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1.
Journal of Neurology, Neurosurgery and Psychiatry ; 93(Supplement 1):A69, 2022.
Article in English | EMBASE | ID: covidwho-2064254

ABSTRACT

Video consultations have become a viable alternative for face-to-face consultations during Covid19 pandemic and are expected to be used increasingly in the future. To date, there is little evidence to support the acceptability of these services or to document the benefits and challenges when offering online clinics to HD patients. Method We report on an EHDN WG Genetic Counselling and Testing project of 41 healthcare professionals from 15 European countries. Participants filled in a purposely-designed survey to assess the acceptability, benefits and challenges of telemedicine with HD affected and at risk individuals. The survey was active from March 2020 until March 2021. Results Respondents were geneticists (34%), neurologists (34%), genetic counsellors (15%), and others (psychologists, psychiatrists and research practitioners) (17%). Before the Covid-19 pandemic, professionals saw 4.5 HD patients per week and most (85%) never used telemedicine. During the pandemic, professionals saw 2.4 patients per week in face-toface consultations and 3.4 patients in online consultations. 85% of professionals felt that HD clinics can be done safely and effectively online. Most respondents agreed several aspects of consultations can be done safely online: follow-up counselling (78%), genetic counselling for predictive testing (54%), psychological assessment (49%), psychiatric and behavioural assessment (44%). The main benefits of telemedicine perceived were and challenges were also listed and discussed at length. Conclusions and discussion Our data are encouraging in relation to the potential for virtual and hybrid consultations in HD care. We draw on both quantitative and qualitative data to discuss professionals' views on telemedicine as well as potential implications for future practice.

2.
American Journal of Transplantation ; 22(Supplement 3):795-796, 2022.
Article in English | EMBASE | ID: covidwho-2063407

ABSTRACT

Purpose: Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine has the potential to facilitate care delivery/ coordination for donors. We aimed to understand center practices and provider attitudes and perceived barriers of telemedicine services for living kidney donation. Method(s): We conducted a national survey of multidisciplinary providers from 194 U.S. active adult living donor kidney transplant centers in 2020. The survey was distributed with an online link from 2/18/2021 to 5/13/2021, and up to two reminders were provided. The target population included nephrologists, surgeons, nurse coordinators, social workers or independent living donor advocates, and psychiatrists or psychologists. We used descriptive statistics and analysis of variance. Result(s): Two hundred ninety-three providers from 128 unique centers responded to the survey, a center representation rate of 66.0%, reflecting 82.9% of U.S. practice by donor volume and 91.5% of U.S. states/territories. Most centers (70.3%) will continue using telemedicine beyond the COVID-19 pandemic. Video only was mostly used for donor evaluation by nephrologists, surgeons, psychiatrists or psychologists. Telephone and video were mostly used by social workers, while no mutual modality was used by coordinators. Vital signs and weight were obtained largely using self-reported measures or a local provider/primary care physician, and a physical exam was mostly completed at a subsequent in-person visit to the transplant center. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation for potential donors. These attitudes were consistent across provider roles (p>0.05). Providers were favorably disposed to use telemedicine beyond the pandemic for donor evaluation and followup care. Out-of-state licensing and reimbursements were key regulatory barriers. Conclusion(s): These findings help inform clinical practice and policy expanding telemedicine services to enhance access to living donation and may be extended to other medical specialties.

3.
Revista de Psiquiatria y Salud Mental. ; 2022.
Article in English, Spanish | EMBASE | ID: covidwho-2061828

ABSTRACT

This review paper analyzes the state of knowledge on Telepsychiatry (TP) after the crisis caused by COVID and the resulting need to use new modalities of care. Six essential aspects of TP are addressed: patient's and mental health staff satisfaction, diagnostic reliability, effectiveness of TP interventions, cost-effectiveness in terms of opportunity cost (or efficiency), legal aspects inherent to confidentiality and privacy in particular and the attitude of professionals toward TP. Satisfaction with TP is acceptable among both patients and professionals, the latter being the most reluctant. Diagnostic reliability has been demonstrated, but requires further studies to confirm this reliability in different diagnoses and healthcare settings. The efficacy of TP treatments is not inferior to face-to-face care, as has been proven in specific psychotherapies. Finally, it should be noted that the attitude of the psychiatrist is the most decisive element that limits or facilitates the implementation of TP. Copyright © 2022 The Author(s)

4.
Journal of the Canadian Academy of Child and Adolescent Psychiatry ; 31(2):110-111, 2022.
Article in English | EMBASE | ID: covidwho-2006794
5.
Voprosy Sovremennoi Pediatrii - Current Pediatrics ; 21(3):234-241, 2022.
Article in Russian | EMBASE | ID: covidwho-1998085

