Severe major depressive disorder readmissions: A national United States population study.

BACKGROUND: National population data are scarce on readmission following hospitalization for severe major depressive disorder (SMDD) in the United States (U.S.). We aim to describe the rates, characteristics, and reasons for readmissions for adults hospitalized for SMDD in the U.S. METHODS: We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult patients (≥18 years) with a "principal" diagnosis of SMDD using (ICD)-10 codes. We excluded elective readmissions. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. The 10 most common reasons for readmission were highlighted. RESULTS: A total of 236,284, 185,737, 120,218, and 21,645 index hospitalizations with a principal diagnosis of SMDD discharged alive, were included in the 30-, 90-180- and 330-day readmission analysis. Among these, 27,443 (11.6 %), 36,844 (19.8 %), 32,269 (26.8 %) and 7915 (36.6 %) were readmitted within 30, 90, 180 and 330 days, respectively. 90-day readmissions were older, had more males, greater hospital costs, fewer patients with private insurance, higher comorbidity burden, more patients from lower-income households, present to metropolitan hospitals, and leave against medical advice compared to index admissions. LIMITATIONS: Limitations of our study include possible coding errors, lack of data on race/ethnicity, age of disease onset, duration of illness, medication use, and adherence. CONCLUSIONS: About 1 in 3 patients admitted for SMDD are readmitted within 11 months. Readmissions constitute a significant economic burden and differ from index admissions. SMDD and other psychiatric disorders are common reasons for readmission. Interventions to reduce readmissions are needed.

Emergency department utilization by patients with bipolar disorder: a national population-based study.

BACKGROUND: There is a scarcity of national United States (US) data on emergency department (ED) utilization of patients with bipolar disorder (BD). This study aims to determine the most common reasons for ED visits of patients with BD, and baseline characteristics of patients who present due to BD. METHODS: We obtained data from the Nationwide Emergency Department Sample (NEDS), the largest all-payer ED database in the US. Each ED visit in NEDS 2018, can have only 1 "principal" diagnosis, which is the main reason for hospitalization, and up to 34 "secondary" diagnoses. We extracted data for all ED visits with "any" diagnosis of BD, using the ICD-10 code. We highlighted the 5 most common "principal" diagnoses based on the organ system involved and the 10 most specific "principal" diagnoses for all ED visits by patients with "any" diagnosis of BD. We highlighted baseline characteristics of ED visits with a "principal" diagnosis of BD. RESULTS: A total of 2,200,197 ED visits for patients with BD in 2018. Mental disorders such as BD, suicidal ideations, anxiety disorders and injuries and poisoning were common reasons for presentation to the ED. Among these, 291,319 had BD as the principal diagnosis. These patients were more likely to come from lower-income households. LIMITATIONS: Possibility of coding errors due to ICD coding, and absence of data on race and medication compliance. CONCLUSIONS: BD, suicidal ideation, and anxiety disorders were the most common specific psychiatric reasons for presentation to the ED among patients with BD.

Remaking the American health care system: a positive reflection on the Affordable Care Act with emphasis on mental health care.

Health care reform under the Patient Protection and Affordable Care Act (PPACA, ACA) of 2010 may be the most significant health care-related legislation enacted since the establishment of Medicare and Medicaid several decades ago. Over two years ago the U.S. Supreme Court upheld the constitutionality of the individual mandate of the Patient Protection and Affordable Care Act. This legislation has emerged as a significant and ambitious undertaking for all levels of the U.S. government. With the need to accommodate the estimated 30 million people projected over time to become newly insured it is increasingly important to understand the necessity of reform, how the legislation has been interpreted and implemented to fit the goals of the federal, state, and local governments, and what the potential benefits and consequences of changing the system are, in particular, as it relates to mental health care.

Thiamine deficiency and delirium.

Thiamine is an essential vitamin that plays an important role in cellular production of energy from ingested food and enhances normal neuronal actives. Deficiency of this vitamin leads to a very serious clinical condition known as delirium. Studies performed in the United States and other parts of the world have established the link between thiamine deficiency and delirium. This literature review examines the physiology, pathophysiology, predisposing factors, clinical manifestations (e.g., Wernicke's encephalopathy, Wernicke-Korsakoff syndrome, structural and functional brain injuries) and diagnosis of thiamine deficiency and delirium. Current treatment practices are also discussed that may improve patient outcome, which ultimately may result in a reduction in healthcare costs.

Postpartum depression: a review.

Postpartum depression is a disorder that is often unrecognized and undertreated. Many psychosocial stressors may have an impact on the development of postpartum depression. The greater risk of postpartum depression is a history of major depression and those who have experienced depression during past pregnancies. Untreated maternal depression can have a negative effect on child development, mother-infant bonding, and risk of anxiety or depressive symptoms in infants later in life. Management of postpartum depression is a vital part of adequate medical care. The obstetrician and pediatrician can serve important roles in screening for and treating postpartum depression. To prevent adverse outcomes associated with depression and its impact on the child, it is important that all health care professionals and nurse practitioners are aware of specific signs and symptoms, appropriate screening methods, and proper treatment. This review article covers major traits of postpartum depression.