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Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches to care for confused patients, particularly optimizing facilitation of care and maintaining vigilance for diagnostic overshadowing. Psychiatrists also offer expertise in primary psychiatric illnesses that can overlap with AMS, and the most common etiology of AMS is delirium. In this article, we provide a consultation liaison psychiatrist perspective on AMS and related psychiatric conditions in addition to delirium. Manic and psychotic episodes have primary and secondary etiologies, with some symptoms that can overlap with delirium. Catatonia, neuroleptic malignant syndrome, and serotonin syndrome are potentially fatal emergencies, and require prompt index of suspicion to optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, and dissociative disorders can present as puzzling cases that require psychiatric facilitation of care. Additionally, AMS is sometimes due to substance intoxication and withdrawal in the hospital. A nonstigmatizing approach to evaluation and management of delirium and AMS can ensure optimal patient care experiences and outcomes. [ABSTRACT FROM AUTHOR]

Aims: Heart transplantation is a well‐established treatment for end‐stage heart failure in paediatric patients, demonstrating excellent long‐term outcomes. Methods: This retrospective study analyses 35 years of data on 244 paediatric recipients (<18 years) at a single institution from 1986 to 2022. The analysis explores changes in diagnoses, survival, waiting times and mechanical circulatory support (MCS) over three decades (1991–2000, 2001–2010 and 2011–2020). Results: Survival outcomes significantly improved over the study period, with 1‐year survival rates increasing from 79.3% (1991–2000) to 92.3% (2011–2020, P = 0.041). The median overall survival was 18.0 years, and median conditional survival to 1 year post‐transplant was 20.9 years. Survival differences were noted among age groups, with infants under 1 year of age experiencing higher early mortality, and adolescents (aged 11–17 years) facing increased long‐term risks, possibly linked to adult donor characteristics. Waiting times for heart transplantation increased, especially for younger age groups (0–5 and 6–10 years), reflecting the growing demand for donor organs. The use of MCS, including ventricular assist devices (VAD), surged, with 67% of recipients in the most recent decade receiving pre‐transplant VAD support. Importantly, despite prolonged waiting times and increased VAD use, overall survival continued to be favourable. Conclusions: Early and long‐term results after paediatric heart transplantation have been continuously improving over the past decades. Despite an increased demand for donor organs and the growing reliance on VAD as bridge to transplantation, post‐transplantation survival is not compromised. [ABSTRACT FROM AUTHOR]

Adolescent suicide is a pressing concern in Guyana, a low-to middle-income country in South America with the highest adolescent suicide rate globally. Gatekeeper trainings for suicide prevention conducted in high-income countries have been found to increase knowledge of suicide prevention, increase referrals of at-risk youth, and reduce stigma toward help-seeking for suicidality. The current study sought to engage in a pilot examination of the effectiveness, acceptability, and feasibility of a culturally informed gatekeeper training suicide prevention program for Guyanese youth. Secondary school teachers and staff (N = 16) were trained in a culturally informed, evidence-based gatekeeper suicide prevention program. Mixed methods analyses revealed significant increases in knowledge of suicide prevention, as well as decreases in rigid or judgmental attitudes toward suicide post-training among secondary school teachers and staff. Further, results indicated that participants deemed the program culturally acceptable and feasible for use in the school setting. Findings have implications for the delivery and implementation of culturally informed gatekeeper training programs for suicide prevention in low-to middle-income countries.

Research emphasises the role that social structures play in shaping national HIV prevalence. This study examined how social, economic, and political contexts that may represent the confluence of individual capabilities and environmental affordances or constraints are associated with national HIV prevalence. Based on social-ecological perspectives, we examined social-structural dimensions in relation to national HIV prevalence. The study identified six publicly available nation-level social, political, and economic indices and examined their associations with national 2009 HIV prevalence across 225 nations. National indices, (a) education expenditures, (b) unemployment rate, (c) homicide rate, (d) freedom of religion, and (e) women's social rights, altogether explained 43% of the variability in national HIV prevalence. Education expenditures, homicide rate, and freedom of religion were significant predictors of national HIV prevalence in the multivariate analysis. The present study identified nation-level factors that capture social, economic, and political contexts to explain between-nation differences in HIV prevalence. Findings extend current literature on the social-structural foundation of HIV-risk and the relationship between human rights and health. National safeguards that afford individuals the power to promote general quality of life and protection from structural violence may be most important to lowering overall rates of HIV transmission.

Complexity in the structure of power relations is a fruitful site of analysis that an intersectional framework brings to bear in articulating radical Black feminisms. The psychological literature utilizing an intersectional approach to study stereotyping has illuminated the importance of moving beyond a single-identity or single-axis lens. For instance, there is burgeoning literature showing that there are unique social categorizations and perceptions that vary by combinations of multiple group memberships (e.g., race and gender together). Further, an intersectional approach also draws attention to similarities and connections across different groups with unique relationships to systems of power and oppression. Focusing on these areas of similarities across difference provides insight into contexts that reinforce social inequality and are powerful avenues for building collective power through coalitions to address inequity. Therefore, the current investigation sought to address how Black and Latinx people in New York City discuss these sites of similarities and differences in power and privilege as they relate to their understanding of sexual stereotypes and their consequences in their everyday lives. We conducted 11 focus groups with 75 participants. Using thematic analysis, we identified four major themes highlighting shared and distinct stereotype-based experiences, including microaggressions and discrimination, double standards, interpersonal relationships, and emotional and behavioral responses. Beyond illuminating harmful consequences of sexual stereotypes, findings underscore the radical potential for achieving collective liberation by amplifying oppressed groups' commonalities and differences simultaneously. [ABSTRACT FROM AUTHOR]