Pub Date : 2024-05-01DOI: 10.1016/j.jaclp.2024.02.005
Laura Renee Warning B.S., Nicholas David Hollman M.P.H., B.S., Ondria Chris Gleason M.D.
{"title":"A Survey of Consultation Liaison Psychiatrists on the Assessment of Maternal Capacity","authors":"Laura Renee Warning B.S., Nicholas David Hollman M.P.H., B.S., Ondria Chris Gleason M.D.","doi":"10.1016/j.jaclp.2024.02.005","DOIUrl":"10.1016/j.jaclp.2024.02.005","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 322-324"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.jaclp.2023.12.004
Sean E. Oldak M.D., Omar Muñoz-Abraham M.D., Lujain Alhajji M.D., Vanessa L. Padilla M.D.
{"title":"Delirium and Near-Death Experience: A Case of Surviving a Complicated Delivery","authors":"Sean E. Oldak M.D., Omar Muñoz-Abraham M.D., Lujain Alhajji M.D., Vanessa L. Padilla M.D.","doi":"10.1016/j.jaclp.2023.12.004","DOIUrl":"10.1016/j.jaclp.2023.12.004","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 313-314"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.jaclp.2024.01.003
Tamaki Hosoda-Urban Ph.D. , Ellen H. O'Donnell Ph.D.
Background
Posttraumatic stress symptoms (PTSS) may adversely affect glycemic control. Yet no studies have focused on trauma and PTSS induced by diabetes-related events in adolescents and young adults (AYA) with type 1 diabetes.
Objective
This study explores PTSS arising from diabetes-related events (e.g., severe symptoms or emergency room visits due to complications) among AYA with type 1 diabetes.
Methods
In this cross-sectional pilot study, self-reported measures (Posttraumatic Diagnostic Scale for DSM-5, Child Posttraumatic Stress Disorder Symptom Scale 5) were employed to assess trauma experiences and PTSS in AYA with type 1 diabetes at a pediatric diabetes clinic within a large hospital/academic medical center.
Results
Fifty AYA with type 1 diabetes completed questionnaires assessing trauma and PTSS. Of the sample, 82% (n = 41) reported experiencing at least one form of general trauma (e.g., physical abuse, witnessing violence, or serious injuries). Among those who reported trauma, 22% (n = 9) indicated that the most distressing event was specifically diabetes-related. Over a quarter of participants exhibited clinically relevant levels of PTSS related to diabetes events. Females assigned at birth and those with a higher frequency of emergency room visits due to diabetes had an elevated risk of developing clinically relevant levels of diabetes-related PTSS.
Conclusions
Our results suggest that diabetes itself can serve as a traumatic stressor for some individuals. Therefore, interventions should be designed to prevent or mitigate PTSS starting from the time of diagnosis.
{"title":"Diabetes-Related Posttraumatic Stress Symptoms in Adolescents and Young Adults With Type 1 Diabetes: A Pilot Study","authors":"Tamaki Hosoda-Urban Ph.D. , Ellen H. O'Donnell Ph.D.","doi":"10.1016/j.jaclp.2024.01.003","DOIUrl":"10.1016/j.jaclp.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><p>Posttraumatic stress symptoms (PTSS) may adversely affect glycemic control. Yet no studies have focused on trauma and PTSS induced by diabetes-related events in adolescents and young adults (AYA) with type 1 diabetes.</p></div><div><h3>Objective</h3><p>This study explores PTSS arising from diabetes-related events (e.g., severe symptoms or emergency room visits due to complications) among AYA with type 1 diabetes.</p></div><div><h3>Methods</h3><p>In this cross-sectional pilot study, self-reported measures (Posttraumatic Diagnostic Scale for DSM-5, Child Posttraumatic Stress Disorder Symptom Scale 5) were employed to assess trauma experiences and PTSS in AYA with type 1 diabetes at a pediatric diabetes clinic within a large hospital/academic medical center.</p></div><div><h3>Results</h3><p>Fifty AYA with type 1 diabetes completed questionnaires assessing trauma and PTSS. Of the sample, 82% (n = 41) reported experiencing at least one form of general trauma (e.g., physical abuse, witnessing violence, or serious injuries). Among those who reported trauma, 22% (n = 9) indicated that the most distressing event was specifically diabetes-related. Over a quarter of participants exhibited clinically relevant levels of PTSS related to diabetes events. Females assigned at birth and those with a higher frequency of emergency room visits due to diabetes had an elevated risk of developing clinically relevant levels of diabetes-related PTSS.</p></div><div><h3>Conclusions</h3><p>Our results suggest that diabetes itself can serve as a traumatic stressor for some individuals. Therefore, interventions should be designed to prevent or mitigate PTSS starting from the time of diagnosis.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 248-253"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266729602400003X/pdfft?md5=07609978cdb48357ea98e4759821893a&pid=1-s2.0-S266729602400003X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs.
