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Jiang W, Yuan Y. Current State of Consultation-Liaison Psychiatry in China and Future Directions. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00045-4. [PMID: 38616016 DOI: 10.1016/j.jaclp.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024]
Abstract
This article provides an overview of the history and current status of consultation-liaison psychiatry (CLP) in China and its development within the Chinese Society of Psychosomatic Medicine. Over the past decade, various CLP practice models have been developed to meet the diverse needs of different regions in China. Notably, the Chinese Multidisciplinary Integrated Centers of Psychosomatic Medicine have been established as regional hubs throughout the country. Additionally, this article delves into the role of Chinese traditional medicine in the practice of CLP in China. Finally, several projects involving CLP-based multidisciplinary collaboration are highlighted. We hope this article offers a bird's-eye view of CLP in China and opens a window for future collaboration with CLP initiatives in other countries.
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Affiliation(s)
- Wenhao Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing, China.
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Sharpe M, Toynbee M, van Niekerk M, Bold R, Walker J. Patient and Medical Unit Staff Experiences of Proactive and Integrated Consultation-Liaison Psychiatry in The HOME Study: A Qualitative Investigation. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00040-5. [PMID: 38522510 DOI: 10.1016/j.jaclp.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Consultation-liaison (C-L) psychiatry services aim to help general hospital staff provide better care for their patients. Recently, many inpatient C-L psychiatry services have adopted proactive and integrated approaches to achieve this aim. Despite these developments, there have been no interview-based studies of patients' and staff members' experiences of the new approaches. OBJECTIVE To gain an in-depth understanding of patients' and medical unit staff members' experiences of a proactive and integrated C-L psychiatry service for older medical inpatients (Proactive Integrated C-L Psychiatry [PICLP]). METHODS We conducted an interview-based qualitative study with thematic analysis. The participants were patients and staff who had experienced PICLP during The HOME Study, a randomized trial that evaluated PICLP in 24 medical units of three UK general hospitals. RESULTS We conducted 97 interviews: 43 with patients or their proxies (family members who were interviewed on behalf of patients with significant cognitive impairment) and 54 with staff members of all relevant disciplines. Patients and staff both described how PICLP was a helpful addition to medical care and discharge planning. It enhanced the medical unit team's ability to address psychological, psychiatric, and social needs and provide patient-centered care. They welcomed proactive biopsychosocial assessments and the broader perspective that these offered on patients' complex problems. They also valued the integration of C-L psychiatrists into the unit teams and their daily contact with them. For patients, it fostered a therapeutic relationship and helped them to be more engaged in decisions about their medical care and discharge planning. For staff, it enabled ready access to psychiatric expertise and training opportunities. The few reported experiences of PICLP being unhelpful were mainly about the greater number of clinicians involved in patients' care and a lack of clarity about professional roles in the integrated team. CONCLUSIONS We found that older inpatients and medical unit staff experienced PICLP as both acceptable and generally helpful. Our findings add to the existing evidence for the benefits of proactive and integrated C-L psychiatry services.
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Affiliation(s)
- Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, University of Oxford Warneford Hospital, Oxford, UK.
| | - Mark Toynbee
- Psychological Medicine Research, Department of Psychiatry, University of Oxford Warneford Hospital, Oxford, UK
| | - Maike van Niekerk
- Psychological Medicine Research, Department of Psychiatry, University of Oxford Warneford Hospital, Oxford, UK
| | - Rhian Bold
- Psychological Medicine Research, Department of Psychiatry, University of Oxford Warneford Hospital, Oxford, UK
| | - Jane Walker
- Psychological Medicine Research, Department of Psychiatry, University of Oxford Warneford Hospital, Oxford, UK
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Carrasco JP, Aguilar EJ. Antibiomania: A Case Report of a Manic Episode Potentially Induced by the Interaction of Clarithromycin and Amoxicillin during H. Pylori Eradication Therapy. Actas Esp Psiquiatr 2024; 52:57-59. [PMID: 38454894 PMCID: PMC10926010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Antibiomanic episodes, or as the DSM-5 refers to them, drug-induced manic episodes, pose a clinical challenge that is still poorly understood. There is insufficient information on the most common clinical presentation, patient profile, or underlying aetiopathogenic mechanisms. We present the clinical case of a 67-year-old woman who, after starting treatment (clarithromycin and amoxicillin) for the eradication of Helicobacter pylori, bacteria presented with a brief manic episode, which resolved after withdrawal of both drugs and with antipsychotic treatment. The possible interaction of both drugs, as GABA antagonists, in the generation of such episodes is discussed, and the clinical importance of such episodes in psychiatric emergency departments and liaison and interconsultation psychiatry, is highlighted.
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Affiliation(s)
- Juan Pablo Carrasco
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
| | - Eduardo Jesús Aguilar
- Department of Psychiatry, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
- Biomedical Research Institute INCLIVA, 46010 Valencia, Spain
- Department of Psychiatry, Faculty of Medicine of Valencia, 46010 Valencia, Spain
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), 28029 Madrid, Spain
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Chawla N, Chadda RK. Challenges for setting up psychiatric services in a trauma centre in India. BJPsych Int 2024; 21:4-7. [PMID: 38304405 PMCID: PMC10803793 DOI: 10.1192/bji.2023.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/19/2023] [Accepted: 09/25/2023] [Indexed: 02/03/2024] Open
Abstract
Psychiatric sequelae may occur following traumatic injury irrespective of whether an insult has been caused to the brain. A range of psychiatric illnesses have been either causative of or associated with road traffic accidents and traumatic injuries, including depression, anxiety, post-traumatic stress disorder, substance use disorder and attention-deficit hyperactivity disorder. Despite literature on such associations, psychiatric intervention in the treatment of patients following traumatic injury is limited. The authors share their experience of challenges in addressing mental health problems in a tertiary care trauma centre located in North India. Steps in overcoming those challenges included: developing a semi-structured form to be completed for referrals and consultations, a psychiatrist attending weekly rounds with the surgeons, and initiating a psychiatry out-patient clinic for patients discharged from the trauma centre. It may be worthwhile in the future to set up a trauma psychiatry unit at the centre, involving a clinical psychologist, a psychiatric social worker and an occupational therapist for the comprehensive care of patients.
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Affiliation(s)
- Nishtha Chawla
- Assistant Professor, Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Rakesh K Chadda
- Professor and Head, Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India.
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Shalev D, Robbins-Welty G, Ekwebelem M, Moxley J, Riffin C, Reid MC, Kozlov E. Mental Health Integration and Delivery in the Hospice and Palliative Medicine Setting: A National Survey of Clinicians. J Pain Symptom Manage 2024; 67:77-87. [PMID: 37788757 PMCID: PMC10841817 DOI: 10.1016/j.jpainsymman.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
CONTEXT Mental health comorbidities among individuals with serious illness are prevalent and negatively impact outcomes. Mental healthcare is a core domain of palliative care, but little is known about the experiences of palliative care clinicians delivering such care. OBJECTIVES This national survey aimed to characterize the frequency with which palliative care providers encounter and manage common psychiatric comorbidities, evaluate the degree of mental health integration in their practice settings, and prioritize strategies to meet the mental health needs of palliative care patients. METHODS A e-survey distributed to the American Academy of Hospice and Palliative Medicine membership. RESULTS Seven hundred eight palliative care clinicians (predominantly physicians) were included in the analysis. Mood, anxiety, and neurocognitive disorders were frequently encountered comorbidities that many respondents felt comfortable managing. Respondents felt less comfortable with other psychiatric comorbidities. Eighty percent of respondents noted that patients' mental health status impacted their comfort delivering general palliative care at least some of the time. Mental health screening tool use varied and access to specialist referral or to integrated psychiatrists/psychologists was low. Respondents were unsatisfied with mental health training opportunities. CONCLUSION Palliative care clinicians play a crucial role in addressing mental health comorbidities, but gaps exist in care. Integrated mental health care models, streamlined referral systems, and increased training opportunities can improve mental healthcare for patients with serious illness.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY; Department of Psychiatry (D.S.), Weill Cornell Medicine, New York, NY.
| | - Gregg Robbins-Welty
- Department of Medicine (G.R.W.), Duke University School of Medicine, Durham, NC; Department of Psychiatry and Behavioral Sciences (G.R.W.), Duke University School of Medicine, Durham, NC
| | - Maureen Ekwebelem
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Jerad Moxley
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine (D.S., M.E., J.M., M.C.R.), Weill Cornell Medicine, New York, NY
| | - Elissa Kozlov
- Department of Health Behavior, Society, and Policy (E.K.), Rutgers School of Public Health, West Piscataway, NJ
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Punko D, Luccarelli J, Bains A, MacLean R, Taylor JB, Kontos N, Smith FA, Beach SR. The Diagnosis of Malingering in General Hospitals in the United States: A Retrospective Analysis of the National Inpatient Sample. Gen Hosp Psychiatry 2023; 85:133-138. [PMID: 38455076 PMCID: PMC10917147 DOI: 10.1016/j.genhosppsych.2023.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Objective To characterize the socio-demographics and comorbid medical and psychiatric diagnoses of patients in the general hospital diagnosed with malingering. Method We conducted a retrospective observational cohort study using data from the 2019 National Inpatient Sample, an all-payors database of acute care general hospital discharges in the United States, querying for patients aged 18 and older discharged with a diagnosis of "malingerer [conscious simulation]," ICD-10 code Z76.5. Results 45,645 hospitalizations (95% CI: 43,503 to 47,787) during the study year included a discharge diagnosis of malingering. 56.1% were for male patients, and the median age was 43 years (IQR 33 to 54). Black patients represented 26.8% of the patients with a discharge diagnosis of malingering, compared to 14.9% of all patients sampled. Zip codes in the lowest household income quartile comprised 39.9% of malingering diagnoses. The top categories of primary discharge diagnoses of hospitalizations included medical ("Diabetes mellitus without complications"), psychiatric ("Depressive disorders"), and substance use ("Alcohol-related disorders") disorders. "Sepsis, unspecified organism," was the most common primary diagnosis. Conclusion The striking overrepresentation of Black patients in hospitalizations with diagnosis of malingering raises concern about the roles of implicit and systemic biases in assigning this label. The disproportionate number of patients of low socioeconomic status is further suggestive of bias and disparity. Another potential contribution is that the lower health literacy in these populations results in a limited knowledge of traditional ways to meet one's needs and thus greater reliance on malingered behavior as an alternative means. Accurate description of these patients' socio-demographics and comorbid medical and psychiatric diagnoses with reliable data from large samples can lead to improved understanding of how the malingering label is applied and ultimately better patient care.
