The 2021 ACLP Annual Meeting generated many high quality and clinically useful workshops and presentations, which are still available to attendees online. ACLP’s Online Education Subcommittee has just completed a review of the many hours of excellent education content from the conference—and provided a guide to some of the lesser-known yet high-yield presentations, now available as recorded sessions to C-L psychiatrists.
Subcommittee members evaluated sessions based on their clinical relevance and educational effectiveness for C-L psychiatrists. Twelve high-yield presentations were identified as summarized below—six general sessions and six more focal topic reviews. Over the next few months, the subcommittee plans to reveal still more online ‘hidden gems’ of which you may not be aware!
General Lectures and Workshops
Invited Presidential Lecture: Transgender Health for the C-L Psychiatrist
This session provides key insights into how Medicine, Psychiatry, and trans people have impacted transgender medicine over time. Max Lichtenstein, MD, shares insights on how Psychiatry, and specifically C-L Psychiatry, can better serve transgender patients. Data is presented on the barriers to care encountered by transgender patients including lack of a safe environment and limited access to health care services. The presentation summarizes a model of transgender medicine and surgery, and the key role psychiatrists can play within this model using a collaborative care approach. The presentation also shares useful resources for supporting transgender mental health that can be utilized by C-L psychiatrists in practice and education.
Invited Presidential Lecture: Critical Care Psychiatry: Unique Challenges in the Management of Sleep, Pain & Delirium During ECMO Treatment
Due to the COVID-19 pandemic, the number of patients on extracorporeal membrane oxygenation (ECMO) treatment requiring analgesia and sedation has increased. In this presentation, Jose Maldonado, MD, FACLP, provides key insights on the causes and interactions of pain, agitation, delirium, and circadian rhythm disturbance in patients receiving ECMO.
The presentation highlights the pharmacokinetic changes caused by ECMO including the concept of drug sequestration, which depends on the drug’s lipophilicity and protein-binding ability. Pharmacokinetic and pharmacodynamic data is shared with an emphasis on drug sequestration on various medications used in this setting, including alpha-2 agonists, GABAergic, analgesic, anti-glutamatergic, hypnotic, psychostimulant and antipsychotic agents.
The presentation also summarizes a protocol for the treatment of sleep, agitation, and delirium in patients on ECMO treatment, which can be utilized by C-L psychiatrists working in critical care settings.
Invited Presidential Lecture: The Power of Meaningful Activities and Occupational Therapy…and Other Things I’ve Learned from My Chair
C-L psychiatrists are often involved in supporting patients during their recovery from disability secondary to physical and mental illness. Here, Kathryn Sorensen, OTD, shares her expertise in occupational therapy and her own lived experience to highlight the integral role of occupational therapy in psychiatric care, including C-L Psychiatry care. Occupational therapists are critical team members in addressing physical and mental disability and this presentation illustrates important opportunities for collaboration between occupational therapists and C-L psychiatrists. Using her lived experience, Dr. Sorensen provides insights into the importance of our words, remembering the “little details,” and the power of hope.
Think You Know How to Spot Catatonia? Let’s Talk About That
This presentation begins with Andrew Francis, MD, discussing the development of the Bush-Francis Catatonia Rating Scale (BFCRS), a tool extensively used in catatonia assessment, both in clinical and research settings. His presentation also reviews specific BFCRS scale items and the evidence on the inter-rater reliability of the BFCRS when used in structured research settings.
Joshua Wortzel, MD, discusses the difficulty in diagnosing catatonia in clinical settings and the factors associated with misdiagnosis. Study results are shared from the comprehensive educational module on catatonia assessment developed by Drs. Wortzel and Mark Oldham, MD. Dr. Oldham discusses the BFCRS Training Manual and Coding Guide, focussing on the items most misidentified on pre-tests including stupor, posturing/catalepsy, echopraxia/echolalia, stereotypy versus mannerisms, rigidity versus waxy flexibility, negativism, withdrawal, ambitendency, perseveration versus verbigeration, and combativeness vs impulsivity. Jo Ellen Wilson, MPH, MD, summarizes specific challenges for catatonia assessment in acutely ill patients, including those with delirium and coma.
