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Psychiatry Consultations in the Hospice Setting: A Case Series
Susan Maixner, MD, University of Michigan Health System, Ann Arbor, MI; Arbor Hospice, Ann Arbor, MI
Caroline A. Vitale, MD, University of Michigan Health System, Ann Arbor, MI; Veterans Administration Ann Arbor Health System, Ann Arbor, MI
Anjanette M. Stoltz, MD, University of Michigan Health System, Ann Arbor, MI; Arbor Hospice, Ann Arbor, MI
Mary Wisely, MD, Arbor Hospice, Ann Arbor, MI
Susan M. Duffy, MD, University of Michigan Health System, Ann Arbor, MI
Marcos Montagnini, MD, Veterans Administration Ann Arbor Health System, Ann Arbor, MI; University of Michigan Health System, Ann Arbor, MI,

Traditionally, palliative medicine services have served patients with cancer diagnoses. However, with our aging population, increasing numbers of older adults are being enrolled into hospice with diagnoses of debility, dementia, or cardiopulmonary disorders. Depression, anxiety, delirium, cognitive impairment, and neuropsychiatric symptoms often accompany these diagnoses. Mental suffering can be as debilitating as physical pain, and can magnify pain symptoms. Additionally, patients with personality disorders can challenge palliative medicine team members, who often have had limited training in managing this patient population. Differentiating acute delirium from terminal delirium can be difficult, and treatment protocols are divergent for these etiologies. Although hospice provides a holistic approach to the patient, psychiatric services are not routine in this setting. With the aging demographic of hospice patients, the intensive, multidisciplinary training of a geriatric psychiatrist should provide expertise to the palliative care team. We explored characteristics of hospice patients referred for a psychiatric consultation to identify recurring clinical questions, patient characteristics, psychiatric diagnoses, medical co-morbidities, and recommendations.

  • Summarize all psychiatric consultations requested by a university-affiliated non-profit hospice between September 1, 2010 and February 29, 2011.
  • Compare the psychiatric consultation population to the demographics of all Arbor Hospice admissions and national hospice data at similar time points
  • Cite the most common 1) referral questions for a psychiatric consultation; 2)psychiatric diagnoses and 3)recommended psychiatric interventions


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