Objective
To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program.
Methods
Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement.
Results
Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6–12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1–1.5) were associated with a higher likelihood of receiving meaningful engagement.
Conclusions
The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.
背景:协作护理(CC)是一种以证据为基础的护理模式,用于在初级保健环境中治疗行为健康问题。协作护理(CC)团队由初级保健提供者(PCP)、行为健康护理经理(CM)和精神科顾问组成,他们共同合作制定治疗计划。迄今为止,关于有意义地参与 CC 计划的相关因素的数据还很有限:目标:确定有意义参与的患者比例,并调查与有意义参与 CC 项目相关的因素:从美国中西部一个学术医疗系统的 27 个成人初级保健诊所实施的 CC 项目中收集数据。采用逻辑回归法(n=5218)估算有意义参与的几率:共收集到 6437 人的数据,其中 68% 为女性,平均年龄为 45 岁(SD 17.6)。总体而言,57%的患者进行了有意义的参与,但这一比例因人口统计学和临床因素而异。在可改变的临床因素中,CM 和精神科医生之间的系统性病例回顾(OR:10.2,95% CI:8.6-12.1)和温馨交接(OR:1.3,95% CI:1.1-1.5)与获得有意义参与的更高可能性相关:结论:行为健康护理经理和精神科顾问之间的系统性病例审查与有意义的参与密切相关。在实施此类项目时,应严格遵守核心原则,包括定期进行系统性病例回顾。
{"title":"Meaningful Engagement in Depression and Anxiety Collaborative Care: Associations With Systematic Case Review","authors":"Heather Huang M.D. , Brandon Huynh M.D. , Nichole Nidey Ph.D. , Hsiang Huang M.D., M.P.H.","doi":"10.1016/j.jaclp.2024.01.006","DOIUrl":"10.1016/j.jaclp.2024.01.006","url":null,"abstract":"<div><h3>Background</h3><p>Collaborative care (CC) is an evidence-based model of care for treating behavioral health conditions in primary care settings. The CC team consists of a primary care provider, behavioral health care manager (CM), and a consultant psychiatrist who collaborate to create treatment plans. To date, there is limited data on factors associated with meaningful engagement in CC programs.</p></div><div><h3>Objective</h3><p>To identify the proportion of patients who were meaningfully engaged and to investigate the factors associated with meaningful engagement in a CC program.</p></div><div><h3>Methods</h3><p>Data was collected from a CC program implemented across 27 adult primary care clinics in a Midwestern, U.S. academic medical system. Logistic regression (n = 5218) was used to estimate the odds of receiving meaningful engagement.</p></div><div><h3>Results</h3><p>Data was collected from 6437 individuals with 68% being female and a mean age of 45 years old (standard deviation 17.6). Overall, 57% of patients were meaningfully engaged; however, this proportion differed based on demographic and clinical factors. Among modifiable clinical factors, systematic case reviews between the CM and psychiatrist (odds ratio: 10.2, 95% confidence interval: 8.6–12.1) and warm handoffs (odds ratio: 1.3, 95% confidence interval: 1.1–1.5) were associated with a higher likelihood of receiving meaningful engagement.</p></div><div><h3>Conclusions</h3><p>The presence of systematic case reviews between the behavioral health CM and the consultant psychiatrist was highly associated with meaningful engagement. When implementing such programs, high fidelity to the core principles including regularly scheduled systematic case reviews should be pursued.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 254-260"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139681885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.jaclp.2023.12.005
Sean T. Lynch M.D. , Rhea Dornbush Ph.D., M.P.H. , Sivan Shahar M.D. , Rayah Mansour M.P.H. , Lidia Klepacz M.D. , Louis H. Primavera Ph.D. , Stephen J. Ferrando M.D.