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Affiliation(s)
- Diana Punko
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Ashika Bains
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Rachel MacLean
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - John B. Taylor
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Felicia A. Smith
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
| | - Scott R. Beach
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, United States
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Feuer V, Mooneyham GC, Malas NM. Addressing the Pediatric Mental Health Crisis in Emergency Departments in the US: Findings of a National Pediatric Boarding Consensus Panel. J Acad Consult Liaison Psychiatry 2023; 64:501-511. [PMID: 37301325 PMCID: PMC10709524 DOI: 10.1016/j.jaclp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/15/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In 2021, several professional organizations declared a national state of emergency in child and adolescent mental health. Rising volume and acuity of pediatric mental health emergencies, coupled with reduced access to inpatient psychiatric care, has caused tremendous downstream pressures on EDs resulting in long lengths of stay, or "boarding", for youth awaiting psychiatric admission. Nationally, boarding times are highly heterogeneous, with medical / surgical patients experiencing much shorter boarding times compared to patients with primary mental health needs. There is little guidance on best practices in the care of the pediatric patient with significant mental health need "boarding" in the hospital setting. OBJECTIVE There is a significant increase in the practice of "boarding" pediatric patients within emergency departments and inpatient medical floors while awaiting psychiatric admission. This study aims to provide consensus guidelines for the clinical care of this population. METHODS Twenty-three panel participants of fifty-five initial participants (response rate 41.8%) committed to completing four successive rounds of questioning using Delphi consensus gathering methodology. Most (70%) were child psychiatrists and represented 17 health systems. RESULTS Thirteen participants (56%) recommended maintaining boarded patients in the emergency department, while 78% indicated a temporal limit on boarding in the emergency department should prompt transfer to an inpatient pediatric floor. Of this group, 65% recommended a 24-hour threshold. Most participants (87%) recommended not caring for pediatric patients in the same space as adults. There was unanimous agreement that emergency medicine or hospitalists maintain primary ownership of patient care, while 91% agreed that child psychiatry should maintain a consultative role. Access to social work was deemed most important for staffing, followed by behavioral health nursing, psychiatrists, child life, rehabilitative services, and lastly, learning specialists. There was unanimous consensus that daily evaluation is necessary with 79% indicating vitals should be obtained every 12 hours. All agreed that if a child psychiatric provider is not available on-site, a virtual consultation is sufficient to provide mental health assessment. CONCLUSIONS This study highlights findings of the first national consensus panel regarding the care of youth boarding in hospital-based settings and provides promising beginnings to standardizing clinical practice while informing future research efforts.
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Affiliation(s)
- Vera Feuer
- Department of Psychiatry and Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell Health, New Hyde Park, NY
| | - GenaLynne C Mooneyham
- Department of Health and Human Services, National Institutes of Health, National Institute of Mental Health (NIMH), Bethesda, MD
| | - Nasuh M Malas
- Department of Psychiatry and Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI.
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8
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Geng W, Zhang S, Cao J, Zhu B, Duan Y, Hong X, Wei J. Antipsychotics reduces mortality in patients with neuropsychiatric systemic lupus erythematosus: a retrospective study of psychiatric consultation cases. Front Psychiatry 2023; 14:1189940. [PMID: 37583844 PMCID: PMC10424435 DOI: 10.3389/fpsyt.2023.1189940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Objective This study aimed to identify the presence of psychiatric comorbidities as well as investigate the relationship between psychiatric interventions for mental symptoms and mortality in patients with systemic lupus erythematosus (SLE). Method We retrospectively evaluated the records of 160 inpatients with SLE who required psychiatric consultation for further therapeutic intervention from 2013 to 2020 in a tertiary general hospital. We collected clinical data, including diagnoses, medications, and mortality rate. We compared clinical characteristics among the diagnosis groups and correlations between variables. Results A total of 138 (86.3%) patients met the diagnostic criteria for at least one mental disorder, with the most common being delirium (54.4%). The average Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) score significantly differed among the diagnosis groups (p = 0.003). The mortality rate among patients with delirium was significantly higher than that in the other patient groups (x2 = 12.967, p = 0.024). SLEDAI-2K score was not significantly correlated with mortality (r = 0.123, p = 0.087). Antipsychotics use was associated with mortality (odds ratio 0.053, p = 0.021). Conclusion Antipsychotic use may decrease death risk for patients with NPSLE. Early psychiatric consultation is necessary for patients with SLE who have developed or have suspected psychiatric symptoms in order to establish a comprehensive intervention plan.
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Affiliation(s)
- Wenqi Geng
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Shangzhu Zhang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jinya Cao
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Boheng Zhu
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Yanping Duan
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Xia Hong
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
| | - Jing Wei
- Department of Psychological Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Peking Union Medical College Hospital, Beijing, China
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Yanwen L, Mei L, Wenwen Z, Huihui J, Hongbin L, Ying W, Ning L, Le H, Xueyang H, Xue Z. Construction of a Nomogram predictive model for post-discharge psychosomatic review of psychiatric liaison consultation patients based on medical record data. Front Psychiatry 2023; 14:1171741. [PMID: 37502812 PMCID: PMC10368869 DOI: 10.3389/fpsyt.2023.1171741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Epidemiological studies have shown that almost all physical illnesses coexist with psychiatric disorders or psychological problems, and the severity of mental illness is positively correlated with the duration and severity of physical illness. Liaison consultations are valuable in identifying and treating psychiatric disorders, but the rate of psychiatric follow-up after consultation is low in outpatients. This study aimed to investigate the factors influencing post-discharge psychosomatic follow-up visits in patients undergoing psychiatric liaison consultation in general hospitals and construct a Nomogram prediction model for patients' post-discharge psychosomatic follow-up visits. Medical record data of inpatients who received psychiatric liaison consultations at Xi'an International Medical Center Hospital in China from September 2019 to September 2020 were analyzed. Lasso regression and multivariate logistic regression analyses were conducted to screen independent influences on the occurrence of post-discharge psychosomatic follow-ups in patients undergoing psychiatric liaison consultations. Risk prediction column line graphs were constructed using R software, and the models were evaluated. Of the 494 inpatients who received psychiatric liaison consultations, 115 patients (23.279%) (mean age = 54.8 years) went for post-discharge psychosomatic follow-up, while 379 patients (mean age = 59.3 years) had no record of psychosomatic follow-up. Furthermore, occupation, interval.time, diagnosis, out.antipsychotics, and recommendations.followup were independent factors influencing post-discharge psychosomatic follow-up. The model accurately predicted post-discharge psychosomatic follow-up behavior of inpatients who received psychiatric liaison consultations. Lastly, the clinical decision curve analysis showed that the model had good validity for clinical application. Patients who received a psychiatric liaison consultation with a ≤ 10-day interval between admission to the hospital and application for consultation, were discharged with prescribed medication, and had a clear written medical order for a follow-up consultation had an increased probability of psychosomatic follow-up after discharge.
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Affiliation(s)
- Liu Yanwen
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an Physical Education University, Xi’an, China
| | - Li Mei
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Zhang Wenwen
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Jing Huihui
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Lu Hongbin
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Wang Ying
- Department of Psychosomatic Medicine, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Liu Ning
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Han Le
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Han Xueyang
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
| | - Zou Xue
- Department of Adolescent Mental Health, Mental Hospital, Xi’an International Medical Center, Hospital of Northwest University, Xi’an, China
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Caravella RA, Ying P, Siegel C, Vaughn R, Deutch AB, Caroff A, Madanes S, Ackerman MG, Lewis C. Quality Improvement Framework to Examine Health Care Disparities in Behavioral Emergency Management in the Inpatient Medical Setting: A Consultation-Liaison Psychiatry Health Equity Project. J Acad Consult Liaison Psychiatry 2023; 64:322-331. [PMID: 37060945 DOI: 10.1016/j.jaclp.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 04/05/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
BACKGROUND De-escalation of behavioral emergencies in the inpatient medical setting may involve restrictive clinical interventions that directly challenge patient autonomy. OBJECTIVE We describe a quality improvement framework used to examine associations between patient characteristics and behavioral emergency de-escalation strategies. This project may inform other Consultation-Liaison Psychiatry teams seeking to promote equity in care. METHODS We examined behavioral emergency response team (BERT) management at an urban, tertiary-care medical center in the United States over a 3-year period. BERT data from an existing dataset were combined with demographic information from the hospital's electronic medical record. Race and ethnic identities were categorized as Black, Hispanic, Asian, White, and unknown. BERT events were coded based on the most restrictive intervention utilized per unique patient. Cross-tabulations and adjusted odds ratios from multivariate logistic regression were used to identify quality improvement targets in this exploratory project. RESULTS The sample included N = 902 patients and 1532 BERT events. The most frequent intervention reached was verbal de-escalation (n = 419 patients, 46.45%) and the least frequent was 4-point restraints (n = 29 patients, 3.2%). Half of BERT activations for Asian and a third for Hispanic patients required interpreter services. Anxiety and cognitive disorders and 2 BERT interventions, verbal de-escalation, and intramuscular/intravenous/ medications, were significantly associated with race/ethnic category. The most restrictive intervention for BERTs involving Black and Asian patients were verbal de-escalation (60.1%) and intramuscular/intravenous(53.7%), respectively. These proportions were higher compared with other race/ethnic groups. There was a greater percentage of patients from the unknown (6.3%) and Black (5.9%) race/ethnic groups placed in 4-point restraints compared with other groups (3.2%) that did not reach statistical significance. A logistic regression model predicting 4-point restraints indicated that younger age, multiple BERTs, and violent behavior as a reason for BERT activation, but not race/ethnic group, resulted in significantly higher odds. CONCLUSIONS This project illustrates that a quality improvement framework utilizing existing clinical data can be used to engage in organizational introspection and identify potential areas of bias in BERT management. Our findings suggest opportunities for further exploration, enhanced education, and programmatic improvements regarding BERT intervention; 4-point restraints; interpreter services; and the influence of race on perception of psychopathology.
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Affiliation(s)
- Rachel A Caravella
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY.
| | - Patrick Ying
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
| | - Carole Siegel
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
| | - Rubiahna Vaughn
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY; Department of Psychiatry, Montefiore Medical Center - Einstein Division, Albert Einstein College of Medicine, Bronx, NY
| | - Allison B Deutch
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
| | - Aviva Caroff
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
| | - Sharon Madanes
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
| | - Marra G Ackerman
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
| | - Crystal Lewis
- Department of Psychiatry, New York University, Grossman School of Medicine, New York, NY
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Loveless JP, Rosen JH, Yost JS. Implementing a workflow-integrated motivational interviewing training program for psychiatry trainees on an inpatient consultation-liaison rotation: lessons learned. Front Psychiatry 2023; 14:1184053. [PMID: 37275965 PMCID: PMC10232741 DOI: 10.3389/fpsyt.2023.1184053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023] Open
Abstract
Background Effective consultation-liaison psychiatry (CLP) is proactive, collaborative, and requires providers to have proficiency with therapeutic skills beyond nosology and medication management. Motivational interviewing (MI) is an evidenced-based intervention that should be considered essential for CLP trainees to learn. Given that the demands of training and patient care are already experienced as stressful for many psychiatry trainees, the authors endeavored to create a MI training program that was integrated into trainees' normal CLP workflow. Method Twenty-two trainees on an inpatient CLP rotation participated in a six-week MI training program that was incorporated into their regular workflow. The program included didactic sessions with role-playing, as well as on-demand between-session coaching via an expert in MI. Trainee participation and perceptions of MI were measured via a questionnaire that was administered prior to each training session. Results Trainee participation in the didactic sessions was inconsistent. Questionnaire data revealed positive baseline perceptions of motivational interviewing and its usefulness in inpatient medical settings. Additionally, as trainees participated in the program, perceived knowledge of motivational interviewing as well as awareness of motivational issues among their patients increased. Finally, participation in program was not perceived as disruptive to daily workflow for the participants. Discussion This the first documented attempt at implementing a MI training program for CLP trainees that was integrated into their regular workflow. Preliminary data identified some encouraging trends, but also unexpected challenges. These lessons could inform how these types of training programs are implemented moving forward.
