PMID- 30620475
OWN - NLM
STAT- MEDLINE
DCOM- 20190313
LR  - 20190313
IS  - 0033-2658 (Print)
IS  - 0033-2658 (Linking)
VI  - 118
IP  - 8
DP  - 2016
TI  - [Hospital Acquired Pneumonia in General Hospital Psychiatric Ward A Retrospective 
      Study].
PG  - 570-583
AB  - (Introduction) Pneumonia is a well-known major physical complication that can 
      occur in the course of treatment for severe psychiatric disorders and 
      antipsychotic treatment. However, there are few reports indicating the 
      differences between pneumonia in the field of psychiatric medicine and the more 
      commonly encountered type of pneumonia. In the present study, we examined the 
      specific characteristics of in-hospital pneumonia in psychiatric wards and 
      factors influencing the aggravation of this infection. (Methods) We 
      retrospectively analyzed 22 patients in the psychiatric ward of Jichi Medi- cal 
      University Hospital, which also has general wards, in whom pneumonia developed 
      during hospitalization. We extracted occurrence, outcome, and sputum culture test 
      results as charac- teristics. Severity of pneumonia was classified using the 
      Pneumonia Severity Index (PSI) as follows : classes I -III, minor group (MG : 15 
      patients) and classes IV-V, moderate to severe group (MSG: seven patients). We 
      examined the following factors related to the aggravation of pneumonia: body mass 
      index (BMI), length of psychiatric treatment, number of hospital admis- sions, 
      Global Assessment of Functioning (GAF) score, dose of antipsychotics, dose of 
      benzodi- azepines (chlorpromazine and diazepam equivalent doses), and dose of 
      antiparkinsonian agents (biperiden equivalent dose). (Results) Aspiration 
      occurred prior to the onset of pneumonia in one patient, and one patient required 
      ventilator management. There were no patient deaths. Streptococcus pneu- moniae 
      and Staphylococcus aureus were detected in five and four patients, respectively. 
      Nei- ther methicillin-resistant Staphylococcus aureus nor Pseudomonas aeruginosa 
      was detected. In comparison with MG patients, MSG patients had significantly 
      lower BMI (18.3 ?2.6 vs. 21.2? 3.5), significantly higher numbers of hospital 
      admissions (3.4?i3.3 times vs. 1.1+?L1.4 times), and a significantly higher ratio 
      of GAF scores of 30 or less (85.7% VS 33.3%). The doses of benzo- diazepines and 
      antiparkinsonian agents were significantly higher for MSG patients in comparison 
      with MG patients (benzodiazepines : 2.3?2.4 mg vs. 0.4?i1.1 mg; antiparkinsonian 
      agents: 2.3?2.4 mg vs. 0.4? 1.1 mg). No significant differences were observed in 
      the doses of antipsy- chotics. Sputum culture tests were performed in 18 
      patients. (Conclusion) Outcomes were comparatively favorable and the results of 
      bacterial culture tests tended to show no antibiotic-resistant bacteria, 
      differing in that regard from hospital- acquired pneumonia. In fact, the 
      characteristics of cases of pneumonia in hospitalized psychiatric patients were 
      similar to those of community-acquired pneumonia. Low BMI, multiple psychiatric 
      ward admissions, and GAF scores of 30 or less all reflect poor mental control. 
      The results of the present study suggest a relationship between the severity of 
      pneumonia and both insufficient psychiatric treatment and the use of 
      benzodiazepines and antiparkinsonian agents.
FAU - Okada, Tsuyoshi
AU  - Okada T
FAU - Shioda, Katsutoshi
AU  - Shioda K
FAU - Kobayashi, Toshiyuki
AU  - Kobayashi T
FAU - Nishida, Masaki
AU  - Nishida M
FAU - Suda, Shiro
AU  - Suda S
FAU - Kato, Satoshi
AU  - Kato S
LA  - jpn
PT  - Journal Article
PL  - Japan
TA  - Seishin Shinkeigaku Zasshi
JT  - Seishin shinkeigaku zasshi = Psychiatria et neurologia Japonica
JID - 9801787
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Community-Acquired Infections/epidemiology
MH  - Female
MH  - Hospitals, General
MH  - Hospitals, Psychiatric
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patients' Rooms
MH  - Retrospective Studies
MH  - Young Adult
EDAT- 2016/01/01 00:00
MHDA- 2016/01/01 00:01
CRDT- 2019/01/09 06:00
PHST- 2019/01/09 06:00 [entrez]
PHST- 2016/01/01 00:00 [pubmed]
PHST- 2016/01/01 00:01 [medline]
PST - ppublish
SO  - Seishin Shinkeigaku Zasshi. 2016;118(8):570-583.