Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations.

Patients hospitalized with COVID-19 are at risk of developing many neuropsychiatric disorders, due to the effects of the disease on the brain and the psychosocial pressures of having the disease. The aim of the present study was to evaluate the characteristics and outcomes of patients who were hospitalized with a diagnosis of COVID-19, who underwent psychiatric consultations. The medical records of 892 patients hospitalized due to COVID-19 and the 89 among them who requested psychiatric consultations were analyzed retrospectively. After the psychiatric consultations, patients were most frequently diagnosed with delirium (38.2 %), adjustment disorder (27.0 %), depressive disorder (19.1 %) and anxiety disorder (11.2 %). Patients with delirium had longer hospital stays (p < 0.001), were transferred more frequently to intensive care units (p < 0.001), and had higher mortality rates during their hospital stays (p < 0.001), than all other patients. The need for oxygen (p < 0.001) and mechanical ventilation (p < 0.001) was also significantly higher in delirium patients, as well as in patients who received other psychiatric diagnoses. Neuropsychiatric disorders develop in patients receiving inpatient treatments in COVID-19 wards, and these disorders negatively affect the prognosis of COVID-19. Our findings suggest that the presence of neuropsychiatric disorders in in-patients with COVID-19 might be associated with the negative outcomes of the disease.

Lockdown logistics in consultation-liaison psychiatry.

We describe the adaptation of services to allow flexible and practical responses to the coronavirus-19 (COVID-19) public health crisis by four Consultation-Liaison Psychiatry (CLP) services; Galway University Hospital (GUH), Beaumont Hospital, University Hospital Waterford and St Vincent's University Hospital (SVUH) CLP services. This article also illustrates close collaboration with community adult mental health services and Emergency Department (ED) colleagues to implement effective community diversion pathways and develop safe, effective patient assessment pathways within the EDs. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post-COVID-19 world, if our psychiatry services receive appropriate resources.

Profile of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital

Introduction: There is sparse literature on child and adolescent consultation liaison psychiatry during the COVID pandemic in India. Aims and objectives: To study the patterns of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital Material(s) and Method(s): This was a retrospective chart-based study. Institutional Ethics Committee clearance was obtained. It was conducted from April 2020-21. The inclusion criteria comprised records of children and adolescents who were referred for consultation liaison services while they were admitted in COVID-19 designated tertiary hospital. Incomplete records were excluded. Data was tabulated and analysed with descriptive analysis. Result(s): We found 50 referrals out of which 42 records were complete and 8 incomplete were excluded. There were 47.62% boys and 52.38% girls with the mean age (10.8 years) All the 42 patients had been tested for COVID-19 at the time of intake admission as per hospital protocol. We found that 11.9% were confirmed cases of COVID-19 disease and 88.1% had tested negative for COVID-19 disease .The referrals were received mostly from Paediatric Intensive Care Unit (57.14%) followed by Paediatric ward (26.19%) and Special Paediatrics COVID High Dependency Unit (16.67%). The most common psychiatric disorder in COVID negative patients was adjustment disorder with deliberate self-harm (35.14%) and in COVID positive patients was delirium (60%) .The most commonly used medication were Escitalopram, Risperidone and Clonazepam. Conclusion(s): We conclude that psychiatric disorders were prevalent in child and adolescent patients admitted during COVID 19 pandemic and had a distinct profile.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: A perspective from Europe and beyond.

OBJECTIVE: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. METHODS: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. RESULTS: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. CONCLUSION: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

Co-Occurring Catatonia and COVID-19 Diagnoses Among Hospitalized Individuals in 2020: A National Inpatient Sample Analysis.