ABSTRACT

Background. Child and adolescent suicides remain one of the most painful public issues. The COVID-19 pandemic has aggravated this topic as the number of suicides among children population has increased in this period. Research and practice guidelines identify the leading role of primary care physicians in the prevention, identification, and routing of patients with suicidal behavior. At the same time, there were no studies on pediatricians’ competence in the field of suicides. Objective. The aim of the study is to study pediatricians’ competence in prevention, risk determination or and detection of suicidal behavior. Methods. Cross-sectional study was conducted with the usage of original electronic questionnaire aimed on identifying the level of pediatricians’ competence in evaluating suicidal behavior in children. Questionnaire included 18 questions. Results. We have received 208 electronic questionnaires. 97.1% of specialists have confirmed that they evaluate emotional status of their patients during admission. During admission: 86.1% of specialists have considered the characteristics of children appearance, facial expression, voice intonation, 65.4% — have asked questions about mood, 62.5% — have interviewed parents. 98.6% of specialists pay attention to the presence of self-inflicted injuries marks, 88.4% — ask about the origin of these injuries. Only 36.1% of respondents ask patients about suicidal thoughts, intentions, or actions. Only 69.3% of specialists are ready to refer their patients to psychologist, and 51.7% — to psychiatrist. Conclusion. Even though most surveyed pediatricians notice signs of suicidal intent (low mood, self-inflicted injuries), they avoid discussing the topic of suicide during admission. Increasing the competence of pediatricians should be aimed on destigmatisation in the field of mental health, increasing the knowledge level, and developing practical skills in working with children with suicidal behavior.

6.
Iranian Journal of Psychiatry and Behavioral Sciences ; 16(2), 2022.
Article in English | EMBASE | ID: covidwho-1988361

ABSTRACT

Background: People with schizophrenia are more stigmatized than those with other mental illnesses. Stigmatization can be measured using the English version of Stigma Measurement Scale contained in the explanatory model interview catalogue (EMIC). Objectives: This study aimed to translate the English version of Stigma Measurement Scale into Berber language and validate the translated version. Methods: This study was conducted in public hospitals in southern Morocco, which are predominantly Berber-speaking. The psychometric properties of the stigma scale contained in the EMIC were validated on a sample including 128 individuals. Results: According to the Cronbach’s alpha (α = 0.826) and the internal convergence calculated by Pearson’s statistic, that the interitem correlation was significant. Also, the intraclass correlation coefficient (ICC) was significant. The added item, concerning the COVID-19 situation has a similar psychometric value to the other items. Conclusions: According to our results, the Berber version of the Stigma Measurement Scale is culturally acceptable and can be used in Moroccan society.

7.
Bipolar Disorders ; 24:35, 2022.
Article in English | EMBASE | ID: covidwho-1978421

ABSTRACT

Introduction: Beyond a significant psychological burden in lives of patients with bipolar disorders, the COVID-19 outbreak created a significant obstacle in accessibility to mental health services, which raised a need for a country-wide network of healthcare providers for bipolar disorders in Turkey. The Bipolar Disorders Chapter of Turkey organized a training program for excellence in diagnosis and management of bipolar disorders in order to train early career psychiatrists who carry out mental services all over the country. Method: We announced a training program consisting of four modules including interactive Zoom lessons giving the theoretical baseline 48 hours), and a supervision module that includes case discussions with experts (96 hours). The lectures and discussions were moderated by leading specialists in bipolar disorders in Turkey. The theoretical modules focused on diagnosis and classification, pharmacological treatment, psychosocial interventions, and special populations (elders, pregnants, patients with comorbidity etc.) in bipolar disorders. Results: We trained 40 early career psychiatrists (14 men, 26 women;between ages of 27-40) from 18 different cities of Turkey. 37 of them have successfully completed the four modules, passed the final examination, and qualified for the supervision module. Most participants agreed that the program enhanced their clinical skills perfectly (satisfaction over 90%). Conclusion: This might be a good example of a postgraduate training program for clinicians serving patients with bipolar disorders. Such training programs might create a basis for building country-wide networks of healthcare professionals for bipolar disorders.

