Psychosomatics
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Depression is commonly reported in patients after cardiac surgery and increases the risk of postoperative cardiac morbidity or mortality or both. Although preoperative depression has been implicated as the strongest predictor of depression after surgery, the characteristics thought to influence reactive or persistent depression have been poorly investigated in cardiac surgery patients. ⋯ The severity of pre-existing depression and biomedical risk factors can be markers of depression-related risk 3 months after cardiac surgery in patients with persistent and reactive depression, respectively. An integrated psychologic and biomedical evaluation is essential to anticipate which patients are likely to show depression after cardiac surgery.
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Delirium in older emergency department (ED) patients is common, associated with many adverse outcomes, and costly to manage. Delirium detection in the ED is almost universally poor. ⋯ A simple risk screening tool using factors evident on initial nurse assessment can be used to identify patients at risk of delirium. Further trials are needed to test whether the tool improves patient outcomes.
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Postictal delirium is a common adverse effect of electroconvulsive therapy (ECT) and can be dangerous to both patient and staff caring for them in the postanesthesia care unit. However, little is known about predictors of postictal delirium. ⋯ A long ECT seizure increases the likelihood of delirium in the postanesthesia care unit at the first treatment. This finding suggests that postanesthesia care unit staff may benefit from knowledge about seizure length for predicting postictal delirium and anticipating the best management of post-ECT patients.