Organic mental disorders in the consultation-liaison psychiatry setting. A multi-site study.

Interventions recommended by consultation-liaison psychiatrists for inpatients they diagnosed as having DSM-III-R organic mental disorder (OMD) were studied to see to what extent specific variables distinguished the OMD patients and differentiated the subgroups of patients with OMD. Prospective data and Mini-Mental State Exam (MMSE) scores on 625 consecutive referrals at 3 general hospitals in Australia and the United States were collected by using the MICRO-CARES database system. The OMD group differed from the other patients because they were significantly more likely to have been referred for "organic brain syndrome" or "agitation," had less mood disorder and lower MMSE scores, and received more recommendations for antipsychotics and for ward-environment manipulation and fewer recommendations for psychological management. The many differences among the OMD subgroups were also consistent with their DSM constructs. A pilot exploration of the validity of the DSM-IV constructs of cognitive disorder and its subgroups performed on the redistributed data suggested that these constructs have similar usefulness.

Psychiatric comorbidity among hospitalized AIDS patients vs. non-AIDS patients referred for psychiatric consultation.

Data were collected on 3,420 psychiatric consultations from July 1, 1989, to January 1, 1994, of which 675 were for patients identified as infected with the human immunodeficiency virus (HIV). Comparisons of psychiatric comorbidity among persons with AIDS (PWAs), HIV+ asymptomatic patients, and non-HIV patients were made. Dementia was a significantly frequent comorbid diagnosis among the referred PWAs compared with the general consultation population and was related to older age. Psychiatric comorbidity among the referred HIV+ asymptomatic patients more closely resembled the general consultation population. Major depression was relatively rare among the PWAs. The authors believe that the large sample size of this study allows for an accurate representation of the psychiatric disorders found among medically ill HIV patients in an urban hospital who are referred for psychiatric consultation.

Delirium and acute psychosis. Mental states calling for clear diagnostic thinking and careful management.

Management of a delirious or acutely psychotic patient calls for rapid but well-considered decision making by the treating physician. Clear diagnostic thinking is vitally important in making a presumptive diagnosis and forming a treatment plan. Appropriate treatment usually returns patients to a less agitated state and allows for definitive treatment of any underlying illness.