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Affiliation(s)
- James P. Loveless
- Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, United States
| | | | - Joanna S. Yost
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, United States
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12
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Muacevic A, Adler JR, Balasubramania Pandian GSD, Mohan S, Altonen B. An Audit of Inpatient Consultation-Liaison Psychiatry Services at an Inner New York City Safety Net Hospital. Cureus 2023; 15:e34801. [PMID: 36777975 PMCID: PMC9910317 DOI: 10.7759/cureus.34801] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Background Our study's primary objective is to audit the resource utilization of a consultation-liaison (CL) psychiatry service in an inner New York City safety net hospital. This cross-sectional, observational study was conducted as a subset of a quality improvement project at the hospital to investigate the characteristics of the emergent nature of consults, types, and the specialty from which the referral was placed to the CL services. This study aims to improve the efficacy of our consult process by improving the appropriateness and precision of consult requests. Methodology This cross-sectional, observational study was reviewed and approved by the Institutional Review Board under a quality improvement exemption. The study investigated the EPIC electronic medical record data for characteristics of consult referrals in the third quarter of 2019 from July 1, 2019, to September 30, 2019. A total of 629 consults were recorded during this period. We excluded follow-up calls, duplicate data rows, and patients with missing data points; the final consults were 421. Patients who required more than one new consult (follow-up excluded) within 90 days were considered; thus, the total number of patients who were included in the study was 327. Results Of the 421 consults identified in the dataset for review, only 45.8% were valid consults, 32.8% were not valid, and 21.4% were uncertain. Further, the most common department from which consults were placed was Medicine (73.2%), followed by Surgery (12.8%), Obstetrics/Gynecology (9%), Critical Care (3.6%), and, finally, Pediatrics (1.4%). Conclusions The study overviews the quality of general consults for the CL psychiatry service and how the CL staff manages it. It also provides an idea about the number of consults that can be comprehensively addressed.
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Kobayashi M, Ogawa Y, Sensaki S, Tanaka K. Biopsychosocial approach implications in suspected long COVID: A case report. Pediatr Int 2023; 65:e15621. [PMID: 37705381 DOI: 10.1111/ped.15621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Madoka Kobayashi
- Division of Child and Adolescent Liaison-Consultation Psychiatry, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yu Ogawa
- Division of Child and Adolescent Liaison-Consultation Psychiatry, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Sonoko Sensaki
- Division of Child and Adolescent Liaison-Consultation Psychiatry, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kyoko Tanaka
- Division of Child and Adolescent Liaison-Consultation Psychiatry, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
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14
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Potkin MT, Mishkin AD, Cheung SG, Hicks-Puig C, Magoon C, Capote J, Muskin PR. Consultation-Liaison Telepsychiatry: A Coded Thematic Analysis of Clinicians' Reported Experiences. J Acad Consult Liaison Psychiatry 2022:S2667-2960(22)00628-0. [PMID: 36584768 DOI: 10.1016/j.jaclp.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/12/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Telepsychiatry is now common practice. Within consultation-liaison psychiatry (CLP), previous work has shown that telepsychiatry is feasible and satisfactory. To date, there has not been qualitative work done within CLP to describe the clinician's experience with telepsychiatry. OBJECTIVE This study aimed to perform a thematic analysis of clinicians' perceived benefits and limitations of providing telepsychiatry in CLP. METHODS An anonymous clinician survey querying demographics, education, training, technological experience, and practice characteristics was distributed via social media and professional listservs, the quantitative results of which are presented elsewhere. Two questions (What was the best/worst aspect of adapting to telepsychiatry?) required free-text responses; comments were allowed elsewhere. We performed a thematic analysis of the text responses because of its flexibility and ability to develop new insights. We synthesized and generated a codebook iteratively. Initial coding was completed by 3 co-authors independently, followed by discussion to build consensus. We used qualitative content analysis to better understand common trends and frequencies in the data. Saturation of themes was reached. RESULTS A total of 333 behavioral health clinicians completed the survey, including 197 CLP participants. Most respondents (98.5%) responded to at least 1 open-answer question, with 314 reporting the worst aspects of telepsychiatry and 315 reporting the best aspects. Respondents made insightful comments about boundaries, public health implications, and the need for training. We categorized the results into implications for practice, therapeutic relationship, and uniquely affected populations. CONCLUSIONS These results show that telepsychiatry has both unique benefits and limitations within CLP. Our work examines and describes these nuances. We believe that future use of telepsychiatry will be synergistic with in-person care and that the 2 modalities will be used together to maximize benefits. A public health focus on improving Internet access and simplifying interstate licensure would improve equitable access and utilization of outpatient telepsychiatry. Telepsychiatry can be successful for inpatient Consultation-Liaison work but requires thoughtful triage and teamwork.
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Affiliation(s)
- Maxmoore T Potkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Adrienne D Mishkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY; Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Irving Medical Center, New York, NY.
| | - Stephanie G Cheung
- Department of Psychiatry, New York University Langone School of Medicine, New York, NY
| | - Christian Hicks-Puig
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Christopher Magoon
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
| | - Justin Capote
- Private Practice, Telepsychiatry Services, New York, NY
| | - Philip R Muskin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY
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15
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Fiore G, Ferrari S, Cutino A, Giorgino C, Valeo L, Galeazzi GM, Marchi M. Delirium in COVID-19 and post-liver transplant patients: an observational study. Int J Psychiatry Clin Pract 2022; 26:343-351. [PMID: 35061952 DOI: 10.1080/13651501.2022.2026403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Delirium is a major complication in hospitalised patients. This study aimed to compare the mortality trends of patients with delirium according to the underlying physical condition. METHODS Hospitalised patients diagnosed with delirium by the Modena Consultation-Liaison Psychiatry Service (Italy) during 2020 were enrolled. Three groups were identified: COVID; after orthotopic liver transplant (OLT); other conditions. The full medical records were screened to retrieve socio-demographic and clinical data. INTERMED score and Delirium Rating Scale were used to retrospectively rate bio-social-complexity and delirium severity. Early (20 days) and end of study (31st January 2021) mortality were ascertained for each subject. RESULTS A total of 103 patients were enrolled. Patients hospitalised for COVID showed higher INTERMED scores (two-tailed t-test, p = 0.019) and higher 20-day mortality (HR = 3.68, p = 0.014). When considering a 1-year follow-up, the main predictor of mortality was patients' age in all three subgroups (HR = 1.06; p = 0.003). CONCLUSION Our results suggest that patients hospitalised for COVID-19 with delirium showed higher bio-psycho-social complexity and higher short-term mortality, regardless of the severity of delirium. OLT patients showed lower mortality and bio-psycho-social complexity, despite being still considered as 'complex', according to the INTERMED score. Future research should focus on understanding the underlying mechanisms in the relationship between delirium and mortality.Key pointsPatients hospitalised for COVID-19 with delirium were found at risk of higher short-term mortality and higher bio-psycho-social complexity.OLT patients showed lower overall mortality and lower bio-psycho-social complexity than the other two groups, despite being still in the 'complex' range according to the INTERMED score.Future research should assess the areas of impact of delirium in patients affected by COVID-19, considering short- and long-term outcomes.
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Affiliation(s)
- Gianluca Fiore
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Section of Clinical Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Anna Cutino
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Giorgino
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Valeo
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian M Galeazzi
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Section of Clinical Neurosciences, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Mattia Marchi
- School of Specialization in Psychiatry, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Shivanekar S, Gopalan P, Pizon A, Spotts C, Cruz N, Lightfoot M, Rohac R, Baumeister A, Griffo A, Panny B, Kucherer S, Israel A, Rengasamy M, Price R. A Pilot Study of Ketamine Infusion after Suicide Attempt: New Frontiers in Treating Acute Suicidality in a Real-World Medical Setting. Int J Environ Res Public Health 2022; 19:13792. [PMID: 36360672 PMCID: PMC9656070 DOI: 10.3390/ijerph192113792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Ketamine, in research settings, rapidly reduces suicidal thoughts 2-24 h after a single infusion in patients with high suicidal ideation. In this study, the authors investigate ketamine's effects on suicidality in a real-world sample of recent suicide attempters on a tertiary-care Consultation-Liaison (CL) psychiatry service. Using an open-label design, 16 transdiagnostic CL patients were recruited, 18-65 years old, to receive a single dose of intravenous ketamine (0.5 mg/kg) in the acute medical setting. All were psychiatrically hospitalized post-infusion. Baseline suicidality and depression measures were compared to ratings taken at 24 h, 5 days, 12 days, and 1, 3 and 6 months post-infusion using paired t-tests. Across all measures, rapid, statistically significant decreases (p's < 0.001) were observed with large to very large effect sizes (Cohen's d's: 1.7-8.8) at acute timepoints (24 h; 5 days). These gains were uniformly maintained to 6 months post-infusion. Open-label ketamine appeared to rapidly and robustly reduced suicidal symptoms in an ultra-high-risk, heterogeneous, real-world sample. Ketamine infusion may therefore be a safe, feasible, viable method to rapidly reduce suicidality among medically hospitalized patients after a suicide attempt, with potentially enduring benefits. The current pilot findings suggest ketamine could be readily integrated into the settings where high-risk CL patients already receive healthcare, with the potential to become an important and novel tool in the treatment of suicidality.
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Affiliation(s)
- Sharvari Shivanekar
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Anthony Pizon
- Department of Emergency Medicine, Division of Medical Toxicology, University of Pittsburgh, 3600 Forbes at Meyran Avenue, Forbes Tower, Suite 10028, Pittsburgh, PA 15213, USA
| | - Crystal Spotts
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Nicolas Cruz
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Michael Lightfoot
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Rebecca Rohac
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Andrew Baumeister
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Angela Griffo
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Benjamin Panny
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Shelly Kucherer
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Alex Israel
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Manivel Rengasamy
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
| | - Rebecca Price
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara St, Pittsburgh, PA 15213, USA
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17
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Pioquinto DJ, Dickerman AL. A COVID-19 Patient's Request to Die and Ensuing Conflict: Psychodynamic Considerations. Psychodyn Psychiatry 2022; 50:461-475. [PMID: 36047800 DOI: 10.1521/pdps.2022.50.3.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The role of psychodynamic theory in consultation-liaison (C-L) work, and particularly the importance of countertransference, has been well established. The psychological impact of the COVID-19 pandemic on healthcare workers is a new factor that must now be taken into account as C-L psychiatrists traverse a changed healthcare landscape. In this article, we highlight the case of a critically ill COVID-19 patient who endorsed a desire for hastened death. This request generated significant conflict between the physicians and nurses caring for him, and it became challenging for the C-L team to perform our typical liaison function. We briefly review the existing literature on the psychological impact of the pandemic on healthcare workers, and examine how psychodynamic factors within this context impacted the events that unfolded. Themes under consideration include the effect of mass trauma on clinician defense mechanisms, and specifically the impact on countertransference toward patients who express a desire for hastened death. C-L psychiatrists themselves are not immune to such reactions and must be particularly attentive to emergent conflict in such cases. Interdisciplinary meetings to discuss and process these disagreements may be effective in repairing staff ruptures.
