Korean Journal of Psychosomatic Medicine (정신신체의학)

Korean Psychosomatic Society (한국정신신체의학회)
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A Study on the Characteristics and Consultation Type of Inpatients Referred for Delirium and Depressive Disorder

섬망 및 우울장애로 자문 의뢰된 입원환자의 임상적 특징 및 의뢰 형태에 관한 연구

  • Seong min Lee (Department of Psychiatry, Konkuk University Medical Center) ;
  • Seung-Ho Ryu (Department of Psychiatry, Konkuk University Medical Center) ;
  • Jee Hyun Ha (Department of Psychiatry, Konkuk University Medical Center) ;
  • Hong Jun Jeon (Department of Psychiatry, Konkuk University Medical Center) ;
  • Doo-Heum Park (Department of Psychiatry, Konkuk University Medical Center)
  • 이성민 (건국대학교병원 정신건강의학과) ;
  • 유승호 (건국대학교병원 정신건강의학과) ;
  • 하지현 (건국대학교병원 정신건강의학과) ;
  • 전홍준 (건국대학교병원 정신건강의학과) ;
  • 박두흠 (건국대학교병원 정신건강의학과)
  • Received : 2023.02.21
  • Accepted : 2023.05.09
  • Published : 2023.06.30
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Abstract

Objectives : The purpose of this study is to investigate the characteristics of patients referred for delirium and depressive disorder and to find direction of improvement of consultation-liason psychiatry in general hospital. Methods : We performed a retrospective computed chart review of the 4,966 inpatients hospitalized at Konkuk University Hospital who were referred to the Department of Psychiatry from August 1, 2005 to December 31, 2011. Results : Depressive disorder shows the order of frequency of consultation type Parallel-Complementary-Mending. Delirium shows the order of frequency of consultation type Mending-Parallel-Complementary. When comparing 'follow up consultation' and 'without follow up consultation' group within the depressive disorder, the proportion of men in the 'follow up consultation' group was higher. In the analysis of the consultation type, the 'follow up consultation' group showed the order of consultation type Parallel-Mending- Complementary, and type Parallel-Complementary-Mending in the 'without follow up consultation' group. When comparing 'follow up consultation' and 'without follow up consultation' group within the delirium, the proportion of the surgical field in the 'follow up consultation' group was higher. In the analysis of the consultation type, both group showed the order of consultation type Mending-Parallel- Complementary. Conclusions : Doctors in each department and psychiatrists should pay attention to delirium symptoms that may occur in surgical inpatients and preventive measures should be taken. Screening tests should be conducted in medical patients to properly evaluate coexisting psychiatric diseases. Risk factors of Delirium and Depressive disorder should be identified from the time of hospitalization, and actively discussing treatment plans and early interventions could improve the quality of medical services.

연구목적 본 연구는 섬망 및 우울장애로 정신건강의학과에 의뢰된 환자들의 인구학적 특성과 자문 의뢰 형태, 재협진 여부에 따른 차이를 알아봄으로써, 종합병원 입원환자에 있어 섬망 및 우울장애의 특징 및 자문 조정 정신의학의 개선 방향을 위한 자료를 얻는 것을 목표로 한다. 방 법 건국대학교병원에 2005년 8월 1일부터 2011년 12월 31일까지 입원한 환자들 중 정신건강의학과로 자문 의뢰된 4966명의 환자를 대상으로 전산화된 의무기록을 후향적으로 분석하였다. 자문의뢰형태는 정신과 과거력, 입원 시 주호소, 의뢰된 증상의 특성 등에 따라 각각 상호보완형, 병렬형, 보수형, 선행 과거력형, 오진형, 단순 재의뢰형의 총 6가지로 분류되었다. 결 과 우울장애 환자의 평균 나이는 57.0세, 섬망 환자의 평균 나이는 68.6세로 섬망 환자군에서 유의하게 더 높았다. 성비의 경우 우울장애 환자에서 여성이 66.7%, 섬망 환자에서 남성이 60.8% 로 각각 더 높았다. 입원환자의 과별 분포는 우울장애의 경우 내과계 환자의 비율이 67.7%, 섬망의 경우 외과계 환자의 비율이 50.1%로 각각 더 높은 비율을 차지하였다. 자문 의뢰 형태에서는 우울장애의 경우 병렬형-상호보완형-보수형의 순서를 보였고, 섬망 환자의 경우 보수형-병렬형-상호보완형 순서였다. 우울장애 환자군 내에서 재협진군과 1회 협진군을 비교해 보았을 때 재협진군에서 남성 비율이 유의하게 높았다. 자문 의뢰 형태 분석에서 재협진군은 병렬형-보수형-상호보완형의 빈도 순을 보였으며 1회 협진군에서 병렬형-상호보완형-보수형의 순서를 보였다. 섬망 진단 환자군 내에서 재협진군과 1회 협진군을 비교해 보았을 때 재협진군에서 외과계의 비율이 유의하게 높았다. 자문 의뢰 형태 분석에서 재협진군과 1회 협진군 모두 보수형-병렬형-상호보완형의 순서를 보였다. 결 론 정신과 자문 의뢰 형태를 분석한 결과 우울장애 환자군과 섬망 환자군에서는 연령, 성비, 자문 의뢰 형태, 재협진률 등에서 유의한 차이를 보였다. 이 같은 결과를 바탕으로 의료진은 환자를 입원시키는 시점부터 우울장애 및 섬망과 같이 호발하는 정신과적 공존 질환에 대해 정신건강의학과 자문을 통해 적극적으로 치료계획을 논의함으로써, 환자에게 이차적으로 발생할 수 있는 우울장애와 섬망 등의 위험 요인을 파악하고 조기에 개입하여 의료 서비스의 질을 향상시킬 수 있을 것이다.