Background
Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection and relying on subjective complaints, screening instruments, or computerized testing. This group previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person 7 months post-COVID-19, particularly those seeking care for cognitive complaints. The current study describes the initial and 6-month follow-up results of an expanded cohort of 75 participants.
Objective
To measure longitudinal changes in neuropsychological test performance, as well as medical and psychiatric changes, post-COVID-19.
Methods
Participants underwent NP, psychiatric, and medical assessments approximately 7 months after acute COVID-19 infection. Sixty-three (84%) returned approximately 6 months later for repeat evaluation.
Results
At the initial visit, 29 (38.7%) met criteria for low NP performance, and 16 (21.3%) met criteria for extremely low NP performance. At 6-month follow-up, several NP domains that were significantly below normative values at the initial visit were no longer abnormal, with the exception of language. Only measures of delayed memory and fatigue showed significant improvements between the 2 time points.
Conclusions
A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over 1 year after infection. While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly between times 1 and 2. No individual declined in NP test performance, though relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports. Longitudinal follow-up of this cohort is in progress.
{"title":"Change in Neuropsychological Test Performance Seen in a Longitudinal Study of Patients With Post-acute Sequelae of COVID-19: A 6-Month Follow-up Study","authors":"Sean T. Lynch M.D. , Rhea Dornbush Ph.D., M.P.H. , Sivan Shahar M.D. , Rayah Mansour M.P.H. , Lidia Klepacz M.D. , Louis H. Primavera Ph.D. , Stephen J. Ferrando M.D.","doi":"10.1016/j.jaclp.2023.12.005","DOIUrl":"10.1016/j.jaclp.2023.12.005","url":null,"abstract":"<div><h3>Background</h3><p><span>Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive </span>symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection and relying on subjective complaints, screening instruments, or computerized testing. This group previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person 7 months post-COVID-19, particularly those seeking care for cognitive complaints. The current study describes the initial and 6-month follow-up results of an expanded cohort of 75 participants.</p></div><div><h3>Objective</h3><p>To measure longitudinal changes in neuropsychological test performance, as well as medical and psychiatric changes, post-COVID-19.</p></div><div><h3>Methods</h3><p>Participants underwent NP, psychiatric, and medical assessments approximately 7 months after acute COVID-19 infection. Sixty-three (84%) returned approximately 6 months later for repeat evaluation.</p></div><div><h3>Results</h3><p>At the initial visit, 29 (38.7%) met criteria for low NP performance, and 16 (21.3%) met criteria for extremely low NP performance. At 6-month follow-up, several NP domains that were significantly below normative values at the initial visit were no longer abnormal, with the exception of language. Only measures of delayed memory and fatigue showed significant improvements between the 2 time points.</p></div><div><h3>Conclusions</h3><p>A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over 1 year after infection. While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly between times 1 and 2. No individual declined in NP test performance, though relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports. Longitudinal follow-up of this cohort is in progress.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 231-247"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.jaclp.2024.01.005
Arushi Mahajan B.S., Thanvi Vatti M.P.H., Andrew Coulter M.D., Elias Khawam M.D., Molly Howland M.D.
{"title":"Palliative ECT for Catatonia in a Terminal Cancer Patient: A Case Report","authors":"Arushi Mahajan B.S., Thanvi Vatti M.P.H., Andrew Coulter M.D., Elias Khawam M.D., Molly Howland M.D.","doi":"10.1016/j.jaclp.2024.01.005","DOIUrl":"10.1016/j.jaclp.2024.01.005","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 315-316"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139673640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-01DOI: 10.1016/j.jaclp.2023.11.684
Vanessa Aversa M.D. , Raed Hawa M.D. , Elliott K. Lee M.D. , Michael S.B. Mak M.D.