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Affiliation(s)
- David J Pioquinto
- PGY-3 Psychiatry Resident at Weill-Cornell Medicine/New York Presbyterian Hospital.
| | - Anna L Dickerman
- Chief of Consultation-Liaison Psychiatry and Associate Professor of Clinical Psychiatry at Weill-Cornell Medical College.
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18
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Chin HP. Case Vignettes in Transplant Psychiatry Ethics. Camb Q Healthc Ethics 2022; 31:386-94. [PMID: 35899550 DOI: 10.1017/S0963180121001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The demand for liver transplants continues to far exceed the number of available viable donor organs; hence, it is of utmost importance to determine those individuals who are best able to care for these valuable, limited resources as potential recipients. At the same time, psychiatric comorbidity is common in the course of end-stage liver disease and can be mutually complicating. This article focuses on liver transplant candidacy from a psychiatric perspective, using illustrative cases to underscore the foundational facets of medical ethics that serve as the guide to these complex medical and ethical decisions.
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Leith T, Brieger K, Malas N, McCaffery H, Monroe K, Kullgren KA, Rappaport L. Increased prevalence and severity of psychiatric illness in hospitalized youth during COVID-19. Clin Child Psychol Psychiatry 2022; 27:804-812. [PMID: 35236147 PMCID: PMC8894913 DOI: 10.1177/13591045221076889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have demonstrated an increase in mental health emergencies among youth seen in ambulatory and emergency room settings during the COVID-19 pandemic. This study investigates rates of mental health-related consultation and markers of illness severity since the start of the pandemic. METHODS We evaluated all pediatric patients admitted to a single children's hospital from March 2019 to March 2021 who received psychiatry and/or psychology consults. We report the absolute number of these patients, as well as the proportion of all study site admissions who received such consults. Severity of psychiatric illness was described in terms of LOS, disposition, and use of restraints and psychotropic medications. RESULTS The number and proportion of pediatric patients receiving psychiatry and/or psychology consults rose during the pandemic. Participants also became proportionally more female and older. The study population had higher odds of requiring restraints and antipsychotics during the pandemic. CONCLUSIONS More pediatric inpatients at the study site have required psychiatric care during the pandemic. The severity of mental illness in this population appears to have worsened based on increased utilization of as-needed psychotropic medications and restraints. These findings highlight the changes experienced by patients and providers during the pandemic and merit further study.
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Affiliation(s)
- Thomas Leith
- 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Nasuh Malas
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA.,Department of Psychiatry, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Harlan McCaffery
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kimberly Monroe
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristin A Kullgren
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
| | - Leah Rappaport
- Department of Pediatrics, 12266University of Michigan Medical School, Ann Arbor, MI, USA
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20
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Choi JJ, Peters CJ, Nickels MW. Arranging Inpatient Psychiatric Treatment for a Patient with a Left Ventricular Assist Device. Prog Transplant 2022; 32:248-251. [PMID: 35686352 DOI: 10.1177/15269248221107033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For patients with a left ventricular assist device (LVAD) as a bridge to transplant, receiving mental health treatment, particularly inpatient treatment, can be challenging due to their complex medical needs. Unfortunately, patients with LVADs have higher rates of depression, anxiety, and suicidality than the general population, making this restricted access to care more problematic. Limited access to full spectrum mental health treatment may negatively impact patients' transplant psychosocial candidacy for transplant. In this article, we present a successful case of arranging inpatient psychiatric treatment for a patient with an LVAD on a medical inpatient unit through a collaborative approach that spans multiple services and programs. This article details the strategic interprofessional process involved in devising the plan that allowed for treatment and successful discharge.
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Affiliation(s)
- Joy J Choi
- Division of Collaborative Care and Wellness, Department of Psychiatry, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Cathy J Peters
- Division of Collaborative Care and Wellness, Department of Psychiatry, 6923University of Rochester Medical Center, Rochester, NY, USA
| | - Mark W Nickels
- Division of Collaborative Care and Wellness, Department of Psychiatry, 6923University of Rochester Medical Center, Rochester, NY, USA
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21
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Holmes A, Clinch A, Moran J, Yoong J, Benson M, Boughey M, Philip J. Working with palliative care physicians to prepare for voluntary assisted dying legislation. Australas Psychiatry 2022; 30:372-374. [PMID: 35107360 DOI: 10.1177/10398562211064252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The Victorian Voluntary Assisted Dying Act 2017 (the Act) exposed a spectrum of opinions regarding euthanasia and physician-assisted suicide amongst Victorian palliative care physicians leading to sometimes acrimonious debate. The profession was unable to articulate a unified role in respect of VAD. METHOD A collaboration between psychiatry and palliative care led to a series of group discussions in order to prepare for the Act and to re-establish professional cohesion. RESULTS Although the meetings revealed a plurality of views regarding VAD amongst palliative care physicians, the majority were firmly against the Act. Early meetings revealed strong feelings of shock and an inability to proceed. Previous debates resurfaced between those in support and those not in support of VAD. Over time, there was increased acceptance of the need to adapt to the presence of the Act in order to limit its impact on the robust relationship with the patient central to the practice of palliative care. CONCLUSIONS The implementation of VAD legislation requires an active process to address the challenges it represents for palliative care physicians. Collaborative facilitated meetings can help re-establish group cohesion through affirming the core principles of palliative care which remain independent of VAD.
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Affiliation(s)
- Alex Holmes
- Department of Psychiatry, 569586University of Melbourne, Melbourne, AU-VIC, Australia; and Department of Psychiatry, Melbourne Health, Melbourne, AU-VIC, Australia
| | - Alexandra Clinch
- Department of Medicine, 569586University of Melbourne, Melbourne, AU-VIC, Australia; and Parkville Integrated Palliative Care Service, 3085Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Parkville, AU-VIC, Australia
| | - Juli Moran
- Palliative Care Service, 3805Austin Health, Melbourne, AU-VIC, Australia
| | - Jaclyn Yoong
- Palliative Care Service, Northern Health, Melbourne, AU-VIC, Australia; and Palliative Care Service, Monash Health, Melbourne, AU-VIC, Australia
| | - Melanie Benson
- Palliative Care Service, Monash Health, Melbourne, AU-VIC, Australia; and Palliative Care Service, 5644Peninsula Health, Melbourne, AU-VIC, Australia
| | - Mark Boughey
- Palliative Care Service, 300145St Vincent's Hospital, Melbourne, AU-VIC, Australia
| | - Jennifer Philip
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and Royal Melbourne Hospitals, Parkville, AU-VIC, Australia; and Palliative Care Service, St Vincent's Hospital, Melbourne, AU-VIC, Australia; and Department of Medicine, 589504Monash University, Melbourne, AU-VIC, Australia
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22
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Kim H, Khanna R, Olver J, Norman TR. Diagnostic agreement and concordance between consultation-liaison psychiatry and non-psychiatric (medical and surgical) doctors: changes within junior doctor's terms. Australas Psychiatry 2022; 30:60-63. [PMID: 35086341 DOI: 10.1177/10398562211037338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate whether diagnostic agreement and concordance between non-psychiatric (medical and surgical) doctors and consultation-liaison psychiatry changes within junior doctors' terms. METHOD This was a retrospective cohort analysis of referrals from medical and surgical units to a consultation-liaison psychiatry service. Diagnostic agreement was calculated across all diagnoses and expressed as a percentage. Diagnostic concordance (expressed using Cohen's Kappa) was calculated for the two most common diagnoses of depression and delirium. Diagnostic agreement and concordance in the first two weeks (Timepoint A) were compared to those in the last two weeks (Timepoint B) of junior doctors' terms. RESULTS Around half the referrals (Timepoint A = 48.1%, Timepoint B = 54.0%) were excluded as no diagnosis was listed.Diagnostic agreement over all diagnoses was 31.7% (Timepoint A) and 29.9% (Timepoint B) and was not statistically different. Diagnostic concordance for depression increased from fair to moderate but was not statistically significant. Diagnostic concordance for delirium was substantial for both timepoints and were not statistically different. CONCLUSIONS No statistically significant change in diagnostic accuracy over a junior doctors' term was found in this study.
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Affiliation(s)
- Hannah Kim
- Consultant Psychiatrist, Peninsula Health, Frankston, VIC, Australia
| | - Rahul Khanna
- Consultant Psychiatrist, Austin Health, Heidelberg, VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - James Olver
- Consultant Psychiatrist, Austin Health, Heidelberg VIC, Australia.,Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
| | - Trevor R Norman
- Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia
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Iqbal Y, Alabdulla M, Latoo J, Kumar R, Albrahim S, Wadoo O, M Haddad P. Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar. Qatar Med J 2021; 2021:65. [PMID: 34888201 PMCID: PMC8631349 DOI: 10.5339/qmj.2021.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. Methods: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. Results: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. Conclusion: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.
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Affiliation(s)
- Yousaf Iqbal
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Majid Alabdulla
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Javed Latoo
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Rajeev Kumar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Sultan Albrahim
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Ovais Wadoo
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
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Valdés-Stauber J, Kendel U. The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital. Int J Psychiatry Med 2021; 56:389-407. [PMID: 33327843 DOI: 10.1177/0091217420982102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. METHODS This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. RESULTS The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. DISCUSSION Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.