BACKGROUND: COVID-19 is associated with a range of neuropsychiatric manifestations. While case reports and case series have reported catatonia in the setting of COVID-19 infection, its rate has been poorly characterized. OBJECTIVE: This study reports the co-occurrence of catatonia and COVID-19 diagnoses among acute care hospital discharges in the United States in 2020. METHODS: The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients of any age discharged with a diagnosis of catatonia and COVID-19 in 2020. RESULTS: Among 32,355,827 hospitalizations in the 2020 National Inpatient Sample, an estimated 15,965 (95% confidence interval: 14,992-16,938) involved a diagnosis of catatonia without COVID-19 infection, 1,678,385 (95% confidence interval: 1,644,738-1,712,022) involved a diagnosis of COVID-19 without a co-occurring catatonia diagnosis, and 610 (95% confidence interval: 578-642) involved both catatonia and COVID-19 infection. In an adjusted model, a diagnosis of COVID-19, but not a diagnosis of catatonia or the combination of catatonia and COVID-19, was associated with increased mortality. Patients with catatonia and COVID-19 were frequently diagnosed with encephalopathy and delirium codes. CONCLUSIONS: Catatonia and COVID-19 were rarely co-diagnosed in 2020, and catatonia diagnosis was not associated with increased mortality in patients with COVID-19. Further research is needed to better characterize the phenomenology of catatonia in the setting of COVID-19 infection and its optimal treatment.

Equity in Practice: How to be an Anti-racist Transplant Psychiatrist

Background: Transplant psychiatry and organ selection committees have a past littered with inequalities. With the growing medical advances in transplantation and the increasing number of transplants, it is the perfect time for transplant psychiatrists to adopt anti-racist practices and promote equity in marginalized communities. Method(s): Search query on PubMed: "Transplant Racism" Last 10 years Results: 42 articles, 25 after exclusion of articles not focused on transplant racism Reviewed the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT), Psychosocial Assessment of Candidates for Transplant (PACT), and the Transplant Evaluation Rating Scale (TERS). Result(s): Our literature review showed many barriers that would serve to limit or diminish the candidacy for transplantation among minority groups. Specific examples include lack of healthcare, lack of cultural and linguistic aides, and racism serving as a barrier to medical care (Purnell, 2021). All three rating scales have domains referencing substance use, social support systems, and transplant literacy. (Maldonado, 2008;Olbrisch, et al. 1988;Twillman, et al., 1993). Discussion(s): Our results are consistent that there is inherent inequity in the current transplantation evaluation process. This marginalization is a result of ongoing systemic barriers and differing rates of health literacy, cohesion of social supports, and cultural differences towards nicotine and marijuana. Conclusion(s): We recommend using a holistic and flexible approach in transplant evaluations, with a focus on equity, by advocating for patients in the following ways: 1. Education of primary care and specialist providers that practice mostly within marginalized communities 2. Advocating for increased health literacy and outreach in marginalized communities 3. Adopting a more nuanced approach in applying the social support system, substance use, health literacy, and lifestyle factors of the transplant rating scales. 4. Less stringent application to absolute and relative contraindications in transplant rating scales, especially concerning drug use, social supports, housing, and health literacy 5. Advocate for abolishing eGFR race corrections 6. Promoting services to help process the effects of racism and promote increased treatment alliance References: 1. Purnell TS, Simpson DC, Callender CO, Boulware LE. Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation. Am J Transplant. 2021;21:2327-2332. 2. Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) Stanford University Medical Center. Maldonado et al, 2008;Maldonado et al, Psychosomatics 2012 3. Olbrisch, M. E., Levenson, J. L., & Hamer, R. (1989). The PACT: A rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation, 3, 164-169. 4. Twillman, R. K., Manetto, C., Wellisch, D. K., & Wolcott, D. L. (1993). The Transplant Evaluation Rating Scale: A revision of the Psychosocial Levels System for evaluating organ transplant candidates. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 34(2), 144-153. Copyright © 2022