8.
Journal of Health Sciences and Surveillance System ; 10(2):233-234, 2022.
Article in English | Scopus | ID: covidwho-1975768
9.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S87-S88, 2022.
Article in English | EMBASE | ID: covidwho-1966676

ABSTRACT

Background: Catatonia is a syndrome comprised of motor and behavioral symptoms that can have many different etiologies including psychiatric and neuromedical1. The modified Bush-Francis Catatonia Rating Scale (BFCRS) is a widely used screening instrument used for both diagnostic and symptom-severity tracking purposes. BFCRS items can be assessed through observation (patient or chart), verbal interactions, and physical exam. The COVID-19 pandemic has introduced limitations in hands-on evaluation due to infection control measures. We conducted a literature review to assess how often physical exam findings are used in diagnosing catatonia and hypothesize whether the pandemic is increasing under-diagnosis of catatonia. Method: We conducted a search of PubMed, Medline, and psycINFO of case reports from 1996 (when the BFCRS was published2) to present day for each individual item on the BFCRS that appeared in the title and/or and excluded publications that did not use the search terms to describe patient symptoms or did not describe catatonia. We then compared the relative appearances of the physical exam items to the non-physical exam items over the past 25 years. Finally, we compared the number of reports collected June 2020 – May 2021 (to approximate cases occurring from March 2020 – February 2021 during the height of COVID) to the average over the previous 25 years and previous 10 years, to determine if there were less reported cases of catatonia during COVID compared to previous years. Results: The most commonly reported symptoms were mutism (19.4%, z=20.1), immobility/stupor (19.1%, z=19.7), posturing/catalepsy (12.2%, z=10.5), and rigidity (9.3%, z=6.6), chi2=88.2, p < 0.0001. Physical exam symptoms were reported less frequently (14.8% of cases) compared to observed (55.1%) and interviewed symptoms (30.1%), chi2=115.19, p < 0.0001. Physical exam symptoms occurred less frequently than expected (14.8% vs 21.7%) based on number of criteria, chi2=21.34, p < 0.0001. There was no decrease in case reports in June 2020 – May 2021;case reports during COVID made up 8.9% of reports in the last 25 years, and 15.9% of reports in the last 10 years, chi2=13.56, p = 0.0002. Discussion: Our data suggests that physical exam items in the BFCRS are used less frequently than non-physical exam items when diagnosing catatonia. Despite a pandemic with increased isolation precautions, the collected data from case reports suggests that there was not a significant increase in missed catatonia diagnoses. However, catatonia is an under-diagnosed condition generally and physical exam of a suspected catatonic patient by a psychiatrist can be a key element to accurate diagnosis.3 Conclusion: While our literature review has limitations (e.g. searching for terms available only in the title and , not in the body of the paper), we feel confident in saying that physical-exam findings are not used as frequently as non-physical exam findings in diagnosing catatonia. While the physical exam should always be done when possible and can lead to more accurate diagnoses, we do not feel that any potential reduction in physical exams during the pandemic has lead to a significant increase in missed catatonia diagnoses. References: 1. Rosebush PI, Mazurek MF. Catatonia and its treatment. Schizophr Bull. 2010 Mar;36(2): 239-42. 2. Bush G, Fink M, Petrides G, Dowling F, Francis A. Catatonia. I. Rating scale and standardized examination. Acta Psychiatr Scand. 1996;93(2): 129-136. 3. Walther S, Stegmayer K, Wilson JE, Heckers S. Structure and neural mechanisms of catatonia. Lancet Psychiatry. 2019 Jul;6(7):610-619.

10.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S61, 2022.
Article in English | EMBASE | ID: covidwho-1966671

ABSTRACT

Background: Post-intensive care syndrome (PICS) affects up to half of ICU patients and comprises neuromuscular, cognitive, and psychiatric impairments that persist up to years after discharge (Inoue, 2019). PICS is often overlooked and under-diagnosed (Rawal, 2017), without clear evidence-based strategies for management. Data supporting interventions for symptoms of anxiety, depression, and post-traumatic stress after discharge is limited (Needham, 2012). Developing high-quality, evidence-based interventions for PICS would address this critical need. Methods: Shortly before discharge, patients are recruited from our neurological ICU who have been intubated for at least 24 hours and score 24–32 on the Impact of Event Scale - Revised (which indicates likely PTSD symptoms without a true diagnosis). Baseline Beck Depression Index and Telephone Interview for Cognitive Status questionnaires are also administered to each patient. Participants are then randomly assigned either to a virtual reality exposure therapy intervention or to a control group that receives no therapeutic intervention. VRET patients are given an online 360° video of an ICU room from the perspective of an intubated patient, complete with sounds and simulated clinical scenarios (rounds, intubation, suctioning, etc.). Intervention patients have unlimited access to the videos for six months, beginning one month after discharge. Follow-up IES-R, BDI, and TICS are administered at 1, 3, and 6 months to both groups. Results/Discussion: Our IRB approved this study in March 2021. Enrollment has begun with 3–5 feasibility patients, to be followed by 30 randomized patients starting in November. Our poster features a case discussion on our first patient's experiences with VRET. Given the novelty of remote VRET for post-ICU PTSD symptoms, our results will be an important contribution with the potential to change practice. Conclusion: This will be the first remote intervention for neuropsychiatric symptoms of PICS, and has far-reaching implications for inpatient and outpatient CL psychiatrists — particularly at a time when patients have grown increasingly accustomed to virtual interventions, and when ICU survivors have multiplied due to COVID-19. Should our VRET prove successful, it will open the eyes of intensivists and CL psychiatrists to a whole realm of remote, efficient, and accessible virtual reality therapies for patients who have undergone acute care. This will improve long-term outcomes, particularly for patients who may have difficulty seeing an outpatient psychiatrist or taking medications consistently. Finally, our study will help to raise awareness of the psychiatric sequelae of acute illness, and so enhance inpatient collaboration between psychiatry and many other specialties. References: 1. Inoue S et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;(3):233-246. 2. Needham DM et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med. 2012;40(2):502-9. 3. Rawal G et al. Post-intensive Care Syndrome: an Overview. J Transl Int Med. 2017;5(2):90-92.