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Affiliation(s)
- Juan Valdés-Stauber
- Department of Psychiatry and Psychotherapy I, Südwürttemberg's Center of Psychiatry, University of Ulm, Ulm, Germany
| | - Ulrich Kendel
- Department of Psychosomatics, Südwürttemberg's Center of Psychiatry, Friedrichshafen, Germany
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Noda Y, Tarasawa K, Fushimi K, Fujimori K. Drug Treatment for Patients with Postoperative Delirium and Consultation-Liaison Psychiatry in Japan: A Retrospective Observational Study of a Nationwide Hospital Claims Database. Ann Clin Epidemiol 2021; 3:116-126. [PMID: 38505471 PMCID: PMC10760470 DOI: 10.37737/ace.3.4_116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/08/2021] [Indexed: 03/21/2024]
Abstract
BACKGROUND Delirium is the most commonly experienced disorder in consultation liaisons. There are currently research and guidelines in Japan for delirium treatment. Still, there is no retrospective observational study of consultation-liaison psychiatry (CLP) and antipsychotic-centered drugs. This study aims to examine CLP's effectiveness and drug treatment. METHODS Using a Japanese national inpatient database of 2016 and 2017, we investigated the presence or absence of CLP for the treatment of delirium in postoperative delirium patients, the status of drug selection, delirium days, and the average days from surgery to discharge. We examined factors affecting days from surgery to discharge using multiple linear regression analysis. RESULTS This study was classified into a CLP group (n = 1,142) and a non-CLP group (n = 11,355). The days from surgery to discharge in the CLP and non-CLP groups was 16.7 and 17.1, respectively (p = 0.3613). There was a significant difference in the delirium days between the CLP and non-CLP groups (8.9 vs. 7.4; p < 0.00001). Haloperidol infusion was frequently used between the days from surgery to first day of delirium. It was prescribed less often than other oral drugs. Multiple regression analysis identified an association between age, men, CCI1-2, CCI ≥3, number of drugs used, days from surgery to first day of delirium, and early CLP (0-2days) with days from surgery to discharge. CONCLUSIONS We investigated the effectiveness of CLP and the actual conditions of pharmacotherapy for postoperative delirium. Our findings suggest that early CLP may be associated with shorter days from surgery to discharge.
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Affiliation(s)
- Yuki Noda
- Department of Health Administration and Policy, Tohoku University
| | - Kunio Tarasawa
- Department of Health Administration and Policy, Tohoku University
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University
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26
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Sutar R, Chaudhary P, Yadav V. Prevalence of collusion in cancer communications: A meta-analysis. Psychooncology 2021; 31:372-387. [PMID: 34562324 DOI: 10.1002/pon.5824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Collusion is the non-disclosure of information about diagnosis or prognosis, frequently encountered in cancer care and palliative services. Unraveling collusion is a skill and differences among communication techniques by Health Care Workers have maintained the process of non-disclosure to patients and caregivers. Identifying the prevalence of collusion in cancer care is required to improve the existing strategies across the world. METHODS A systematic review of the literature from 1991 to 2020 in the English language was conducted with the protocol registration on PROSPERO ID (CRD 42021249216.) to identify the pooled prevalence of collusion. RESULTS By using random effect model, the pooled prevalence estimate among patients for the diagnostic and prognostic collusion was 24.15, (95% CI [17.09; 32.96], Tou2 = 1.0801, I2 = 97.9%, Cochran's Q = 1058.22, df = 21, p-value < 0.001) and 37.92, (95% CI [22.46; 56.30], Tou2 = 1.9641, I2 = 98.6%, Cochran's Q = 944.26, df = 13, p-value < 0.001) respectively. There was no difference across subgroups with different types of setting for the interview, WHO regions and trend over the years. CONCLUSIONS Substantial prevalence of collusion goes unnoticed in cancer care. A meaningful understanding of such a large prevalence requires inquiry into the existing communication paradigm in cancer care across the world. The findings also question the need of formulating uniform interview techniques and structured assessment tools or questionnaires in cancer care to improve the disclosure rates.
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Affiliation(s)
- Roshan Sutar
- Department of Psychiatry, AIIMS Bhopal, Bhopal, India
| | | | - Vikas Yadav
- Department of Environmental Health and Epidemiology, Indian Council of Medical Research, National Institute for Research in Environmental Health, Bhopal, India
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27
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Yagi Y, Takahashi Y, Ogata Y, Yamana H, Kumakura Y, Ichihashi K, Kasai K, Kondo S. Oral corticosteroid dosage and clinical presentation of psychiatric conditions after steroid use: A consultation-liaison psychiatry service's experience. Neuropsychopharmacol Rep 2021; 41:471-475. [PMID: 34467675 PMCID: PMC8698699 DOI: 10.1002/npr2.12204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/30/2022] Open
Abstract
Aim Psychiatric disturbances are the major adverse effects of corticosteroids. There are no consistent conclusions regarding changes in steroid dosage and the incidence of psychiatric conditions, due in part to the lack of consistent evaluation criteria. The purpose of this research was to determine the incidence and dose‐dependency of psychiatric conditions as assessed by trained psychiatrists. Methods A retrospective chart review was conducted at a university hospital in Japan. We identified inpatients receiving oral prednisolone treatment, who were referred to the consultation‐liaison psychiatry team from April 2015 to March 2018. Patients were divided into high‐dose (≥0.5 mg/kg/day) and low‐dose (<0.5 mg/kg/day) groups. We investigated the associations between steroid dosage and incidence of psychiatric conditions. Results A total of 93 patients (35 in the high‐dose group, 58 in the low‐dose group) were included. Various psychiatric conditions, such as insomnia, delirium, depression, and psychosis, occurred during steroid therapy. The most common condition was insomnia (72%). We observed no significant differences in the patient background characteristics and the incidence of most psychiatric conditions between the high‐dose and low‐dose groups. However, there were more patients with delirium in the low‐dose group than in the high‐dose group. Conclusions Based on the accurate assessment of psychiatric conditions by psychiatrists, our analysis suggests that, among inpatients referred to a consultation‐liaison psychiatry team, the incidence of psychiatric conditions, with the exception of delirium, is independent of the dose of oral prednisolone. We investigated the differences in psychiatric symptoms and clinical features according to the dose of oral prednisolone by conducting a retrospective chart review of the 93 patients referred to our consultation‐liaison psychiatry team. The results showed that psychiatric symptoms, except for delirium, were not dose‐related.![]()
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Affiliation(s)
- Yuko Yagi
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan.,Japanese Red Cross Medical Center, Shibuya-ku, Japan
| | - Yusuke Takahashi
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan.,St. Luke's International Hospital, Chuo-ku, Japan
| | - Yu Ogata
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Hayato Yamana
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan.,Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Yousuke Kumakura
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan.,Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Kayo Ichihashi
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Shinsuke Kondo
- Department of Neuropsychiatry, The University of Tokyo Hospital, Bunkyo-ku, Japan
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Esque J, Rasmussen A, Spada M, Gopalan P, Sarpal D. First-Episode Psychosis and the Role of the Psychiatric Consultant. J Acad Consult Liaison Psychiatry 2021; 63:32-35. [PMID: 34325090 DOI: 10.1016/j.jaclp.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Timely recognition and treatment of first-episode psychosis (FEP) is paramount. Studies suggest a significant relationship between longer duration of untreated psychosis and poorer functional outcomes. Limited data exist that characterize how treatment for FEP is initiated by consultation-liaison psychiatric services. We conducted a systematic review of FEP treatment by a consultation-liaison service at a large academic medical tertiary care. Approach to care was reviewed including recommendations for clinical assessment and management. METHODS Psychiatric consultations performed at a tertiary academic center were reviewed to identify potential FEP cases during a 12-month period. Patients of ages 15-49 years, for whom the diagnostic assessment was concerning for possible FEP, were included. Demographic features and management were summarized. RESULTS A total of 3365 new psychiatric consults were conducted during our study period. Of these, 28 were identified as having symptoms consistent with possible FEP (0.83% of total sample). However, only 12% were referred to coordinated specialty care for psychosis after discharge from an inpatient medical or psychiatric hospital. CONCLUSIONS The results of our systemic chart review indicate that workup, management, and disposition recommendations for FEP patients seen by consultation-liaison services are variable, suggesting a need for a standardized, evidence-based approach in the medical setting.
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Affiliation(s)
- Jacquelin Esque
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Amy Rasmussen
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Meredith Spada
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Priya Gopalan
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Deepak Sarpal
- Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA
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29
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Keng A, Stewart DE, Sheehan KA. Neuropsychiatric Symptoms After Brain Tumor Resection in Children and Adolescents: A Scoping Review. J Acad Consult Liaison Psychiatry 2021; 63:110-118. [PMID: 34229094 DOI: 10.1016/j.jaclp.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brain tumors are one of the most common solid tumors in pediatric populations, with their treatments having significant neuropsychiatric impact. OBJECTIVE The objective of this study was to review the literature on neuropsychiatric sequelae after surgical resection of brain tumors in children and adolescents. METHODS Using a scoping method, we reviewed empirical articles describing pediatric patients with brain tumors who underwent partial or total resection and examined major neuropsychiatric domains postoperatively over time. RESULTS The initial search yielded 15,543 articles. After duplicate removal, abstract screening, and review, 44 articles were included. Cognitive deficits were the most widely studied outcomes and found to be associated with tumor location, operative variables, perioperative complications, treatment types, and psychosocial factors. Cerebellar mutism, or posterior fossa syndrome, commonly co-occurred with emotional and behavioral dysregulation after posterior fossa resections. Depression, anxiety, and somatization were frequently grouped together as "distress," with higher rates among pediatric patients with brain tumor than among healthy peers. Problematic school behaviors, antisocial, and attention-deficit traits were increased; however, several other behaviors (e.g., risky sexual behaviors, substance use) were equal or lower when compared to peers. Posttraumatic stress disorder was highly prevalent and often interfered with social functioning. Delirium, eating disorders, and longer-term outcomes received inadequate attention. CONCLUSION Identifying risk factors of neuropsychiatric sequelae and their impact after pediatric brain tumor resection is important for prognostication and the development of tailored management strategies for these children and adolescents.
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Affiliation(s)
- Alvin Keng
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathleen Ann Sheehan
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
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30
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Oldham MA, Lang VJ, Hopkin JL, Maeng DD. Proactive Integration of Mental Health Care in Hospital Medicine: PRIME Medicine. J Acad Consult Liaison Psychiatry 2021; 62:606-616. [PMID: 34229093 DOI: 10.1016/j.jaclp.2021.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Proactive consultation-liaison (C-L) psychiatry has been shown to reduce hospital length of stay (LOS), increase psychiatric C-L consult rate, and improve hospital staff satisfaction. Nursing attrition has not been studied in relation to proactive C-L. OBJECTIVE Our primary aim in evaluating the proactive C-L service called Proactive Integration of Mental Health Care in Medicine (PRIME Medicine) is to analyze change in LOS over 10 months using historical and contemporary comparison cohorts. As secondary aims, we assess change in psychiatric consultation rate, time to consultation, and change in nurse attrition. METHODS PRIME Medicine was implemented in 3 hospital medicine units as a quality-improvement project. Team members systematically screened patients arriving to assigned units for psychiatric comorbidity. Identified patients were reviewed with hospitalist teams and nurses with the goal of early intervention. RESULTS Including historical and contemporary comparison cohorts, the mean sample age was 62.4 years (n = 8884). Absolute LOS was unchanged, but difference-in-difference analysis trended toward reduced LOS by 0.16 day (P = 0.08). Consultation rate increased from 1.6% (40 consults) to 7.4% (176 consults). Time to consultation was unchanged (4.0-3.8 d). Annual per-unit nursing turnover increased from 4.7 to 5.7 in PRIME units but from 8.5 to 12.0 in comparison units. Nurses citing "population" as the reason for leaving decreased from 2.7 to 1.7 in PRIME units but increased from 1.5 to 4.5 in comparison units. PRIME Medicine led to increased consultation rate, and our unit-wide outcomes provide a conservative estimate of effect. Factors that may have influenced effect size include our cohort's advanced age, considerable emergency department boarding times, increasing proportion of patients discharged to skilled nursing facilities, and concurrent LOS-reduction initiatives on all units. The favorable trends in nursing attrition on PRIME units may be explained in part by our prior finding that PRIME Medicine was associated with enhanced nursing satisfaction. CONCLUSIONS While PRIME Medicine had no more than a modest effect on LOS, it was associated with a markedly increased psychiatric consult rate and favorable trends in nursing retention. This analysis highlights important factors that should be considered when implementing and determining value metrics for a proactive C-L service.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
| | - Valerie J Lang
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Justin L Hopkin
- Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Daniel D Maeng
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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31
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Prajapati NK, Parikh NC, Shah ND, Darji VM, Jariwala HB, Miroliya MT. Evaluation of Psychiatric Morbidity in COVID-19-Positive Inpatients Referred to Consultation Liaison Psychiatry in a Tertiary Care Hospital. Indian J Psychol Med 2021; 43:330-335. [PMID: 34385727 PMCID: PMC8327862 DOI: 10.1177/02537176211022146] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital. METHOD This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal-Wallis test, and fisher exact test. RESULTS Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy. CONCLUSIONS Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.
