Epic Delirium Order Set Screensaver Project!

So in a previous post I announced the reinvigorating agenda of the Delirium Early Intervention and Prevention Project committee. One of the ideas that I had was to create screensaver images for our hospital’s computers to remind doctors and nurses about the importance of being on the alert for delirium, especially in elderly patients.

We’re supposed to create the screensavers on powerpoint slides and I thought it might be neat to include pearls on some of them. Pearls are little bits of clinical wisdom that are informed by experience and research. There are pearls which arise from interesting psychoanalytic perspectives on psychosomatic medicine and consultation psychiatry, as you can see from the links and quotes below, which Psych Practice was kind enough to pass along:

PEP Web – Psychosomatic Medicine: A Psychoanalyst’s Journey Through a Somatic World

PEP Web – The Place of Psychodynamic Psychiatry in Consultation-Liaison Psychiatry with Special Emphasis on Countertransference

“Similar conditions rule in other acute excitements. Acute and subacute deliria may be impossible to analyze if very acute. The subacute delirium of alcoholic hallucinosis in an intelligent individual may give surprisingly good results by analytic treatment, however, and also lead to the uncovering of the motives for the alcoholism.”–Jelliffe, S.E. (1914). Technique of Psychoanalysis. Psychoanal. Rev., 1:178-186.

“There are always monsters in children’s play, there are always monsters on the film screen, there are always monsters in dreams. So, normal development, as was mentioned, isn’t always benign development. It has to include quite a lot of monsters in it as well. So, the only way I tend to look at this is that we inevitably finish up with what Klein would have called “archaic bad objects.” She changed her mind about that quite clearly. In one of her later papers she announces they haven’t been resolved in the depressive position, they have been banished to what she calls the deep unconscious, and there they remain. There they remain to reemerge presumably under unfavorable circumstance. Those are the unfavorable circumstances we can all be familiar with. In delirium, for instance, or any situation where the individual is at their mercy.”–(2006). Journal of Infant, Child & Adolescent Psychotherapy, 5:282-307 – S.

 “It is time for liaison psychiatrists to realize that their goal of converting other physicians to view disease as having psychosocial as well as a somatic component cannot be accomplished.”—Thomas P. Hackett in 1982 Academy of Psychosomatic Medicine Annual Meeting lecture entitled “Liaison Psychiatry—Fixture or Fantasy.” Hackett was Chief of Psychiatry at Massachusetts General Hospital (1974-1989) and was a leader in the history of Psychosomatic Medicine.

But as psychiatry moved further away from the psychoanalytic to the biomedical paradigm, the psychosomatic medicine literature content followed suit, usually adopting a generally disparaging tone toward psychoanalysis [1].

I think we’re better off respecting the evolution of psychiatry and learning from the pearls passed down.

Anyway, some medical students and residents are helping with the screensaver project. Some slides are below. Can you think of any others?

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1. Rosenbaum, M. and T. McCarty (1994). “The relationship of psychosomatic medicine to consultation-liaison psychiatry.” Psychosomatics 35(6): 569-573.

Consultation-liaison psychiatry arose in the mid-1960s from the matrix of psychoanalytically oriented psychosomatic medicine. The influence of psychoanalysis and psychoanalytically trained academic psychiatrists gradually waned. The liaison aspect of consultation-liaison psychiatry faded in the early 1980s, and most consultation-liaison services are now primarily high-quality consultation services that contribute much to university teaching hospitals. The consultation-liaison service at the University of New Mexico (UNM) and several others have eliminated the term “liaison.” The consultation service at UNM sees relatively few patients with classic psychosomatic disorders. The majority of requests to UNM’s consultation service relate to suicide attempts, delirium, complicated medical problems with psychiatric illness, substance abuse, burns, trauma, and competency evaluations.



  1. The screen saver idea is genius. I wish I knew how to do animated programming so there could be oysters opening up on the screen with pearls bubbling out of them.

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