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Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Increasingly, patients are exercising the right to refuse treatment. Patients who have been chronically ill or those who consider themselves terminally ill are most apt to do so. Accordingly, liaison psychiatrists are asked to determine whether refusal of treatment is an act of suicide or a competent choice. This is difficult to assess in the absence of delirium or overt psychosis. It is suggested that the dynamics and affective tones of the patients' reaction to the health care system as well as to family and friends are of major significance in this determination. The actual process of exploring these areas with patients making this choice is often therapeutic in restoring the patients' sense of control or authenticity. Often this process enables them to continue treatment and avoid the impulsive interpersonal anger that characterized the suicidal act.
Gen Hosp Psychiatry 1979 Dec
PMID:Refusal of treatment: suicide or competent choice. 52 Aug 32

Several authors have attempted to establish a correlation between glucose-6-phosphate dehydrogenase (G-6-PD) deficiency and chronic schizophrenia, and the results were contradictory. We propose that the correlation between G-6-PD deficiency and schizophrenia is to be found in the form of an acute delirium.
Arch Gen Psychiatry 1976 Oct
PMID:Glucose-6-phosphate dehydrogenase deficiency with psychosis. 97 Oct 29

Transient psychotic episodes may result from continuous cerebral epileptiform discharges unaccompanied by clinically observed seizures. Such episodes may mimic depressive, hysterical and schizophrenic psychosis and delirium. I describe two patients here and review eight patient histories from the literature. Diagnosis is established by use of electroencephalography during the psychotic episode. Correct diagnosis is essential because specific treatment is available and additional episodes may be prevented by appropriate long-term anticonvulsant therapy.
Arch Gen Psychiatry 1975 Sep
PMID:Transient ictal psychosis. 118 Jun 71

We retrospectively gathered survival data for a cohort of previously published, prospectively studied liver transplantation candidates. Of the 247 candidates in the original cohort, 130 were transplanted at our hospital. The 117 who were not transplanted were older, had significantly more cognitive impairment on Trailmaking Tests and slowing on electroencephalogram (EEG), and had more delirium (25% vs 15%); they also had significantly more impairment in family relationships prior to transplant. Of the 130 patients who were transplanted, 91 survived as of December 1989 and 39 did not. None of the cognitive, EEG, or serum albumin results differentiated these groups, nor did age or incidence of pretransplant delirium (21% of those who died vs 12% of survivors). However, the highest level of adaptive functioning in the year prior to candidacy evaluation was significantly better in survivors; and there was more family and social dysfunction in nonsurvivors. Though the nonsurvivors received significantly more livers, histocompatibility did not distinguish the groups. The presence or absence of delirium did not predict survival status or duration for the whole group of transplanted patients. However, for the subgroup of transplant survivors, delirious patients had significantly shorter waits for transplantation and longer survival times than nondelirious ones.
Gen Hosp Psychiatry 1992 Nov
PMID:Survival of 247 liver transplant candidates. Relationship to pretransplant psychiatric variables and presence of delirium. 147 8

The psychiatric morbidity of a general hospital's male medical ward in Hong Kong was studied using a one-stage single-rater method. Medical diagnoses were made according to ICD-9 on 91.5% of patients and 24% were diagnosed with DSM-III. The most common mental disorders included substance use disorder, dementia, and delirium. Of all the patients, 8.5% were not medically diagnosable and 5.3% were given only psychiatric diagnoses, the majority of which were substance use disorders.
Gen Hosp Psychiatry 1992 May
PMID:Psychiatric morbidity in a general medical ward. Hong Kong's experience. 160 Dec 96

