Posters Contribute to Knowledge Base of C-L Psychiatry Across Wide Spectrum
Rigorous grading process used to select the highest quality abstracts with a focus on scientific value, original data, and level of scholarship
A random selection of posters accepted for presentation at CLP 2021 demonstrates the extent of research and studies being undertaken in support of C-L Psychiatry across a wide spectrum of subspecialties.
ACLP’s Oral Papers & Posters Subcommittee, responsible for managing poster displays at Academy annual meetings, this year received 288 abstracts for consideration as posters.
The subcommittee has been engaged in its rigorous grading process aimed at selecting the highest quality abstracts with a focus on scientific value, original data, and level of scholarship.
For posters, the subcommittee sought original studies, case series, and case reports that contribute to the knowledge base of C-L Psychiatry.
This year, the subcommittee selected nearly 200 posters for exhibition ‘blind’ to ensure the review process is fair and unbiased. “By not seeing names of the abstract submitters the work has been judged solely on the quality of the science,” says subcommittee chair Michael Marcangelo, MD, DFAPA, FACLP.
Dr. Marcangelo has added comments.
NEUROCOGNITIVE DISORDERS, DELIRIUM AND NEUROPSYCHIATRY
Use of Assertive Community Treatment model in patients with Traumatic Brain Injuries
Lead presenter: Sarah Van Remmen, MD, University of Maryland/ Sheppard Pratt Psychiatry Residency Program
The findings of this study could lead to Traumatic Brain Injury (TBI) becoming a qualifying diagnosis for assertive community treatment (ACT) services, which would ultimately improve outcomes for TBI patients.
TBI is a common cause of physical and psychiatric disability. It is associated with several psychiatric sequelae including anxiety, depression, PTSD, and psychosis; behavioral symptoms of agitation, aggression, irritability, mood fluctuations, and impaired executive function; and substance use disorders.
Best practice recommends an interdisciplinary treatment model since patients diagnosed with TBI commonly fail traditional outpatient models. ACT might provide the intensive service required to improve outcomes in TBI.
Currently, TBI diagnosis alone does not qualify for ACT services. However, many patients with TBI and psychiatric comorbidities do qualify and receive ACT services.
The poster presenters hypothesized that those receiving ACT services with TBI and other psychiatric comorbidities have improved outcomes compared to standard of care.
So they conducted a retrospective case-control study measuring outcomes such as frequency of incarceration, emergency department visits, and hospitalizations of 18-65 year old patients diagnosed with TBI and psychiatric comorbidities before and after utilization of ACT team services.
Outcomes including housing status, incarcerations, emergency department use, and the number of days of inpatient hospitalizations were collected during a period of time when patients were and were not engaged in the ACT team services.
Data collection was pending Institutional Review Board approval when the abstract was submitted. “We hypothesize that ACT level of care is associated with improved outcomes for patients who have sustained TBIs,” say the presenters.
Dr. Marcangelo: “This selection will provide novel information about the impact that an assertive community treatment team can have on outcomes for patients with traumatic brain injuries. Consultation psychiatrists care for people with TBIs acutely and over time and this poster’s findings could potentially change current approaches and urge adaptation of models based on those used to treat people with severe and persistent mental illness.”
Evidence-based inpatient assessment of alcohol relapse risk in patients undergoing liver transplant evaluation
Lead presenter: Anastasia Grieb, Baylor College of Medicine
A more standardized approach in assessing the risk of alcohol relapse in a patient being considered for a liver transplant is needed, say the poster presenters. “To assess these patients in a more evidence-based manner, we reviewed several recent literature reviews and found that certain risk factors were more consistent with predicting alcohol relapse.”
C-L Psychiatry services are often used by liver transplant teams for screening candidates for emergency liver transplant. A relapse in alcohol use after transplantation entails a worse prognosis and therefore should be weighted along with other psychosocial factors in order to establish whether a patient would be an appropriate candidate for a liver transplant, say the presenters.
Plenty of research has been done to try to determine how to assess a patient’s risk of relapse, but the literature has discrepant findings. This presents a challenge to C-L psychiatrists faced with the task of assessing the risk of alcohol relapse.