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Affiliation(s)
- Nisha K Prajapati
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Nimesh C Parikh
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Nilima D Shah
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Vinodkumar M Darji
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Heena B Jariwala
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
| | - Manthan T Miroliya
- Department of Psychiatry, Smt NHL Municipal Medical College, Ellis Bridge, Ahmedabad, Gujarat, India
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Cheung SG, Capote J, Fan W, Mishkin AD. Pilot Assessment of Patient and Provider Characteristics Associated With Satisfactory Consultation-Liaison Telepsychiatry Encounters. J Acad Consult Liaison Psychiatry 2021; 62:582-587. [PMID: 34051404 PMCID: PMC8592650 DOI: 10.1016/j.jaclp.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/15/2021] [Accepted: 05/18/2021] [Indexed: 11/09/2022]
Abstract
Background The COVID-19 pandemic created pressure to attempt remote consultation, but there are limited data on the use of telepsychiatry in general, and almost none about the experience of telepsychiatry in a consultation-liaison context. Objective We looked for attributes that correlated with satisfactory tele-encounters. Methods Eleven consultation-liaison attending surveys and 8 attendings' tele-encounter logs from March to June 2020 were completed and reviewed to assess for patient and provider characteristics associated with barriers to using telepsychiatry. Results A vast majority of 223 tele-psychiatric encounters were acceptable to providers in terms of technology (82%) and their ability to form a connection with the patient (78%). In multivariable logistic regression models, an unresolvable difficulty in using the platform was less common for female patients (odds ratio = 0.239, P = 0.002) and more common for patients who prefer a non-English language (odds ratio = 9.059, P < 0.001); achieving a personal connection that felt right was also less likely for patients who prefer a non-English language (odds ratio = 0.189, P = 0.001). Conclusions Telepsychiatry has previously been limited to outpatient use and, generally, for providers and patients who specifically preferred it. However, abrupt transition to the use of telepsychiatry to limit contagion risk was mostly satisfactory in our center; identifying for which patient encounters it is most and least appropriate will help guide future use.
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Affiliation(s)
- Stephanie G Cheung
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, Columbia University Irving Medical Center, New York, NY.
| | | | - Weijia Fan
- Biostatistics, Epidemiology, and Research Design, Columbia Irving Institute for Clinical and Translational Research, Mailman School of Public Health, New York, NY
| | - Adrienne D Mishkin
- Department of Psychiatry, Division of Consultation-Liaison Psychiatry, Columbia University Irving Medical Center, New York, NY; Blood and Marrow Transplantation and Cell Therapy Program, Division of Hematology & Oncology, Columbia University Irving Medical Center, New York, NY
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Simpson SA, Bienvenu OJ, Andrews SR, Close JS, Adler Cohen MA, Fernandez-Robles C, Francis BA, Gandhi J, Gangopadhyay M, Gershengoren L, Grimaldi JA, Isenberg-Grzeda E, Key RG, Kiong T, Kontos N, Loh RM, Luchsinger W, Munjal S, Niazi SK, Nichols NA, Pathare A, Pereira LF, Shim JJ, Tobin MB, Zimbrean PC. Identifying the Most Important Consultation-Liaison Psychiatry Publications in 2020 Using a Novel Literature Assessment Instrument. J Acad Consult Liaison Psychiatry 2021; 62:493-500. [PMID: 34048960 DOI: 10.1016/j.jaclp.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/22/2021] [Accepted: 03/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-Based Medicine Subcommittee reviews articles of interest to help academy members remain familiar with the latest in evidence-based practice. OBJECTIVE We identify the 10 most important articles for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality instrument for assessing scientific literature. METHODS The subcommittee published annotated abstracts for 97 articles on the academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the Importance and Quality instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of Importance and Quality instrument. RESULTS Twenty-four raters identified the top 10 scoring articles of 2020. These articles provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. CONCLUSION These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.
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Brahmbhatt K, Mournet AM, Malas N, DeSouza C, Greenblatt J, Afzal KI, Giles LL, Charoensook J, Feuer V, Raza H, Mooneyham GC, Pergjika A, Schlesinger A, Chapman A, Strain A, Gandhi B, Johnson K, Mroczkowski MM, Ibeziako P, Graham R, Yoon Y, Plioplys S, Fuchs C, Shaw RJ, Pao M. Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey. J Acad Consult Liaison Psychiatry 2021; 62:511-521. [PMID: 34033972 PMCID: PMC8141785 DOI: 10.1016/j.jaclp.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.
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Affiliation(s)
- Khyati Brahmbhatt
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA.
| | - Annabelle M Mournet
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | - Nasuh Malas
- University of Michigan Medical School, Department of Psychiatry and Department of Pediatrics, 1500 East Medical Center Drive, Ann Arbor, MI
| | - Claire DeSouza
- University of Toronto, Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Jeanne Greenblatt
- NYU Grossman School of Medicine, Departments of Child Psychiatry and Pediatrics, NYU Hassenfeld Children's Hospital and Bellevue Hospital Center, New York, NY
| | - Khalid I Afzal
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Lisa L Giles
- University of Utah School of Medicine, Departments of Pediatrics and Psychiatry, Primary Children's Hospital, Salt Lake City, UT 84113
| | - Janet Charoensook
- Children's Hospital Los Angeles, Division of Psychiatry, Los Angeles, CA
| | - Vera Feuer
- Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY
| | - Haniya Raza
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
| | | | - Alba Pergjika
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Amanda Schlesinger
- University of Minnesota Medical School. F262 West Building, Minneapolis, MN
| | - Andrea Chapman
- University of British Columbia, Department of Psychiatry, British Columbia Children's Hospital, Vancouver, BC
| | - Angela Strain
- The University of North Carolina at Chapel Hill, Department of Emergency Medicine, Chapel Hill, NC
| | - Bela Gandhi
- Nationwide Children's Hospital, Department of Psychiatry. 444 Butterfly Gardens Drive, Columbus, OH
| | - Kyle Johnson
- Oregon Health & Science University. Division of Child & Adolescent Psychiatry, Portland, OR
| | - Megan M Mroczkowski
- Columbia University Irving Medical Center, Department of Psychiatry, New York, NY
| | - Patricia Ibeziako
- Department of Psychiatry, Boston Children's Hospital and Harvard Medical School, Boston MA
| | - Regina Graham
- University of California, San Francisco, Department of Psychiatry & Behavioral Sciences, UCSF Weill Institute for Neurosciences, UCSF Benioff Children's Hospital, San Francisco, CA
| | - Yesie Yoon
- University of Alabama at Birmingham, Department of Psychiatry and Behavioral Neurobiology, Birmingham, AL
| | - Sigita Plioplys
- Ann and Robert H, Lurie Childrens Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, Chicago IL
| | - Catherine Fuchs
- Vanderbilt University, Department of Psychiatry and Behavioral Sciences and Pediatrics, Division of Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Richard J Shaw
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences. 401 Quarry Road, Palo Alto, CA
| | - Maryland Pao
- National Institute of Mental Health, NIH, Office of the Clinical Director, Intramural Research Program, Bethesda, MD
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Oldham MA. The Roles of Psychiatric Consultant and Liaison Realized Through Proactivity and Care Integration. J Acad Consult Liaison Psychiatry 2021; 62:167-168. [PMID: 33973525 DOI: 10.1016/j.jaclp.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
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Novoa KC, Dunn T, Curry A, Froude R, Simpson SA. Limitations of Traditional Models for Medical Decision-Making Capacity and Ethical Clinical Practice in Light of the SARS-CoV-2 Pandemic. Cureus 2021; 13:e14716. [PMID: 34055555 PMCID: PMC8158071 DOI: 10.7759/cureus.14716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has upended psychiatric practice and poses unprecedented challenges for maintaining access to quality care. We discuss the ethical challenges of treating a patient with schizophrenia in need of hospitalization but who declined severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surveillance testing. The traditional framework of capacity assessment depends on the patient’s ability to weigh risks and benefits, but this framework is of limited utility in context of the COVID-19 pandemic; the personal benefits of testing for the patient are unclear and in fact may not outweigh the risk of being declined psychiatric care. Moreover, classic capacity assessment does not well account for physicians’ obligations to other patients and the public health. We conclude that physicians cannot coerce surveillance testing, and we consider the implications of requiring SARS-CoV-2 testing for accessing mental health treatment.
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Affiliation(s)
| | - Thom Dunn
- Psychiatry, Denver Health Medical Center, Denver, USA
| | - Ashley Curry
- Psychiatry, Denver Health Medical Center, Denver, USA
| | - Richard Froude
- Psychiatry, University of Colorado School of Medicine, Denver, USA
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Vulser H, Vinant V, Lanvin V, Chatellier G, Limosin F, Lemogne C. Association between the timing of consultation-liaison psychiatry interventions and the length of stay in general hospital. Br J Psychiatry 2021; 218:204-209. [PMID: 31718721 DOI: 10.1192/bjp.2019.233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Psychiatric comorbidities are frequent in patients admitted in general hospital and are associated with greater lengths of stay (LOS). Early consultation-liaison psychiatry (CLP) interventions may reduce the LOS but previous studies were underpowered to allow subgroup analyses and have generally not considered the severity of the condition for which patients were admitted ('disease severity'). AIMS To investigate the association between the timing of CLP interventions and LOS in a general hospital. METHOD We retrospectively included 4500 consecutive patients admitted in non-psychiatric wards of a university hospital between 2008 and 2016 who had a first CLP intervention. We used general linear models to examine the association between the referral time, defined as log(days before the consultation)/log(LOS), and log(LOS), adjusting for age, gender, year of admission, place of residence, main psychiatric diagnosis, admission to the intensive care unit (ICU), main physical condition and disease severity. RESULTS Referral time was associated with log(LOS) (β = 0.31; P <0.001), notably for older patients (β = 0.43; P <0.001) and those admitted to the ICU (β = 0.50; P <0.001), but not for those with psychotic disorders (β = -0.20; P = 0.10). The association was confirmed when considering the expected LOS for each patient. For instance, for an expected LOS of 10 days, a CLP intervention on day 3 compared with day 6 was associated with a reduction of the actual LOS of 2.4 days. CONCLUSIONS Earlier CLP interventions were associated with a clinically significant shorter LOS in a large population even after adjusting for disease severity. Early CLP interventions may have benefits for both patients and health-related costs.
