Misidentification of mental health symptoms in presence of organic diseases and delirium during psychiatric liaison consulting.

OBJECTIVE: To identify predictors of misidentification of organic mental disorders and delirium in patients undergoing psychiatric liaison consultation. METHODS: Data were collected at Santa Casa de São Paulo between July of 2009 and March of 2013. We included in our analysis all inpatients for whom the requesting service judged that a psychiatric consultation was required for a possible mental health condition. Outcomes of interest were the instances of misidentification where a condition was initially deemed to be of a psychiatric nature, whereas the final diagnosis by the liaison psychiatric team was of an organic disease or delirium. Our predictors were the clinical specialty of the requesting service, requester and patient characteristics. A series of generalised linear models were used to evaluate misidentification risks. RESULTS: A total of 947 subjects met our inclusion criteria, 14.6% having a final liaison diagnosis of organic mental disorder and 8.1% of delirium. Older patients were significantly associated with increased risk of misidentification for both organic conditions (OR 3.01 - 95% CI 2.01, 4.5) and delirium (OR 3.92 - 2.4, 6.39). CONCLUSIONS: Educational interventions in general hospitals focused on preventing psychiatric misdiagnosis should target in-hospital services where patients tend to be older.

Choosing to use compared to taking medication: the meaning of medication as described by people who experience schizophrenia.

PURPOSE: The use of medication is an important aspect within the experience of schizophrenia. DESIGN AND METHODS: Interviews with 14 people with schizophrenia were analyzed using van Kaam's psychophenomenological method, and findings revealed two opposing and important attitudes toward medication. FINDINGS: Adopting an attitude of choosing to use prescribed medication means autonomously self-managing medication and taking prescribed medication means feeling challenged and being under external pressure through being told or forced by others and therefore having no personal connection to the details or purpose of medication. PRACTICE IMPLICATIONS: Nurses need to actively work in partnership to support consumers to take an active stance toward choosing to use medication rather than ensuring consumers take medication.