Inappropriate Psychiatric Admission of Elderly Patients with Unrecognized Delirium
Inappropriate Psychiatric Admission of Elderly Patients with Unrecognized Delirium
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DOI：
10.1097/smj.0b013e3181c99423
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发表时间：
2010-02-01
影响因子：
1.1
通讯作者：
Hart, Roy H.
中科院分区：
文献类型：
--
作者：
Reeves, Roy R.;Parker, Jefferson D.;Hart, Roy H.
目的：探讨老年精神疾病患者精神状态改变误诊为精神疾病的原因。方法：回顾2001-2007年间某公立医院900例退伍军人事务部精神科住院患者和413例公立医院精神科住院患者的临床资料。因未识别的精神错乱继发症状而转诊的病例接受了进一步的入院前评估分析。结果：30例(2.3%)转诊至精神科的患者在12小时内被发现有躯体障碍，需要医疗干预。与住进医疗单位的30名精神错乱患者相比，那些不适当地转诊到精神病科的患者，适当的病史、体检、认知评估和实验室/放射学研究的比率明显较低。在转诊到精神病院的精神错乱患者中，66.7%的患者有精神疾病史，而在医疗机构的类似入院患者中，有26.7%的患者有精神疾病史(X(2)(7)=60.00，P<；0.001)。结论：我们的研究结果表明，住进精神病院的老年精神错乱患者接受完整诊断评估的可能性低于进入医疗机构的精神错乱老年患者。与没有精神病史的患者相比，有精神病史的患者更有可能将精神错乱的症状错误地归咎于精神疾病。对这些发现提出了可能的解释，并提出了解决这些问题的建议。
Objectives: To explore factors that might contribute to misattribution of mental status changes to psychiatric illness when an elderly patient actually has a delirium (mental status changes due to a medical condition).Methods: Records of 900 elderly patients referred to a Veterans Affairs psychiatric inpatient unit and 413 to an inpatient psychiatric team at a public hospital from 2001 to 2007 were reviewed. Cases referred because of symptoms secondary to an unrecognized delirium underwent further analysis of preadmission assessments. Comparisons were made to elderly patients with delirium appropriately admitted to medical units.Results: Thirty (2.3%) of the patients referred to psychiatric units were found to have a physical disorder requiring medical intervention within twelve hours. Compared to 30 delirious patients admitted to medical units, those inappropriately referred to psychiatric units had significantly lower rates of adequate medical histories, physical examinations, cognitive assessments, and laboratory/radiological studies. Among patients with delirium referred to psychiatric units, 66.7% had a history of mental illness, versus 26.7% of comparable admissions to medical units (chi(2) (7) = 60.00, P < 0.001).Conclusions: Our findings suggest that elderly patients with delirium admitted to psychiatric units are less likely to undergo complete diagnostic assessments than delirious elderly patients admitted to medical units. Symptoms of delirium appear more likely to be incorrectly attributed to psychiatric illness in patients with a history of mental illness than in patients without such a history. Possible explanations for these findings and suggestions for addressing these issues are offered.