Characteristics of psychiatric comorbidities in emergency medicine setting and impact on length of hospitalization: A retrospective study
https://doi.org/10.4081/ecj.2022.10216
Accepted: 10 January 2022
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
This study aims to evaluate clinical correlates of psychiatric comorbidity and length of hospitalization in patients admitted in a general hospital emergency medicine setting. Overall, 160 patients hospitalized for different acute medical pathologies were selected consecutively over 12 months. All subjects were evaluated with proper forms to collect data on medical and psychiatric diagnoses. Levels of C-reactive protein were also measured in all patients. Statistical analyses were conducted with univariate, logistic, and multiple linear regressions. Patients with psychiatric comorbidity had significantly longer hospitalization than did patients with no psychiatric diagnoses (days 10.9±9.5 vs. 6.9±4.5, p<0.005). Agitation and delirium were more frequent in the psychiatry comorbidity study group (p<0.05), as was cognitive impairment (p=0.001). These variables predicted longer hospitalisation (respectively: t=-3.27, p=0.002; t=-2.64, p=0.009; t=-2.85, p=0.006). Psychiatric comorbidity acts as an adjunct factor in determining clinical severity and predicting a more difficult recovery in patients hospitalized in an emergency medicine setting.
Echols MR, O’Connor CM. Depression after myocardial infarction. Current Heart Failure Reports 2010;7:185-93. DOI: https://doi.org/10.1007/s11897-010-0024-6
Carney RM, Blumenthal JA, Stein PK, et al. Depression, Heart Rate Variability, and Acute Myocardial Infarction. Circulation 2001;104:2024-8. DOI: https://doi.org/10.1161/hc4201.097834
Suchyta MR, Beck CJ, Key CW, et al. Substance dependence and psychiatric disorders are related to outcomes in a mixed ICU population. Intensive Care Med 2008;34:2264-7. DOI: https://doi.org/10.1007/s00134-008-1263-9
Larkin GL, Claassen CA, Emond JA, et al. Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv 2005;56:671-7. DOI: https://doi.org/10.1176/appi.ps.56.6.671
Ranney ML, Locci N, Adams EJ, et al. Gender-specific research on mental illness in the emergency department: current knowledge and future directions. Acad Emerg Med 2014;21:1395-402. DOI: https://doi.org/10.1111/acem.12524
Roy-Byrne PP, Davidson KW, Kessler RC, et al. Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 2008;30:208-25. DOI: https://doi.org/10.1016/j.genhosppsych.2007.12.006
Chapa DW, Akintade B, Son H, et al. Pathophysiological relationships between heart failure and depression and anxiety. Crit Care Nurse 2014;34:14-24. DOI: https://doi.org/10.4037/ccn2014938
Stern T, Freudenreich O, Smith F, et al. Massachusetts General Hospital Handbook of General Hospital Psychiatry. 7th Edition. Philadelphia: Elsevier; 2017.
Thase ME. The multifactorial presentation of depression in acute care. J Clin Psychiatry 2013;74:3-8. DOI: https://doi.org/10.4088/JCP.12084su1c.01
Frasure-Smith N, Lespérance F. Recent evidence linking coronary heart disease and depression. Can J Psychiatry 2006;51:730-7. DOI: https://doi.org/10.1177/070674370605101202
Wells KB, Rogers W, Burnam A, et al. How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study. Am J Psychiatry 1991;148:1688-96. DOI: https://doi.org/10.1176/ajp.148.12.1688
Cassem EH. Depression and anxiety secondary to medical illness. Psychiatr Clin North Am 1990;13:597-612. DOI: https://doi.org/10.1016/S0193-953X(18)30338-1
Miret M, Ayuso-Mateos JL, Sanchez-Moreno J, Vieta E. Depressive disorders and suicide: Epidemiology, risk factors, and burden. Neurosci Biobehav Rev 2013;37:2372-4. DOI: https://doi.org/10.1016/j.neubiorev.2013.01.008
Doshi A, Boudreaux ED, Wang N, et al. National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997-2001. Ann Emerg Med 2005;46:369-75. DOI: https://doi.org/10.1016/j.annemergmed.2005.04.018