We present the case of a 67-year-old male with a history of major depressive disorder, panic disorder, treatment refractory hypertension, dyslipidemia, benign prostatic hypertrophy, and environmental allergies who was initially brought to medical attention following an unwitnessed fall. He subsequently developed symptoms of insomnia disorder. Experts in consultation-liaison psychiatry and sleep medicine provide guidance for this clinical scenario based on their experience and a review of current literature, exploring the epidemiology of insomnia disorder and comorbidities in relation to this case. Furthermore, we offer a review of current treatment for insomnia disorder, including non-pharmacologic methods such as cognitive behavioral therapy for insomnia and pharmacotherapy.
{"title":"C-L Case Conference: Insomnia Disorder","authors":"Vanessa Aversa M.D. , Raed Hawa M.D. , Elliott K. Lee M.D. , Michael S.B. Mak M.D.","doi":"10.1016/j.jaclp.2023.11.684","DOIUrl":"10.1016/j.jaclp.2023.11.684","url":null,"abstract":"<div><p><span><span><span><span>We present the case of a 67-year-old male with a history of major depressive disorder<span>, panic disorder, treatment refractory hypertension, </span></span>dyslipidemia<span>, benign prostatic hypertrophy, and </span></span>environmental allergies who was initially brought to medical attention following an unwitnessed fall. He subsequently developed </span>symptoms of insomnia disorder. Experts in consultation-liaison psychiatry and </span>sleep medicine<span> provide guidance for this clinical scenario based on their experience and a review of current literature, exploring the epidemiology of insomnia<span> disorder and comorbidities in relation to this case. Furthermore, we offer a review of current treatment for insomnia disorder, including non-pharmacologic methods such as cognitive behavioral therapy for insomnia and pharmacotherapy.</span></span></p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 3","pages":"Pages 293-301"},"PeriodicalIF":2.3,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138453026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.jaclp.2023.12.001
Jennifer A. Hoffmann M.D., M.S. , Anisha Kshetrapal M.D., M.S.Ed. , Alba Pergjika M.D., M.P.H. , Ashley A. Foster M.D. , Julia H. Wnorowska R.N., B.S.N. , Julie K. Johnson M.S.P.H., Ph.D.
Background
Mental health visits to the emergency department (ED) by children are rising in the United States, and acute agitation during these visits presents safety risks to patients and staff.
Objective
We sought to assess barriers and strategies for providing high-quality care to children who experience acute agitation in the ED.
Methods
We conducted semistructured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. We asked participants about their experiences with acute agitation care in the ED, barriers and facilitators to providing high-quality care, and proposed interventions. Interviews were coded and analyzed thematically.
Results
Participants discussed identifying risk factors for acute agitation, worrying about safety and the risk of injury, feeling moral distress, and shifting the culture toward patient-centered, trauma-informed care. Barriers and facilitators included using a standardized care pathway, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. Nine interventions were proposed: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities.
Conclusions
Understanding barriers can inform solutions to improve care for children who experience acute agitation in the ED. The perspectives of families and patients should be considered when designing interventions to improve care.
