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PubMed1987

Toward a profile of medically ill psychiatric patients.

We reviewed 564 consecutive psychiatric inpatient admissions. In support of previous studies, we found 51.9% to have significant medical disorders, nearly half of them "new" or previously unsuspected. Women, the elderly, substance abusers, and patients with nonschizophrenic functional psychoses had a higher prevalence of medical disorders. Using this information as a starting point, further work should be done to define a profile of the psychiatric patients at highest risk for medical illnesses.

Adult↗
PubMed2026

Genetic Contributors to Postoperative Delirium and Their Implications for Dementia Outcomes.

BACKGROUND: Postoperative delirium (POD) is a perioperative neurocognitive disorder that substantially impairs patient recovery. Unfortunately, its genetic risk profile and relationship with subsequent dementia remain unclear. This study aimed to elucidate genetic contributors to POD identified via Hospital Episode Statistics codes and to examine its association with subsequent dementia. METHODS: The study included 230,179 noncardiac and 21,254 cardiac surgery subjects from the UK Biobank, defining POD using delirium codes from the International Classification of Diseases (10th revision) recorded within the first 7 postoperative days. Genome-wide association studies were performed in the noncardiac and cardiac cohorts and their prespecified subgroups, followed by functional annotation, gene prioritization and drug-target analyses. Associations between POD and subsequent dementia were estimated using Cox models. RESULTS: In the noncardiac cohort, one genome-wide significant locus was identified at the APOE region, with rs429358 as the lead variant ( P = 5.00 × 10 -28 ). Integrative gene prioritization analyses highlighted multiple genes within this locus. Exploratory drug-target analyses suggested potential subgroup-specific drug-target enrichment. In the cardiac cohort, no genome-wide significant signals were detected. POD was associated with all-cause dementia after both noncardiac (hazard ratio, 6.45; 95% CI, 5.45 to 7.63) and cardiac (hazard ratio, 2.95; 95% CI, 1.71 to 5.08) surgeries. CONCLUSIONS: This study demonstrates APOE as a genetic risk locus for International Classification of Diseases-coded POD in the noncardiac surgery setting and confirms an association between POD and subsequent dementia.

Humans↗
PubMed1993

Psychiatry and mental retardation: towards a behavioural pharmacological concept.

The rediscovery of psychiatric disorders in mentally retarded subjects has revealed the inadequacy of existing diagnostic and classification systems. The major reason for the limitations of the latter is that such systems have not been developed for application in subjects with substantial intellectual handicaps or other brain dysfunctions. Furthermore, the impact of the different aetiological brain factors is more or less neglected, and so are the specific interrelations between brain dysfunctions and psychiatric symptoms. For a better understanding of the behavioural disorders in mentally retarded subjects, the data from primate studies should be taken into consideration, especially where these suggest a relationship between developmental factors and brain dysfunction. Finally, a functional approach is advocated, linking biological and psychological dysfunctions, that could eventually lead to a so-called functional psychopharmacology.

Animals↗
PubMed1990

Psychogeriatric patients in a general hospital: role of geropsychiatric consultation.

A total of 505 elderly patients aged 65 and over, seen at the Department of Psychiatry of Tosei General Hospital, were investigated retrospectively and classified according to the DSM-III-R criteria. The increase in the number of psychogeriatric patients over the last two decades was statistically significant. Organic mental disorders were most frequent (51%), followed by mood disorders (22%), sleep disorders (7%), somatoform disorders (6%), anxiety disorders (5%) and others. A high referral rate (42%) and a high incidence of various concurrent physical disorders (52%) were observed, and the role of geropsychiatric consultation in a general hospital was evaluated and discussed.

Aged↗
PubMed1988

Issues in the classification of mental retardation: differentiating among organic etiologies.

Many researchers of mental retardation fail to take etiological differences into account, although the value of distinguishing between organic and familial mental retardation has long been discussed. The argument is made that even the two-group approach needs to be extended so that groups with different organic etiologies are studied separately. Taking etiological distinctions into account will allow for more precise research and a better understanding of mental retardation. Evidence for the utility of differentiating retarded persons by etiology is provided by a research review showing examples of behavioral differences between organically retarded groups. It is concluded that such differentiation also has clear implications for intervention.

