Geropsychiatric consultation in a general hospital in Taiwan

Abstract

The aim of this study was to characterize clinically significant issues in a psychiatric consultation service for geriatric inpatients in a general hospital in Taiwan. This was a case-control study. During a 5-month period, 100 geriatric (age ≥ 65 years) inpatients consecutively referred for consultationliaison psychiatric service from non-psychiatric departments formed the study group. Another 100 medical inpatients, also referred for consultation-liaison to the psychiatric service, but aged 17-50, formed the control (non-geriatric) group. The diagnosis, demography, reason for referral, symptomatology, and other clinical characteristics were determined by consensus between two psychiatrists. Psychiatric diagnosis was made according to criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The geropsychiatric consultation rate was 0.9%. Geriatric patients constituted 20.1% of all psychiatric referrals. Common reasons for referral of geriatric inpatients were confusion (32%), depression (17%), disturbing behaviors (14%), and psychosis (14%). The most common psychiatric disorder among geriatric patients was an organic mental disorder (79%), followed by a depressive disorder (13%). More geriatric patients suffered from cancers and cerebrovascular diseases than non-geriatric patients. The geriatric group was more likely to have multiple physical illnesses. Organic mental disorder and depressive disorders are the most common psychiatric diagnoses in the geropsychiatric consultation service of the authors. In the authors' experience, both psychotropic medication treatment and psychosocial intervention are important in geropsychiatric consultation.

Psychiatric diagnosis in the elderly referred to a consultation‐liaison psychiatry service in a general geriatric hospital in Japan

“…In another study of 100 consecutive psychiatric consultations for geriatric inpatients of a general hospital in Taiwan, common reasons for referral were confusion (32%), depression (17%) and psychosis (14%), whereas the most common diagnoses of the C-L psychiatrists were organic mental disorder (79%), followed by depressive disorder (13%). 2 In the present survey, the kappa statistics, which measured the degree of agreement between the referring doctor and the C-L psychiatrist for each F category under ICD-10, were 0.47 for F0, 0.27 for F1, 0.28 for F2/3 and 0.32 for F4/5. Compared with the diagnostic accuracy of doctors recorded in Spitzer's studies, 18,19 the referring doctors in the present survey had a lower level of diagnostic accuracy for psychiatric disorders, especially for alcoholism and depression.…”

“…Both referring doctors and corresponding C‐L psychiatrists in the present survey recognized organic brain syndrome, delirium and dementia as the primary psychiatric diagnoses. In another study of 100 consecutive psychiatric consultations for geriatric inpatients of a general hospital in Taiwan, common reasons for referral were confusion (32%), depression (17%) and psychosis (14%), whereas the most common diagnoses of the C‐L psychiatrists were organic mental disorder (79%), followed by depressive disorder (13%) 2 …”

“…Depression is highly prevalent and is often responsible for referral to consultation-liaison (C-L) psychiatry services worldwide. [1][2][3][4] Patients with late-life depression tend to frequently experience agitation, fatigue and appetite loss, and less frequently sleep problems and feelings of guilt. 5 Hypochondriasis and somatization are consistently reported in late-life depression, and the Accepted for publication 20 September 2011.…”

Physical complications for elderly inpatients with senile dementia in the Imaise Branch of Ichinomiya City Hospital

“…It is extremely important for all facilities to have the full cooperation of specialists in other medical departments. [18][19][20][21][22] Because of the 2006 revision to the medical fee system, almost all hospitals in Japan have fallen into severe financial difficulties, especially municipal hospitals that operate unprofitable departments, such as those that diagnose and treat psychogeriatric physical complications of the elderly with BPSD. On 30 June 2008, the IB-ICH was closed by the Ichinomiya City government due to financial difficulties.…”

“…Many studies suggest that physical complications are a common and serious problem in the elderly with senile dementia [12][13][14][15][16][17][18][19][20][21][22] and although we previously reported on the state of the physical complications in our WED, 18 there is very little concrete information available in the literature.…”