Validating the Busch Francis Scale for use in Telepsychiatry

Background: The COVID-19 pandemic has dramatically accelerated the utilization and acceptance of telepsychiatry, with many departments transitioning to virtual models over the past 2 years out of necessity. While there has been some research on physician and patient satisfaction with the transition, there has been significantly less research on the quality of care provided (Mishkin). By its nature, telemedicine precludes physical examination. While many psychiatric conditions are amenable to diagnosis via patient interview alone, some such as catatonia require a physical exam for diagnosis. The Busch Francis Catatonia Rating Scale (BFCRS) is a well validated in-person exam for catatonia to both screen for and rate the severity of a catatonia diagnosis (Sienaert), but to our knowledge it has not been validated via telemedicine. Our literature review revealed a paucity of research on the contribution of each individual item to the overall sensitivity of the rating scale, thus it is impossible to predict the value of a fully virtual or hybrid exam. We plan to evaluate the inter-relater reliability between an in-person BFCRS performed by a psychiatrist and one supervised by a psychiatrist through telemedicine technology. Current practice at our institution is for the psychiatry resident performing tele-consults to Methods: We will draw participants from the pool of patients for whom psychiatric consults are ordered at two separate medical campuses. Our team will consist of C-L psychiatry fellows performing BFCRS exams patients at these campuses;we will strive to see all patients for whom a psychiatric consultation is ordered. In addition to a standard psychiatric consult (which may or may not include a BFCRS), patients will receive an in-person BFCRS screening exam performed and scored by the research team member at their site and one additional hybrid BFCRS exam scored by the research team member at the alternate site with physical exam components only performed by the onsite research team member. Data collected for each participant will include demographic information, medical and psychiatric diagnoses and BFCRS scores. We will compare the sensitivity and specificity fully virtual (which will by necessity exclude some components such as rigidity) and hybrid BFCRS exam to the full in-person scale, which we will treat as a gold standard. Discussion/Conclusion: This project is currently in early stages. We hope to gather data to inform the future practice of C-L psychiatrists performing consults through telemedicine. Mishkin AD, Cheung S, Capote J, Fan W, Muskin PR. Survey of clinician experiences of telepsychiatry and tele-consultation-liaison psychiatry. J Acad Consult Liaison Psychiatry. Published online November 15, 2021:S2667-2960(21)00184-1. Reference: Sienaert P, Rooseleer J, De Fruyt J. Measuring catatonia: a systematic review of rating scales. J Affect Disord. 2011;135(1-3):1-9 Copyright © 2022

The impact of the second wave of COVID-19 on liaison psychiatry: a comparative retrospective study with the homologous non-pandemic period.

OBJECTIVE: To determine the impact of COVID-19 pandemic (COVID-19-P) on clinical and health organisational variables of patients evaluated by Liaison Psychiatry (LP). METHODS: Revision of all collaboration requests (CR) to LP for patients hospitalised in a Portuguese General Hospital during the second wave of COVID-19-P, from 1 October to 31 December of 2020. Medical charts were analysed and selected variables were compared with those of the homologous non-pandemic period. Data were statistically analysed. RESULTS: There was a 22.3% decrease in the number of CR in 2020. The most frequently given reasons for CR were depressive symptoms, psychomotor agitation, and difficulties in adapting to the disease in both years. However, 5.9% more patients reported suicidal ideation in 2020. The hospitalisation length before CR was smaller in 2020 than in 2019 (9 vs 11). There was a higher proportion of patients followed in a psychiatric consultation and previously taking psychotropic medication before hospitalisation in 2020 than in 2019. After the assessment, the trend was that both groups did not meet diagnostic criteria for any disorder and no pharmacological adjustment was needed. CONCLUSION: This study highlights the need to better characterise the indirect repercussion of COVID-19-P, and focus on the prevention and treatment of mental illness particularly in adverse contexts.Key PointsFewer collaboration requests to liaison psychiatry during the second wave of COVID-19;Collaboration requests were made earlier in the hospitalisation;For patients with more medical comorbidities, psychiatric history, and psychotropic medication;Most because of depressive symptoms and more with suicidal ideation;Fewer collaboration requests to liaison psychiatry during COVID-19;Made earlier in the hospitalisation;For patients with more medical comorbidities, psychiatric history, and medication;Most because of depressive symptoms and more with suicidal ideation.