Child↗
PubMed1975

A psychogeriatric assessment program. II. Clinical and laboratory findings.

In a Psycholgeriatric Assessment Program, the statistical evaluation of clinical and laboratory data related to thyroid function in 80 patients led to the conclusion that: 1) differences in thyroid function between psychogeriatric patients of the organic and functional types were only slight, as determined by clinical symptoms and thyroxine blood levels, and 2) factor analysis for 53 selected variables indicated that loading for "gross disturbance of psychobiologic function" may be related to the symptom complex of hyperthyroidism/hyperadrenergism, and particularly to psychobiologic symptoms rather than purely somatic symptoms of hyperthyroidism. In comparison with a group of 60 healthy old people, the psychogeriatric patients showed many more signs of hyperactivity and other characteristics of this symptom complex. The results supported the preliminary impression of an energetic (hyperthyroid-sympathicotonic) reaction to mental decline, accompanied by plasma corticosteroid and electroencephalographic changes.

Adrenal Cortex Hormones↗
PubMed1975

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients.

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

Aged↗
PubMed1975

A psychogeriatric assessment program. I. Social functioning and ward behavior.

Eightly newly admitted psychogeriatric patients were intensively investigated by a variety of disciplines -- medical, laboratory, and psychologic-psychiatric tests, including a Minimal Social Behavior Scale and an Integrative Social Functioning Scale. The sample of patients and methods of study for this 10-month Geriatric Assessment Program are described. Assessment of present and past social functioning revealed good agreement between ratings made by different staff members. A decline in social functioning with time differentiated organic from functional psychiatric illness. Some of the scales employed may be of value for social screening purposes in the community.

Aged↗
PubMed1980

Relative mortality of chronically ill geriatric patients with organic brain damage, before and after relocation.

Elderly patients in whom mental impairment is associated with organic brain damage (chronic brain syndrome) usually bear a higher mortality risk than do other sick geriatric patients, especially under the stress of relocation. When Ste. Anne's Hospital moved, the patients with chronic brain syndrome had the highest mortality rate during the following year. Apparently these brain-damaged subjects failed to cope with the situation until it became real (after relocation). Thus, in a stress prevention program adopted when a geriatric institution plans to move, special attention should be paid to the subpopulation with chronic brain syndrome in the period immediately following the relocation.

Aged↗
PubMed1982

Geriatric psychiatry in the emergency department: characteristics of geriatric and non-geriatric admissions.

A study was made of the Emergency Department records of 49 elderly (65 years old or older) and 49 middle-aged (40-64 years old) patients seen in an urban hospital's psychiatric emergency service. The data were compared for demographic and admission information, psychiatric treatment history, presenting complaints, symptoms, diagnoses, and final disposition status. For the elderly patients, the referral was more likely to be their first contact with psychiatric treatment, and they were more likely to be referred (accompanied) by family or friends than to be self-referred. Among the middle-aged patients, "substance abuse" (e.g., drugs, alcohol) disorders and schizophrenic disorders were more common. The elderly, however, were much more likely to be regarded as having an organic brain syndrome of unspecified cause (34.7 per cent vs 0). Access to treatment was fairly consistent for both groups as measured by the hospital's priority code, total time spent in the emergency department, and final disposition. These results raise important issues concerning the unique psychosocial characteristics and psychiatric treatment needs of elderly patients. This applies particularly to the emergency-department medical clearance of elderly patients with symptoms of organic brain syndrome.

Adult↗
PubMed1986

Psychiatric emergency consultations to elderly patients in a Canadian general hospital.

The authors compared the demographic and clinical characteristics and treatment recommendations for elderly (greater than or equal to 60 years) and younger patients (17 to 59 years) seen for an emergency psychiatric consultation in a teaching general hospital. Findings revealed 11 distinctive characteristics that differentiated elderly from younger patients. Most notably, the elderly experienced their chief complaint for a longer time before referral to the emergency room by their primary care physician and had higher prevalence of affective disorders and psychologic factors affecting physical condition. Some of the implications of these results are discussed with the view to planning psychiatric services for the elderly and education programs.

Adolescent↗