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Psychiatric Annals ; 51(6):272-277, 2021.
Article in English | ProQuest Central | ID: covidwho-1278539


Public and community psychiatrists who care for patients with serious mental illnesses regularly face ethical challenges. This article summarizes key ethical considerations in the care of a population that can be difficult to engage and may reject treatment, sometimes necessitating coercive care. The digital revolution in medicine, with its promises and perils and accelerated by coronavirus disease 2019 (COVID-19), has added ethical complexity regarding privacy and access to care. Shared decision-making, a process to resolve ethical dilemmas, and commitments to professionalism and reflective practice are emphasized as three ways to practice ethically in public and community psychiatrists' daily work. Additionally, COVID-19 has highlighted that engagement in social justice is a critical element of ethical practice for physicians today. [Psychiatr Ann. 2021;51(6):272–277.]

J Acad Consult Liaison Psychiatry ; 62(5): 493-500, 2021.
Article in English | MEDLINE | ID: covidwho-1246006


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.

Psychiatry , Referral and Consultation , COVID-19/psychology , Cannabis/adverse effects , Delirium/classification , Encephalitis , Evidence-Based Medicine , Humans , Lithium Compounds/adverse effects , Lithium Compounds/therapeutic use , Mental Disorders/complications , Mental Disorders/mortality , Mindfulness , Neoplasms/complications , Neoplasms/mortality , Neoplasms/psychology , Reproducibility of Results , Sexually Transmitted Diseases/epidemiology
Gen Hosp Psychiatry ; 65: 47-53, 2020.
Article in English | MEDLINE | ID: covidwho-327315


INTRODUCTION: Neuropsychiatric manifestations of the coronavirus disease 2019 (COVID-19) have been described, including anosmia, ageusia, headache, paresthesia, encephalitis and encephalopathy. Little is known about the mechanisms by which the virus causes central nervous system (CNS) symptoms, and therefore little guidance is available regarding potential workup or management options. CASES: We present a series of four consecutive cases, seen by our psychiatry consultation service over a one-week period, each of which manifested delirium as a result of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). DISCUSSION: The four cases highlighted here all occurred in older patients with premorbid evidence of cognitive decline. Unique features seen in multiple cases included rigidity, alogia, abulia, and elevated inflammatory markers. In all four cases, a change in mental status was the presenting symptom, and three of the four cases lacked significant respiratory symptoms. In addition to discussing unique features of the cases, we discuss possible pathophysiologic explanations for COVID-19 delirium. CONCLUSIONS: Delirium should be recognized as a potential feature of infection with SARS-CoV-2 and may be the only presenting symptom. Based on the high rates of delirium demonstrated in prior studies, hospitals should consider adding mental status changes to the list of testing criteria. Further research is needed to determine if delirium in COVID-19 represents a primary encephalopathy heralding invasion of the CNS by the virus, or a secondary encephalopathy related to systemic inflammatory response or other factors.

Brain Diseases/etiology , Coronavirus Infections/complications , Delirium/etiology , Pandemics , Pneumonia, Viral , Aged , Aged, 80 and over , Brain Diseases/virology , COVID-19 , Cognitive Dysfunction/complications , Coronavirus Infections/pathology , Delirium/virology , Female , Humans , Male