The Impact of the COVID-19 Pandemic on Psychiatric Emergency Service Volume and Hospital Admissions.

BACKGROUND: During the COVID-19 pandemic, there have been an increasing number of emergency department visits for behavioral health reasons, even as overall emergency department volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high-intensity care for severely ill patients who are likely to be homeless and underserved. OBJECTIVE: We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States. METHODS: Changes in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020. RESULTS: The pandemic's impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance. CONCLUSIONS: There has been a decrease in volume at these services after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.

Identifying the Most Important Consultation-Liaison Psychiatry Publications in 2020 Using a Novel Literature Assessment Instrument.

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.

Limitations of Traditional Models for Medical Decision-Making Capacity and Ethical Clinical Practice in Light of the SARS-CoV-2 Pandemic.

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.

Coronavirus and its implications for psychiatry: A rapid review of the early literature

BACKGROUND: The coronavirus pandemic has changed health care rapidly and dramatically. OBJECTIVE: To provide a critical synthesis of the scientific literature on the pandemic's implications for psychiatric practice. METHODS: A rapid literature review was undertaken to identify scientific literature linking psychiatric outcomes and practice changes due to coronavirus and the disease it causes (COVID-19). A structured quality assessment was used to assess those articles reporting quantitative data. RESULTS: Fifty articles were identified for inclusion, but only 12 contained original data. Eleven of those twelve were rated as of weak quality. The literature described psychiatric sequelae of the coronavirus and related public health interventions through cross-sectional surveys among different populations;no studies include diagnostic or functional impairment data. Populations at risk include COVID-19 survivors, health care workers, the elderly, and those with preexisting psychiatric disease. Impacts on psychiatric practice were described, again without data on changes to quality or access of care. CONCLUSIONS: There is a quickly accumulating body of evidence on the psychiatric implications of coronavirus including psychological effects on the general public and at-risk subgroups. Similarly, psychiatric practice has witnessed substantial adaptation to the pandemic. However, there remain significant gaps in scientific knowledge. We suggest opportunities for consultation-liaison psychiatry to improve the understanding of the relationship between coronavirus and psychiatric care. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

A Three-Step, Single Session Therapy Intervention for COVID-Related Anxiety in a Pediatric Emergency Department.

The novel Coronavirus disease (COVID-19) pandemic has led to increases in anxiety and depression, and mental health-related emergency department visits remain frequent despite overall changes in ED utilization. Here, we present a case of COVID-related anxiety and demonstrate the utility of a brief, single-session therapy intervention delivered in the ED. The growing mental health burden of COVID-19 suggests that pediatric health care providers will treat patients with COVID-related anxiety during this pandemic. This case demonstrates a common presentation of somatization of anxiety and outlines a three-step, cognitive-behavioral intervention that can be particularly effective in treating COVID-related anxiety in the context of a single ED or medical visit.