Selection from the latest research impacting C-L Psychiatry
Consensus needed on best practice in C-L Psychiatry
Research: Implementation of a Psychiatry Consultation-Liaison Service ‘Conseminar’
Authors: Rishika Reddy, BS, et al.
Abstract/Extract: C-L Psychiatry needs a consensus-building process to inform best practices for common clinical dilemmas, say the authors. They describe a novel educational process, a ’conseminar,’ intended to minimize the variability in teaching and practice on a service staffed by multiple faculty members.
Faculty generates a list of candidate topics and prioritizes them for a focused and critical literature review, aided by a librarian. In the absence of definitive clinical trial data or established practice guidelines, faculty articulates a consensus best-practice approach and creates a brief document that summarizes specific recommendations for learners on the service.
Importance: C-L Psychiatry has generated a relatively small number of rigorous clinical trials that guide clinical care. A consensus-building process is needed to inform best practices.
Lockdowns that block treatment increase hospitalization
Research:Increase in admissions for anorexia nervosa after lockdown measures: Focus on a children’s neuropsychiatry unit
Authors: Antonio Marino et al.
Abstract/Extract: This analysis is part of a wider ongoing project involving all hospitalized patients of the children’s neuropsychiatry department of Children’s Di Cristina Hospital, Palermo.
The authors evaluated the effects of social restrictions on admissions of patients with anorexia nervosa (AN) to the children’s neuropsychiatry unit and found that admissions for AN rose sharply during the pandemic.
“Considering that patients with AN often have problematic family interactionsthat are characterized by having lower levels of emotional closeness totheir experiences, we hypothesize that a new family organization inducedbylockdown could break the equilibrium of such patients and result in the onset or exacerbation of AN,” say the authors.
“Indeed, it is reasonable to speculate that the uncertainty of the future, combined with the closure ofschools, mayprevent adolescents with AN from controlling different areas of their lives. This lack of control may subsequently exacerbate the need of these individuals to cope by exerting more control on their food restrictions.”
Importance: Several studies have suggested that COVID-19 lockdowns represent a risk factor for the development of different mental health conditions, both in the general population and in subgroups of psychiatric patients. Patients with pre‐existing vulnerabilities, who have partially benefitted from the lockdown period, may be at high risk of sudden deterioration in their mental state after isolation is lifted and they are forced to return to their previous habits.
Incontrast withprevious literature, thisstudy observed that increases in AN hospitalization occurred after the implementation of lockdown measures that blocked treatment. Virtual care supports could facilitate treatments for patients with AN and their families unable to access treatment face-to-face.
C-L psychiatrists well-placed to counteract microaggressions
Research: A Workshop on Interrupting Microaggressions for a Surgical Service: An Opportunity for Consultation-Liaison Psychiatry to Address Bias and Inequity
Authors: Jennifer Sotsky, MD, et al.
Abstract/Extract: ‘Microaggressions’ by health care workers—described by under-represented minority patients—are common and harmful, but rarely discussed or addressed in the busy, hierarchical health care setting, say the authors.
The term ‘microaggression’ was first coined by Harvard psychiatrist Chester Pierce et al in the 1970s to describe everyday “subtle, stunning, often automatic, and non-verbal exchanges which are ‘put-downs’ of blacks.” It has since been expanded in psychology literature to describe the experiences of various other under-represented minorities.
In 2007, psychologist Derald Wing Sue et al. described microaggressions as “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color.”
Importance: Unlike overt aggression and bias, which can be more readily identified, microaggressions are more insidious and cause cumulative damage over time that can go unnoticed by others. Importantly, microaggressions are often unintentional and completely outside the conscious awareness of the person or group enacting them.
The authors’ experience while facilitating a workshop on microaggressions in the health care setting led them to believe that C-L psychiatrists may be uniquely positioned to develop knowledge on this topic, generate important discussions with colleagues, and eventually effect change in our workplace.
Monitoring the temporal trends of suicidal behaviors
Research: Temporal Trends in Suicidal Ideation and Attempts Among US Adolescents by Sex and Race/Ethnicity, 1991-2019
Authors: Yunyu Xiao, PhD, et al.
Abstract/Extract:The researchers set out to discover whether temporal trends in suicidal ideation and attempts among US adolescents are different across sex and race/ethnicity.
In this study of 183,563 adolescents in the US from 1991 through 2019, a decreasing temporal trend in suicidal ideation changed to an increase, with different turning points for female, White, Hispanic, and Black adolescents. Male and Black youths had non-significant changes in suicidal ideation, but the greatest increase in the prevalence of non-fatal suicide attempts.
Importance: Suicide is the second leading cause of death in young people aged 12 to 18 years in the US. In 2019, 2,090 (7.1 per 100 000) adolescents in this age group died by suicide.
Visits to hospital emergency departments due to suicidal ideation, or attempts in young people aged 15 to 19 years, are increasing: the largest increase between 2008 and 2015 was in Black, Hispanic, and female adolescents.
Monitoring the temporal trends of suicidal behaviors is important to guide development of effective suicide prevention. In particular, detecting changes in temporal trends in subgroups—and when the risk of suicide is greater in those groups—can identify high-risk populations for targeted intervention and guide hypothesis generation and testing.
Walk-in psychiatry crisis services either flat-lining or declining
Research: Trends and Geographic Availability of Emergency Psychiatric Walk-In and Crisis Services in the United States
Authors: Luther Kalb, PhD, et al.
Abstract/Extract: To date, no research has examined the availability of psychiatric emergency walk-in and crisis services. The goal of this study was to examine temporal trends, geographic variation, and characteristics of psychiatric facilities that provide emergency psychiatric walk-in and crisis services across the US.
The authors used cross-sectional, annually collected data covering 2014–2018 from the National Mental Health Services Survey, a survey of both public and private mental health treatment facilities.
Overall, 42.6% of all US mental health facilities did not offer any mental health crisis services between 2014 and 2018. Yet one-third of all facilities (33.5%) offered emergency psychiatric walk-in services, and just under one-half (48.3%) provided crisis services. When examining population-adjusted estimates, the authors noted a 15.8% (1.52–1.28 per 100,000 US adults) and 7.5% (2.01–1.86 per 100,000 US adults) decrease in walk-in and crisis services, respectively, from 2014 to 2018. Large geographic variation in service availability was also observed.
Importance: A large proportion of psychiatric facilities in the US do not provide psychiatric walk-in or crisis services. Availability of these services has either flat-lined or is declining. Disparities, particularly around US borders and coasts, suggest policy efforts would be valuable for ensuring equitable service availability.