11.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S54, 2022.
Article in English | EMBASE | ID: covidwho-1966668

ABSTRACT

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

12.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S52, 2022.
Article in English | EMBASE | ID: covidwho-1966667

ABSTRACT

Introduction: Kratom (mitragynine speciosa) is a tree native to Southeast Asia that has both opioid, stimulant, and other unknown properties. It is currently legal in the United States and used for therapeutic and recreational purposes. There is a dearth of literature on kratom’s effects on the body. At least half of reported kratom exposures resulted in a serious medical outcome, including death (1). In contrast, there are no controlled clinical trials on safety and efficacy of kratom as a treatment (2). Case: A 32-year-old Caucasian, currently unemployed, unmarried, mother of two children presented intubated to the MICU from an outside hospital with acute fulminant hepatic failure in the setting of significant kratom use. The patient also presented febrile with intracranial hemorrhage, cerebral edema, GI bleeding, acute renal failure, and diffuse intravascular coagulation. Psychiatry was consulted for potential liver transplant candidacy. Her previous history included six years of opioid use and transition to kratom 1-2 years prior to admission, with recent ingestion up to twenty-five times the patient’s usual amount (up to 125mg). Pertinent positive labs included elevated troponin (0.4), transaminitis ( >11,000), elevated PT/PTT (99/52), D-dimer ( >20), hematuria, pyuria, serum ferritin, prolonged QTc (514), and hypoglycemia. Pertinent negatives included unrevealing serum ethanol, phosphatidylethanol, viral hepatitis, HIV, COVID-19, EBV, CMV, other viral panels, acetaminophen level, toxicology screen, and EEG. Imaging revealed interstitial pulmonary edema and diffuse cerebral edema. Given lack of published information on kratom, the team emergently listed the patient for liver transplant despite significant concern for kratom use disorder. Over the course of three days, the patient’s mental status and labs continued to worsen, ultimately resulting in death. Interventions pursued included dialysis, mechanical ventilation, intracranial pressure monitoring with pressure optimization, anticonvulsant therapy, antibiotic therapy, N-acetylcysteine, and other routine MICU care. Due to relatively unremarkable health before ingestion, lack of other significant events, and severe rapid decline, multidisciplinary team consensus cause of death was due to kratom ingestion causing “acute liver failure with hepatic coma”. Discussion: This case report will go into further detail on kratom by analyzing kratom’s mechanism of action, therapeutic use, known side effects including addictive potential, effects on the liver including acute fulminant injury, and current laws and regulations surrounding kratom in the United States with relevance to public health. This is relevant to psychiatrists in the general consult, transplant, and addictions services. References: 1. Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers: 2011–2017. Clinical Toxicology. 2019 57:10,847-854. DOI:10.1080/15563650.2019.1569236 2. Prozialeck W. Update on the Pharmacology and Legal Status of Kratom. J of the AOA. 2016, 116, 802-809. DOI: https://doi.org/10.7556/jaoa.2016.156

13.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S50, 2022.
Article in English | EMBASE | ID: covidwho-1966665

