Pub Date : 2020-11-01DOI: 10.1016/j.psym.2020.04.008
Lisa M. Horowitz Ph.D., M.P.H. , Deborah J. Snyder M.S.W. , Edwin D. Boudreaux Ph.D. , Jian-Ping He M.S. , Colin J. Harrington M.D. , June Cai M.D. , Cynthia A. Claassen Ph.D. , Joan E. Salhany M.B.A.H.C.M., R.N. , Tram Dao Psy.D. , John F. Chaves M.D. , David A. Jobes Ph.D. , Kathleen R. Merikangas Ph.D. , Jeffrey A. Bridge Ph.D. , Maryland Pao M.D.
Background
Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk–screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults.
Methods
Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard.
Results
A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%–100%), a specificity of 89% (95% confidence interval = 86%–91%), and a negative predictive value of 100% (95% confidence interval = 99%–100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire.
Conclusions
The ASQ is a valid and brief suicide risk–screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener.
{"title":"Validation of the Ask Suicide-Screening Questions for Adult Medical Inpatients: A Brief Tool for All Ages","authors":"Lisa M. Horowitz Ph.D., M.P.H. , Deborah J. Snyder M.S.W. , Edwin D. Boudreaux Ph.D. , Jian-Ping He M.S. , Colin J. Harrington M.D. , June Cai M.D. , Cynthia A. Claassen Ph.D. , Joan E. Salhany M.B.A.H.C.M., R.N. , Tram Dao Psy.D. , John F. Chaves M.D. , David A. Jobes Ph.D. , Kathleen R. Merikangas Ph.D. , Jeffrey A. Bridge Ph.D. , Maryland Pao M.D.","doi":"10.1016/j.psym.2020.04.008","DOIUrl":"10.1016/j.psym.2020.04.008","url":null,"abstract":"<div><h3>Background</h3><p>Few brief suicide risk screening instruments are validated for use in both adult and pediatric medical populations. Using the pediatric Ask Suicide-Screening Questions (ASQ) development study as a model, this study aimed to determine whether the ASQ is a valid suicide risk–screening instrument for use among adults medical patients, as well as to evaluate a set of other potential screening questions for use in adults.</p></div><div><h3>Methods</h3><p>Adult patients hospitalized on inpatient medical/surgical units from 4 hospitals were recruited to participate in a cross-sectional instrument-validation study. The 4-item ASQ and other candidate items were compared against the 25-item, previously validated Adult Suicidal Ideation Questionnaire as the criterion standard.</p></div><div><h3>Results</h3><p>A total of 727 adult medical inpatients completed the screening process. Compared with the Adult Suicidal Ideation Questionnaire, the ASQ performed best among the full set of candidate items, demonstrating strong psychometric properties, with a sensitivity of 100% (95% confidence interval = 90%–100%), a specificity of 89% (95% confidence interval = 86%–91%), and a negative predictive value of 100% (95% confidence interval = 99%–100%). A total of 4.8% (35/727) of the participants screened positive for suicide risk based on the standard criterion Adult Suicidal Ideation Questionnaire.</p></div><div><h3>Conclusions</h3><p>The ASQ is a valid and brief suicide risk–screening tool for use among adults. Screening medical/surgical inpatients for suicide risk can be performed effectively for both adult and pediatric patients using this brief, primary screener.</p></div>","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 713-722"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.04.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10786905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diagnostic Challenges and Treatment of the Neuropsychiatric Symptoms of Adult-Onset Niemann-Pick Type C With Electroconvulsive Therapy","authors":"Rachel Foels B.S. , Kimberly Hartney M.D. , Alexis Cohen-Oram M.D.","doi":"10.1016/j.psym.2020.06.011","DOIUrl":"10.1016/j.psym.2020.06.011","url":null,"abstract":"","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 752-755"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.06.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38172987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1016/j.psym.2020.06.006
Janice Chung B.S. , Prudhvi Bandi B.S. , Daniel B. Janiczak M.D. , Jason P. Caplan M.D. , Curtis A. McKnight M.D.
{"title":"The Use of Security Dogs in De-escalation of Agitated Patients","authors":"Janice Chung B.S. , Prudhvi Bandi B.S. , Daniel B. Janiczak M.D. , Jason P. Caplan M.D. , Curtis A. McKnight M.D.","doi":"10.1016/j.psym.2020.06.006","DOIUrl":"10.1016/j.psym.2020.06.006","url":null,"abstract":"","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 756-758"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.06.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38155893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1016/j.psym.2020.05.011
Christine Sawhill D.O. , David C. Fipps D.O. , Jennifer V. Palomo M.S. , Melanie Miller M.D.
