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  1. Article ; Online: Connecting acute and chronic neurocognitive impairment.

    Oldham, Mark A

    International psychogeriatrics

    2022  Volume 34, Issue 4, Page(s) 323–325

    MeSH term(s) HIV Infections ; Humans ; Neurocognitive Disorders/diagnosis ; Neuropsychological Tests
    Language English
    Publishing date 2022-03-15
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 1038825-4
    ISSN 1741-203X ; 1041-6102
    ISSN (online) 1741-203X
    ISSN 1041-6102
    DOI 10.1017/S104161022200028X
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  2. Article ; Online: Follow the Money: The Widening Coding Disparity Between Acute Encephalopathy and Delirium.

    Oldham, Mark A

    Journal of the Academy of Consultation-Liaison Psychiatry

    2022  Volume 63, Issue 5, Page(s) 423–425

    MeSH term(s) Brain Diseases ; Delirium ; Humans
    Language English
    Publishing date 2022-02-21
    Publishing country Netherlands
    Document type Editorial ; Comment
    ISSN 2667-2960
    ISSN (online) 2667-2960
    DOI 10.1016/j.jaclp.2022.02.004
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  3. Article ; Online: Describing the features of catatonia: A comparative phenotypic analysis.

    Oldham, Mark A

    Schizophrenia research

    2022  Volume 263, Page(s) 82–92

    Abstract: Background: Catatonia is widely under-detected, and the many differences across catatonia rating scales and diagnostic criteria could be a key reason why clinicians have a hard time knowing what catatonia looks like and what constitutes each of its ... ...

    Abstract Background: Catatonia is widely under-detected, and the many differences across catatonia rating scales and diagnostic criteria could be a key reason why clinicians have a hard time knowing what catatonia looks like and what constitutes each of its features.
    Methods: This review begins by discussing the nature of catatonia diagnosis, its evolution in ICD and DSM, and different approaches to scoring. The central analysis then provides a descriptive survey of catatonia's individual signs across scales and diagnostic criteria. The goal of this survey is to characterize distinctions across scales and diagnostic criteria that can introduce variance into catatonia caseness.
    Results: Diagnostic criteria for catatonia in DSM-5-TR and ICD-11 are broadly aligned in terms of which items are included, item definitions and number of items required for diagnosis; however, the lack of item thresholds is a fundamental limitation. Many distinctions across scales and criteria could contribute to diagnostic discordance.
    Discussion: Clear, consistent definitions for catatonia features are essential for reliable detection. Of available scales, Bush-Francis and Northoff can be converted to diagnostic criteria with limited modification. Bush-Francis is the most efficient, with a screening instrument, videographic resources and standardized clinical assessment. Northoff offers the most detailed assessment and uniquely emphasizes emotional and volitional disturbances in catatonia.
    Conclusions: The field's understanding of the catatonia phenotype has advanced considerably over the past few decades. However, this review reveals many important limitations in the ICD and DSM as well as differences across scales and criteria that stand in the way of reliable catatonia detection.
    MeSH term(s) Humans ; Catatonia/diagnosis ; Catatonia/psychology ; Psychiatric Status Rating Scales ; Diagnostic and Statistical Manual of Mental Disorders ; International Classification of Diseases ; Surveys and Questionnaires
    Language English
    Publishing date 2022-08-20
    Publishing country Netherlands
    Document type Review ; Journal Article
    ZDB-ID 639422-x
    ISSN 1573-2509 ; 0920-9964
    ISSN (online) 1573-2509
    ISSN 0920-9964
    DOI 10.1016/j.schres.2022.08.002
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  4. Article ; Online: The Roles of Psychiatric Consultant and Liaison Realized Through Proactivity and Care Integration.

    Oldham, Mark A

    Journal of the Academy of Consultation-Liaison Psychiatry

    2021  Volume 62, Issue 2, Page(s) 167–168

    MeSH term(s) Consultants ; Humans ; Psychiatry ; Referral and Consultation
    Language English
    Publishing date 2021-01-29
    Publishing country Netherlands
    Document type Editorial
    ISSN 2667-2960
    ISSN (online) 2667-2960
    DOI 10.1016/j.jaclp.2021.01.004
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  5. Article ; Online: Delirium disorder: Unity in diversity.

    Oldham, Mark A

    General hospital psychiatry

    2021  Volume 74, Page(s) 32–38

    Abstract: Objective: The first objective of this review is to explore the factors that have led to and maintain the division between delirium and acute encephalopathy. The second is to explore the value of harmonizing them through the model of delirium disorder.!# ...