ABSTRACT

Background: Disasters are broadly defined as “encounters between forces of harm (hazards), and a vulnerable human population in harm's way, that create demands exceeding the coping capacity of the affected community,” (Shultz, 2014). Disasters predictably produce behavioral and psychosocial consequences;in fact, more survivors are affected psychologically than are harmed physically. Type of disaster event, severity and duration of exposure, geographic scope, and extremity of resource losses contribute to distress and diagnosable psychopathology. For persons currently undergoing treatment for disease, injury, or life-changing medical condition, exposure to a disaster may complicate their care, exacerbate their condition, threaten their survival, and trigger psychological reactions. The ongoing COVID-19 pandemic has increased baseline population prevalence rates of common mental disorders worldwide, thereby compounding risks for psychopathology among persons whose communities are affected by disaster. The current era, marked by layered stressors, creates a compelling impetus to train upcoming psychiatrists on skills to support disaster survivors, including those with special needs. We are designing and implementing a curriculum to teach the principles of disaster behavioral health to our psychiatry residents based aligned with national guidelines (Flynn and Morganstein, 2020). Method: An electronic survey was distributed to psychiatry residents to assess their current knowledge and skill levels for performing key actions when dealing with disaster survivors, post-impact. Residents were asked to rate their current knowledge regarding disaster behavioral health principles, their confidence for providing psychological support to disaster survivors, and their interest in evidence-based disaster behavioral health training, grounded on national recommendations. Interested residents will participate in an expert-led lecture series that will include pre- and post-training assessment of disaster behavioral health knowledge and skills. Results: The initial interest survey garnered a 40% resident response rate. Apart from rating their ability to “gather information in a disaster situation” at 4-of-5, most residents rated their current knowledge levels and confidence in their skills to provide support to disaster survivors at 2-of-5 or below. Regarding interest in a disaster behavioral health lecture series, 86% indicated they would be interested. Pre- and post-training assessment are pending the delivery and completion of the lecture series. Discussion: Initial resident survey results demonstrate limited knowledge of disaster behavioral health principles, low levels of confidence in skills to support the psychological needs of survivors, and strong interest in receiving training. Conclusion: We will proceed to develop a robust disaster behavioral health training curriculum for our residents, starting with a lecture series featuring experts in the field and rapidly expanding to skills training and real-world disaster deployment/response opportunities. References: 1. Flynn BW, Morganstein JC. Curriculum Recommendations for Disaster Health Professionals: Disaster Behavioral Health, Second Edition, 2020. 2. https://www.usuhs.edu/sites/default/files/media/ncdmph/pdf/ncdmph_csts_revised.pdf 3. Shultz JM. Perspectives on disaster public health and disaster behavioral health integration. Disaster Health. 2014;2(2):69-74.

14.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S30-S31, 2022.
Article in English | EMBASE | ID: covidwho-1966662