{"title":"End-Stage Anorexia Nervosa: When to Say “When”—A Literature Review of an Ethically Complicated Case","authors":"Christine Sawhill D.O. , David C. Fipps D.O. , Jennifer V. Palomo M.S. , Melanie Miller M.D.","doi":"10.1016/j.psym.2020.05.011","DOIUrl":"10.1016/j.psym.2020.05.011","url":null,"abstract":"","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 779-786"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.05.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38160848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1016/j.psym.2020.05.013
Erica B. Baller M.D., M.S. , Charlotte S. Hogan M.D. , Mark A. Fusunyan M.D. , Ana Ivkovic M.D. , James W. Luccarelli M.D., D.Phil. , Elizabeth Madva M.D. , Mladen Nisavic M.D. , Nathan Praschan M.D., M.P.H. , Nadia V. Quijije M.D. , Scott R. Beach M.D. , Felicia A. Smith M.D.
Background
The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified.
Objective
In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19.
Methods
We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients.
Results
Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled.
Conclusions
COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.
{"title":"Neurocovid: Pharmacological Recommendations for Delirium Associated With COVID-19","authors":"Erica B. Baller M.D., M.S. , Charlotte S. Hogan M.D. , Mark A. Fusunyan M.D. , Ana Ivkovic M.D. , James W. Luccarelli M.D., D.Phil. , Elizabeth Madva M.D. , Mladen Nisavic M.D. , Nathan Praschan M.D., M.P.H. , Nadia V. Quijije M.D. , Scott R. Beach M.D. , Felicia A. Smith M.D.","doi":"10.1016/j.psym.2020.05.013","DOIUrl":"10.1016/j.psym.2020.05.013","url":null,"abstract":"<div><h3>Background</h3><p>The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified.</p></div><div><h3>Objective</h3><p>In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19.</p></div><div><h3>Methods</h3><p>We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients.</p></div><div><h3>Results</h3><p>Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled.</p></div><div><h3>Conclusions</h3><p>COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.</p></div>","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 585-596"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.05.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38299579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1016/j.psym.2020.07.005
Andrea Giacalone Ph.D., Gennaro Rocco Ph.D., Enzo Ruberti Ph.D.
{"title":"Physical Health and Psychosocial Considerations During the Coronavirus Disease 2019 Outbreak","authors":"Andrea Giacalone Ph.D., Gennaro Rocco Ph.D., Enzo Ruberti Ph.D.","doi":"10.1016/j.psym.2020.07.005","DOIUrl":"10.1016/j.psym.2020.07.005","url":null,"abstract":"","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 851-852"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.07.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38322743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1016/j.psym.2020.07.006
Nicole Allen M.D. , Adrienne Mishkin M.D., M.P.H.
Background
When a patient is found to be lacking capacity to make a medical decision, the medical team is advised to turn to the patient's most appropriate surrogate decision maker (hereafter, surrogate) to make a choice on behalf of the patient. The assumption made by the medical team is that the surrogate will have the capacity to make appropriate medical decisions on behalf of the patient. At times though, the capacity of the surrogate himself may be called into question, leading to uncertainty in terms of how best to proceed in the care of the patient. Consultation-liaison psychiatrists are commonly consulted to assess a patient's capacity to make a particular medical decision, but their role assisting in cases of incapacitated surrogates is less clear.
Objective
In this article, we summarize the existing literature and current state laws regarding incapacitated surrogates and propose guidelines for the role the consultation-liaison psychiatrist can take when the surrogate may be incapacitated.
{"title":"The Incapacitated Surrogate: What is the Consultation-Liaison Psychiatrist's Role?","authors":"Nicole Allen M.D. , Adrienne Mishkin M.D., M.P.H.","doi":"10.1016/j.psym.2020.07.006","DOIUrl":"10.1016/j.psym.2020.07.006","url":null,"abstract":"<div><h3>Background</h3><p>When a patient is found to be lacking capacity to make a medical decision, the medical team is advised to turn to the patient's most appropriate surrogate decision maker (hereafter, surrogate) to make a choice on behalf of the patient. The assumption made by the medical team is that the surrogate will have the capacity to make appropriate medical decisions on behalf of the patient. At times though, the capacity of the surrogate himself may be called into question, leading to uncertainty in terms of how best to proceed in the care of the patient. Consultation-liaison psychiatrists are commonly consulted to assess a patient's capacity to make a particular medical decision, but their role assisting in cases of incapacitated surrogates is less clear.</p></div><div><h3>Objective</h3><p>In this article, we summarize the existing literature and current state laws regarding incapacitated surrogates and propose guidelines for the role the consultation-liaison psychiatrist can take when the surrogate may be incapacitated.</p></div>","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 672-677"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38375139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clonidine and Tizanidine for Management of Bipolar Disorder Due to Dengue Encephalopathy: A Case Report","authors":"Pornjira Pariwatcharakul M.D., M.Sc., M.A., M.R.C.Psych. (UK), F.R.C.Psych.T., Maytinee Srifuengfung M.D., F.R.C.Psych.T.","doi":"10.1016/j.psym.2020.08.001","DOIUrl":"10.1016/j.psym.2020.08.001","url":null,"abstract":"","PeriodicalId":20746,"journal":{"name":"Psychosomatics","volume":"61 6","pages":"Pages 727-731"},"PeriodicalIF":3.4,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.psym.2020.08.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38370471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}