main diagnosis resulting from the psychiatric consultation.
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Affiliation(s)
- Jeff Huarcaya-Victoria
- Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú; Departamento Académico de Psiquiatría, Facultad de Medicina de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Victoria Segura
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Danitza Cárdenas
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Kathia Sardón
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Mónica Caqui
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
| | - Ángela Podestà
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú
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11
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Munisami T, Namasivayam RK, Annamalai A. Mental-Illness-Related Stigma in Health Care in South India: Mixed-Methods Study. Indian J Psychol Med 2021; 43:58-64. [PMID: 34349308 PMCID: PMC8295582 DOI: 10.1177/0253717620932244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Stigma related to mental illness is a reality among health care providers. This study is an attempt to understand the attitudes of doctors from different specialties toward mental illness and the stigma related to it. METHODS We used a concurrent nested mixed-methods approach to understand and identify the various factors of mental-illness-related stigma in medical practitioners. Between November 2018 and March 2019, 100 medical practitioners from South India were administered a self-reporting OMS-HC (Opening Minds Scale for Health Care Providers), followed by in-depth interviews among 25 of the 100 participants selected using purposive sampling. Quantitative surveys were analyzed using SPSSv23. In-depth interviews were transcribed as extended notes, translated, and initially explored using focused coding and the constant comparative method. RESULTS Though findings from quantitative analysis show low to moderate stigma (Mean = 53.52, SD = 7.61), the qualitative study revealed unintended and covert negative attitude toward mental illness. CONCLUSION As stigma occurs at various levels-structural, institutional, interpersonal, and personal-anti-stigma measures also need to be systematically designed. Qualitative studies give more insight regarding the nature of stigma in medical practitioners toward mental illness.
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Affiliation(s)
- Thenral Munisami
- Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kanchipuram, Tamil Nadu, India
| | - Rajesh Kannan Namasivayam
- Government Institute of Psychiatric Medicine, Research and Rehabilitation, Government Theni Medical College & Hospital, Theni, Tamil Nadu, India
| | - Arunkumar Annamalai
- LAMED, Center for Interdisciplinary Research on Language Acquisition and Allied Sciences, Chennai, Tamil Nadu, India
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12
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AlSalem M, AlHarbi MA, Badeghiesh A, Tourian L. Accuracy of initial psychiatric diagnoses given by nonpsychiatric physicians: A retrospective chart review. Medicine (Baltimore) 2020; 99:e23708. [PMID: 33371117 PMCID: PMC7748330 DOI: 10.1097/md.0000000000023708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/17/2020] [Indexed: 12/03/2022] Open
Abstract
Despite the increased morbidity and mortality associated with psychiatric illnesses, there remains a substantial level of inaccuracy of the initial psychiatric diagnoses given by nonpsychiatric physicians. This study examines the accuracy of initial psychiatric diagnoses by non-psychiatric physicians at the McGill University Health Center (MUHC).We conducted a retrospective chart review for all consultations requested from the consultation-liaison psychiatry service at MUHC. We included all the consultations from January 1, 2018, to December 30, 2018, and excluded patient data with established psychiatric diagnoses. In all requested consults, each diagnosis of a referring physician was compared with the final diagnosis given by the C-L psychiatry team. Conformity between the 2 was validated as accurate.Of the 980 referred inpatients, 875 were enrolled. Patients ranged in age and those older than 70 years constituted the largest group: 54.4% were male. For 467 patients (55.20%), the initial diagnostic impression given by the referring physicians agreed with the final diagnosis made by the C-L psychiatry team, while in 379 patients (44.80%), the initial diagnostic impression was not consistent with the final diagnosis made by the C-L team.Diagnostic impressions of neurocognitive and substance use disorders were highly accurate, but this was not the case when the referring physicians suspected depression or bipolar, personality, or psychotic disorders. This study shows that around half of the referrals were accurately diagnosed, which evinces that nonpsychiatric physicians' knowledge regarding psychiatric conditions is not optimal and that might negatively impact screening and treating these conditions.