ABSTRACT

Background/Significance: Nationwide, the number of hospital emergency department (ED) visits has steadily increased over the past decade;since 2009, ED volumes have increased over 11%.1 The proportion of ED visits primarily involving psychiatric concerns (including substance use) has also been on the rise, from 6.6% of all visits in 2007 to 10.9% of all visits in 2016.2 A recent retrospective analysis of ED visit data from the National Emergency Department Sample examining the years 2010 through 2014 identified mental health concerns (including substance use) as the second-most frequent ED presentation, with abdominal pain ranking as the most frequent.3 Challenges to caring for patients with prominent psychiatric concerns in EDs include: prolonged lengths of stay (LOS),4 boarding and overcrowding,5 increased restraint use,6 financial sequelae,7 and safety implications for patients and staff.5 Many EDs have limited access to psychiatric expertise. Unique features of our innovative ED-based Psychiatry service line include: 1) joint administration by academic departments of Emergency Medicine and Psychiatry, and 2) concurrent, rather than consecutive, evaluations conducted by Emergency Medicine physicians and Psychiatrists for optimal efficiency and collaboration. Methods: The ED Psychiatry Program at Froedtert Hospital was implemented in 2019 to improve patient care, systems-based processes, and cross-specialty education. IRB approval was granted on 4/7/2020 to review data collected on all patients seen in the ED by the new ED Psychiatry service and compare metrics with primary psychiatric patients seen in the ED prior to program implementation. Patient care metrics from the first 12 months has been analyzed;cases in which the ED psychiatrist was involved total 382 (data from 5 patients seen during this period could not be reviewed due to erroneous recording of identifying information). 754 charts were reviewed in total—377 post-implementation (9/1/2019-8/31/2020) and 377 pre-implementation (9/1/2018-8/31/2019). The following metrics were recorded and analyzed using basic summary statistics: ED LOS, disposition, psychiatric diagnosis at discharge, medication class recommended, medication class administered, medication route recommended, and medication route administered. Statistical analysis was performed both on the 12-month groups in aggregate, as well as separately in 6-month groupings to assess for any COVID-19 related confounding effect. Results: Analysis of the first 12 months of data (n = 377 control and intervention patients) demonstrates statistically significant results across a number of domains, including disposition (decrease in hospital admissions and increases in transfers and ED discharges post-implementation), psychiatric diagnoses (increases in personality, intellectual developmental, and anxiety spectrum disorders post-implementation), and medication classes and administration routes utilized (decrease in benzodiazepine use and increases in both atypical antipsychotic use, as well as oral route of administration post-implementation). There were also notable decreases in ED LOS for patients being admitted and transferred from the ED;however, these differences were not statistically significant. Discussion: Analysis of the first year of service data suggests program efficacy and overall value to the health system, with relevant metrics including shorter ED LOS, improved diagnostic accuracy, increased provision of pharmacological treatment interventions in the ED setting and upon discharge, and more resource-appropriate dispositions for patients presenting to the ED with psychiatric concerns. Future directions for further study include: 1) review of the total data set, numbering over 1300 patients in 2 years;2) de-duplication of the data set to eliminate repeat patient encounters as a potential source of confounding;3) collaboration with a faculty biostatistician team for further statistical analysis;and 4) collection and analysis of additional relevant metrics, including restraint use (both f equency and duration), utility of 1:1 observers, patient insurance status (to aid in quantifying possible financial impact), additional patient demographic data (including age, race, gender, ethnicity), and time of patient presentation to the ED. Conclusion/Implications: Integration of psychiatric care into medical settings has been widespread in outpatient environments, but acute models are lacking. Complex psychiatric presentations impede ED workflows and often lead to inadequate care for this vulnerable population. Our jointly administered program that embeds CL Psychiatrists into our academic ED care team has improved and enhanced the care of ED patients presenting with psychiatric concerns as well as operational efficiencies within the department. References: 1. Agency for Healthcare Research and Quality. (2021, April). HCUP Fast Stats. Retrieved from Healthcare Cost and Utilization Project (HCUP): www.hcup-us.ahrq.gov/faststats/national/inpatienttrendsED.jsp 2. Theriault, K., Rosenheck, R., & Rhee, T. (2020). Increasing Emergency Department Visits for Mental Health Conditions in the United States. J Clin Psychiatry, 20m13241. 3. Hooker, E. A., Mallow, P. J., & Oglesby, M. M. (2019). Characteristics and trends of emergency department visits in the United States (2010-2014). J Emerg Med, 344-351. 4. Ding, R., McCarthy, M., Desmond, J., Lee, J., Aronsky, D., & Zeger, S. (2010). Characterizing waiting room time, treatment time, and boarding time in the emergency room using quantile regression. Acad Emerg Med, 813-823. 5. American College of Emergency Physicians. (2014). Polling Survey Results. 6. Zeller, S., Calma, N., & Stone, A. (2014). Effects of a dedicated regional psychiatric emergency service on boarding of psychiatric patients in area emergency departments. West J Emerg Med, 1-6. 7. Nicks, B. A., & Manthey, D. M. (2012). The impact of psychiatric patient boarding in emergency departments. Emerg Med Int.

15.
Journal of the Academy of Consultation-Liaison Psychiatry ; 63:S8-S9, 2022.
Article in English | EMBASE | ID: covidwho-1966659

ABSTRACT

Background: Psychiatric symptoms, particularly depression, are common in Huntington’s Disease (HD) patients. Catatonia is relatively rare in this population, and there is no current standardized treatment for catatonic HD patients (Merida-Puga et al., 2011). ECT is not generally used for treatment of psychiatric disorders in HD patients;however, there is evidence that it should be considered for some catatonic HD patients (Mowafi and Millard, 2021). Here, we present the case of a HD patient with catatonia rapidly responsive to ECT and conduct a literature review, adding further evidence of its efficacy in this population. Case: Mr. S is a 60-year-old male with a history of HD, MDD, and anxiety who presented to the ED with suicidal ideation and a plan to overdose due to his disease progression, significant anxiety, and paranoia surrounding the COVID-19 pandemic. He was previously admitted to another psychiatric hospital without clinical benefit. His psychotropic regimen at admission included buspirone, citalopram, deutetrabenazine, paliperidone, propranolol, and tiagabine. Four days into his admission, he was nonresponsive on interview. Given concern for catatonia (Bush-Francis Rating Scale, BFRS, 24), a successful lorazepam challenge was administered. Paliperidone was held and lorazepam was scheduled. In the subsequent days, multiple medication changes were made, including discontinuation of deutetrabenazine given concern for depression exacerbation. ECT was started due to continuation of catatonia symptoms despite scheduled lorazepam (BFRS fluctuating from 1 to 23). Following his first two treatments, he resumed oral intake, and his BFRS reduced to 0. By ECT #3, he was speaking fluently with improvement in his mood and suicidal ideation. Following an initial series of eight ECT, treatments were tapered with maintained improvement. Discussion: Our patient had complete resolution of his catatonia and remission of depression with a short course of ECT, experiencing profound improvement even two treatments into the course. Prior case reports indicated the need for longer ECT courses before resolution with the minimum being five treatments and the maximum being 42 (Mowafi and Millard, 2021). However, our patient has had sustained improvement in mood and catatonia symptoms allowing for minimization of polypharmacy. Implications: Given the neuropsychiatric burden in HD patients, it is important for C-L psychiatrists to be aware of ECT's efficacy for both depression and catatonia in this population. References: 1. Merida-Puga, J., Ramirez-Bermudez, J., Aguilar-Venegas, L. C., Fricchione, G. L., & Espinola-Nadurille, M. (2011). Westphal variant Huntington disease and refractory catatonia: a case report. Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology, 24(4), 204–208. 2. Mowafi, W., & Millard, J. (2021). Electroconvulsive therapy for severe depression, psychosis and chorea in a patient with Huntington's disease: case report and review of the literature. BJPsych bulletin, 45(2), 97–104.

