Impact of COVID-19 Mitigation Efforts on Adults With Serious Mental Illness: A Patient-Centered Perspective.

ABSTRACT: In response to COVID-19 mitigation policies, mental health and social service agencies have had to rapidly change their operations, creating challenges for patients with serious mental illness (SMI). This study aimed to explore the experiences of adults with SMI navigating these altered systems during the pandemic. In-depth interviews were conducted with 20 hospitalized adults with SMI in the fall of 2020; they were coded using thematic analysis. Most participants found the new systems effective at meeting their essential needs. However, several reported significant unmet needs, including inability to access mental health care and public benefits. These participants lacked identification documents, housing, and/or a personal device. Although none of the participants used telemedicine before COVID-19, most reported no or minimal problems with telemental health. Those reporting difficulties did not have personal devices, were receiving audio-only services, or viewed telemedicine as less personal or too distracting.

Reduced pain perception in patients with schizophrenia; A missed case of hand fracture.

Altered pain perception among patients with schizophrenia is often underrecognized in the medical community. The cause is not known, and medical professionals are not sure whether these patients experience less pain or are simply unable to express it. There are documented cases of patients with schizophrenia presenting to hospital settings with serious injuries without obvious (expected) pain. Research into the underlying cause(s) is underway; meanwhile, ensuring awareness of this issue among medical providers is of upmost importance. We report a case of a patient with schizophrenia who presented voluntarily to the emergency department (ED) with a hand fracture that went unrecognized in the ED and further discuss the implications of reduced pain perception. Additionally, we summarize existing hypotheses regarding the source of this reduced pain perception in this population.

Reproductive health in an inpatient psychiatric unit: A retrospective chart review.

OBJECTIVE: The purpose of this study was to evaluate the degree to which reproductive health issues are discussed with women of child-bearing age on an inpatient psychiatric unit. We hypothesized that preconception care is limited, and that contraceptive status of patients is rarely elicited. For this sub-analysis, we focused on counseling related to potential impacts of psychotropic medications on pregnancy, and on contraceptive status, especially when prescribed teratogenic medications. METHODS: A retrospective search was conducted for women between the ages of 18 to 49 years at the time of admission, over a 6-month period. One hundred and forty-eight unique encounters were identified, and electronic charts were reviewed for information regarding: discharge medications, medication counseling, contraceptive use, pregnancy and relationship status, pregnancy history, nature of obstetrics and gynecology consults, substance use, and diagnoses. RESULTS: Almost a fifth (n = 29) of encounters included discharge on at least one potentially teratogenic medication and more than 50% had recent substance use. However, less than 10% of all encounters had documentation of contraceptive status and only one case had documented discussion of reproductive effects of medication; this despite the fact that roughly one third (33.8%) had at least one documented prior pregnancy and two patients were pregnant at the time of admission. CONCLUSION: Few women of reproductive age admitted to the inpatient psychiatric unit had chart-documented counseling on reproductive health, including known side effects of teratogenic medications. This indicates an urgent need for inclusion of reproductive health, including counseling on the risks and benefits of taking psychotropics during the peripartum period, into inpatient mental health care.

QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry.

OBJECTIVE: Several psychiatric medications have the potential to prolong the QTc interval and subsequently increase the risk for ventricular arrhythmias such as torsades de pointes (TdP). There is limited guidance for clinicians to balance the risks and benefits of treatments. METHODS: After a review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus guidelines for ECG monitoring of the QTc interval for patients with medical and psychiatric comorbidities who are prescribed medications with the potential to prolong the QTc interval. A risk score was developed based on risk factors for QTc prolongation to guide clinical decision-making. RESULTS: A baseline ECG may not be necessary for individuals at low risk for arrythmia. Those individuals with a risk score of two or more should have an ECG prior to the start of a potentially QTc-prolonging medication or be started on a lower risk agent. Antipsychotics are not equivalent in causing QTc prolongation. A consensus-based algorithm is presented for the management of those identified at high (QTc >500 msec), intermediate (males with QTc 450-499 msec or females with QTc > 470-499 msec), or low risk. CONCLUSIONS: The proposed algorithm can help clinicians in determining whether ECG monitoring should be considered for a given patient. These guidelines preserve a role for clinical judgment in selection of treatments that balance the risks and benefits, which may be particularly relevant for complex patients with medical and psychiatric comorbidities. Additional studies are needed to determine whether baseline and serial ECG monitoring reduces mortality.