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Academy Members Bring their Expertise to New APA Resources

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Several collaborations between the Academy and the American Psychiatric Association (APA) are on the brink of bringing valuable resources to the field. Academy members have been hard at work contributing to key APA documents in development.

One group of C-L psychiatrists and fellows—who are also members of the APA’s Council on Consultation-Liaison Psychiatry—have contributed to a Resource Document on Decisional Capacity Assessments in Consultation-Liaison Psychiatry, soon to be published on the APA website.

They are ACLP members James Bourgeois, MD, OD, FACLP; Maria Tiamson-Kassab, MD, FACLP; Kathleen Sheehan, MD; Diana Robinson, MD; and Mira Zein, MD, MPH.

The aim is to provide all psychiatrists with a common framework to guide them when periodically functioning in a
C-L role, and to assist them in completing decisional capacity assessments in an evidence-based, standard method.

The paper outlines a seven-step, recommended approach to decisional capacity assessments and cites recent research literature.

More details, including an interview with Dr. Bourgeois, will be in ACLP News once the paper is published.

Meanwhile, two ACLP members based at Massachusetts General Hospital—Kelly Irwin, MD, MPH, at the Cancer Center, and Oliver Freudenreich, MD, FACLP, at the Schizophrenia Clinical and Research Program—have taken the lead in assisting ACLP’s official feedback to APA’s draft Practice Guideline for the Treatment of Patients with Schizophrenia. Their comments were incorporated into a formal response to APA from ACLP president Rebecca Weintraub Brendel MD, JD, FACLP.

Through ACLP News, the Academy also invited wider comment on the guidelines from its members.

Executive director James Vrac says: “In general, we raised concern regarding the lack of inclusion of schizophrenia treatment in medical settings. Our reviewers also highlighted the omission of medical-psychiatric integration for individuals with schizophrenia—both in primary care and specialty settings.”

Specific ACLP recommendations focused on the interface of medicine and psychiatry uniquely occupied by patients with schizophrenia. “As psychiatrists for the medically ill, we are particularly aware of the significant medical morbidity and mortality associated with schizophrenia related in particular to cardiovascular disease and malignancy,” ACLP wrote in its response, quoting references. “ACLP’s review of the practice guideline found no inclusion of this morbidity and mortality risk.”

ACLP also suggested that the guidelines should include a specific recommendation regarding tobacco use/smoking cessation and also emphasize tobacco use assessment as a core element of the initial patient assessment. For ACLP, addressing nicotine use disorders is necessary, “especially in light of lung cancer morbidity and mortality in individuals with schizophrenia and documented evidence of the importance and effectiveness of smoking cessation treatment, including in individuals with mental illness.”

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