As medical students on a C-L Psychiatry service, the presenters wanted to establish which factors associated with alcohol relapse were most consistent among the literature, in order to create a more standardized approach to assessing these patients and improve the quality and reliability of emergency pre-transplant evaluations.
Results showed that smoking and sobriety were the most common risk factors identified. Next, comorbid psychiatric illness and family history of alcohol or substance use disorder were identified. Younger age, poor social or family support, and prior treatment or failed attempt at treatment (e.g. rehab, AA meetings, inpatient or outpatient programs) were also acknowledged.
Based on their findings, the presenters produced a seven-point checklist with the above-mentioned factors to better inform their transplant board about the number of factors present in each patient that correlate with increased risk of relapse.
Dr. Marcangelo: “This presentation will present a literature review done by students on a C-L Psychiatry service that helped them to highlight risk factors for relapse after liver transplant. It highlights how trainees can contribute to clinical decision-making in an academic medical center and also provides a timely review of alcohol relapse at a time when liver transplant teams are transplanting more and more patients with alcohol use disorder.”
INFECTIOUS DISEASE AND HIV PSYCHIATRY
Childhood trauma modifies the impact of brain volume on cognitive and daily functioning in virally-suppressed people with HIV
Lead presenter: Lillian Ham, SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
People with HIV (PWH) experience childhood trauma (ChT) at up to two-fold higher rates than the general population. ChT can negatively impact brain development, resulting in worse health outcomes.
So the poster presenters investigated whether brain volume affected the impact of ChT on cognition and daily functioning among virally-suppressed PWH.
245 PWH (Mage= 48.7 years) were recruited from an ongoing, longitudinal study. PWH all received antiretroviral therapy and have a viral load < 200 c/mL for 1 year. PWH were categorized as ChT+ if they reported a history of physical or sexual abuse in childhood or witnessed violence while growing up. Participants completed a 7-domain neuropsychological battery and three measures of daily functioning (one performance-based, two self-report).PWH were excluded if they reported interpersonal trauma in adulthood but not in childhood or if they failed performance validity testing. Volume and cortical thickness were extracted using FreeSurfer to analyze MRI brain scans. Cross-sectional analyses were conducted using Mann-Whitney U and chi-square tests, and multiple linear regressions adjusted for relevant covariates.
67% of our sample had ChT and 78% were women. The majority of ChT+ PWH were women (71%, p=0.0001) and non-White (predominately Black) (59%, p=0.019). ChT+ PWH had more years of untreated HIV (4.8 v. 2.8, p=0.044), more psychiatric medication (32% v. 12%, p=0.001), and more depressive symptoms (9.1 v. 5.5, p< 0.0001). In univariate analyses, ChT+ PWH had worse learning (47.8 v. 50.4 T-score points, p=0.029) and daily functioning across all 3 measures (ps<0.031). In regression analyses, ChT reduced the positive association between total gray matter and learning, and caudate volume and learning (B=-4.81E-5, p=0.010; B=-0.004, p=0.016), adjusting for covariates. ChT reduced the negative association between cortical thickness and functional declines (B=2.01, p=0.048), but the interaction was non-significant after adjusting for depressive symptoms and Hepatitis C antibody (B=1.86, p=0.071).
Greater gray matter, caudate volume, and cortical thickness might be protective against learning deficits and functional declines associated with ChT in PWH, say the presenters.
While detrimental effects of ChT on neurocognition and brain structures have been reported, this study is the first to examine the moderating role of brain volume and thickness among virally-suppressed men and women with HIV.
The presenters concluded that ChT is highly prevalent among PWH and intrinsically integrated in the neurobiology and clinical presentation of NeuroHIV. Better understanding of this role may advance efforts to optimize neurocognition and daily functioning of PWH.
Dr. Marcangelo: “This poster will have original neuroimaging data from a large population of people with HIV. By examining the relationship between childhood trauma and brain volume they hope to better understand risk factors for neurocognitive disorders and how trauma mediates the relationship. The strengths of the study include the sample size and the rigorous methods and the data presented will move the field’s understanding of how trauma impacts cognitive disorders in HIV forward.”