16.
Psychiatry and Clinical Psychopharmacology ; 32(2):167-173, 2022.
Article in English | EMBASE | ID: covidwho-1957533

ABSTRACT

Background: Hikikomori, a severe and often prolonged social withdrawal observed primarily in young people, was first described in Japan, but cases have now been reported in many other countries. Methods: A review paper on hikikomori has been prepared following the literature searches in 3 databases. Search terms related to hikikomori included epidemiology, globalization, diagnosis, treatment, comorbidity, and COVID-19. Conclusions: Hikikomori was first reported in Japan and has been described in detail by researchers there, but there are now reports in many countries of hikikomori-like cases. It occurs primarily in young people, often men in their late teens and early twenties who isolate themselves, sometimes confining themselves to their homes for months or even years. It has been proposed that hikikomori has increased in recent years in part because of advances in information technology that result in decreased socialization. Hikikomori was originally considered a non-psychotic phenomenon, but comorbidity with psychiatric disorders is often present and should be considered during diagnosis. Considerable efforts have been made in recent years to establish reliable, widely applicable guidelines for the diagnosis and treatment of hikikomori. There is very little information with regard to neurobiology, although involvement of the immune system, oxidative stress, and the social brain network has been proposed. It is widely agreed that hikikomori must be treated in a multi-dimensional fashion, with family support very important. Lessons learned from these treatment approaches are relevant to the potential increased risk of social withdrawal arising from COVID-19 pandemic lockdowns.

17.
European Journal of Clinical Pharmacology ; 78:S130, 2022.
Article in English | EMBASE | ID: covidwho-1955961

ABSTRACT

Introduction: Zolpidem and zopiclone are widely used for sleep disorders, yet their abuse and dependence potential has been underestimated. The electronic prescription of zolpidem/zopiclone became mandatory on 17.07.2019 in Greece. Objectives: To investigate descriptive characteristics of zolpidem/ zopiclone prescriptions and the impact of the mandatory electronic prescription mandate. Methods: Anonymized prescriptions of zopiclone (ATC: N05CF01) and/or zolpidem (ATC: NC05CF02) that were executed in pharmacies between 01.10.2018 and 01.10.2021 were obtained from the Greek nationwide prescription database. The database covers almost the entire Greek population and it is administrated by IDIKA of the Greek Ministry of Health. We investigated descriptive characteristics of prescriptions, and calculated themonthly number of prescriptions taking into consideration dates with potential impact, i.e., the date of the mandatory electronic prescription mandate (on 17.07.2019) and the date of the first case of COVID-19 in Greece (on 26.02.2020). Results and Conclusion: During the investigated period of three years, there were 1229842 executed prescriptions of zolpidem (89.4%), zopiclone (10.4%) or both (0.3%), considering 156554 unique patients. The patients weremainly elderly (73.1%were ≥ 65 years old) andwomen (64.5%). The majority of the prescription physicians (69.9%) were general practitioners or internists, followed by 17% psychiatrists or neurologists, 5.3% cardiologists, 4.5% physicians in specialty training, 1% nephrologists and 2.4% of physicians with another specialty. After the mandatory electronic prescription mandate and before COVID- 19 in Greece, i.e., between 08.2019 to 03.2020, there was a notable increase of prescriptions in comparison to the previous period from 10.2018 to 07.2019 (median 37267 vs median 34106;Mann-Whitney U=9, p-value=0.009). After COVID-19, the median monthly number of prescriptions was 36363, yet there were variations ranging from 16963 to 39956. In conclusion, the mandatory electronic prescription system could increase the surveillance of drugs with abuse potential such as zolpidem and zopiclone. Nevertheless, the large number of prescriptions in elderly patients and prescribed by primary care physicians is worrisome and warrants further investigation.