Impact of COVID-19 pandemic on the Acute Confusional Syndrome by the liaison psychiatry service of Hospital del Mar

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has had a profound worldwide impact on health. Acute Confusional Syndrome (ACS) is the most common neuropsychiatric complication in COVID-19 infection. Objective(s): Describe the characteristics of the admited patients attended by the liaison psychiatry service for acute confusional syndrome during the COVID 19 pandemic. Sociodemographical and clinical variables were descrived. Method(s): We conducted an observational, descriptive study. All patients attended by the liaison psychiatry service of Hospital del Mar, between February and April 2020, with ACS diagnosis were included. Result(s): We included 62 patients with acute confusional syndrom;35 were men (56.5%), and mean age was 71.71 years (standard deviation [SD]:11.345). The mean duration of admision stay was 41.19 days [SD: 38.039]. The mean number of consultations carried out was 6.5 [SD: 5.422]. 52.5% of our sample of our sample had confusional symptoms for 8 days. 50 patients presented complications during admission (80.6%), of which 43 patients developed infectious complications (69.4%). 59 patients had a history of chronic diseases (95.2%). 54 patiens (88.5%) had potencial risk factors associated with acute confusional syndrome including: isolation in 24 (39.3%), active infection in 46 (74.2%), hypoxemia in 25 (40.3%), previous cognitive impairment in 15 (24.6%) Conclusion(s): Acute Confusional Syndrome mainly affects people with risk factors such as isolation, active infection and hypoxemia (which in turn are symptoms of Covid-19).

Is the management of acute confusional syndrome secondary to covid-19 pneumonia different from the management of confusional syndrome secondary to other causes?

Introduction: Acute Confusional Syndrome (ACS) is the most common neuropsychiatric complication in COVID-19 infection. Its management is still a challenge because the data and recommendations based on the evidence are limited. Objective(s): To describe the differential characteristics in the management of ACS in patients with COVID-19 pneumonia compared to ACS secondary to other causes. Method(s):We present a descriptive study that is has been carried out in 62 patients with ACS (26 of them diagnosed with COVID 19 pneumonia), who have required assessment by the liaison psychiatry service of Hospital del Mar between February and April, 2020. The sample was divided in 2 groups (with and without COVID 19 pneumonia). Chi square and Fisher's tests were used to comparisons. Result(s): Dexmetomidine (26 vs 0) and olanzapine (13 vs 3) were significantly more frequently used in COVID-19 patients (p< 0 001). A greater number of different antipsychotic drugs were used in COVID 19 patients (2.40+/- 1 323 number of drugs), (p<0.0001). Further neuroimaging tests were requested in COVID 19 patients and they received less family support (4) compared to non COVID-19 (22), (p<0.005). Conclusion(s): ACS associated with COVID-19 pneumonia in the patients in our sample is more difficult to manage than ACS associated with other pathologies, similar to which described in other series. It is associated with a longer duration of confusional symptoms and difficulties for control it.

Chaos Unleashed: The impact of recreational drugs and COVID on young adults

Introduction: This case series reveals a number of young adults, whom after chronic use of recreational drugs, suffer the life-long consequence of severe chronic mental illness. Objective(s): * Review the illicit drugs that are commonly associated with psychotic symptoms. * Highlight exposures theorized to impact genetics associated with DSM 5 diseases. * Compare trends in illicit drug use during the worldwide COVID pandemic. Method(s): A literature review is used to examine the impact of COVID pandemic on illicit drug use in metropolitan cities in European countries and compare the trends with what is seen by the consult liaison psychiatry service at a metropolitan community hospital in the USA. Result(s): In European Countries with data available, there were measurable differences in which illicit drugs were used most during the COVID 19 pandemic. In the US this data is not readily available at the time of submission for proper comparisson. Conclusion(s): Although definitive comparrison is pending, the results of extensive illicit drug use demostrate a high comorbidity with psychotic spectrum disorders in the DSM 5.

Characteristics of suicidal poisoned patients admitted to tertiary care center during COVID-19 pandemic.