Fick DM, Steis MR, Waller JL, Inouye SK. Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med 2013;8:500-5. DOI: https://doi.org/10.1002/jhm.2077
Bo M, Fonte G, Pivaro F, et al. Prevalence of and factors associated with prolonged length of stay in older hospitalized medical patients. Geriatr Gerontol Int 2016;16:314-21. DOI: https://doi.org/10.1111/ggi.12471
Meagher D, Adamis D, Trzepacz P, Leonard M. Features of subsyndromal and persistent delirium. Br J Psychiatry 2012;200:37-44. DOI: https://doi.org/10.1192/bjp.bp.111.095273
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.20. DOI: https://doi.org/10.1176/appi.books.9780890425596
Abengaña J, Chong MS, Tay L. Delirium superimposed on dementia: phenomenological differences between patients with and without behavioral and psychological symptoms of dementia in a specialized delirium unit. Int Psychogeriatrics 2017;29:485-95. DOI: https://doi.org/10.1017/S1041610216001836
Sobin C, Sackeim HA. Psychomotor symptoms of depression. Am J Psychiatry 1997;154:4-17. DOI: https://doi.org/10.1176/ajp.154.1.4
Faurholt-Jepsen M, Brage S, Vinberg M, et al. Differences in psychomotor activity in patients suffering from unipolar and bipolar affective disorder in the remitted or mild/moderate depressive state. J Affect Disord 2012;141:457-63. DOI: https://doi.org/10.1016/j.jad.2012.02.020
Cummings J, Mintzer J, Brodaty H, et al. Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. Int Psychogeriatrics 2015;27:7–17. DOI: https://doi.org/10.1017/S1041610214001963
Sachs GS. A review of agitation in mental illness: Burden of illness and underlying pathology. J Clinical Psych 2006;67:5-12.
Chevrolet JC, Jolliet P. Clinical review: Agitation and delirium in the critically ill - Significance and management. Critical Care 2007;11:214. DOI: https://doi.org/10.1186/cc5787
National Institute of Mental Health. CGI. Clinical Global Impressions. ECDEU Assessment Manual for Psychopharmacology 1976.
Kadouri A, Corruble E, Falissard B. The improved Clinical Global Impression Scale (iCGI): Development and validation in depression. BMC Psychiatry 2007;7:7. DOI: https://doi.org/10.1186/1471-244X-7-7
IBM SPSS Inc. SPSS Statistics for Windows. IBM Corp Released 2012. 2012;
Morris PLP, Goldberg RJ. Impact of psychiatric comorbidity on length of hospital stay in gastroenterology patients. Gen Hosp Psychiatry 1990;12:77-82. DOI: https://doi.org/10.1016/0163-8343(90)90018-8
Schor JD, Levkoff SE, Lipsitz LA, et al. Risk factors for delirium in hospitalized elderly. JAMA 1992;267:827-31. DOI: https://doi.org/10.1001/jama.267.6.827
Stevens LE, De Moore GM, Simpson JM. Delirium in hospital: Does it increase length of stay? Aust N Z J Psychiatry 1998;32:805-8. DOI: https://doi.org/10.3109/00048679809073869
Saravay SM, Lavin M. Psychiatric comorbidity and length of stay in the general hospital. A critical review of outcome studies. Psychosomatics 1994;35:233-52. DOI: https://doi.org/10.1016/S0033-3182(94)71772-2
Fulop G, Strain JJ, Vita J, Lyons JS, Hammer JS. Impact of psychiatric comorbidity on length of hospital stay for medical/surgical patients: a preliminary report. Am J Psychiatry 1987;144:878-82. DOI: https://doi.org/10.1176/ajp.144.7.878
Baek JH, Lee H, Myung W, et al. The association between inflammatory markers and general psychological distress symptoms. Gen Hosp Psychiatry 2018;46:9-12. DOI: https://doi.org/10.1016/j.genhosppsych.2018.11.002
Khan BA, Perkins AJ, Prasad NK, et al. Biomarkers of delirium duration and delirium severity in the ICU. Crit Care Med 2020;48:353-61. DOI: https://doi.org/10.1097/CCM.0000000000004139
Orsolini L, Sarchione F, Vellante F, et al. Protein-C reactive as biomarker predictor of schizophrenia phases of illness? A systematic review. Curr Neuropharmacol 2018;16:583-606. DOI: https://doi.org/10.2174/1570159X16666180119144538
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Downloads
Citations
