BACKGROUND:Solid organ transplantation in patients with schizophrenia is challenging. In particular, there are limited data to support the practice of lung transplantation in patients with schizophrenia. We previously reported the first case of right unilateral lung transplantation in a patient with schizophrenia. However, the long-term outcomes of psychiatric symptoms and social functioning following lung transplantation remain unclear. OBJECTIVE:To describe the long-term psychiatric symptoms and social functioning outcomes following the previously reported lung transplantation in a patient with schizophrenia and to provide evidence to guide transplant eligibility decision-making in this population. METHODS:In this case report and literature review, we present the case of a 53-year-old male diagnosed with schizophrenia who underwent right unilateral lung transplantation at age 35 years and was followed-up over 17 years. We then review the literature for additional case reports that describe patients with schizophrenia who underwent solid organ transplantation. RESULTS:The patient presented in our case report showed favorable long-term social functioning as a full-time clerical staffer as part of a disability employment program. Among the case reports reviewed, most documented follow-up periods were three years or less; thus, little information has been published on social functioning outcomes. CONCLUSIONS:This review highlights the need for additional research on lung transplantation in patients with schizophrenia to better understand pretransplant evaluation and posttransplant management.
BACKGROUND:Patients with schizophrenia spectrum disorders are vulnerable to clinically significant perioperative psychiatric deterioration, including delirium, which may require consultation-liaison psychiatry management and complicate medical and surgical care in general hospitals. Although postoperative delirium and nondelirious psychiatric worsening have been studied separately, no validated prediction tool has integrated these clinically relevant outcomes for perioperative risk assessment in patients with schizophrenia spectrum disorder. OBJECTIVE:To develop and internally validate a predictive scoring model for perioperative symptom exacerbation in patients with schizophrenia spectrum disorders. METHODS:We conducted a retrospective multicenter registry study of patients with schizophrenia spectrum disorder admitted to nonpsychiatric wards for surgical treatment at 3 general acute care hospitals in Japan between April 2017 and March 2022. Perioperative psychiatric symptom exacerbation was defined as clinically meaningful deterioration requiring specialist psychiatric management, operationalized as psychiatrist-initiated psychotropic medication changes lasting ≥4 days, psychiatric symptom-related physical restraints, or transfer to a psychiatric ward. Predictors retained in the final model were identified using multivariable logistic regression, and a simplified scoring system was internally validated using bootstrap resampling. RESULTS:Among 200 patients, perioperative psychiatric symptom exacerbation occurred in 25 (12.5%). Emergency surgery, operative time ≥180 min, and admission from another hospital or facility were retained in the final multivariable model. The simplified score (0-3) showed acceptable discrimination (optimism-adjusted area under the curve 0.741). At a cutoff score ≥1, the model demonstrated high sensitivity (88.0%) and negative predictive value (95.5%), suggesting potential utility as a rule-out tool. CONCLUSIONS:This preliminary scoring model showed high sensitivity and negative predictive value in internal validation and may provide a framework for future validation as a perioperative triage-support tool. External validation is required before routine clinical implementation.
Functional somatic disorders (FSDs) are characterized by persistent and bothersome physical symptoms associated with impairment or disability. FSD have a significant impact on quality of life, whereas concurrently presenting clinicians with considerable challenges, due to the difficulty in comprehending the reasons for and the mechanisms by which physical symptoms persist. A history of medical events (e.g., severe infections, injuries, or invasive procedures) is common in patients with FSD and has been identified as a potential trigger factor. The emergence of physical symptoms and health-related psychologic symptoms after a stressful medical event provides a compelling basis for comparison with posttraumatic stress disorder (PTSD). We hypothesize that a subset of FSD cases can be conceptualized as a "postmedical event stress disorder," a condition analogous to PTSD. We reinterpret FSD symptoms as consequences of a stressful medical event, detailing the psychopathological processes that may explain their emergence and persistence in a specific subset of patients. While acknowledging key differences between FSD and PTSD, we propose a therapeutic framework for this specific subgroup of FSD patients that draws on successful PTSD treatment models. We conclude by outlining future research to further explore and validate this proposed PTSD-like mechanism.
BACKGROUND:Critically ill patients and their family members experience profound psychologic stress and are at elevated risk for persistent psychiatric sequelae. Despite this, the role of embedded clinical psychologists in the medical intensive care unit remains understudied. OBJECTIVE:This study aims to characterize consultation patterns and service utilization of dedicated psychology services across 2 medical intensive care units and inform future outcomes-focused research. METHODS:This retrospective observational study describes 2 models of an embedded clinical psychology service within a medical intensive care unit. Psychology consultation data were collected at 2 large, urban academic medical centers over a 1-year period (July 2022-June 2023; N = 428). Descriptive statistics and chi-square and independent t-tests were used to characterize and compare sociodemographic, clinical, and consultation variables across sites. RESULTS:Family support was the most common reason for psychology consultation across both sites (Cooper University Health Care: 40%, Columbia University Irving Medical Center: 28%). Among patient referrals, anxiety, depression, adjustment difficulties, and coping were most frequent. Trauma/stressor-related, depressive, and anxiety disorders were the most common diagnoses; approximately one-third of patients at each site did not receive a formal psychiatric diagnosis. Columbia University Irving Medical Center patients had significantly longer intensive care unit and hospital lengths of stay and higher rates of extracorporeal membrane oxygenation use. Rates of mortality (∼40-43%) and comfort care transitions (∼25-26%) among referred patients were notably elevated at both sites. Other similarities and differences of key sociodemographic, psychologic, and medical variables across the 2 sites are presented and discussed. CONCLUSIONS:Embedded psychologic services were highly utilized for patient and family support in the medical intensive care unit, particularly in the context of communication barriers, end-of-life care, and high medical complexity. Notably, a substantial proportion of patients who did not meet formal psychiatric diagnostic criteria still presented with clinically significant distress amenable to psychologic intervention-a finding with important implications for how psychology services are justified and resourced in critical care settings. Future research should examine associations between embedded psychology consultation and intensive care unit outcomes, including length of stay, delirium incidence and duration, post-intensive care unit psychiatric distress, and family member wellbeing.