Background: Suicidal poisoning is a major concern during the COVID-19 pandemic that has several physical and mental hazards. This study aimed to evaluate the characteristics of suicidal poisoned patients admitted to a tertiary poison control center during the pandemic lockdown and assess COVID-related knowledge and attitude among those patients to identify the high-risk group for suicide. This cross-sectional study was conducted on acutely poisoned patients admitted to Tanta University Poison Control Center from June to December 2020. Upon admission, socio-demographic data, causative poisoning agents, COVID-related knowledge and attitude, Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D) were collected from all participants. Results: A total of 254 poisoned patients were categorized into suicidal (85.04%) and accidental (14.96%) poisoning groups. The former was caused mainly by phosphides and was significantly associated with a history of using psychotropic medications and high HAM-A and HAM-D results. Logistic regression analysis showed that a history of psychiatric illness, low attitude scores, and high HAM-D scores were significant risk factors for suicidal poisoning. Conclusions: Considerable number of suicidal poisoned patients had moderate-to-severe depressive symptoms, highlighting the importance of providing specialized psychiatric services in poisoning centers, particularly among vulnerable populations, to prevent the overwhelming repeated suicidal attempts. Supplementary Information: The online version contains supplementary material available at 10.1186/s41983-022-00577-4.

[Morpheus syndrome: Psychotic symptoms in a case series of patients with COVID-19]. / Le syndrome de Morpheus : symptômes psychotiques chez une série de cas de patients atteints de la COVID-19.

During the first wave of the COVID-19 epidemic, the Colmar hospital was at the epicenter of the pandemic in France because of a religious gathering that caused a wave of contamination. In order to face the growing wave of admissions in intensive care, the state in partnership with the army set up the operation MORPHEE aiming at transferring intubated patients to other hospitals. On their return to Alsace, the inter-service liaison psychiatry team was called upon for several of them who presented psychotic disorders on waking up, even though they had no previous psychiatric history, and who had resolved spontaneously. These pictures do not correspond to the delirious pictures usually observed in the ICU, such as "reanimatory black-holes" or "near-death-experience". No iatrogenic origin was found and the imaging examinations do not allow to explain this picture; therefore, we cannot exclude that this picture could be a neurological manifestation of COVID-19. The disorder appeared to be spontaneously resolving, so we would urge caution about a drug approach to this problem.

A COVID-19 Patient's Request to Die and Ensuing Conflict: Psychodynamic Considerations.

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.

Substance use and self-harm emergency department presentations during COVID19: evidence from a National Clinical Programme for Self-Harm.

INTRODUCTION: Given the evidence that drinking patterns and self-harm hospital presentations have changed during COVID-19, this study aimed to examine any change in self-harm and suicide-related ideation presentations, together with any possible contribution made by alcohol or substance misuse, to Irish Emergency Departments in 2020, compared with 2018 and 2019. METHODS: A population-based cohort with self-harm and suicide-related ideation presenting to Irish hospitals derived from the National Clinical Programme for Self-Harm was analysed. Descriptive analyses were conducted based on sociodemographic variables and types of presentation for the period January to August 2020 and compared with the same period in 2018 and 2019. Binomial regression analyses were performed to investigate the independent effect of demographic characteristics and pre/during COVID-19 periods on the use of substances as contributory factors in the self-harm and suicide-related ideation presentations. RESULTS: 12,075 presentations due to self-harm and suicide-related ideation were recorded for the periods January-August 2018-2020 across nine emergency departments. The COVID-19 year was significantly associated with substances contributing to self-harm and suicide-related ideation ED presentations (OR = 1.183; 95% CI, 1.075-1.301, p < 0.001). No changes in the demographic characteristics were found for those with self-harm or suicide-related ideation across the years. Suicide-related ideation seemed to be increased after May 2020 compared with previous years. In terms of self-harm episodes with comorbid drug and alcohol overdose and poisoning, these were significantly increased in January-August 2020, compared with previous timepoints (χ2 = 42.424, df = 6, p < 0.001). CONCLUSION: An increase in suicide-related ideation and substance-related self-harm presentations may indicate longer term effects of the pandemic and its relevant restrictions. Future studies might explore whether those presenting with ideation will develop a risk of suicide in post-pandemic periods.

