ELDERLY PATIENTS WITH ALTERED MENTAL STATUS (original) (raw)
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Bulletin of Clinical Psychopharmacology, 2015
The evaluation of mental status of elderly patients presenting to emergency services and the comparison between the last diagnosis and their complaints Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as they age. In the emergency department, one of the main premises of patient management is anamnesis. However, impairments in mental status of geriatric patients decrease the reliability of anamnesis. In this study, we aimed to determine the mental status of elderly patients who presented to the emergency department, the relationship between mental status and patients' complaints, and last diagnoses and mortality. Materials and Methods: The study was planned to be prospective. The mental status of geriatric patients who presented to the emergency department was evaluated with a six-question screening test. Complaints, final diagnosis information, hospitalization department, duration of hospitalization, judicial status and mortality information were recorded. Consistency between patients' complaints and symptoms determined in physician examination was evaluated. Symptom-finding consistency levels based on mental status were compared. Kappa tests for consistency assessments and chi-square test for intergroup comparisons were used. Findings: The match between patient complaints and final diagnosis of 755 patients was evaluated by two independent specialist physicians. As a result of the six-question screening test, a mismatch between patient complaint and final diagnosis was found in 16.2% of 204 patients with abnormal screening tests (n=33) compared to 0.4% of 551 patients, who had a normal screening test (n=2). Mortality was found to be 9.8% in patients with abnormal test results while it was found to be 2.0% in patients with normal screening tests. Conclusion: Mental status variance determined in elderly patients appears to be a risk factor in terms of mortality. Complaints in geriatric patients having mental status variance can be deceptive in terms of pointing to the current disease. Exploring this relationship in detail with further studies should be considered, in order to make a significant contribution to the service provided to this patient group.
International Journal of Advances in Medicine
Background: Authors conducted this study to find the profile of causes and diseases that affect patients of younger age group in altered sensorium admitted in a general hospital associated with Government Medical College Srinagar, in India.Methods: Authors conducted present study over a period of eight months. The patients of young and middle age who were admitted in their hospital ward with altered mental status were included. The study subjects were divided into two groups: group A included patients of age upto 30 years, and group B with patients in age group 31-50 years. The patients were studied for their diagnoses, comorbidities, gender distribution, duration of stay in hospital and mortality patterns.Results: Authors had a total of 112 patients of young and middle age admitted in their hospital ward with altered mental status during the study period. In group A, there were 42 patients or 37.5% (20 males and 22 females). In group B, there were 70 patients or 62.5% (30 males and...
Dementia and Psychiatric Emergencies in the Elderly Population
Socijalna psihijatrija
S obzirom na kontinuirano povećanje broja starijih osoba u ukupnoj populaciji u Hrvatskoj, za očekivati je da će se broj starijih osoba s akutnim psihičkim smetnjama koje zahtijevaju hitno zbrinjavanje sve više povećavati. Najčešći psihički poremećaji kod starijih osoba su: depresivni poremećaji, kognitivni poremećaji, demencija, poremećaji vezani uz uzimanje alkohola, poremećaji vezani uz druga zdravstvena stanja i lijekovima izazvani poremećaji. Gerijatrijski bolesnici bi u pravilu prvo trebali biti pregledani od strane stručnjaka somatske medicine (internista, neurologa, kirurga) prije nego što se upućuju u hitnu psihijatrijsku službu, kako bi se ustanovilo da su primarne smetnje iz psihijatrijske domene. Izražena depresija, suicidalnost, agitacija, sklonosti lutanju i ostalim rizičnim ponašanjima kod kuće, izražena anksioznost i smanjena sposobnost brige o sebi, glavni su razlozi hospitalizacije kod ovih bolesnika. / Related to the fact of the continuous increase in the number of elderly people in the total population of Croatia, it can be expected that the number of elderly people with acute psychiatric disorders that require emergency care will increase. The most common psychiatric disorders found in the elderly are depressive disorders, cognitive disorders, dementia, alcoholrelated disorders, disorders related to other health conditions and drug-induced disorders. Geriatric patients should, generally speaking, first be reviewed by a psychosomatic medical specialist (internist, neurologist, surgeon) before they are sent to psychiatric emergency services in order to establish that the primary complaint is connected with the psychiatric domain. Pronounced depression, suicidality, agitation, wandering tendencies and other home-based risk behaviours, with anxiousness and reduced self-care ability, are the main reasons for hospitalization.
