Psychotic disorders versus other psychiatric diagnoses in consultation-liaison psychiatry: 10 years of a single-center experience.

INTRODUCTION: The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings. OBJECTIVES: To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs). MATERIALS AND METHODS: Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a posthoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs. RESULTS: We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care. CONCLUSIONS: Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs.

Trastornos psicóticos versus otros diagnósticos psiquiátricos en psiquiatría de enlace e interconsulta: estudio unicéntrico durante un periodo de 10 años / Psychotic disorders versus other psychiatric diagnoses in consultation-liaison psychiatry: 10 years of a single-center experience

Introducción. El manejo clínico de los pacientes con trastornos psicóticos (TPs) es particularmente complejo si se lleva a cabo en el contexto de los servicios de psiquiatría de enlace e interconsulta (PEI) de un hospital general. Sin embargo, disponemos de pocos estudios que hayan investigado de forma específica los procedimientos asistenciales de tratamiento agudo para estos pacientes en entornos PEI. Objetivos. Examinar las características de una muestra de pacientes hospitalizados que presentan un TPs primario, que son remitidos a un servicio de PEI durante un período de 10 años y comparar las características clínicas de este subgrupo con respecto a los pacientes con otros diagnósticos (OD). Material y métodos. Estudio observacional y descriptivo llevado a cabo durante un período de 10 años (2005-2014), evaluando prospectivamente pacientes adultos ingresados en unidades no psiquiátricas del Hospital Clínico Universitario de Barcelona, que fueron remitidos de forma consecutiva a nuestro servicio de PEI. Realizamos un análisis post-hocpara comparar las características clínicas entre el subgrupo de pacientes con TPs y el resto de pacientes que cumplían los criterios para OD. Resultados. Se recibieron 393 interconsultas referentes a pacientes que presentaban un diagnóstico de TPs primario y 9.415 derivaciones de pacientes con OD. Nuestros resulta-dos mostraron que los pacientes con TPs eran más jóvenes que los pacientes con OD, tenían una mayor prevalencia de enfermedades somáticas relacionadas con un estilo de poco saludable (como enfermedades infecciosas, endocrinas o metabólicas), una menor frecuencia de cáncer y una necesidad de recibir asistencia psiquiátrica de forma más intensiva. Conclusiones. Los pacientes hospitalizados con TPs que son remitidos a los servicios de PEI tienen diferentes características clínicas en comparación con aquellos que cumplen con los criterios para OD. Se trata de un grupo complejo, con necesidades específicas en cuanto a la atención psiquiátrica

Introduction. The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings. Objectives. To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs).Materials and methods. Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a post-hoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs. Results. We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care. Conclusions. Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs

Evaluación de las cargas de enfermería en la atención del intoxicado en un servicio de urgencias / Assessment of the nursing burden in the care of intoxicated patients in the emergency department

Objetivos: Medir la intensidad de los cuidados enfermeros que precisan los intoxicados que acuden a Urgencias. Método: Durante cuatro meses se registraron los intoxicados remitidos a Urgencias y se seleccionó un subgrupo en el que se midieron los tiempos consumidos por enfermería en cada una de las actividades asistenciales. Resultados: Se registraron 155 intoxicados. La intoxicación medicamentosa fue más frecuente en días laborables (p < 0.05) y la alcohólica en los no laborables (p < 0.05). Al 72 % se les realizó una extracción de sangre y al 55 % de orina para identificar la presencia de tóxicos. Al 79 % se le administró alguna medicación y al 25% carbón activado. El consumo de tiempo en la comunicación verbal fue mayor en el grupo intoxicado con fármacos (p < 0.001). Conclusiones: La ingesta de fármacos ha sido la intoxicación atendida con mayor frecuencia, en particular en días laborables. El intoxicado por medicamentos es el que requiere más tiempo de comunicación verbal

Objectives: To describe and measure the intensity of nursing care in intoxicated patients attended by different levels of emergency care, depending on the day of admission and type of poison involved. Methods: Observational, cross-sectional, descriptive study. For four months, patients referred to the emergency department for acute poisoning were recorded. Of the total patients, a subgroup in which the nursing time used in each activity of the care process were measured was selected. Epidemiological variables (sex, age, date and time of admission to the emergency room), toxicology (type of poison), level of triage, nursing activities and patient outcomes were recorded. Results: 155 cases of poisoning were recorded. Drug poisoning was more common in working days (p < 0.05) and alcoholic in nonworking (p < 0.05). 72 % of patients underwent a blood test and 55 % a urine test to detect the presence of toxic substances. 79 % was administered any medication and 25 % activated carbon. The use of time in verbal communication was greater in patients consuming medicaments (p < 0.001) compared with patients consuming alcohol or illicit drugs. Conclusions: The intake of drugs has been the most frequently attended poisoning, particularly on working days. The intoxicated by drugs is the most time-consuming verbal communication

Aceptación de la terapia sustitutiva de nicotina en pacientes psiquiátricos hospitalizados / Nicotine replacement therapy acceptance in psychiatric inpatients