Keywords

References

  1. Millar HR. Psychiatric morbidity in elderly surgical patients. Br J Psychiatry 1981;138:17-20. https://doi.org/10.1192/bjp.138.1.17
  2. Shevitz SA, Silberfarb PM, Lipowski ZJ. Psychiatric consultations in a general hospital. A report on 1,000 referrals. Dis Nerv Syst 1976;37:295-300.
  3. Lipowski ZJ. Review of consultation psychiatry and psycho-somatic medicine. I. General principles. Psychosom Med 1967;29:153-171. https://doi.org/10.1097/00006842-196703000-00007
  4. Gobar AH, Collins JL, Mathura CB. Utilization of a consultation liaison psychiatry service in a general hospital. J Natl Med Assoc 1987;79:505-508.
  5. Mudgal V, Rastogi P, Niranjan V, Razdan R. Pattern, clinical and demographic profile of inpatient psychiatry referrals in a tertiary care teaching hospital: a descriptive study. Gen Psychiatr 2020 Jun 18;33:e100177.
  6. Byoun WT, Kim JH, Je YM, Chung YI, Kim JC, Park JM. A study for advancement of psychiatric consultation-liaison activity I. A survey of the prevalence of psychiatric m orbidity in adult patient population of medical and surgical ward, and physician's a ttitudes toward psychiatric consultation. J Korean Neuropsychiatr Assoc 1986;25:81-91.
  7. Kim SR, Rim HD. A clinical study of psychiatric consultation at kyungbook national university hospital. J Korean Neuropsychiatr Assoc 1995;34:90-107.
  8. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA 1996;275: 852-857. https://doi.org/10.1001/jama.1996.03530350034031
  9. Hafner M, Singler K. Definition and epidemiology of delirium in the elderly. Ther Umsch 2010;67:57-61. https://doi.org/10.1024/0040-5930/a000011
  10. Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE, Marcantonio ER. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc 2010;58:643-649. https://doi.org/10.1111/j.1532-5415.2010.02762.x
  11. Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a metaanalytic review. Int Psychogeriatr 2007;19:197-214. https://doi.org/10.1017/S104161020600425X
  12. Pompei P, Foreman M, Rudberg MA, Inouye SK, Braund V, Cassel CK. Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 1994;42:809-815. https://doi.org/10.1111/j.1532-5415.1994.tb06551.x
  13. Swigart SE, Kishi Y, Thurber S, Kathol RG, Meller WH. Misdiagnosed delirium in patient referrals to a university-based hospital psychiatry department. Psychosomatics 2008; 49:104-108. https://doi.org/10.1176/appi.psy.49.2.104
  14. The psychological care of medical patients. Recognition of need and service provision. Joint Working Party of the Royal Colleges of Physicians and Psychiatrists. J R Coll Physicians Lond 1995;29:192-193.
  15. Kim JM, Stewart R, Bae KY, Yang SJ, Yoon JS, Jung SW, Lee MS, Yim HW, Jun TY. Physical comorbidity and 12-week treatment outcomes in Korean patients with depressive disorders: the CRESCEND study. J Psychosom Res 2011;71:311-318. https://doi.org/10.1016/j.jpsychores.2011.05.001
  16. Han KM, Ko YH, Yoon HK, Han C, Ham BJ, Kim YK. Relationship of depression, chronic disease, self-rated health, and gender with health care utilization among community-living elderly. J Affect Disord 2018;241:402-410. https://doi.org/10.1016/j.jad.2018.08.044
  17. Mechanic D. Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy. J Clin Psychiatry 2007;68 Suppl 2:20-6.