Acute and Chronic Neuropsychiatric Sequelae of COVID-19
Scott Beach, MD, FACLP, discusses acute neuropsychiatric complications of COVID-19, including psychotic disorders, delirium, dementia, mood disorders, catatonia, and akinetic mutism. He reviews imaging and laboratory findings in this patient population.
Erica Baller, MD, discusses potential pathophysiological mechanisms for involvement of the CNS by the virus and potential clinical correlates. She highlights various pharmacological treatment options in COVID-19-related delirium and shares a clinically applicable published algorithm on pharmacological treatment of delirium associated with COVID-19.
Christian Hicks, MD, highlights the clinical findings and treatment of Post-Acute Sequalae of COVID-19 (PASC) or Long-COVID. The session concludes with David Quinn, MD, FACLP, reviewing clinical trajectories, possible pathophysiology, and suggested work-up for patients with Long-COVID.
Advancing Knowledge, Developing Careers, and Strengthening Community Around Social Justice in C-L
C-L psychiatrists are well positioned to apply social justice principles within the health care system. This workshop discusses the role C-L psychiatrists can play in advancing social justice and addressing structural factors negatively impacting health outcomes of patients. Abhisek Khandai, MD, introduces core concepts of social justice, social determinants of health, stigma, and structural vulnerability. Diana Robinson, MD, applies these concepts to a clinical case related to opioid use disorder and focuses on challenges related to structural stigma and health disparities.
Mira Zein, MD, explores the concept of structural vulnerability using a case presentation of an individual who was an undocumented immigrant and suffered a traumatic brain injury. Adrienne Taylor, MD, discusses the intersection with law enforcement and mental health in Black patients with schizophrenia using a social justice lens. Lastly, Kayla Behbahani, MD, discusses how structural competency applies to a case presentation of an individual who is undergoing an invasive medical procedure and who is a trauma survivor. Opportunities for C-L psychiatrists to further develop their competency in social justice are shared.
High-Yield Focal Reviews in Brief
High-yield Pearls from the APA Council on C-L Psychiatry Workgroup on Treatment of Opioid Use Disorder in the General Hospital: A Guide for C-L Psychiatrists
In the context of the opioid epidemic nationally, this presentation highlights the critical role of C-L psychiatrists in supporting medical and surgical teams in treating opioid use disorders. The session discusses the recent APA Council on C-L Psychiatry Resource Document on the treatment of opioid use disorders in general hospital settings, including practical must-know clinical pearls.
2021 Neuropsychiatry Updates
The presentation highlights the pathophysiology, clinical presentation, and the evidence-based management of various neuropsychiatric disorders including cytokine-induced delirium, cefepime-induced neurotoxicity, paraneoplastic limbic encephalitis, and frontotemporal dementia.
Ten Most Important Papers
This presentation highlights 10 important studies published in C-L Psychiatry for the 2020-2021 academic year. Summarized studies cover: delirium, emergency psychiatry, COVID-19, transplantation, psycho-nephrology, cardiac psychiatry, infectious diseases, psycho-oncology, HIV, and Hispano-American psychiatry.
From Goals to Meanings: Role of Psychotherapeutics for Psychiatrists Working in Palliative Care
This presentation highlights multiple psychotherapeutically informed skills in the palliative care setting, with a focus on educating palliative care clinicians and improving patient care.
Current Controversies in Agitation Management in the Emergency Department
Management of agitation is common for C-L psychiatrists and this presentation summarizes the current evidence on controversial issues in agitation management, including the concept of “excited delirium,” the role of ketamine, and the use of intramuscular olanzapine.
Neuropsychiatric Consequences of Vitamin Deficiencies: A Critical Review
C-L psychiatrists often encounter vitamin deficiencies when caring for patients with psychiatric and comorbid medical conditions. This workshop provides practical approaches to the assessment and management of five major vitamin deficiencies from a C-L Psychiatry perspective: thiamine, folic acid, vitamin B12, vitamin D, and vitamin C.