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Affiliation(s)
- Hélène Vulser
- Doctor, Paris Descartes Faculty of Medicine, University of Paris; and Department of Psychiatry, European Georges-Pompidou Hospital, AP-HP.Centre, Université de Paris, France
| | - Victoire Vinant
- Doctor, Department of Psychiatry, European Georges-Pompidou Hospital, AP-HP.Centre, Université de Paris, France
| | - Victoria Lanvin
- Doctor, Department of Psychiatry, European Georges-Pompidou Hospital, AP-HP.Centre, Université de Paris, France
| | - Gilles Chatellier
- Professor, Paris Descartes Faculty of Medicine, University of Paris; and Department of Medical Informatics, Biostatistics and Public Health Department, European Georges-Pompidou Hospital, AP-HP.Centre, Université de Paris, France
| | - Frédéric Limosin
- Professor, Paris Descartes Faculty of Medicine, University of Paris; Department of Psychiatry, European Georges-Pompidou Hospital, AP-HP.Centre, Université de Paris; and Inserm U1266, Institute of Psychiatry and Neuroscience of Paris, France
| | - Cédric Lemogne
- Professor, Paris Descartes Faculty of Medicine, University of Paris; Department of Psychiatry, European Georges-Pompidou Hospital, AP-HP.Centre, Université de Paris; and Inserm U1266, Institute of Psychiatry and Neuroscience of Paris, France
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Della CD, Teo DCL, Agiananda F, Nimnuan C. Culturally informed psychotherapy in Asian consultation-liaison psychiatry. Asia Pac Psychiatry 2021; 13:e12431. [PMID: 33073528 DOI: 10.1111/appy.12431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 11/28/2022]
Abstract
Psychotherapy provides substantial benefits for patients with medical illness. Western-based psychotherapies are commonly practiced by consultation-liaison psychiatrists in Asia. Although such interventions benefit Asian patients, they are limited by their cultural applicability. Sociocultural factors shape the meaning, expression, and treatment of medical illnesses. In helping patients with medical problems, it is imperative that psychiatrists be mindful of the value of culture in their clinical work. The concept of the self, religion, spirituality, adaptation, coping, and defense mechanisms are all culturally determined. This article discusses how these concepts impact the practice of psychotherapy in the Asian consultation-liaison psychiatry setting. Currently, there is a dearth of systematic research about this subject matter. Most studies describe the application of Western-based psychotherapies for patients with medical illness with little input as to cultural modifications or implications of such interventions. The authors of this article identify culturally consonant psychotherapeutic techniques in the Asian consultation-liaison psychiatry context. Furthermore, they also propose general guidelines in the cultural adaptation of psychotherapy interventions or development of indigenous psychotherapies.
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Affiliation(s)
- Constantine D Della
- College of Medicine, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - David Choon Liang Teo
- Department of Psychological Medicine, Changi General Hospital, Duke-NUS Medical School, Singapore
| | - Feranindhya Agiananda
- Faculty of Medicine, Department of Psychiatry, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta Pusat, Indonesia
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Muskin PR. The Only Thing I Have to Fear Is Fear Itself. Psychodyn Psychiatry 2021; 49:9-13. [PMID: 33635107 DOI: 10.1521/pdps.2021.49.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This autobiographical essay provides a discussion of how understanding being counterphobic limited the physician's ability to be realistically afraid during the intial phase of the COVID-19 pandemic.
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Affiliation(s)
- Philip R Muskin
- Department of Psychiatry, Columbia University Vagelos, College of Physicians and Surgeons
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Oldham MA, Desan PH, Lee HB, Bourgeois JA, Shah SB, Hurley PJ, Sockalingam S. Proactive Consultation-Liaison Psychiatry: American Psychiatric Association Resource Document. J Acad Consult Liaison Psychiatry 2021; 62:169-185. [PMID: 33970855 DOI: 10.1016/j.jaclp.2021.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
In 2019, the American Psychiatric Association Council on Consultation-Liaison (C-L) Psychiatry convened a work group to develop a resource document on proactive C-L psychiatry. A draft of this document was reviewed by the Council in July 2020, and a revised version was approved by this Council in September 2020. The accepted version was subsequently reviewed by the American Psychiatric Association Council on Health Care Systems and Financing in November 2020. The final version was approved by the Joint Reference Committee on November 24, 2020, and received approval for publication by the Board of Trustees on December 12, 2020. This resource document describes the historical context and modern trends that have given rise to the model of proactive C-L psychiatry. Styled as an inpatient corollary to outpatient collaborative care models, proactive C-L provides a framework of mental health care delivery in the general hospital designed to enhance mental health services to a broad range of patients. Its 4 elements include systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based care delivery, and care integration with primary teams and services. Studies have found that proactive C-L psychiatry is associated with reduced hospital length of stay, enhanced psychiatric service utilization, reduced time to psychiatric consultation, and improved provider and nurse satisfaction. These favorable results encourage further studies that replicate and build upon these findings. Additional outcomes such as patient experience, health outcomes, and readmission rates deserve investigation. Further studies are also needed to examine a broader array of team compositions and the potential value of proactive C-L psychiatry to different hospital settings such as community hospitals, surgery, and critical care.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
| | - Paul H Desan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Hochang B Lee
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - James A Bourgeois
- Department of Psychiatry, Baylor Scott & White Health, Temple, TX; Department of Psychiatry, Texas A&M University College of Medicine, Temple, TX
| | - Sejal B Shah
- Department of Psychiatry, Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | - Patrick J Hurley
- Department of Psychiatry, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Sanjeev Sockalingam
- Department of Psychiatry, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON
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Fipps DC, Rainey E. Teaching Psychopharmacology in the Medically Ill: A Problem-Based Learning Card Game for Consultation-Liaison Psychiatry Didactics. J Med Educ Curric Dev 2021; 8:23821205211041799. [PMID: 34778563 PMCID: PMC8573508 DOI: 10.1177/23821205211041799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Our educational report discusses a unique card game that provides an engaging, and competitive strategy for teaching psychopharmacology in the medically ill. It engages the players and helps them learn how to justify medical decisions in the context of complicated medical comorbidity. METHODS We describe a problem-based learning approach where learners are presented with randomized diagnoses and complications and are then forced to make prescription decisions for treatment from a limited and randomized supply of medication cards. Each round is facilitated by the teacher, who engages the teams and/or individual players in discussions regarding the rationale and justification of the medication decisions. These treatment plans are scored according to the appropriateness of the medication choice and the process is repeated. DISCUSSION The game is flexible regarding players' levels of education and has been played by medical students, psychiatry residents, and fellows throughout their years of training. Overall feedback has been positive from facilitators and trainees and the game has been a valuable source of engaging learners in the process of making complex medication decisions in the medically ill.
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Affiliation(s)
- David C. Fipps
- Mayo Clinic, Department of Psychiatry and Psychology, Rochester, MN, USA
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Omichi C, Ayani N, Oya N, Matsumoto Y, Tanaka M, Morimoto T, Kadotani H, Narumoto J. Association between discontinuation of benzodiazepine receptor agonists and post-operative delirium among inpatients with liaison intervention: A retrospective cohort study. Compr Psychiatry 2021; 104:152216. [PMID: 33227543 DOI: 10.1016/j.comppsych.2020.152216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/28/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Several studies have investigated the association between benzodiazepine receptor agonist (BZDRA) use during the perioperative period and an elevated incidence of delirium. However, no study has focused on the time course of BZDRA use, including continuation, discontinuation, initiation, and no use. This study aimed to examine the influence of the time course of BZDRA use on post-operative delirium. METHODS This retrospective cohort study was conducted by reviewing medical records. We included patients who were scheduled for surgery under general anesthesia and had been referred to a liaison psychiatrist for pre-operative psychiatric assessment. The patients were classified into four groups based on the pre- and post-operative time course of oral BZDRA use, as follows: continuation, discontinuation, initiation, and no use (never used). The primary outcome was the prevalence of post-operative delirium in non-intensive care unit settings. We also performed stratified analyses according to age, the presence of cognitive impairment, the presence of delirium history, and antipsychotic drug use on admission. RESULTS Among 250 patients, 78 (31%) developed post-operative delirium. The Discontinuation group had a higher rate of delirium (49%, 24/49) than the other groups (Continuation [14%, 4/29]; Initiation [38%, 3/8], Never used [29%, 47/164], p = 0.008). CONCLUSIONS Abrupt discontinuation of BZDRAs during the perioperative period may be a risk factor for post-operative delirium and should therefore be avoided.
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Affiliation(s)
- Chie Omichi
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Nobutaka Ayani
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; Department of Psychiatry, National Hospital Organization, Maizuru Medical Center, 2410 Yukinaga, Maizuru, Kyoto 625-8502, Japan.
| | - Nozomu Oya
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yoshihiro Matsumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Maki Tanaka
- Department of Medical Safety Management, University Hospital, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroshi Kadotani
- Department of Sleep and Behavioral Sciences, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu City, Shiga 520-2192, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Reddy R, Gerkin JS, Laughon SL, Nash RP, Sowa NA, Park EM, Gala GJ, Rosenstein DL. Implementation of a Psychiatry Consultation-Liaison Service "Conseminar". J Acad Consult Liaison Psychiatry 2020; 62:472-477. [PMID: 34219658 DOI: 10.1016/j.jaclp.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 12/20/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The field of consultation-liaison psychiatry has generated a relatively small number of rigorous clinical trials that guide clinical care. Consequently, there is a need for a consensus-building process to inform best practices for common clinical dilemmas in consultation-liaison psychiatry. OBJECTIVE We review several consensus-building approaches in academic medicine and describe a novel educational process called a "conseminar," which is intended to minimize the variability in teaching and practice on a service staffed by multiple faculty members. METHODS The conseminar is an iterative group exercise among faculty who attend on a consultation-liaison service. Faculty members generate a list of candidate topics and then prioritize those topics for a focused and critical literature review, aided by a librarian. In the absence of definitive clinical trial data or established practice guidelines, the faculty articulates a consensus "best-practice" approach and creates a brief document that summarizes specific recommendations for learners on the service. CONCLUSIONS The conseminar process can minimize variability among consultation-liaison faculty within a single institution with respect to the diagnostic and treatment recommendations conveyed to trainees. Furthermore, conseminar documents can be shared across institutions to promote more consistent teaching and practice within consultation-liaison psychiatry.