  18. Vaz FJ, Salcedo MS. A model for evaluating the impact of consultation-liaison psychiatry activities on referral patterns. Psychosomatics 1996;37:289-298. https://doi.org/10.1016/S0033-3182(96)71568-2
  19. Seo YE, Kim TS, Won WY, Lee CU, Lee C. Risk factors associated with the severity of delirium. J Korean Neuropsychiatr Assoc 2010;49:586-592.
  20. Bae JH, Kang WS, Paik JW, Kim JW. Changing trends in the occurrence and management of delirium for 5 years in a university hospital. J Psychosom Res 2012;20:112-119.
  21. Elie M, Cole MG, Primeau FJ, Bellavance F. Delirium risk factors in elderly hospitalized patients. J Gen Intern Med 1998;13:204-212. https://doi.org/10.1046/j.1525-1497.1998.00047.x
  22. Park JH, Kim KW. A review of the epidemiology of depression in Korea. Journal of the Korean Medical Association 2011;54:362-369. https://doi.org/10.5124/jkma.2011.54.4.362
  23. Inouye SK. Delirium in older persons. N Engl J Med 2006;354:1157-1165. https://doi.org/10.1056/NEJMra052321
  24. Pepersack T, De Breucker S, Mekongo YP, Rogiers A, Beyer I. Correlates of unrecognized depression among hospitalized geriatric patients. J Psychiatr Pract 2006;12:160-167. https://doi.org/10.1097/00131746-200605000-00005
  25. Alamri SH, Bari AI, Ali AT. Depression and associated factors in hospitalized elderly: a cross-sectional study in a Saudi teaching hospital. Ann Saudi Med 2017;37:122-129 https://doi.org/10.5144/0256-4947.2017.122
  26. Pompei P, Foreman M, Cassel CK, Alessi C, Cox D. Detecting delirium among hospitalized older patients. Arch Intern Med 1995;155:301-307. https://doi.org/10.1001/archinte.1995.00430030095011
  27. Kimberly FR, Pratik PP, Christopher GH. Postoperative delirium. La Presse Medicale 2018;47:e53-e64. https://doi.org/10.1016/j.lpm.2018.03.012
  28. Mishel MH. Perceived uncertainty and stress in illness. Res Nurs Health 1984;7:163-171. https://doi.org/10.1002/nur.4770070304
  29. McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. Arch Intern Med 2002;162:457-463. https://doi.org/10.1001/archinte.162.4.457
  30. Creed F, Morgan R, Fiddler M, Marshall S, Guthrie E, House A. Depression and anxiety impair health-related quality of life and are associated with increased costs in general medical inpatients. Psychosomatics 2002;43:302-309. https://doi.org/10.1176/appi.psy.43.4.302
  31. Martucci M, Balestrieri M, Bisoffi G, Bonizzato P, Covre MG, Cunico L, De Francesco M, Marinoni MG, Mosciaro C, Piccinelli M, Vaccari L, Tansella M. Evaluating psychiatric morbidity in a general hospital: a two-phase epidemiological survey. Psychol Med 1999;29:823-832. https://doi.org/10.1017/S0033291799008491
  32. Vonammon Cavanaugh S. The prevalence of emotional and cognitive dysfunction in a general medical population: using the MMSE, GHQ, and BDI. Gen Hosp Psychiatry 1983;5:15-24. https://doi.org/10.1016/0163-8343(83)90038-5
  33. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571. https://doi.org/10.1001/archpsyc.1961.01710120031004
  34. Mouchoux C, Rippert P, Duclos A, Fassier T, Bonnefoy M, Comte B, Heitz D, Colin C, Krolak-Salmon P. Impact of a multifaceted program to prevent postoperative delirium in the elderly: the CONFUCIUS stepped wedge protocol. BMC Geriatr 2011;11:25.