Despite offering many benefits to patients, the hospital, and the hospital staff, an academic psychiatric consultation service is difficult to fund. By screening Medicare patients for psychiatric complications and comorbid conditions, the consultation-liaison (C-L) service can generate incremental revenue for the hospital by moving patients from lower-paying to higher-paying Diagnostic Related Groups (DRGs). The C-L service chief can negotiate with the hospital to obtain a portion of these incremental funds to support the C-L service. Concurrent psychiatric disorders that move patients to more complex DRGs include substance abuse, substance dependence, drug-induced delirium, drug-induced organic affective syndrome, and psychotic depression. This paper presents a method of calculating the incremental hospital revenue generated by such screening along with the results of applying the method to selected DRGs at a west coast teaching hospital. Implementing this program at that hospital in fiscal year 1989 would have resulted in screening 142 Medicare patients (2.2% of Medicare admissions), discovering an estimated 25 patients with comorbid psychiatric conditions, and generating $51,800 in incremental hospital revenue. In creating a screening program, a C-L service chief must be prepared to negotiate issues with the medical records department, referring physicians, and the hospital administration.
Gen Hosp Psychiatry 1992 Jan
PMID:Funding consultation-liaison psychiatry via Medicare screening. 173 Apr 4

The physiological imbalances associated with organ insufficiency and the complexity of organ transplant surgery and postoperative care puts patients at risk for psychiatric disorders. The brain is susceptible to a variety of insults as a result of these complex processes, including those secondary to medications and infections. We review literature relevant to organ transplant patients and also include empirical knowledge based on clinical practice. We first describe the physiologic and psychiatric issues for each major organ that is commonly transplanted, including liver, kidney, heart, bone marrow, and pancreas, as well as multiple organ transplantation. We then discuss the pharmacologic treatment and neuropsychiatric side effects of rejection with various immunosuppressants, including cyclosporine, azathioprine, OKT3, FK506, and corticosteroids. Certain bacterial, fungal, viral, and protozoal infections occur more frequently in the transplant population; their relationship to neuropsychiatric dysfunction is discussed. We then present details of psychopharmacotherapy of delirium, other organic mental disorders, depression, mania, anxiety, and insomnia, with attention to drug interactions and differential diagnosis. Particularly cautious monitoring of medication doses and serum levels is recommended in these patients.
Gen Hosp Psychiatry 1991 Jul
PMID:Psychopharmacology and neuropsychiatric syndromes in organ transplantation. 187 24

We report here a case of delirium that occurred after discontinuation of glucocorticoid therapy. Administration of hydrocortisone reversed the mental status changes seen in this patient. We review similar reported cases and discuss the direct actions of glucocorticoids on the brain.
Gen Hosp Psychiatry 1991 Jul
PMID:Delirium after cessation of glucocorticoid therapy. 187 29

The use of neuroleptic medication as antiemetics, or in the treatment of neuropsychiatric disorders in patients with AIDS, may be associated with extrapyramidal side effects and lead to difficulty with diagnosis and management. Two cases are presented that describe severe extrapyramidal syndromes occurring in two patients with AIDS, one treated with prochlorperazine and the other with prochlorperazine and metoclopropramide. It is possible that the neuropathologic lesions found in patients with the AIDS dementia complex may pre-dispose to extrapyramidal side effects of neuroleptic medication. The differential diagnosis and treatment of delirium, dementia, depression, and extrapyramidal reactions in patients with AIDS is discussed.
Gen Hosp Psychiatry 1989 Jul
PMID:Extrapyramidal reactions. Neuropsychiatric mimics in patients with AIDS. 256 9

The authors conducted comprehensive medical record reviews of 100 medical and surgical patients who received an organic mental disorder diagnosis by the Psychiatry Consultation-Liaison (C/L) Service of a large teaching hospital. The cases were randomly selected from among 182 patients with an organic mental disorder diagnosis, who, in turn, were drawn from 1085 consecutive psychiatric consultations conducted during a 1-year period. Dementia (34%) and delirium (32%) constituted the most common diagnoses. Approximately 78% of the patients were noted to have laboratory abnormalities (2.7 per patient), three quarters of which were routine tests. The mean age of patients without laboratory abnormalities (47.6 years) was 15 years younger than those with abnormal findings (62.6 years). The patients averaged 5.7 medications, with delirious patients averaging 7 medications and those with dementia, 4.5, a statistically significant difference. Patients with no laboratory abnormalities were receiving less medication (2.6) than those with abnormalities (6.5).
Gen Hosp Psychiatry 1989 Mar
PMID:An evaluation of patients who received an organic mental disorder diagnosis on a psychiatric consultation-liaison service. 270 92


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