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Affiliation(s)
- Rishika Reddy
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jonathan S Gerkin
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Sarah L Laughon
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Nate A Sowa
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Eliza M Park
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Gary J Gala
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | - Donald L Rosenstein
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC.
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Bronson B, Perlman G. The Management Experiences, Priorities, and Challenges of Medical Directors in the Subspecialty of Consultation-Liaison Psychiatry: Results of a Needs Assessment. J Acad Consult Liaison Psychiatry 2020; 62:309-317. [PMID: 33092820 DOI: 10.1016/j.psym.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Medical directors need management skills, yet few studies describe the specific tasks that directors consider most important, their confidence for these tasks, and how their confidence develops. We studied these questions among directors in the subspecialty of Consultation-Liaison Psychiatry. METHODS A needs survey was sent to 48 registrants of a new forum for Consultation-Liaison Psychiatry directors. The survey asked about 6 professional experiences, the relative importance of 14 management tasks, and the directors' confidence in managing these tasks, using 7-point Likert scales. Correlations between experiences, task importance, and task confidence were performed. RESULTS Twenty-seven directors responded (56% response). The experiences that correlated most with management confidence were years in practice and health care leadership training, yet approximately half of responders were directors for ≤5 years and had received minimal training. Management tasks with the highest importance included demonstrating value of their service and roles for nonphysician clinical staff on their teams. Significant associations were identified between years in practice and confidence for leading faculty scholarship, trainee staffing ratios and roles, fee coding, measurement of faculty clinical productivity, and faculty recruitment. Leadership training correlated with confidence in demonstrating service value, measuring faculty clinical productivity, novel models of care, and growing a new service. CONCLUSION Consultation-Liaison directors with fewer years of experience and minimal health care management training need time and support to grow into their roles. They should be pointed toward training opportunities to improve their confidence to lead the wide range of management tasks that are important to their roles.
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Affiliation(s)
- Brian Bronson
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY.
| | - Greg Perlman
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a major psychosocial impact in the community due to its direct effects and restrictive control strategies, e.g. lockdown. The current pandemic, a highly stressful situation, can predispose not only vulnerable but previously well-adjusted individuals for psychological disorders. A retrospective chart review of consultation-liaison psychiatry (CLP) case records was conducted for one month before and after the start of lockdown. Patients seen during lockdown were relatively younger; t = 1.8, p = 0.074. The most common psychiatric emergency was a suicidal attempt (34.3%) and delirium (35.4%) during and before lockdown, respectively. The probability of the emergency psychiatry presentation for attempted suicide increased significantly during lockdown (odds ratio (OR) 8.0, 95% CI 2.03 to 31.57, p = 0.003). The most common stressors for CLP patients with suicide attempts during lockdown were relationship issues and loss of privacy. It seems that stressors arising due to the current crisis are not only highly severe and multiple but qualitatively different. Further studies with larger sample sizes and from other parts of the country can further improve our understating of the psychological impact of the COVID-19 pandemic in the affected community. Needless to say, higher vigilance in the community for at-risk individuals, availability, and awareness about telemedicine services can play an important role to combat the risk of suicide during the lockdown.
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Affiliation(s)
- Shubham Jhanwar
- Psychiatry, All India Institute of Medical Sciences, Rishikesh, IND
| | - Vijay Krishnan
- Psychiatry, All India Institute of Medical Sciences, Rishikesh, IND
| | - Jitendra Rohilla
- Psychiatry, All India Institute of Medical Sciences, Rishikesh, IND
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Ferrari S, Mattei G, Marchi M, Galeazzi GM, Pingani L. Is Consultation-Liaison Psychiatry 'Getting Old'? How Psychiatry Referrals in the General Hospital Have Changed over 20 Years. Int J Environ Res Public Health 2020; 17:ijerph17207389. [PMID: 33050480 PMCID: PMC7601334 DOI: 10.3390/ijerph17207389] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022]
Abstract
There is an ever-growing awareness of the health-related special needs of older patients, and Consultation-Liaison Psychiatry Services (CLPS) are significantly involved in providing such age-friendly hospital care. CLPS perform psychiatric assessment for hospitalized patients with suspected medical-psychiatric comorbidity and support ward teams in a bio-psycho-social oriented care management. Changes in features of the population referred to a CLPS over a 20-year course were analysed and discussed, especially comparing older and younger referred subjects. Epidemiological and clinical data from all first psychiatric consultations carried out at the Modena (North of Italy) University Hospital CLPS in the period 2000–2019 (N = 19,278) were included; two groups of consultations were created according to the age of patients: OV65 (consultations for patients older than 64 years) and NONOV65 (all the rest of consultations). Consultations for OV65 were about 38.9% of the total assessments performed, with an average of approximately 375 per year, vs. the 589 performed for NOV65. The number of referrals for older patients significantly increased over the 20 years. The mean age and the male/female ratio of the sample changed significantly across the years in the whole sample as well as both among OV65 and NOV65. Urgent referrals were more frequent among NOV65 and the rate between urgent/non urgent referrals changed differently in the two subgroups. The analysis outlined recurring patterns that should guide future clinical, training and research activities.
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Affiliation(s)
- Silvia Ferrari
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Giorgio Mattei
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
- Department of Economics “Marco Biagi”, University of Modena and Reggio Emilia, Via Jacopo Berengario 51, 41121 Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
| | - Luca Pingani
- Department of Biomedical, Metabolic Sciences and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy; (S.F.); (G.M.); (M.M.); (G.M.G.)
- Department of Health Professions, Azienda USL–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-0522-522077
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47
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Iqbal Y, Al Abdulla MA, Albrahim S, Latoo J, Kumar R, Haddad PM. Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team. BJPsych Open 2020; 6:e109. [PMID: 32907692 PMCID: PMC7484218 DOI: 10.1192/bjo.2020.85] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients' clinical status. Representative samples are needed to inform service planning and research. AIMS To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar. METHOD Retrospective review of 50 consecutive referrals. RESULTS Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%). CONCLUSIONS A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.
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Affiliation(s)
- Yousaf Iqbal
- Psychiatric Hospital, Hamad Medical Corporation, Qatar
| | - Majid Ali Al Abdulla
- Psychiatric Hospital, Hamad Medical Corporation; and College of Medicine, Qatar University, Qatar
| | | | - Javed Latoo
- Psychiatric Hospital, Hamad Medical Corporation, Qatar
| | - Rajeev Kumar
- Psychiatric Hospital, Hamad Medical Corporation, Qatar
| | - Peter M Haddad
- Psychiatric Hospital, Hamad Medical Corporation, Qatar; and College of Medicine, Qatar
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Abstract
OBJECTIVE The aim of this study was to conduct the first national survey of consultation-liaison psychiatry (CLP) services in New Zealand. METHOD An online survey based on the Multidimensional Matrix for Consultation-Liaison Psychiatry (mMAX-LP) was circulated to a psychiatrist at each of 12 identified CLP services nationally during April-May 2018. Existing data for Middlemore Hospital (where the lead author is based) were added later for completion. RESULTS Most CLP services in New Zealand are funded and managed by the mental health division, operate within office hours, and have psychologists and other allied health staff external to their service. However, there was significant heterogeneity amongst these services in terms of structure and function and in particular, the coverage of emergency departments and young/older patient groups. CONCLUSION This first national survey has provided a snapshot of CLP services in New Zealand in 2018 and found striking heterogeneity. The survey has established a baseline for future local and international comparisons.
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Affiliation(s)
- John Hopkins
- Psychological Medicine, Middlemore Hospital, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, University of Auckland, New Zealand
| | - Frederick Sundram
- Department of Psychological Medicine, University of Auckland, New Zealand
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49
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Fabrazzo M, Zampino R, Vitrone M, Sampogna G, Del Gaudio L, Nunziata D, Agnese S, Santagata A, Durante-Mangoni E, Fiorillo A. Effects of Direct-Acting Antiviral Agents on the Mental Health of Patients with Chronic Hepatitis C: A Prospective Observational Study. Brain Sci 2020; 10:E483. [PMID: 32726940 PMCID: PMC7463817 DOI: 10.3390/brainsci10080483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/04/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023] Open
Abstract
In chronic hepatitis C (CHC) patients, interferon-based treatments showed toxicity, limited efficacy, and psychiatric manifestations. Direct-acting antiviral (DAA) agents appeared safer, though it remains unclear if they may exacerbate or foster mood symptoms in drug-naïve CHC patients. We evaluated 62 CHC patients' mental status, before and 12 weeks after DAA therapy, by assessment scales and psychometric instruments. We subdivided patients into two groups, CHC patients with (Group A) or without (Group B) a current and/or past psychiatric history. After DAA treatment, Group A patients showed low anxiety and improved depression, no variation in self-report distress, but worse general health perceptions. No significant difference emerged from coping strategies. Depression and anxiety improved in Group B, and no change emerged from total self-reported distress, except for somatization. Moreover, Group B increased problem-focused strategies for suppression of competing activities, and decreased strategies of instrumental social support. Contrarily, Group B reduced significantly emotion-focused strategies, such as acceptance and mental disengagement, and improved vitality, physical and social role functioning. DAA therapy is safe and free of hepatological and psychiatric side effects in CHC patients, regardless of current and/or past psychiatric history. In particular, patients without a psychiatric history also remarkably improved their quality of life.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Rosa Zampino
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
- Internal Medicine, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Miraglia 1, 80138 Naples, Italy
| | - Martina Vitrone
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Lucia Del Gaudio
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Daniela Nunziata
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Salvatore Agnese
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
| | - Anna Santagata
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Emanuele Durante-Mangoni
- Division of Internal Medicine, Unit of Infectious and Transplant Medicine, University of Campania “L. Vanvitelli”, AORN Ospedali dei Colli, Monaldi Hospital, Piazzale Ettore Ruggieri, 80131 Naples, Italy; (R.Z.); (M.V.); (A.S.); (E.D.-M.)
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (G.S.); (L.D.G.); (D.N.); (S.A.); (A.F.)
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50
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Mustafa FA. Use of Clozapine in the General Hospital. Psychopharmacol Bull 2020; 50:119-124. [PMID: 32733115 PMCID: PMC7377545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Patients with treatment-resistant schizophrenia receiving clozapine therapy are at risk of potentially serious complications in the general hospital setting, due to the complex pharmacokinetic and pharmacodynamic profile of clozapine. We summarize common clinical challenges that face clinicians who care for clozapine patients in the general hospital, and make recommendations based on the available literature and clinical experience. Early collaborative management between consultation-liaison psychiatry and other clinical teams in the general hospital is paramount to improve clinical outcomes and avoid serious complications in this patient group.
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Affiliation(s)
- Feras Ali Mustafa
- Mustafa, MD, Department of Liaison Psychiatry, Northampton General Hospital, Northampton, United Kingdom
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