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Affiliation(s)
- Moayyad AlSalem
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
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13
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Grover S, Sahoo S, Mehra A, Dua D, Chakrabarti S, Bhalla A, Puri GD. New consultation liaison model of providing care to COVID patients. Asian J Psychiatr 2020; 54:102437. [PMID: 33271717 PMCID: PMC7546647 DOI: 10.1016/j.ajp.2020.102437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Swapnajeet Sahoo
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Aseem Mehra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Devakshi Dua
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashish Bhalla
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Goverdhan Dutt Puri
- Department of Anesthesia & Critical Care, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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14
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Dua D, Grover S. Profile of Patients Seen in Consultation-Liaison Psychiatry in India: A Systematic Review. Indian J Psychol Med 2020; 42:503-512. [PMID: 33354074 PMCID: PMC7735242 DOI: 10.1177/0253717620964970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This review aimed to evaluate all the published studies from India conducted in the consultation-liaison (CL) psychiatry setting to identify the diagnostic patterns and referral rates in this setting. Understanding the same can help in organizing the services and knowing the training needs. MATERIALS AND METHODS A thorough literature search was done in August 2020 using different search engines (PubMed, Medknow, and Google Scholar). This was followed by an individual search of various Indian Psychiatry journals and a hand search of references in the available articles. Only those studies that described patients referred to psychiatry services from various specialties were included. RESULTS A total of 33 studies were selected for the review. More than half of them were published in the last 5 years. Studies have primarily reported psychiatric profile medically ill inpatients referred to CL psychiatry services, with the majority of the studies reporting the number of patients seen for the duration of at least 1 year. The referral rates for inpatients across different institutes have varied from 0.01% to 3.6%. The referral rates from emergency set-ups have varied from 1.42% to 5.4%, and in outpatients, from 0.06% to 7.17%. The most commonly diagnosed psychiatric disorders across different studies include depression; organic disorders, including delirium; substance use; intentional self-harm; and anxiety disorders. CONCLUSIONS A limited number of studies have reported the profile of patients seen in CL psychiatry setups. Available data from these studies suggest that referral rates to psychiatry services from other specialists are dismal. There is an urgent need to change the focus of psychiatry training at both undergraduate and the postgraduate levels to enhance the psychiatric knowledge of physicians to improve psychiatry referrals.
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Affiliation(s)
- Devakshi Dua
- Dept. Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Dept. Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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Jo SJ, Jeong H, Son HJ, Lee HK, Lee SY, Kweon YS, Yim HW. Diagnostic Usefulness of an Ultra-Brief Screener to Identify Risk of Online Gaming Disorder for Children and Adolescents. Psychiatry Investig 2020; 17:762-768. [PMID: 32777921 PMCID: PMC7449830 DOI: 10.30773/pi.2019.0279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/24/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study examined the diagnostic validity of a three-item ultra-brief screening tool for online gaming disorder in line with the gaming disorder criteria in the International Classification of Diseases 11th Revision. METHODS The Three-item Gaming disorder Test-Online-Centered (TIGTOC) was composed of three items using a four-point Likert scale selected from the Internet Game Use-Elicited Symptom Screen (IGUESS). Among a cohort of 2319 young-adolescent Internet users, the baseline data of 228 healthy controls and 45 Internet-gaming-disorder cases were analyzed. Receiver operation characteristic (ROC) analysis was performed using mental health specialists' diagnoses as the gold standard. RESULTS The ROC curve analysis showed an area under the curve of 86%. Using a cut-off score of 4 from a full range of 0-9, the sensitivity, specificity, and Cronbach's α were 72%, 90%, and 0.811, respectively. TIGTOC scores was positively associated with time spent on online gaming, depressive symptoms, attention-deficit/hyperactivity disorder symptoms, and addictive Internet use. CONCLUSION The TIGTOC appears to be a brief, valid, and reliable screening tool for online gaming disorder within the community or in primary care settings.
