Delirium and decisional incapacity in veterans with schizophrenia and medical illness.
OBJECTIVE
The objective was to examine the characteristics of Veterans with schizophrenia admitted for nonpsychiatric hospitalizations.


METHODS
We conducted a review of the electronic medical record and data warehouse downloads of Veterans with schizophrenia admitted to nonpsychiatric services of a large, academic Veterans Affairs hospital between 2004 and 2009 on whom psychiatry was consulted.


RESULTS
Seventy-four veterans were admitted 89 times. Their mean age was 62 years. Among these veterans, the most common reasons for nonpsychiatric admission were infection, cardiac disease or altered mental status. Thirty-three percent of consultations were for patients who required intensive care. Consultation was requested most frequently for assessing psychotropic medication, decision-making capacity or altered mental status, or for assistance with behavioral problems. Thirty-seven percent of patients were diagnosed with delirium, and 42% lacked decision-making capacity, mostly secondary to delirium. Twenty-seven percent of patients died during the study period.


CONCLUSIONS
In an aging cohort of Veterans with schizophrenia, a substantial proportion of patients developed delirium, lost decision-making capacity and required intensive care during nonpsychiatric hospital admission.
Mental Health Division, Portland VAMC, P.O. Box 1034, Portland, OR 97207, USA. Linda.Ganzini@va.gov
Linda
L
Ganzini
David
D
Mansoor
Robert
R
Socherman
Jonathan
J
Duckart
D003657:Decision Making; D003693:Delirium / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012017:Referral and Consultation; D012565:Schizophrenic Psychology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*