Consultation-Liaison psychiatry in a high-complexity university hospital in Turin, Italy: an observational study with a focus on delirium and predictive factors of clinical outcome.

BACKGROUND AND

aimThis observational study aims to provide an overview of consultation-liaison psychiatry (CLP) activity within the high-intensity, complex hospital setting of the 'Azienda Ospedaliera Universitaria Città della Salute e della Scienza' in Turin. The study is mainly focused on delirium-related features and predictive factors of clinical outcome.

methodA retrospective analysis was conducted on 500 psychiatric consultations provided by the University Facility of Psychiatry. Additional analysis was performed in a subgroup of patients with a diagnosis of delirium (143 subjects). The Delirium Rating Scale-Revised-98 (DRS-R-98) was administered at the time of consultation (T0) and 1 week later (T1). Descriptive statistics were performed on the whole sample. In the subgroup of patients with delirium, linear regression for continuous variables and one-way analysis of variance for categorical variables were conducted. Stepwise multiple regression was performed with ΔDRS-R-98 (difference of DRS-R-98 score between T0 and T1) as the dependent variable.

resultsThe majority of requests for consultation came from the internal medicine department or from orthopaedic and trauma units and concerned male patients with a positive history of psychiatric disorders. Although psychiatric re-evaluations were frequently required, transfers to the psychiatric ward were rare (9.8%), and there were no compulsory psychiatric admissions in our sample. In addition to delirium, the most frequent reason for requesting CLP evaluation was depressive disorder. Among the 143 cases of delirium, the mean age and prevalence of males were higher than in the whole sample. Mortality was also higher (28%) than in the whole sample (17.6%). In the stepwise multiple regression analysis, variables significantly and independently associated with ΔDRS-R-98 included: age (t=-4.074; p<0.001), treatment with benzodiazepines (BDZ) (t=-5.737; p<0.001) and treatment with atypical antipsychotics (t=3.104; p=0.002).

conclusionsCLP interventions in our high-complexity general university hospital were mainly requested for patients with mood disorders and delirium. CLP service provides an important opportunity to identify unknown psychiatric disorders or symptoms below the diagnostic threshold. Predictors of improvement of delirium-related symptoms are young age and the use of atypical antipsychotics, while BDZ treatment can be considered a negative predictor of outcome in patients with delirium. Further research on this topic is recommended to better understand the relevance of CLP, particularly the effects of this type of intervention in the management of delirium.