ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic presented unprecedented challenges to the provision of inpatient psychiatric care. The nature of the physical plant, programmatic constraints, and the patient population required a rapid and agile approach to problem-solving under conditions of uncertainty and stress. Flexibility in decision-making, excellent communication, an effective working relationship with infection prevention and control experts, and attention to staff morale and support were important elements of successful provision of care to our inpatients. We present our experience, lessons learned, and recommendations should a resurgence of the pandemic or a similar crisis occur.
Subject(s)
Attitude of Health Personnel , COVID-19 , Inpatients , Mental Disorders/therapy , Personnel, Hospital , Psychiatric Department, Hospital , Adult , COVID-19/prevention & control , Humans , Personnel, Hospital/psychology , Personnel, Hospital/standards , Psychiatric Department, Hospital/organization & administration , Psychiatric Department, Hospital/standardsABSTRACT
OBJECTIVE: COVID-19 is an international public health crisis, putting substantial burden on medical centers and increasing the psychological toll on health care workers (HCW). METHODS: This paper describes CopeColumbia, a peer support program developed by faculty in a large urban medical center's Department of Psychiatry to support emotional well-being and enhance the professional resilience of HCW. RESULTS: Grounded in evidence-based clinical practice and research, peer support was offered in three formats: groups, individual sessions, and town halls. Also, psychoeducational resources were centralized on a website. A Facilitator's Guide informed group and individual work by including: (1) emotional themes likely to arise (e.g., stress, anxiety, trauma, grief, and anger) and (2) suggested facilitator responses and interventions, drawing upon evidence-based principles from peer support, stress and coping models, and problem-solving, cognitive behavioral, and acceptance and commitment therapies. Feedback from group sessions was overwhelmingly positive. Approximately 1/3 of individual sessions led to treatment referrals. CONCLUSIONS: Lessons learned include: (1) there is likely an ongoing need for both well-being programs and linkages to mental health services for HCW, (2) the workforce with proper support, will emerge emotionally resilient, and (3) organizational support for programs like CopeColumbia is critical for sustainability.
Subject(s)
Academic Medical Centers , Adaptation, Psychological , COVID-19 , Health Personnel/psychology , Program Development , Psychiatric Department, Hospital , Psychotherapy , Resilience, Psychological , Social Support , Adult , Humans , New York City , Outcome Assessment, Health Care , Peer Group , Personal SatisfactionABSTRACT
The medical home concept has been in existence since the late 1960s and has recently been significantly broadened to encompass comprehensive primary care for all patient populations throughout the lifespan. This article provides (1) a review of the foundations and evolution of the medical home concept; (2) an analysis of patient/family, provider, and systemic challenges to developing an effective pediatric medical home particularly in relation to children's mental health needs; and (3) a discussion of future directions for its further adoption and successful implementation.
Subject(s)
Child Health Services/organization & administration , Medical Records , Pediatrics/standards , Pediatrics/trends , Primary Health Care/organization & administration , Child , Delivery of Health Care/statistics & numerical data , Forecasting , Health Policy , Humans , Practice Patterns, Physicians'/organization & administrationABSTRACT
Methylphenidate (MPH) is one of the most commonly prescribed medications to treat attention deficit hyperactivity disorder (ADHD). Despite the elevated rates of ADHD in children with epilepsy, few studies have examined the use of MPH in this population. Case reports have warned about new-onset seizures in patients treated with MPH, and drug-drug interactions between MPH and antiepileptic drugs (AEDs), as well as antidepressants. However, retrospective chart reviews, open-label trials and controlled trials of MPH in patients with epilepsy and ADHD have noted significant improvements in ADHD symptoms without an exacerbation of seizures or an adverse effect on AED serum levels. This paper reviews the chemistry and mechanisms of action of MPH, as well as preclinical, premarketing clinical trials and postmarketing data relevant to its use in patients with ADHD and epilepsy.
Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Central Nervous System Stimulants/therapeutic use , Methylphenidate/therapeutic use , Animals , Anticonvulsants/administration & dosage , Anticonvulsants/adverse effects , Anticonvulsants/pharmacokinetics , Anticonvulsants/therapeutic use , Attention Deficit Disorder with Hyperactivity/complications , Central Nervous System Stimulants/administration & dosage , Central Nervous System Stimulants/adverse effects , Central Nervous System Stimulants/pharmacokinetics , Child , Drug Interactions , Epilepsy/complications , Epilepsy/drug therapy , Humans , Methylphenidate/administration & dosage , Methylphenidate/adverse effects , Methylphenidate/pharmacokineticsABSTRACT
OBJECTIVE: To assess longitudinal maintenance of improvements in depression, anxiety, global functioning, and physical health perception in 11 adolescents at 6 and 12 months following completion of manual-based cognitive-behavioral therapy. METHOD: Standardized instruments assessed follow-up changes in depression, anxiety, physical health, and global psychological functioning. RESULTS: At both assessments, 10 adolescents did not meet criteria for mood disorders. Improvements in depression, anxiety, global functioning, and physical health perceptions at completion of the cognitive-behavioral therapy were maintained during the 12-month period. Additional cognitive-behavioral therapy sessions (mean = 4.36; SD = 4.37) and psychopharmacology (n = 5) were required during the follow-up period. CONCLUSIONS: CBT with maintenance sessions and medication offers promise to adolescents facing comorbid depressive and physical disorders.
Subject(s)
Cognitive Behavioral Therapy , Depressive Disorder/therapy , Inflammatory Bowel Diseases/therapy , Activities of Daily Living , Adolescent , Anxiety , Depressive Disorder/psychology , Female , Humans , Inflammatory Bowel Diseases/psychology , Longitudinal Studies , Male , Severity of Illness IndexABSTRACT
This case report describes the successful treatment of severe self-injurious behavior in a 16-year-old adolescent with Tourette's disorder and obsessive-compulsive disorder. Treatment is described from initial presentation to the emergency department for severe self-inflicted oral lacerations through discharge from the inpatient psychiatric service. Modes of treatment included emergent medical intervention, intensive care services, psychopharmacology, and psychological services. The collection of treatment modalities implemented by this multidisciplinary team may serve as a guide to other health care professionals when severe self-injurious behavior is the presenting problem.