BACKGROUND:Droperidol carries a black box warning from the US Food and Drug Administration regarding the risk for corrected QT (QTc) prolongation and torsades de pointes but is experiencing a resurgence of use for agitation in emergency medicine settings. OBJECTIVE:This structured review aims to investigate effects of droperidol on cardiac conduction and risk of arrhythmias when used at standard doses. METHODS:We searched PubMed from inception through February 2025. We included studies describing cardiac effects or changes in vital signs in the setting of droperidol usage, excluding those involving other QTc-prolonging medications that lacked independent examination of droperidol effects. Two reviewers assessed articles and extracted data. RESULTS:Forty-nine articles were included-18 randomized controlled trials, 3 nonrandomized trials, 19 observational studies, 7 case reports/series, and 2 Cochrane meta-analyses-with 41,878 individuals taking droperidol. Data were highly heterogenous, but QTc prolongation was observed in all levels of literature. Several randomized controlled trials suggested QTc prolongation of 10-25 ms at doses less than 10 mg. Evidence of increased risk for arrhythmias or sudden cardiac death was not present. Mixed effects were seen on vital signs. CONCLUSIONS:Despite practical advantages for agitation, the use of droperidol is associated with moderate- to high-risk QTc prolongation, comparable to ziprasidone and greater than intravenous haloperidol. Although droperidol use does not appear to be associated with an increased risk for arrhythmia, alternative agents may be preferred in patients with other risk factors for arrhythmias. Consultation-liaison and emergency psychiatrists should be familiar with these risks.
BACKGROUND:Medically complex inpatients with severe somatic illness and comorbid mental disorders are rarely reached by standard psychiatric or psychosomatic services due to physical limitations and complex care needs. The Nuremberg Integrated Psychosomatic Acute Unit (NIPA)-an embedded, ward-based psychosomatic care model delivering multidisciplinary treatment-was developed to address this gap by providing proactive, individualized psychosomatic care directly within internal medicine wards. OBJECTIVE:To describe symptom trajectories and hospitalization patterns associated with participation in the NIPA model under real-world conditions. METHODS:We analyzed real-world clinical data from a retrospective cohort of 139 patients with gastrointestinal, respiratory, and oncological diseases treated by NIPA between 2018 and 2024. Depression (Patient Health Questionnaire 9), anxiety (Generalized Anxiety Disorder 7), and somatic symptom burden (Patient Health Questionnaire 15) were assessed at admission and discharge. Patient satisfaction was assessed using the Nuremberg Satisfaction with Treatement Questionnaire (ZUF-8). A postal follow-up survey was conducted 3 months postdischarge (response rate 25.2%). Hospitalization data for the 3 months before and after NIPA were obtained from hospital records and supplemented by follow-up self-reports. RESULTS:Statistically significant improvements in depression (η2 = 0.30), anxiety (η2 = 0.37), and somatic symptoms (η2 = 0.19) were observed at discharge. At 3-month follow-up, sustained improvements were observed for anxiety (η2 = 0.36) and moderate improvements for depression (η2 = 0.17). Within 3 months of discharge, 26.2% of patients were rehospitalized; in only 8.2% of cases was readmission associated with the same psychosocial symptom constellation. Most readmissions were attributable to somatic deterioration or planned medical interventions. Among patients with frequent prior hospitalizations, mean inpatient days were observed to decrease from 8.4 to 3.2, and 64.6% were not readmitted. CONCLUSIONS:Participation in the NIPA program was associated with clinically meaningful improvements in psychological distress and favorable hospitalization patterns among medically complex inpatients. These findings suggest that this kind of integrated proactive psychosomatic care is feasible for this underserved population and support the need for controlled studies to further evaluate its effectiveness.
Hydromorphone is a potent semi-synthetic opioid analgesic frequently administered for acute pain management in hospitalized patients. Opioids have been shown to cause muscle rigidity, akinesia, and catalepsy in human and animal models (Vankova, 1996), but full syndromic catatonia induced by opioids is not well documented. To our knowledge, only four published cases describe opioid-induced catatonia, with reported presentations predominantly characterized by motor findings such as rigidity, and only one case requiring treatment with lorazepam (Yeoh, 2022; Huang, 2007; Di Rosa, 2014; Ketigian, 2023). We present a unique case of hydromorphone-induced mixed state catatonia that met standardized diagnostic criteria and resolved completely with lorazepam. This case underscores that catatonia remains under-recognized outside of psychiatric settings, where its features may be misattributed to delirium, highlighting the importance of early psychiatric consultation.