    Abstract Objective: The first objective of this review is to explore the factors that have led to and maintain the division between delirium and acute encephalopathy. The second is to explore the value of harmonizing them through the model of delirium disorder.
    Method: This narrative review outlines major distinctions between delirium and acute encephalopathy. It also compares them with the model of delirium disorder, which seeks not only to integrate them but also to offer a broader palette of treatment targets.
    Results: Delirium implies an underlying acute encephalopathy, whereas acute encephalopathy presents as a spectrum from subsyndromal delirium to coma. Key factors that differentiate these two models include tradition, nuances of the models themselves, linguistic connotations, evoked responses from clinicians, implications of preventability and responsibility, cultural perceptions of non-pharmacological vs pharmacological interventions and economic incentives. A validated set of pathophysiological subtypes may ultimately help link the delirium-spectrum phenotype with various acute encephalopathies.
    Conclusions: Developing a coherent clinical and scientific approach to this set of conditions demands that we first develop a coherent understanding of the conditions themselves and how they relate to one another. Such an approach must embrace the tension between a convergent phenotype and its diverse biological underpinnings.
    MeSH term(s) Brain Diseases ; Delirium/therapy ; Humans ; Surveys and Questionnaires
    Language English
    Publishing date 2021-12-03
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 392299-6
    ISSN 1873-7714 ; 0163-8343
    ISSN (online) 1873-7714
    ISSN 0163-8343
    DOI 10.1016/j.genhosppsych.2021.11.007
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  6. Article ; Online: The phenotype of delirium based on a close reading of diagnostic criteria.

    Oldham, Mark A / Weber, Miriam T

    International journal of geriatric psychiatry

    2023  Volume 38, Issue 12, Page(s) e6046

    Abstract: Objective: Although delirium is well known to acute care clinicians, the features required for its diagnosis and how to understand and operationalize them remain sticking points in the field. To clarify the delirium phenotype, we present a close reading ...

    Abstract Objective: Although delirium is well known to acute care clinicians, the features required for its diagnosis and how to understand and operationalize them remain sticking points in the field. To clarify the delirium phenotype, we present a close reading of past and current sets of delirium diagnostic criteria.
    Methods: We first differentiate the delirium syndrome (i.e., features evaluated at bedside) from additional criteria required for diagnosis. Next, we align related features across diagnostic systems and examine them in context to determine intent. Where criteria are ambiguous, we review common delirium instruments to illustrate how they have been interpreted.
    Results: An acute disturbance in attention is universally attested across diagnostic systems. A second core feature denotes confusion and has been included across systems as disturbance in awareness, impaired consciousness, and thought disorganization. This feature may be better understood as a disturbance in thought clarity and operationalized in terms of neuropsychological domains thereby clearly linking it to global neurocognitive disturbance. Altered level of activity describes a third core feature, including motor and sleep/wake cycle disturbances. Excluding stupor (wherein mental content cannot be assessed due to reduced arousal) from delirium, as in DSM-5-TR, is appropriate for a psychiatric diagnosis, but the brain injury exclusion in ICD-11 is unjustified.
    Conclusions: The delirium phenotype involves a disturbance in attention, qualitative thought clarity, and quantitative activity level, including in relation to expected sleep/wake cycles. Future diagnostic systems should include a severity threshold and specify that delirium diagnosis refers to a 24-h period.
    MeSH term(s) Humans ; Arousal ; Attention ; Delirium/diagnosis ; Delirium/psychology ; Phenotype
    Language English
    Publishing date 2023-12-26
    Publishing country England
    Document type Review ; Journal Article
    ZDB-ID 806736-3
    ISSN 1099-1166 ; 0885-6230
    ISSN (online) 1099-1166
    ISSN 0885-6230
    DOI 10.1002/gps.6046
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  7. Article ; Online: Requesting That Delirium Achieve Parity With Acute Encephalopathy in the MS-DRG System.

    Oldham, Mark A / Heinrich, Thomas / Luccarelli, James

    Journal of the Academy of Consultation-Liaison Psychiatry

    2024  

    Abstract: Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap ...

    Abstract Since 2007, the Medicare Severity Diagnosis Related Groups classification system has favored billing codes for acute encephalopathy over delirium codes in determining hospital reimbursement and several quality-of-care value metrics, despite broad overlap between these sets of diagnostic codes. Toxic and metabolic encephalopathy codes are designated as major complication or comorbidity, whereas causally specified delirium codes are designated as complication or comorbidity and thus associated with a lower reimbursement and lesser impact on value metrics. The authors led a submission to the U.S. Centers for Medicare and Medicaid Services requesting that causally specified delirium be designated major complication or comorbidity alongside toxic and metabolic encephalopathy. Delirium warrants reclassification because it satisfies U.S. Centers for Medicare and Medicaid Services' guiding principles for re-evaluating Medicare Severity Diagnosis Related Group severity levels. Delirium: (1) has a bidirectional relationship with the permanent condition of dementia (major neurocognitive disorder per DSM-5-TR), (2) indexes vulnerability across populations, (3) impacts healthcare systems across levels of care, (4) complicates postoperative recovery, (5) consigns patients to higher levels of care, (6) impedes patient engagement in care, (7) has several recent treatment guidelines, (8) often indicates neuronal/brain injury, and (9) represents a common expression of terminal illness. The proposal's impact was explored using the 2019 National Inpatient Sample, which suggested that increasing delirium's complexity designation would lead to an upcoding of less than 1% of eligible discharges. Parity for delirium is essential to enhancing awareness of delirium's clinical and economic costs. Appreciating delirium's impact would encourage delirium prevention and screening efforts, thereby mitigating its dire outcomes for patients, families, and healthcare systems.
    Language English
    Publishing date 2024-02-22
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2667-2960
    ISSN (online) 2667-2960
    DOI 10.1016/j.jaclp.2024.02.004
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  8. Article ; Online: Personality-Informed Care: Speaking the Language of Personality.

