Journal of the Academy of Consultation - Liaison Psychiatry

INTRODUCTION: In critically ill patients, delirium is a prognostic indicator of morbidity and mortality. This study investigates the impact of a delirium diagnosis on outcomes after Left Ventricular Assist Device (LVAD) implantation. METHODS: This retrospective study included all adult patients who received LVADs at our institution between January 2016 and December 2020. We compared pre-implantation characteristics between the two groups, with and without a diagnosis of delirium, and compared their outcomes, including 1-month, 6-month, and in-hospital mortality, as well as re-intubation rate, length of stay (LOS), discharge disposition, and readmission rates...

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This article provides an overview of the history and current status of Consultation-Liaison Psychiatry (CLP) in China and its development within the Chinese Society of Psychosomatic Medicine. Over the past decade, various CLP practice models have been developed to meet the diverse needs of different regions in China. Notably, the Chinese Multidisciplinary Integrated Centers of Psychosomatic Medicine have been established as regional hubs throughout the country. Additionally, this article delves into the role of Chinese traditional medicine in the practice of CLP in China...

OBJECTIVES: There have been notable increases pediatric mental health boarding in the United States in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement at psychiatric treatment programs. We aimed to evaluate outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital during a national pediatric mental health crisis. METHODS: Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department and on inpatient medical/surgical units for boarding patients awaiting placement...

We present the case of a 76 year old male with mild cognitive impairment and delirium referred to Consultation-Liaison Psychiatry for assessment of capacity to choose discharge. Cases involving "dispositional capacity" are complex and increasingly frequent, with momentous consequences for patients and their families, but rarely discussed in the literature. In this article, experts in functional assessment, cognition, and ethics provide guidance for this commonly encountered clinical scenario based on their experience and available literature...

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BACKGROUND: Consultation-liaison (C-L) psychiatry services aim to help general hospital staff provide better care for their patients. Recently, many inpatient C-L psychiatry services have adopted proactive and integrated approaches to achieve this aim. Despite these developments, there have been no interview-based studies of patients' and staff members' experiences of the new approaches. OBJECTIVE: To gain an in-depth understanding of patients' and medical unit staff members' experiences of a proactive and integrated C-L psychiatry service for older medical inpatients (Proactive Integrated C-L Psychiatry, PICLP)...

BACKGROUND: Psychiatric illness during pregnancy is associated with adverse obstetric outcomes, but investigations for its impact on parenting capacity are limited. Child Protective Services (CPS) contact disproportionately impacts families marginalized by poverty, mental health disorders, and substance use disorders. Recently, there have been investigations into the significance of psychiatric illness and non-mental health-related factors that predict CPS custody arrangements. METHODS: We conducted a retrospective review of electronic medical records over a 10-year period (2012-2021) for patients who were pregnant during their inpatient psychiatric hospitalizations...

BACKGROUND: Proactive psychiatric consultation services rapidly identify and assess medical inpatients in need of psychiatric care. In addition to more rapid contact, proactive services may reduce length of stay, and improve staff satisfaction. However, it is in some settings impractical to integrate a proactive consultation service into every hospital unit; on-request and proactive services are likely to coexist in the future. Prior research has focused on changes in outcomes with implementation of proactive services...

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Fast-tracking is the option for residents to pursue fellowship training in place of their final residency year. It is currently permissible to fast-track into a child and adolescent psychiatry fellowship, but this remains a controversial idea for other psychiatry subspecialties. In 2022, the Annual Meeting of the Academy of Consultation-Liaison Psychiatry (ACLP) featured a plenary session debate about the pros and cons of fast-tracking. Here, the authors present some of the information discussed at that session and highlight the potential benefits and pitfalls of fast-tracking into consultation-liaison (C-L) psychiatry...

BACKGROUND: Diabetic Ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening conditions that send nearly 180,000 patients to the ICU each year, with mortality rates up to 5-10%. Little is known about the impact of concurrent psychiatric disorders on specific DKA/HHS outcomes. Identifying these relationships offers opportunities to improve clinical management, treatment planning, and mitigate associated morbidity and mortality. METHODS: We conducted a retrospective review including adult DKA/HHS admissions within a large Massachusetts hospital system from 2010 - 2019...

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Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics...

BACKGROUND: There is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education (CME). Although professional medical organizations' annual meetings play an instrumental role in CME for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for Consultation-Liaison (C-L) psychiatrists...

BACKGROUND: People with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited. METHODS: This retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization. Nutrition was increased until patients were gaining 0...

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