DIVERSITY, EQUITY, AND INCLUSION
Race and gender disparities in antipsychotic medications and consultation-liaison psychiatry involvement in a level 1 trauma center
Lead presenter: Yasmin Lachir, University of Maryland School of Medicine
This poster team set out to highlight race and gender differences in prevalence and patterns of psychotropic medication prescription and C-L Psychiatry involvement, following admission to a Level 1 Trauma Center (L1TC).
One of the most vulnerable times for acute decompensation in one’s mental health is in the setting of stress, such as physical trauma, to which people of color are disproportionately exposed, say the presenters.
In physical trauma, the first point of contact with treatment and, therefore, inequitable mental health treatment, is the inpatient hospital setting. Therefore, it is important to identify and address disparities in care because adequate treatment is instrumental for long-term patient success.
The study used data collected from a retrospective chart review. All patients were admitted to a L1TC and had a documented safety/security incident. Chi-square, loglinear analysis, and multiple regression with categorical variables were used to examine the relationship between race, gender, C-L Psychiatry consult, and antipsychotic medication.
The team hypothesize:
Patients receiving antipsychotic medication have more consults than those without.
Race and gender differences in consults exist.
Different relationships exist based on race, gender, C-L Psychiatry consult, and antipsychotic medication.
Race, gender, and C-L Psychiatry consult will significantly predict antipsychotic medications received.
Several studies have demonstrated racial and ethnic disparities in the prescription of psychopharmacology. Also, studies have shown that early incorporation of C- L Psychiatry is cost-effective and has the potential to reduce hospital length of stay. However, this is the first study to examine C-L Psychiatry involvement and antipsychotic prescribing practices among patients admitted to a L1TC.
“We expect that racial and gender disparities will exist in pharmacotherapy practices and involvement of C-L Psychiatry in this already vulnerable community,” say the presenters. “Identification of these disparities will allow for interventions that would benefit not only the patient, but the larger health care system.
“Support for our hypotheses will underscore the importance of establishing an inter-collaborative relationship between departments of Psychiatry and trauma. Together, this team can collaboratively address treatment disparities and improve patient care practices.”
Dr. Marcangelo: “This submission will examine the use of antipsychotics in patients admitted to a level one trauma center and specifically examine if there are racial or gender disparities in the use of medications. As C-L Psychiatry confronts the role structural racism plays in care delivery studies such as this can provide important new insights and improve patient outcomes.”
The relationship between glycemic control and food insecurity in people with diabetes mellitus and comorbid psychosis
Lead presenter: Michelle Wiese, University of Washington Department of Psychiatry
Gaining a greater understanding of the overlap of psychosis, diabetes mellitus, and food insecurity can inform effective interventions that seek to reduce the cardiovascular health disparities.
In the US, adults with psychosis have increased mortality mostly due to cardiovascular disease. Diabetes mellitus (DM) is a potent CVD risk factor, which occurs in 28% of individuals with serious mental illnesses.
But little is understood of the contribution of social and environmental factors to diabetes health disparities experienced by people with psychosis.
Food insecurity has been shown to be an independent risk factor for poor glycemic control.
This survey aims to describe the prevalence and correlates of food insecurity among adults with DM and comorbid psychosis who receive primary care through 13 clinics affiliated with a large academic health care system in Washington state.
624 patients with diabetes and psychosis were identified. When the abstract was submitted 434 surveys had been sent to date, and 103 patients had completed the survey (a response rate of 23.7%.) 52% of respondents were female, 30.5% non-white, and 70.9% had a diagnosis of bipolar disorder. 50% of this preliminary sample reported no current employment and 42% were receiving food assistance. Final results will be shown at CLP 2021.
Given the well-established link between poverty and serious mental illness, this study may increase understanding about the contribution of food insecurity to poor diabetes disease control among adults with diabetes and comorbid psychosis.
Dr. Marcangelo: “This poster combines so many elements of consultation psychiatry—severe psychiatric disorders, chronic medical conditions, the structural determinants of health—and will provide original data about how these factors impact each other. The information provided could suggest new treatment avenues that address food insecurity directly as a way to improve outcomes for patients.”
More posters will be featured in the next ACLP News.