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. Method: 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. Conclusion: 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.