Behavioral Emergencies in the General Hospital: Role of C-L Psychiatry in Early Management and Prevention

Background: Within the general hospital setting, Consultation-Liaison (C-L) Psychiatry services are critical for managing patients with behaviors that frequently result in behavioral emergencies, including agitation, verbal aggression, physical aggression, and demanding behavior (Pestka et al., 2012). To most effectively manage these difficult patient behaviors, early consultation to C-L Psychiatry may prevent behavior from escalating to the level of a behavioral emergency. Yet, data is limited regarding the effectiveness of C-L Psychiatry in impacting the occurrence and reoccurrence of behavioral emergencies. Method: Data on all behavioral emergencies that occurred at the University of Virginia Medical Center from January 2020 to December 2020 were collected. Variables collected include patient demographic information, frequency of behavioral emergency, type of behavioral emergency, factors contributing to behavioral emergency, and whether the C-L Psychiatry service had been consulted. Patients who received a C-L Psychiatry consult prior to a behavioral emergency will be compared on the above variables to patients who did not receive this consult to identify differences between the two groups. Results: Preliminary data indicates that UVA Medical Center had an average of 61.2 (range 38-82) behavioral emergencies per month between January 2020 and December 2020. These fell into five categories consistent with previous pilot data: physical aggression, leaving the unit, verbal aggression, agitation, and non-compliance (Yost & Smith, 2020). Factors contributing to behavioral emergencies were identified as delirium, dementia, personality disorder, substance withdrawal, frustration, and TBI. Data will be further analyzed to determine how frequently patients who exhibit behavioral emergencies had received C-L Psychiatry services prior to the behavioral emergency or had not received this service during their hospitalization. Additional analyses will be conducted to determine differences between these two groups on type of behavioral emergency and factors contributing to behavioral emergency. Discussion: This data will inform how patients with challenging behavior are identified early in their hospitalization and how C-L Psychiatry can proactively intervene to decrease behavioral emergencies. Further, this project suggests a need to create process for identifying patients at risk for behavioral emergencies. Future directions will be discussed. Conclusions/Implications: The findings from this quality improvement project have important clinical implications concerning how C-L Psychiatry manages patients with challenging behavior and how frontline staff identify and utilize C-L Psychiatry. References: 1. Pestka EL, Hatteberg DA, Larson LA, Zwygart AM, Cox DL, Borgen EE Jr. Enhancing safety in behavioral emergency situations. Medsurg Nurs. 2012;21(6):335-41. 2. Yost, JS & Smith, JB. A taxonomy of behavioral emergencies in the general hospital: A comparison of behavioral emergencies pre-covid-19 and during the covid-19 outbreak. Brief oral presentation delivered at the 2020 Annual Meeting of the Academy of Consultation-Liaison Psychiatry.