Objetivos: Determinar el grado de aceptación de la terapia sustitutiva de nicotina (TSN) de los pacientes ingresados en una unidad hospitalaria aguda de Psiquiatría. Método: Se realizó un estudio observacional prospectivo en una unidad de Psiquiatría de adultos en un hospital de tercer nivel. Se incluyeron pacientes adultos fumadores que aceptaron participar. Las principales variables estudiadas fueron: edad, sexo, diagnóstico principal, consumo de cigarrillos diarios, número de intentos previos para dejar de fumar, porcentaje de pacientes que aceptan la TSN, el método de TSN recibido e intención en dejar de fumar. Resultados: Se registraron 122 pacientes, de los cuales un 42.1 % fueron mujeres. La edad media fue de 39 años. El diagnóstico más frecuente fue esquizofrenia (33.1 %). De media, los pacientes fumaban 19.4 cigarrillos por día. El 47 % de la muestra fumaba más de 20 cigarrillos por día. El promedio de intentos para dejar de fumar fue de 1.5 intentos. Un 60 % de los pacientes lo había intentando al menos una vez. El 46 % de los pacientes responde afirmativamente ante la pregunta: «¿Quieres dejar de fumar?». Durante la hospitalización, el 94 % aceptó algún método de TSN. El 39.6 % de los pacientes utilizó un método combinado de TSN (oral y transdérmico), siendo este el más prevalente. Conclusiones: Hay una elevada aceptación de la TSN por parte de los pacientes psiquiátricos, siendo la opción combinada (oral y transdérmico) la más escogida. Un elevado número de pacientes (46 %) responde afirmativamente cuando se le pregunta si quieren dejar de fumar, lo cual sugiere que, contrariamente a lo que podría suponerse, esta población es susceptible de iniciar un abordaje de su tabaquismo mientras están ingresados en una unidad de agudos de Psiquiatría

Objectives To determine inpatients’ degree of nicotine replacement therapy (NRT) acceptance in an acute psychiatric unit. Method: A prospective, observational study was conducted in a tertiary hospital. Accepting participants were enrolled. The main variables assessed were age, gender, psychiatric diagnosis, smoking history, including: number of cigarettes smoked daily, number of previous quit attempts, rate of acceptance of NRT, method of NRT used and intention to quit smoking. Results: A total of 122 patients were enrolled in the study (42.1 %, women, mean age 39). The most prevalent diagnosis was schizophrenia (33.1 %). Patients smoked on average 19,4 cigarettes per day. Almost half (47 %) of the sample smoked more than 20 cigarettes daily. The mean number of previous quit attempts was 1.5. 60 % of patients had tried at least once to quit smoking. 46 % of patients reported intentions of quitting smoking. NRT was accepted by 94 % of patients (39.6 % used both oral and transdermal therapy). Conclusions: NRT was highly accepted by psychiatric inpatients. A combined use of oral and transdermal NRT was the most frequent option. A high number of patients (46 %) reported intentions to quit smoking, suggesting that it is indeed feasible to initiate a smoking cessation intervention among this population while hospitalized

Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-yearperiod.

OBJECTIVE: Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005–2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years. METHODS: Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service. RESULTS: 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes. CONCLUSIONS: Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty.

Características clínicas de los pacientes derivados a un servicio hospitalario de psiquiatría de enlace e interconsulta: un estudio observacional evaluando cambios a lo largo de un período de 10 años / Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-year-period

Objetivo. Existen diversas investigaciones previas que han descrito las características de distintos servicios hospitalarios de Psiquiatría de Enlace e Interconsulta (PEI) a lo largo de un periodo de tiempo de uno o más años. El propósito del presente artículo es el de examinar las características de una muestra amplia de pacientes remitidos a un servicio hospitalario de PEI, durante un período de 10 años (2005-2014) y determinar los posibles cambios de la práctica clínica a lo largo del tiempo. El tamaño muestral de nuestro estudio, la duración del periodo de observación y la aplicación de procedimientos estandarizados para la obtención y codificación de los datos, aportan una evidencia más sólida en comparación con otros estudios similares publicados en los últimos años. Métodos. Estudio observacional, longitudinal y descriptivo. Los datos se recopilaron de forma prospectiva mediante procedimientos estandarizados, en base a las solicitudes recibidas en el servicio hospitalario de PEI del Hospital Clínico Universitario de Barcelona. Resultados. se solicitaron un total de 9.808 consultas psiquiátricas (tasa de derivación=2,2%). Las derivaciones a nuestro servicio fueron realizadas principalmente por unidades médicas. Los diagnósticos psiquiátricos más frecuentes fueron los trastornos relacionados con el consumo de alcohol, los cuadros confusionales y los trastornos de adaptación. El porcentaje medio de pacientes manejados con tratamiento psicofarmacológico fue del 81,6%. La duración media de las hospitalizaciones de los pacientes con comorbilidad psiquiátrica, derivados a nuestro servicio de psiquiatría de enlace, fue significativamente mayor a la estancia media global del hospital durante ese periodo. La mayoría de las variables estudiadas permanecieron constantes durante el período de 10 años. Sin embargo, algunos diagnósticos médicos en el momento del ingreso, motivos de derivación y recomendaciones de tratamiento psicofarmacológico presentaron cambios significativos. Conclusiones. A pesar de la evolución continua y los importantes cambios que se han producido en los sistemas de salud en las dos últimas décadas, la práctica clínica de los servicios de PEI ha permanecido bastante estable en el tiempo. Sin embargo, nuestros resultados apoyan la idea de una especialidad dinámica

Objective. Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005-2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years. Methods. Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service. Results. 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes. Conclusions. Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty