Selection from the latest research impacting C-L Psychiatry
‘Fully immersive virtual reality may improve cognition, including executive functioning’
Research: Cognitive Training with Fully Immersive Virtual Reality in Patients with Neurological and Psychiatric Disorders: A systematic review of randomized controlled trials
Authors: Frida Simon Jahn, Neurocognition and Emotion in Affective Disorders Group, Copenhagen Affective Disorder Research Centre, Copenhagen University Hospital, and colleagues.
Abstract/Extract: This is the first systematic review of randomized controlled intervention trials investigating pro-cognitive effects of cognitive training in fully immersive virtual reality (VR) scenarios in patients with neurological or psychiatric disorders.
Nine trials were examined, including one in ADHD, three in schizophrenia, four in MCI, and one in stroke.
The aims were:
- To investigate the efficacy of fully immersive VR for cognitive rehabilitation across neuropsychiatric disorders.
- To examine the particular interventions including (a) specific components involved in efficacy, (b) feasibility of the interventions, and (c) relationship between any cognitive improvements and improvements in daily-life functioning and quality of life.
Importance: The VR field is emerging but only a few pilot studies have been published. Randomized controlled pilot studies indicate that immersive VR-based cognitive training is highly feasible and may improve aspects of cognition, including executive functioning, across neuropsychiatric disorders.
Availability: Pre-publication in Psychiatry Research
‘Model to predict C-L Psychiatry consults and aid staffing levels’
Research: Mental Health Diagnoses and Seasonal Trends at a Pediatric Emergency Department and Hospital, 2015-2019
Authors: Rebecca Marshall, MD, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Oregon Health & Science University, and colleagues.
Abstract/Extract: A child and adolescent C-L Psychiatry team within a tertiary care academic pediatric hospital collected data for five consecutive years on all the inpatient and emergency department consults they received.
They characterized consults by DSM-5 diagnosis and presenting complaint and mapped the number of consults, both cumulatively over time and by average, per month.
In total, 2,367 patients were included in their analysis, about a third of which presented after a suicide attempt. From January 2015 to December 2019, annual inpatient consultations increased 28%, and emergency department (ED) consultations increased 88%. In contrast, total pediatric ED presentations increased only 8%, and medical inpatient volume slightly decreased.
Suicide attempts were most prevalent in the spring of each year, from February to May. Psychiatry consultations were most frequent each year in the months of January, April, May, October, and November.
Based on the data, the team created a correlative multivariable model to predict future consultation volume. Suicidality and a depressive diagnosis accounted for most of the seasonal variability.
Importance: The author’s development of a predictive model demonstrates that it is possible to use trends in C-L Psychiatry consultations, both cumulatively over time as well as by month, to aid hospital teams with planning for staffing. Additionally, the authors noted seasonal increases in the number of patients boarding in the hospital, awaiting an inpatient psychiatric bed, which could be helpful for hospital systems’ planning. Understanding seasonal variations in diagnoses and presenting complaint can aid in creating targeted and timely preventive measures.
Availability: Published in Hospital Pediatrics and selected by Jeylan Close, MD, in the 2021 first quarter Annotations, just published on the ACLP website by the Academy’s Guidelines & Evidence-Based Medicine Subcommittee.
‘Depressive symptoms in older patients reduced by social engage psychotherapy’
Research: A Pilot Randomized Trial of Engage Psychotherapy to Increase Social Connection and Reduce Suicide Risk in Later Life
Authors: Kimberly van Orden, PhD, and Yeates Conwell, MD, Department of Psychiatry, University of Rochester Medical Center; and Patricia Areán, PhD, Department of Psychiatry & Behavioral Sciences, University of Washington.
Abstract/Extract: This study examines acceptability, feasibility, and efficacy of social engage psychotherapy (S-ENG) to improve subjective disconnection (target mechanisms: low belonging and perceived burden), and improve clinical and functional outcomes (depression, suicide ideation, quality of life).