A Survey of Adult Psychiatry Residency Programs About Training in C-L Psychiatry

Background: Despite training in consultation-liaison (CL) psychiatry representing a core requirement for general residency training in psychiatry, there is significant variation in the structure, timing, length, setting, and educational components for residents in programs throughout the country. The last official survey of CL training in residency was conducted by the Academy of Consultation-Liaison Psychiatry (ACLP) in 2010 with responses from 92 residency programs across the country (Heinrich 2013). Based on the results of that survey, recommendations were issued by the ACLP in 2014 concerning best practices for residency training in CL psychiatry (Heinrich 2014). Methods: Members of the ACLP Residency Education Subcommittee designed an updated survey based on the survey tool used in 2013. In addition to questions about the structure of residency training, we also asked questions about CL fellowships and their relationship to the CL experience of residents attending structures on CL services, learners from other health professions, educational content, and modifications made during the COVID-19 pandemic. Following exemption by the Partners Institutional Review Board, we distributed the survey in anonymous and confidential format through RedCap to 273 adult psychiatry residency program directors using the American Medical Association’s FREIDATM database. Program directors were instructed that they could complete the survey themselves or forward to relevant faculty. Results: We will discuss the results of the survey including the response rate;distribution of programs in terms of geography, size and focus;length, timing, structure and setting of CL rotation;presence and role of fellows and other learners;model of attending staffing;educational and didactic components;and modifications made in the setting of COVID-19. Discussion: Based on the findings, we anticipate a discussion of trends in residency CL education over the past decade. Specifically, we anticipate focus on earlier CL training, novel training patterns, CL rotations spread across multiple years, increasing focus on outpatient CL experiences, and increased learners and other staff on services. The topic is of immediate relevance to training in CL psychiatry and thus to developing careers in CL psychiatry, a meeting theme. Conclusion: We expect these findings will provide important information for issuing an updated set of guidelines for CL training in residency for the next decade. References: 1. Heinrich TW, Schwartz AC, Zimbrean PC, Lolak S, Wright MT, Brooks KB, Ernst CL, Gitlin DF. “Recommendations for training psychiatry residents in psychosomatic medicine.” Psychosomatics 2014;55:438-449. 2. Heinrich TW, Schwartz AC, Zimbrean PC, Wright MT;Academy of Psychosomatic Medicine's Residency Education Subcommittee. The state of the service: a survey of psychiatry resident education in psychosomatic medicine. Psychosomatics. 2013 Nov-Dec;54(6):560-6. doi: 10.1016/j.psym.2013.07.005.

Measuring Quality Standards for a Consultation-Liaison Psychiatry Service in a Chilean Teaching Hospital

Background: To date, scarce structured guidelines for the assessment of service quality improvement interventions and service quality standards for Consultation Liaison Psychiatry Services (CLP) have been described (1-4). Our aim is to measure the impact of introducing an electronic triage referral system (ETR) and a proactive CLP model (PCL) during the COVID-19 pandemic by establishing key performance indicators (KPI). Methods: Observational exploratory study conducted at the Hospital Clínico Red Salud-UCChristus, a teaching hospital in Santiago, Chile, ∼400 beds. ETR was introduced in May 2020, and PCLP from May to August 2020. Data was collected from CLP discharged records, from January 2019 to September 2021. Study approved by our Ethical Review Board. Results: We observed a constant increase in the number of referrals and assessments from 2019 to 2021. Most frequent referrals in 2019-2021 were made by the Internal Medicine team and the most common diagnosis was delirium. Two main KPIs were assessed: • Time of Response (ToR): After the introduction of ETR, there was an increase in the % of patients seen within 24 hours of referral between 2019, 2020 & 2021 (51.4%, 69.9% and 71.3% respectively). A similar trend was observed in ToR within 48 hours. Of those considered urgent by referrers, 87% were seen within 24 hours of referral in both 2020 and 2021, with an overall achievement of 100% within 48 hours. • “Staffing workload index” (SWI): After ETR & PCL were introduced, we observed an increase in staffing available working hours at the hospital in 2020 and 2021 (40% increase), which was sustained after PCL was terminated. We were able to estimate a rate between staff hours and average referrals per week (SWI), to measure the staff turn towards clinical activities as needed by referrals. The overall SWI was 1.32 in 2019, 1.57 in 2020 (1.05 during 3-month COVID-19 peak of cases) and 1.09 in 2021. Moreover, SWI had a -0.17 correlation with % of ToR Discussion: The ETR and PCL initiatives had an impact in our service, as observed in our KPIs ToR and SWI. Our CLP service has been able to adapt to service demands, by increasing staffing available working hours when needed and reducing time of response. Conclusions: ToR may be a useful and easy to collect KPI to routinely monitor service efficiency. Still remains a challenge for our service to introduce qualitative parameters of service user satisfaction in a 360º fashion to integrate patients, family, referrers and CLP staff. Trials to assess the efficacy of introducing complex interventions such as ETR, PCL and KPI surveillance are needed. References: 1. Trigwell, P., & Kustow, J. (2016). A multidimensional Framework for Routine Outcome Measurement in Liaison Psychiatry (FROM-LP). BJPsych bulletin, 40(4), 192–194. https://doi.org/10.1192/pb.bp.115.051458 2. Wood, R., & Wand, A. P. (2014). The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. Journal of psychosomatic research, 76(3), 175–192.https://doi.org/10.1016/j.jpsychores.2014.01.002 3. Brightey-Gibbons F, Patterson E, Rhodes E, Ryley A, Hodge S, Eds. Quality Standards for Liaison Psychiatry Services (Fifth ed.). London: Royal College of Psychiatrists;2017. 4. Kovacs, Z., Asztalos, M., Grøntved, S., & Nielsen, R. E. (2021). Quality assessment of a consultation-liaison psychiatry service. BMC psychiatry, 21(1), 281. https://doi.org/10.1186/s12888-021-03281-4