18.
Progress in Neurology and Psychiatry ; 26(2):16-17, 2022.
Article in English | EMBASE | ID: covidwho-1955932
19.
Open Access Macedonian Journal of Medical Sciences ; 10:1248-1254, 2022.
Article in English | EMBASE | ID: covidwho-1939088

ABSTRACT

BACKGROUND: COVID-19 pandemic has demonstrated the impact of a major public health emergency on mental health. AIM: The aim of the study was to assess psychological impact among university students and train them to raise mental health awareness among their peers during the pandemic. METHODS: This an online electronic survey that was carried out over the period of July to September 2020. Study participants were medical and paramedical university students representing students’ union alliance of the Egyptian Youth Initiative. A convenient non-probability sampling method used for recruiting the study participants. Key mental health outcomes investigated 2 weeks before the survey were posttraumatic stress symptoms, symptoms of depression using Patient Health Questionnaire (PHQ-9), anxiety using Generalized Anxiety Disorder scale (GAD-7), insomnia using Insomnia Severity Index, and perceived stress using Perceived Stress Scale (PSS). Based on the preliminary analysis of the online questionnaires, a PhD qualified psychiatrist was assigned to develop an online psychosocial support to the volunteers’ students (n = 60) to be facilitators for raising mental awareness among peers and train them how to handle stress. RESULTS: Of the 115 students, 42.6% experienced moderate to severe depression, 21.7% were afflicted with moderate to severe anxiety, and 62.7% suffered from sub-threshold to severe insomnia. PSS analysis showed moderate levels of stress among the study participants. A significant difference was detected between pre-and post-test mean scores of the PSS (p = 0.001) 8 weeks after the training program included psychological support for the students. CONCLUSIONS: The findings of this study showed that young people suffered of more than one psychological problems and highlighted the urgent need to develop interventions and preventive strategies to address mental health of college students.

20.
Movement Disorders Clinical Practice ; 9(SUPPL 1):S23-S24, 2022.
Article in English | EMBASE | ID: covidwho-1925973

ABSTRACT

Objective: To evaluate the feasibility of using telemedicine for predictive genetic testing in Huntington's disease (HD). Background: While a specific protocol for genetic testing in HD exists, evidence regarding its applicability via telemedicine is lacking. The implementation of social distancing guidelines during the COVID-19 pandemic led us to utilize telehealth visits in our clinic for predictive testing. Methods: From May 2020 to Sep 2021, eligible patients seen at the UTHealth Houston, HDSA Center of Excellence multidisciplinary clinic were offered predictive genetic testing via telemedicine. The 2016 HDSA recommendations for predictive testing were adapted and implemented via telemedicine. Visits were conducted by a team consisting of a movement disorder specialist, genetic counselor, psychiatrist, neuropsychologist, and social worker utilizing institute-approved telemedicine platforms. Patient satisfaction and telehealth quality were assessed with Telehealth Usability Questionnaire (TUQ), which included the components of usefulness, ease of use, interface quality, interaction quality, reliability, and satisfaction [1]. Results: 50 individuals expressed interest in predictive testing via telemedicine. Of these, 11 did not continue after initial inquiry and three had already prior testing [Fig. 1]. Of the remaining 36 individuals (mean age: 37.17 ± 13.23 years), 21 completed the consent and sample collection with an in-person visit. For 15 elected to use telemedicine consent was obtained via telemedicine, and sample collection was coordinated remotely. 21 individuals had results disclosure via telemedicine, 13 of whom used telemedicine for both visits. Seven out of 21 completed the TUQ and rated the visit usability as 92.5% usefulness, 75.5% ease of use, 78.6% interface quality, 86.7% interaction quality, 64.1% reliability, and 89.3% satisfaction and future use. Conclusion: Delivering the predictive testing protocol via telemedicine depends on various patient and clinician-related factors including ease of use, comfort with the type of visit and technology used. In our experience, a majority of patients who underwent telemedicine for genetic counseling and result disclosure were satisfied and would use this service in the future. Despite the convenience and patient satisfaction, it is imperative that caution is applied prior to determining patient readiness and result disclosure given the sensitive nature of HD gene testing.

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