Journal of Medical Science And clinical Research, 2019
Background: Evaluation of a patient with Altered Mental Status AMS in the Emergency department ED is difficult for many reasons. Emergency physician is usually expected to make q a correct working provisional diagnosis in AMS in quick time; and the accuracy of this provisional diagnosis has an important bearing sometimes on prognosis of patient Objective: The Aim of the study was to determine retrospectively the diagnostic accuracy in the Emergency Department and to determine diagnostic value of various components of clinical evaluation. Methods: The study was conducted prospectively in 201 patients who presented to a tertiary care hospital with AMS .Children, and patients with history of dementia, psychiatric disease, were excluded. History and examination was done, and provisional diagnosis made. CT scan head & CSF analysis were routinely done. All required investigations were done to reach the final diagnosis. Results: In 11.4% provisional diagnosis did not match with final diagnosis, in 16.4%, diagnosis matched partially, in 71.6 % diagnosis matched completely. The specific features of the clinical evaluation of diagnostic value followed by rates of positive diagnostic finding included:
Characteristics of elderly people using the psychiatric emergency system
Psychiatry and Clinical Neurosciences, 2009
We investigated the differences between elderly and under-65-year-old patients using the psychiatric emergency system. The following characteristics were more common in elderly patients than in younger patients: organic mental disorder, mood disorder, dementia, disturbed consciousness, no excitation, physical complications, no history of visiting a psychiatrist and no history of hospitalization. In addition, significantly more elderly patients with mood disorder attempt suicide.
The prevalence of psychiatric illness in acute geriatric admissions
International Journal of Geriatric Psychiatry, 1993
The prevalence of psychiatric illness among 100 elderly medical inpatients was determined using the Geriatric Mental State Schedule, in its Community Version. Due to the difficulties in assessing this group of patients, less than half of those admitted could be included in the study. The diagnostic cases identified were in three groups: organic brain disease (chronic brain failure), depression, and anxiety. Depression was found in 23%, anxiety in 7% and organic brain disease in 13%.
International Journal of Geriatric Psychiatry, 1991
This study examines the point prevalence of psychiatric morbidity in patients admitted to acute geriatric care, the performance of screening questionnaires in detecting psychiatric morbidity and the relationship between psychiatric morbidity and outcome (in terms of length of hospital admission and mortality) after controlling for severity of physical illness. In a sample of 119 consecutive admissions, 65 (61%) of the 106 patients assessed had dementia, while nine (10%) of the 88 assessed had a diagnosis of depression and a further 35 (40%) significant depressive symptoms, and 22 (20%) of the 106 assessed had delirium. Screening with the Mini-Mental State Examination had 81% sensitivity and 83% specificity for dementia. The Geriatric Depression Scale (GDS) had 74% sensitivity and 72% specificity for depressive symptoms; both the GDS and General Health Questionnaire had 100% sensitivity for depressive illness. Mortality was significantly higher in the delirious (62%) than in the non-delirious (14%, p<O.OOl) and in the severely demented (65%) than the mildly demented (29%) and non-demented (15%, p<O.OOl) subjects. For delirium this effect was found to be independent of the severity of physical illness. Patients with severe dementia had significantly longer hospital admissions (p < 0.02). No relationship was found between depression and outcome. KEY WORDS-Dementia, delirium, depression, general hospital psychiatry, old age, mental disorders. Although dementia only affects a minority of elderly people in the community (1% of those aged 65-74 years, rising to 10% in the over-75s (Ineichen, 1987)), it appears to be much commoner in institutions. In a survey of old people's homes in an inner London borough, Mann and colleagues (I 984) found that over a third of the residents had mild to moderate cognitive impairment and a further 31% severe dementia.
Psychotic Symptoms in the Elderly
The Primary Care Companion to The Journal of Clinical Psychiatry, 2005
The Psychiatric Consultation Service at Massachusetts General Hospital (MGH) sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During rounds, Dr. Stern and the chief resident discuss the diagnosis and management of conditions confronted. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.