The interdisciplinary psychiatric ward round - Evaluation of a pilot project

While interdisciplinary ward rounds have been shown to improve patient care in surgical disciplines such as trauma surgery, comparable ward rounds have not yet been regularly established in clinical psychiatry. Here, we present results of the interdisciplinary psychiatric ward round initiated as a pilot project at our university hospital, which mainly took place as a review of patients' medical charts during the study period (July 3 to December 11, 2020) due to restrictions in connection with the coronavirus disease 2019 (COVID-19) pandemic. Physicians from psychiatry, neurology, internal medicine/geriatrics, and clinical pharmacology were involved. A total of 295 reviews were conducted on 105 individual patients. A mean (± standard deviation) of 1.3 ± 0.8 recommendations were made per patient;these were distributed between 1.1 ± 0.8 pharmacological recommendations (PR) and 0.2 ± 0.2 general recommendations (GR). Among PRs, recommendations on antipsychotics were most common (14.4 % of all PRs), followed by antidepressants (8.9 % of all PRs). Among GRs, recommendations on diagnostic measures dominated (41.7 % of all GRs). Limitations of our pilot project mainly arise from the monocentric setting and the lack of a control group. Follow-up studies should examine whether interdisciplinary ward rounds in psychiatry can contribute to the improvement of patient-related outcomes and, among other things, reduce the number of adverse drug reactions. © 2021 Wissenschaftliche Verlagsgesellschaft Stuttgart.

[Psychopharmacotherapy during the COVID-19 pandemic]. / Psychopharmakotherapie in Zeiten der COVID-19-Pandemie.

In view of the current coronavirus disease 2019 (COVID-19) pandemic, patient care, including that of psychiatric patients, is facing unprecedented challenges. Treatment strategies for mental illness include psychotherapy and psychopharmacological interventions. The latter are associated with a multitude of adverse drug reactions (ADR); however, they may currently represent the preferred treatment due to restrictions regarding patient care (i.e. social distancing). Direct contact to patients may have to be reduced in favor of telephone calls or video conferences, so that new techniques in diagnosing and treating patients have to be established to guarantee patient safety. Patients should be extensively informed about relevant ADRs and physicians should actively ask patients about the timely recognition of ADRs. The use of psychotropic drugs may lead to an increased risk of developing ADRs, which are considered to be particularly unfavorable if they occur simultaneously with an acute infection or may even lead to an increased risk of infection. These include respiratory depression, agranulocytosis, intoxication by inhibition of metabolizing enzymes and venous thromboembolism, each of which may be associated with potentially fatal consequences; however, physicians should simultaneously ensure adequate efficacy of treatment, since the ongoing crisis may lead to a worsening of preexisting mental illnesses and to a surge in first onset of psychiatric disorders.