A&E Abstracts and Extracts

Authors: Patricia Ibeziako, MD, et al

Abstract: Increases in pediatric mental health boarding in the US have been reported in recent years, with youth remaining in emergency departments or admitted to inpatient medical/surgical units, awaiting placement at psychiatric treatment programs.

The authors evaluated outcomes of interventions to reduce boarding and improve access to acute psychiatric services at a large tertiary pediatric hospital.

Boarding interventions included expanding inpatient psychiatric beds and hiring additional staff for enhanced crisis stabilization services and treatment initiation in the emergency department, and on inpatient medical/surgical units for boarding patients awaiting placement.

Post-hoc assessment was conducted via retrospective review of patients presenting with mental health emergencies during the beginning of intervention implementation in October-December 2021, plus one year later, October-December 2022.

Inclusion criteria were patients ≤ 17 years who presented with mental health-related emergencies during the study period.

One year after full intervention implementation (2022), length of board decreased by 53% for boarding patients discharged to high (e.g., inpatient, acute residential) and intermediate (e.g., partial hospital, in-home crisis stabilization programs) levels of care, compared to 2021.

Additionally, mean length of board at all the 24-hour acute psychiatry treatment programs was reduced by 27%, and more patients were able to access such programs.

Across both years, youth with aggressive behaviors had 193% longer length of board than those without aggression, and youth with previous psychiatric admissions had 88% longer length of board than those without.

Importance: The study shows decreased length of board and improved access for youth requiring acute psychiatric treatment after comprehensive interventions, and highlights challenges with placement for youth with aggressive behaviors. The authors recommend a call-to-action for pediatric hospitals to commit sufficient investment in acute psychiatric resources to address pediatric mental health boarding.

Availability: Pre-publication in the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Authors: Kristopher Kast, MD, et al.

Abstract: This is the largest study to date showing a significant association between addiction psychiatry consultation and improved opioid use disorder (OUD) outcomes when compared to controls.

Of 26,766 admissions (10,501 patients) with OUD at an academic medical center between 2018 and 2023, 2,826 addiction consultations were completed.

Outcome criteria included initiating medication for OUD (MOUD); hospital length of stay; before-medically-advised (BMA) discharge; and 30- and 90-day post-discharge acute care utilization.

Consultation was associated with greater MOUD initiation, fewer emergency department visits, and fewer hospitalizations. Consultation patients were also more likely to have a longer hospital stay and higher BMA rating.

Importance: 80%-90% of the total US population with substance use and related disorders (SUD) do not receive specialty addiction treatment.

Despite this specialty ‘treatment gap’, those with SUD experience significant comorbidities across organ systems and represent 15%-20% of general medical inpatients.

Post-discharge acute care utilization is high among hospitalized persons with SUD, with 22%-39% experiencing readmission within 30 days of discharge. These general hospital admissions present an opportunity to engage individuals with SUD in the ‘treatment gap’.

Availability: Published by the American Journal on Addictions.

Authors: Wenhao Jiang, BE, ME, PhD, et al.

Abstract: This study provides an overview of the history and current status of C-L Psychiatry in China and its development within the Chinese Society of Psychosomatic Medicine.

Over the past decade, various C-L Psychiatry practice models have been developed to meet the diverse needs of different Chinese regions, notably, the Chinese Multidisciplinary Integrated Centers of Psychosomatic Medicine (CSPM) have been established as regional hubs throughout the country.

The study also delves into the role of Chinese traditional medicine in the practice of C-L Psychiatry in China.

Several projects involving C-L Psychiatry-based multidisciplinary collaborations are highlighted.

Importance: Modern C-L Psychiatry in China traces its origins back to the late 1940s, coinciding with the establishment of the People’s Republic of China. The nascent health care system, spurred by the new government, systematically established psychiatry departments in general hospitals across the nation. Key institutions included Peking University Sixth Hospital and Shanghai Mental Health Center.

Over the past three decades, the CSPM, the official society for psychosomatic medicine in China, has welcomed all professionals interested in the field. The society, now with 20,000 members, has experienced rapid growth.

Chinese Traditional Medicine holds significant importance in China, both historically and in contemporary times. It is deeply ingrained in Chinese culture, and its influence extends across various aspects of health care, including clinical practice, preventive medicine, and overall well-being.

Psychosomatics, or the interaction between the body and mind, has deep roots in Chinese history and culture, and during the past decade the demand for psychiatry and C-L Psychiatry services have notably increased in general hospitals.

It has been reported that by 2022, China had 9.74 million hospital beds, 4.4 million physicians (including 0.7 million physician assistants), and 5.2 million nurses. However, among them, only 1.5% were psychiatrists and approximately 0.6 million psychiatric beds were available, suggesting a significant gap.

Availability: Pre-publication by the Journal of the Academy of Consultation-Liaison (JACLP).

Authors: L Molteni, MD, et al.

Abstract: Interoception is defined as the sense of the internal state of the body, and dysfunctions in interoception are found in trauma-related conditions. Mindfulness-based interventions (MBIs) have been shown to influence interoceptive processes.

The brain is believed to build a model of sensations that arise from within the body by combining the moment-to-moment scan of the body with prior information, including beliefs and expectations, which can strongly shape the current interoceptive perception.

After integrating interoceptive information, brain activity leads to behaviors to attain desired physiological states, through regulatory reflexes and feedback control on humoral secretions. However, extensive research in recent decades has shown that dysfunction in interoceptive pathways can result in maladaptive behaviors and may be linked to mental and physical illnesses, including trauma-related disorders.

Improved interoceptive accuracy is associated with reduced post-traumatic symptomatic burden.

The aim of this study was to systematically review the literature and quantitatively pool relevant studies to assess whether MBIs improve trauma-related symptoms and interoception, and to evaluate if changes in interoception could be a mechanism of action for these interventions.

The authors aimed to answer three questions:

• Do MBIs significantly improve symptoms in patients with trauma-related disorders, or that have been exposed to traumatic events?
• Is there a significant change in interoceptive measures in individuals with trauma-related disorders, or that have been exposed to traumatic events treated with MBIs?
• Is there a correlation between the two?

The authors synthesized data from randomised controlled trials. Twelve studies were included in the systematic review, and 11 in the meta-analysis. Overall, MBIs showed small to moderate positive effects on both interoception and symptoms.

The authors conclude that the efficacy of MBIs on trauma-related symptoms and interoception is supported by randomised evidence. However, further research is needed to understand whether changes in interoception might underpin the effectiveness of MBIs in trauma-related disorders.

Importance: The authors aimed to provide, for the first time, meta-analytic evidence of the effect of MBIs on symptoms and interoception in patients affected by trauma-related disorders, or those exposed to traumatic events. Their findings support the need for future research exploring the impact of mindfulness and other MBIs in patients with trauma-related disorders.

Availability: Pre-publication by Psychiatry Research.