Multinational development and validation of an early prediction model for delirium in ICU patients

Rationale Delirium incidence in intensive care unit (ICU) patients is high and associated with poor outcome. Identification of high-risk patients may facilitate its prevention. Purpose To develop and validate a model based on data available at ICU admission to predict delirium development during a patient’s complete ICU stay and to determine the predictive value of this model in relation to the time of delirium development. Methods Prospective cohort study in 13 ICUs from seven countries. Multiple logistic regression analysis was used to develop the early prediction (E-PRE-DELIRIC) model on data of the first two-thirds and validated on data of the last one-third of the patients from every participating ICU. Results In total, 2914 patients were included. Delirium incidence was 23.6 %. The E-PRE-DELIRIC model consists of nine predictors assessed at ICU admission: age, history of cognitive impairment, history of alcohol abuse, blood urea nitrogen, admission category, urgent admission, mean arterial blood pressure, use of corticosteroids, and respiratory failure. The area under the receiver operating characteristic curve (AUROC) was 0.76 [95 % confidence interval (CI) 0.73–0.77] in the development dataset and 0.75 (95 % CI 0.71–0.79) in the validation dataset. The model was well calibrated. AUROC increased from 0.70 (95 % CI 0.67–0.74), for delirium that developed 6 days. Conclusion Patients’ delirium risk for the complete ICU length of stay can be predicted at admission using the E-PRE-DELIRIC model, allowing early preventive interventions aimed to reduce incidence and severity of ICU delirium

Physician-assisted suicide: a review of the literature concerning practical and clinical implications for UK doctors

BACKGROUND: A bill to legalize physician-assisted suicide in the UK recently made significant progress in the British House of Lords and will be reintroduced in the future. Until now there has been little discussion of the clinical implications of physician-assisted suicide for the UK. This paper describes problematical issues that became apparent from a review of the medical and psychiatric literature as to the potential effects of legalized physician-assisted suicide. DISCUSSION: Most deaths by physician-assisted suicide are likely to occur for the illness of cancer and in the elderly. GPs will deal with most requests for assisted suicide. The UK is likely to have proportionately more PAS deaths than Oregon due to the bill's wider application to individuals with more severe physical disabilities. Evidence from other countries has shown that coercion and unconscious motivations on the part of patients and doctors in the form of transference and countertransference contribute to the misapplication of physician-assisted suicide. Depression influences requests for hastened death in terminally ill patients, but is often under-recognized or dismissed by doctors, some of whom proceed with assisted death anyway. Psychiatric evaluations, though helpful, do not solve these problems. Safeguards that are incorporated into physician-assisted suicide criteria probably decrease but do not prevent its misapplication. SUMMARY: The UK is likely to face significant clinical problems arising from physician-assisted suicide if it is legalized. Terminally ill patients with mental illness, especially depression, are particularly vulnerable to the misapplication of physician-assisted suicide despite guidelines and safeguards

Tech-Enabled Collaborative Care: Population-Focused Screening, Triage and Integrated Treatment of Psychiatric Illness in Primary Care and Other Medical Settings

Objectives Discuss the medical consequences and the morbidity, mortality and costs associated with psychiatric illness. Describe the impact of psychiatric illness from a population health perspective. Review why behavioral health integration (BHI) is critical and discuss population-focused, measurement guided, and evidenced-based model(s) of care. Explain how technology can be leveraged to enhance clinical care from a population health perspective and to scale BHI in medical settings on a regional, state or national level

Psychiatric and medical co-morbidity in mitral valve prolapse

Objective: Significant controversy continues to exist in the empirical literature regarding the diagnosis and treatment of mitral valve prolapse (MVP). In addition, there is also inconsistency in the correlation of anxiety disorders as co-existing with MVP, as well as cause and effect issues in terms of the role of the autonomic nervous system, MVP and panic attacks. Recent studies suggest that the co-morbidity of an anxiety disorder and clinical depression appears to increase the likelihood of MVP in predisposed patients. The objective of this review was to examine, clarify, and further define the medical and psychiatric aspects of MVP. Methods: A literature review was conducted on empirical studies and reviews examining MVP. Results: It was found that although MVP is highly correlated with psychiatric disorders, the lack of adequate control groups and clear criteria for a diagnosis of MVP in most empirical studies examining these associations make it difficult to determine the relationship between MVP and psychiatric disorders. Conclusions: Suggestions for further research in the areas of depression and personality characteristics are offered. It is also suggested that the use of control groups from populations with cardiac disorders and a better definition of MVP will clarify many of the problems in empirical studies aiming to determine the relationship between MVP and psychiatric disorders

Quality of sleep in escitalopram-treated female patients with panic disorder

ObjectiveThe purpose of this study was to assess the development of the night-activity rhythm and quality of sleep during escitalopram treatment of patients suffering from panic disorder.MethodsFifteen women with panic disorder were included and followed-up over a 5-week study period during treatment with escitalopram. An age-matched control group of 15 women were also assessed for 1 week. Motor activity was continuously measured with an electronic wrist device (Actiwatch), sleep was assessed with the Pittsburgh sleep quality index (PSQI) and patients were clinically assessed with the panic and agoraphobic scale (P&A), the global assessment of functioning (GAF) score, the Hamilton depression and anxiety scales (HAM-D, HAM-A) and the clinical global impression (CGI) score.ResultsThere was a statistically significant difference on the self-rated PSQI between the panic disorder patients and the control group. This difference disappeared after 4 weeks of treatment with escitalopram. There was no statistically significant difference of the objective measurements of the Actiwatch between the patients and the control group. In addition, no statistically significant changes were found in the actigraphy measurements at the beginning and the end of the treatment period for patients with panic disorder.ConclusionsPatients with panic disorder rate their sleep worse than healthy controls. Treatment with escitalopram improved the subjective quality of sleep, whereas objective measures remained unchanged during treatment.D. Todder and B. T. Baun