Study participants focusing on social engagement demonstrated high levels of compliance. S-ENG did not show preliminary evidence of impact on belonging or perceived burden, but was effective in reducing depressive symptoms and improving social-emotional quality of life.
Importance: Older adults who report social disconnection are a population at risk for suicide. S-ENG holds promise for improving social-emotional quality of life and depressive symptoms. But research is needed to identify and measure target mechanisms that account for clinical and functional improvement.
Availability: Pre-publication in The American Journal of Geriatric Psychiatry.
‘Cognitive behavioral therapy may be useful in Long COVID’
Research (correspondence): Long COVID and Its Psychiatric Aspects
Authors: Baris Sancak, MD, Acıbadem Mehmet Ali Aydinlar University, Faculty of Medicine, Department of Psychiatry, Istanbul, and colleagues.
Abstract/Extract: Although fatigue is the most common symptom of Long COVID, symptoms such as cough, shortness of breath, headache, diarrhea, stinging and burning sensations, and palpitations are seen. A common feature of the disease is its course with remissions and relapses.
One study investigating ongoing symptoms after recovery of the infection showed that three or more symptoms persisted even after two months in 55% of patients, and 44.1% of these patients had a deterioration in their quality of life. Another study found that 99% of patients in the low-risk group had four or more symptoms, and 42% had 10 or more symptoms, even after 140 days.
While research on Long COVID continues, psychiatrists should be involved in this process much more effectively, say the authors. “It is necessary to be curious and open-minded about the chronic effects of a disease such as COVID-19 that can only be fully understood in time.”
They continue: “We think that psychiatrists have two critical duties. At first, since we are facing a disease whose etiology and long-term symptomatology are not yet fully defined, diagnosing the present symptoms as psychiatric symptoms such as anxiety, somatization, and so on, may harm the patient by delaying the appropriate treatment.
“Secondly, it should not be forgotten that psychiatric symptoms may accompany Long COVID. Health anxiety and depressive complaints associated with the feeling of hopelessness can be seen. Insomnia and concentration problems are also among common psychiatric findings. Long COVID is a condition that may seriously affect the functionality of patients. Diagnosis and treatment of psychiatric symptoms can significantly improve patients' quality of life.
“Thus, a careful psychiatric examination and effective treatment of psychiatric comorbidities are crucial in COVID-19 patients...Psychotherapy options should be evaluated in cases where there is hesitation about psychopharmacology. In particular, cognitive behavioral therapy is considered to be effective on post-viral fatigue and may be useful in Long COVID.”
Importance: Since the early stages of the pandemic, C-L psychiatrists have played a critical role in the evaluation of COVID-19 patients. Their role in the diagnosis of Long COVID and its management is equally crucial.
Availability: Pre-publication in the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).
‘Blended digital therapy for paranoia in patients with psychosis’
Research: Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis. A Randomized Clinical Trial
Authors: Philippa Garety, PhD, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, and colleagues.
Abstract/Extract: SlowMo therapy adopts an interventionist-causal approach to increasing cognitive behavioral therapy for psychosis (CBTp) effectiveness by targeting reasoning processes considered causal in paranoia.
These biased processes include jumping to conclusions (forming rapid judgments using limited information) and belief inflexibility (reduced metacognitive capacity for reflecting on and reviewing one’s beliefs and considering alternatives).
This randomized clinical trial involving 361 individuals aimed to test the efficacy of SlowMo in reducing paranoia and improving reasoning.
Although no effect was demonstrated on the primary paranoia outcome at 24 weeks, the pattern of results on secondary outcomes indicates SlowMo had a positive effect on paranoia, mostly sustained at follow-up, that matched or exceeded effects observed for standard CBTp. Improvements in well-being, quality of life, and self-concept also occurred. Treatment was effective, in part, through helping people to slow down their thinking and to worry less.
Importance: Persistent paranoia is common among patients with psychosis. CBTp can be effective, however, challenges in engagement and effectiveness remain. This is believed to be the first randomized clinical trial to test a blended digital therapy for paranoia in people with psychosis.
Availability: Published by JAMA Psychiatry.