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Affiliation(s)
- Sun-Jin Jo
- Deptartment of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyunsuk Jeong
- Deptartment of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Jung Son
- Department of Mental Health Research, National Center for Mental Health, Seoul, Republic of Korea
| | - Hae Kook Lee
- Department of Psychiatry, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Seung-Yup Lee
- Department of Psychiatry, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Republic of Korea
| | - Yong-Sil Kweon
- Department of Psychiatry, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Hyeon Woo Yim
- Deptartment of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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16
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Rosenblat JD, Kurdyak P, Cosci F, Berk M, Maes M, Brunoni AR, Li M, Rodin G, McIntyre RS, Carvalho AF. Depression in the medically ill. Aust N Z J Psychiatry 2020; 54:346-366. [PMID: 31749372 DOI: 10.1177/0004867419888576] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Depressive disorders are significantly more common in the medically ill compared to the general population. Depression is associated with worsening of physical symptoms, greater healthcare utilization and poorer treatment adherence. The present paper provides a critical review on the assessment and management of depression in the medically ill. METHODS Relevant articles pertaining to depression in the medically ill were identified, reviewed and synthesized qualitatively. A systematic review was not performed due to the large breadth of this topic, making a meaningful summary of all published and unpublished studies not feasible. Notable studies were reviewed and synthesized by a diverse set of experts to provide a balanced summary. RESULTS Depression is frequently under-recognized in medical settings. Differential diagnoses include delirium, personality disorders and depressive disorders secondary to substances, medications or another medical condition. Depressive symptoms in the context of an adjustment disorder should be initially managed by supportive psychological approaches. Once a mild to moderate major depressive episode is identified, a stepped care approach should be implemented, starting with general psychoeducation, psychosocial interventions and ongoing monitoring. For moderate to severe symptoms, or mild symptoms that are not responding to low-intensity interventions, the use of antidepressants or higher intensity psychotherapeutic interventions should be considered. Psychotherapeutic interventions have demonstrated benefits with small to moderate effect sizes. Antidepressant medications have also demonstrated benefits with moderate effect sizes; however, special caution is needed in evaluating side effects, drug-drug interactions as well as dose adjustments due to impairment in hepatic metabolism and/or renal clearance. Novel interventions for the treatment of depression and other illness-related psychological symptoms (e.g. death anxiety, loss of dignity) are under investigation. LIMITATIONS Non-systematic review of the literature. CONCLUSION Replicated evidence has demonstrated a bidirectional interaction between depression and medical illness. Screening and stepped care using pharmacological and non-pharmacological interventions is merited.
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Affiliation(s)
- Joshua D Rosenblat
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy.,Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Parkville, VIC, Australia.,Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.,Centre of Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Andre R Brunoni
- Service of Interdisciplinary Neuromodulation (SIN), Laboratory of Neuroscience (LIM27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Madeline Li
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Gary Rodin
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
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17
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Lee KKS, Silim UA. Implementation of the CLiP database. Int J Health Care Qual Assur 2019; ahead-of-print. [PMID: 31886638 DOI: 10.1108/ijhcqa-08-2018-0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to review the findings from an audit of the implementation of a consultation-liaison psychiatry (CLiP) database in all inpatients referred to a CLiP service at the largest hospital in Malaysia with the aim of improving the quality CLiP services. DESIGN/METHODOLOGY/APPROACH All inpatient referrals to the CLiP team were recorded over a three-month period and compared to previous audit data from 2017. Four audit standards were assessed: the reporting of referrals, timeliness of response indication of reason for referral and presence of a management plan. FINDINGS The compliance of reporting using the CLiP form was 70.1 per cent compared to 28 per cent in the audit data from 2017 after interventions were conducted. Analysis of the completed CLiP form reveals that 89 per cent of referrals were seen within the same working day. All referrals included the reason for referral. The most common reason for referral was for depressive disorders, but post-assessment, delirium was the most common diagnosis. In total, 87.8 per cent satisfied the audit criteria for a completed written care plan. ORIGINALITY/VALUE Specialised CLiP services are relatively new in Malaysia and this is the first paper to examine the quality of such services in the country. Interventions were effective in improving the compliance of reporting using the CLiP database. The findings suggest that the CLiP services are on par with international audit standards. Furthermore, data from this clinical audit can serve as a benchmark for the development of national operating policies in similar settings.
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Affiliation(s)
| | - Umi Adzlin Silim
- Department of Consultation-Liaison Psychiatry Unit, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Predictors of Disagreement Between Diagnoses From Consult Requesters and Consultation-Liaison Psychiatry. J Nerv Ment Dis 2019; 207:1019-1024. [PMID: 31790047 DOI: 10.1097/nmd.0000000000001018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We evaluated disagreement between reported symptoms and a final diagnosis of depression, anxiety, withdrawal, psychosis, or delirium through regression models assessing individual and combined diagnoses. Highest disagreement rates were reported for services classified as others (88.2%), general surgery (78.5%), and bone marrow transplant (77.7%). Disagreement rates varied widely across different diagnoses, with anxiety having the highest disagreement rate (63.3%), whereas psychosis had the lowest disagreement rate (10.6%). When evaluating kappa coefficients, the highest agreement occurred with diagnoses of withdrawal and psychosis (0.66% and 0.51%, respectively), whereas anxiety and depression presented the lowest values (0.31% and 0.11%, respectively). The best-performing predictive model for most outcomes was random forest, with the most important predictors being specialties other than the ones focused on single systems, older age, lack of social support, and the requester being a resident. Monitoring disagreement rates and their predictors provides information that could lead to quality improvement and safety programs.
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Elwadhi D, Gupta H, Ahmed Z, Jiloha R. Consultation-liaison psychiatry in newly established general hospital psychiatry unit: Scope and suggestions. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2019. [DOI: 10.4103/jmhhb.jmhhb_43_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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