    Oldham, Mark A

    Psychosomatics

    2020  Volume 61, Issue 3, Page(s) 220–230

    Abstract: Background: Personality describes an enduring pattern of experiences and behaviors in the interpersonal and social sphere. Several aspects of personality, e.g., defenses, relational dynamics, and reactions, are commonly accentuated in the midst of ... ...

    Abstract Background: Personality describes an enduring pattern of experiences and behaviors in the interpersonal and social sphere. Several aspects of personality, e.g., defenses, relational dynamics, and reactions, are commonly accentuated in the midst of medical care; therefore, understanding a patient's personality allows the clinician to make informed predictions about how a specific patient may respond to illness and how care interactions might be modified to optimize care engagement and outcomes.
    Objective/methods: This article provides a brief description of the personalities in the Psychodynamic Diagnostic Manual, Second Edition, and discusses how each one might inform clinical interactions. Two additional personality-like presentations-the traumatized patient and cognitive impairment-are included for clinical utility given their high prevalence in medical settings and their potential for broad impact on clinical relationships.
    Results: Personality-informed care is an approach that incorporates information about the patient's personality into the clinical relationship. It describes what the clinician might say and when, what recommendations to offer and how to frame them, and how to comport oneself while providing care.
    Conclusions: Personality-informed care operationalizes several aspects of personalized medicine, and it offers a heuristic framework that may facilitate and enhance the implementation of evidence-based care.
    MeSH term(s) Humans ; Language ; Patient-Centered Care ; Personality ; Personality Disorders/psychology ; Physician-Patient Relations
    Language English
    Publishing date 2020-01-28
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 209487-3
    ISSN 1545-7206 ; 0033-3182
    ISSN (online) 1545-7206
    ISSN 0033-3182
    DOI 10.1016/j.psym.2020.01.005
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  9. Article ; Online: Response to Commentary Titled "Conflation of Delirium and Coma as Acute Encephalopathy".

    Oldham, Mark A / Crone, Catherine C / Rosenthal, Lisa J

    Journal of the Academy of Consultation-Liaison Psychiatry

    2023  Volume 64, Issue 4, Page(s) 412–413

    MeSH term(s) Humans ; Coma/etiology ; Brain Diseases ; Delirium/etiology
    Language English
    Publishing date 2023-06-14
    Publishing country Netherlands
    Document type Letter ; Research Support, N.I.H., Extramural ; Comment
    ISSN 2667-2960
    ISSN (online) 2667-2960
    DOI 10.1016/j.jaclp.2023.04.006
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  10. Article: Sex Differences in Delirium after Coronary Artery Bypass Graft Surgery and Perioperative Neuropsychiatric Conditions: A Secondary Analysis of a Cohort Study.

    Oldham, Mark A / Kukla, Bennett / Walsh, Patrick / Lee, Hochang B

    Journal of geriatric psychiatry and neurology

    2024  , Page(s) 8919887241246226

    Abstract: Background: Biological sex influences the risk of depression and cognitive impairment, but its role in relation to postoperative delirium is unclear. This analysis investigates sex differences in delirium risk after coronary artery bypass graft (CABG) ... ...

    Abstract Background: Biological sex influences the risk of depression and cognitive impairment, but its role in relation to postoperative delirium is unclear. This analysis investigates sex differences in delirium risk after coronary artery bypass graft (CABG) surgery and sex-related differences in relation to affective and cognitive symptoms.
    Methods: This is a secondary analysis of the Neuropsychiatric Outcomes After Heart Surgery (NOAHS) study, a single-site, observational study of a CABG surgery cohort (n = 149). Preoperative characteristics are stratified by sex, and baseline variables that differ by sex are evaluated to understand whether sex modifies their relationships with delirium. We also evaluate sex differences in one-month depression and cognition.
    Results: Female sex is associated with several delirium risk factors, including higher risk of preoperative depression and middle cerebral artery (MCA) stenosis. MCA stenosis was statistically associated with delirium only among women (OR 15.6, 95% CI 1.5, 164.4); mild cognitive impairment (MCI) was associated with delirium only in men (OR 4.6, 95% CI 1.2, 17.9). Other sex-based differences failed to reach statistical significance. Depression remained commoner among women 1 month post-CABG.
    Conclusions: Women in this CABG cohort were more likely to have depression at baseline and 1 month postoperatively, as well as MCA stenosis and postoperative delirium. Sex might modify the relationship between post-CABG delirium and its risk factors including MCA stenosis and MCI. Cerebrovascular disease deserves study as a potential explanation linking female sex and a range of poor outcomes among women with coronary heart disease.
    Language English
    Publishing date 2024-04-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1035760-9
    ISSN 0891-9887
    ISSN 0891-9887
    DOI 10.1177/08919887241246226
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