{"title":"A Qualitative Assessment of Barriers and Proposed Interventions to Improve Acute Agitation Management for Children With Mental and Behavioral Health Conditions in the Emergency Department","authors":"Jennifer A. Hoffmann M.D., M.S. , Anisha Kshetrapal M.D., M.S.Ed. , Alba Pergjika M.D., M.P.H. , Ashley A. Foster M.D. , Julia H. Wnorowska R.N., B.S.N. , Julie K. Johnson M.S.P.H., Ph.D.","doi":"10.1016/j.jaclp.2023.12.001","DOIUrl":"10.1016/j.jaclp.2023.12.001","url":null,"abstract":"<div><h3>Background</h3><p><span>Mental health visits to the </span>emergency department (ED) by children are rising in the United States, and acute agitation during these visits presents safety risks to patients and staff.</p></div><div><h3>Objective</h3><p>We sought to assess barriers and strategies for providing high-quality care to children who experience acute agitation in the ED.</p></div><div><h3>Methods</h3><p>We conducted semistructured interviews with 6 ED physicians, 6 ED nurses, 6 parents, and 6 adolescents at high risk for developing agitation. We asked participants about their experiences with acute agitation care in the ED, barriers and facilitators to providing high-quality care, and proposed interventions. Interviews were coded and analyzed thematically.</p></div><div><h3>Results</h3><p>Participants discussed identifying risk factors for acute agitation, worrying about safety and the risk of injury, feeling moral distress, and shifting the culture toward patient-centered, trauma-informed care. Barriers and facilitators included using a standardized care pathway<span>, identifying environmental barriers and allocating resources, partnering with the family and child, and communicating among team members. Nine interventions were proposed: opening a behavioral observation unit with dedicated staff and space, asking screening questions to identify risk of agitation, creating personalized care plans in the electronic health record, using a standardized agitation severity scale, implementing a behavioral response team, providing safe activities and environmental modifications, improving the handoff process, educating staff, and addressing bias and inequities.</span></p></div><div><h3>Conclusions</h3><p>Understanding barriers can inform solutions to improve care for children who experience acute agitation in the ED. The perspectives of families and patients should be considered when designing interventions to improve care.</p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 2","pages":"Pages 167-177"},"PeriodicalIF":2.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138626062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1016/j.jaclp.2023.09.001
Joshua B. Franklin M.D., Ph.D. , Bruce Leewiwatanakul D.O. , Adrienne D. Taylor M.D. , Erica B. Baller M.D., M.S. , Samantha J. Zwiebel M.D., M.A.
We present the case of a 34-year-old Black patient with no significant psychiatric history who presented with catatonia and psychotic symptoms following a recent severe acute respiratory syndrome coronavirus-2 infection, whose diagnosis of coronavirus disease 2019 encephalitis was delayed by premature attribution of his symptoms to a primary psychiatric etiology. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include the diagnosis and management of coronavirus disease 2019 encephalitis, cognitive bias, and racial bias. Specifically, this case illustrates the role of the consultation-liaison psychiatrist in identifying medical conditions that may overlap with psychiatric presentations and in advocating for marginalized patients.
{"title":"Consultation-Liaison Case Conference: Overcoming Bias in the Differential Diagnosis of Psychosis","authors":"Joshua B. Franklin M.D., Ph.D. , Bruce Leewiwatanakul D.O. , Adrienne D. Taylor M.D. , Erica B. Baller M.D., M.S. , Samantha J. Zwiebel M.D., M.A.","doi":"10.1016/j.jaclp.2023.09.001","DOIUrl":"10.1016/j.jaclp.2023.09.001","url":null,"abstract":"<div><p><span>We present the case of a 34-year-old Black patient with no significant psychiatric history<span> who presented with catatonia and psychotic </span></span>symptoms<span> following a recent severe acute respiratory syndrome coronavirus-2 infection, whose diagnosis of coronavirus disease 2019 encephalitis was delayed by premature attribution of his symptoms to a primary psychiatric etiology. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include the diagnosis and management of coronavirus disease 2019 encephalitis, cognitive bias, and racial bias. Specifically, this case illustrates the role of the consultation-liaison psychiatrist in identifying medical conditions that may overlap with psychiatric presentations and in advocating for marginalized patients.</span></p></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 2","pages":"Pages 195-203"},"PeriodicalIF":2.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10288784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anti-N-Methyl-D-Aspartate Receptor Encephalitis—Are We Missing a Treatable Illness in the Elderly That Is Causing Severe Disability and Death?","authors":"Joshua Kontrobarsky M.B.B.S. (Hons), Joshua Laing BBiomedSci M.B.B.S., F.R.A.C.P., Ph.D., Brett Coulson F.R.A.N.Z.C.P.","doi":"10.1016/j.jaclp.2023.10.003","DOIUrl":"10.1016/j.jaclp.2023.10.003","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"65 2","pages":"Pages 214-215"},"PeriodicalIF":2.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49684908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}