COVID-19 Related Mental Health Issues among Patients with Cancer: A Pilot Study

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic is associated with more psychological distress than its rampant spread, mortality, and morbidity. Cancer patients are at increased risk of mortality and morbidity than the general population. Due to this, there is a possibility that cancer patients may be suffering from a higher level of COVID-19 related anxiety, fear, and obsession. Aim: To explore COVID-19 related mental health issues (anxiety, fear, and obsession) and its correlates in patients with cancer. Materials and Methods: The present study was a cross-sectional pilot study which was conducted in a tertiary care teaching hospital located in Ratnagiri, Maharashtra, India. Patients receiving treatment for cancer (n=55) consequently at tertiary care teaching hospital of India were recruited. The Corona Anxiety Scale (CAS), Obsession with COVID-19 Scale (OCS), Fear of COVID-19 Scale (FCV-19S), Patient Health Questionnaire-9 (PHQ-9), and Generalised Anxiety Disorder-7 Scale (GAD-7) were used to assess all eligible patients. Fisher's-exact test. spearman's rank correlation, and logistic regression were used to analyse the data. Results: Among the 55 patients (mean age was 49.64 +/- 13.08 years) with cancer, 11 (20%) had Coronavirus related anxiety and 2 (3.6%) had obsession related COVID-19, 22 (40%) had depression and 18 (32.7%) has GAD. CAS score positively correlated with FCV-19S score [rho=0.50 (p<0.001)], PHQ-9 score [rho=0.90 (p<0.001)] and GAD-7 score [rho=0.74 (p<0.001)]. Conclusion: COVID-19 related mental health issues (fear, anxiety), depression, and GAD were prevalent among patients with cancer. Further, COVID-19 specific issues may not be addressed in routine screening and evaluation in current practice. Therefore, there is an urgent need to develop systematic strategies to screen and develop specific mental health interventions for patients with cancer.

THE '4 Ds': ADDRESSING MENTAL HEALTH ISSUES IN HEART AND LUNG TRANSPLANT RECIPIENTS

Mental health (MH) issues related to COVID-19 can arise at each of the following stages: Onset (managing fear, uncertainty, stigma) and re-emerging MH problems;Acute (managing panic, fear, delirium, isolation);Long COVID (managing the cognitive, emotional, physical sequelae of COVID-19 and differentiating from pre- COVID 'unfinished emotional business' that has arisen;and Recovery (adjusting to full recovery or a 'new normal'). This talk will address the issues seen in post-COVID-19 follow-up in relation to these stages. Consultation-liaison psychiatry's role throughout the transplant journey from assessment to post-transplant management. This has grown in importance as the range of potential recipients has grown to include people who are older, and with more evidence of the '4 Ds' (depression, disordered personality, delirium, decline in cognitive function). Several innovations to the assessment process have improved outcomes in predicting delirium, survival, and intensive care unit (ICU)/hospital stays. First, addition of frailty assessment and the effects of adding depression and cognitive capacity to the standard frailty score. While depression improves post-transplantation, cognitive function tends not to. Similarly, patients with high scores on the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) are at increased risk of adverse outcomes (delirium, poor post-transplant adherence and increased ICU/hospital stays). Findings: The implications of these findings will be discussed.