Consultation-liaison Psychiatry Service Research Articles

Automated Screening to Enhance Proactive Consultation-Liaison Psychiatry Services in Acute Medicine Units

Automated Screening to Enhance Proactive Consultation-Liaison Psychiatry Services in Acute Medicine Units

Automated Screening to Enhance Proactive Consultation-Liaison Psychiatry Services in Acute Medicine Units: Evaluation of Service Outcomes.

Automated Screening to Enhance Proactive Consultation-Liaison Psychiatry Services in Acute Medicine Units: Evaluation of Service Outcomes.

Patient and Medical Unit Staff Experiences of Proactive and Integrated Consultation-Liaison Psychiatry in The HOME Study: A Qualitative Investigation

Consultation-liaison (C-L) psychiatry services aim to help general hospital staff provide better care for their patients. Recently, many inpatient C-L psychiatry services have adopted proactive and integrated approaches to achieve this aim. Despite these developments, there have been no interview-based studies of patients' and staff members' experiences of the new approaches. To gain an in-depth understanding of patients' and medical unit staff members' experiences of a proactive and integrated C-L psychiatry service for older medical inpatients (Proactive Integrated C-L Psychiatry, PICLP). We conducted an interview-based qualitative study with thematic analysis. The participants were patients and staff who had experienced PICLP during The HOME Study, a randomized trial which evaluated PICLP in 24 medical units of three UK general hospitals. We conducted 97 interviews; 43 with patients or their proxies (family members who were interviewed on behalf of patients with significant cognitive impairment) and 54 with staff members of all relevant disciplines. Patients and staff both described how PICLP was a helpful addition to medical care and discharge planning. It enhanced the medical unit team's ability to address psychological, psychiatric and social needs and provide patient-centered care. They welcomed proactive biopsychosocial assessments and the broader perspective that these offered on patients' complex problems. They also valued the integration of C-L psychiatrists into the unit teams and the daily contact with them. For patients, this fostered a therapeutic relationship and helped them to be more engaged in decisions about their medical care and discharge-planning. For staff, it enabled ready access to psychiatric expertise and training opportunities. The few reported experiences of PICLP being unhelpful were mainly about the greater number of clinicians involved in patients' care and a lack of clarity about professional roles in the integrated team. We found that older inpatients and medical unit staff experienced PICLP as both acceptable and generally helpful. Our findings add to the existing evidence for the benefits of proactive and integrated C-L psychiatry services.

Medical Student Attitudes Toward Patients With Substance Use Disorder After Experiential Learning on an Addiction Psychiatry Consultation-Liaison Service: A Pilot Study.

Stigma surrounding substance use disorder (SUD) is highly prevalent in health care. Negative attitudes toward patients with SUD have been shown to negatively impact patient care. Addressing SUD stigma in medical students is a promising approach, however, few curricula include experiential learning on addiction psychiatry clinical services. We describe a medical student rotation on an addiction psychiatry clinical service and examine its effect on attitudes toward patients with SUD. Medical students were integrated onto an addiction psychiatry consultation-liaison service serving medically/surgically hospitalized patients with co-occurring SUD and other psychiatric disorders. Students learned and practiced in-person assessment of patients and received instruction on basic principles of psychiatry and evaluation and management of SUD. A targeted anti-stigma curriculum was included. Attitudes toward patients with SUD were measured with the Medical Condition Regard Scale (MCRS) before and after the experience. Each item of the MCRS and an overall composite attitude score were analyzed. Of the 36 students on the clinical rotation, 33 completed the survey. Attitudes showed widespread improvement toward patients with SUD. Mann-Whitney U tests showed significant improvement in most items of the MCRS. Further analysis of composite scores showed an improvement in overall attitudes toward patients with SUD. Inclusion of medical students on an addiction psychiatry consult service as part of the core psychiatry clerkship may hold promise for helping improve student attitudes and decrease stigma toward patients with SUD. Controlled study is needed to compare other clinical experiences and determine specific causative effects.

Proactive and integrated consultation-liaison psychiatry for older medical inpatients: A mixed methods description of training, care provided and clinician experience in the HOME study

ObjectivesTo describe the practical experience of delivering a proactive and integrated consultation-liaison (C-L) psychiatry service model (PICLP). PICLP is designed for older medical inpatients and is explicitly biopsychosocial and discharge-focused. In this paper we report: (a) observations on the training of 15 clinicians (seven senior C-L psychiatrists and eight assisting clinicians) to deliver PICLP; (b) the care they provided to 1359 patients; (c) their experiences of working in this new way. MethodA mixed methods observational study using quantitative and qualitative data, collected prospectively over two years as part of The HOME Study (a randomized trial comparing PICLP with usual care). ResultsThe clinicians were successfully trained to deliver PICLP according to the service manual. They proactively assessed all patients and found that most had multiple biopsychosocial problems impeding their timely discharge from hospital. They integrated with ward teams to provide a range of interventions aimed at addressing these problems. Delivering PICLP took a modest amount of clinical time, and the clinicians experienced it as both clinically valuable and professionally rewarding. ConclusionThe experience of delivering PICLP highlights the special role that C-L psychiatry clinicians, working in a proactive and integrated way, can play in medical care.

Determinants of workload-related clinician stress levels in general hospital consultation liaison psychiatry services during the COVID-19 pandemic in England and Ireland. Short report

ObjectiveTo explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic. MethodsData were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total. Dependent variable: workload-related stress levels in CLP services due to COVID-19 (0–10 point scale). Independent variables: hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed. ResultsThere was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74). ConclusionOur findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.

The relation between vaccination status and referral to a consultation–liaison psychiatry service for hospitalized patients with COVID-19

BackgroundPrevious studies have shown that patients with Coronavirus Disease 2019 (COVID-19) are likely to be affected by delirium and other psychiatric complications. We aimed to evaluate the relation between COVID-19 vaccination status and referral of patients hospitalized with COVID-19 for consultation–liaison psychiatry services.MethodFrom the medical records used for this retrospective, single hospital-based study, 576 patients were identified who were over 18 years-of-age and hospitalized with a diagnosis of COVID-19 between March 2020 and March 2022. The data of 531 for whom the vaccine history was obtained from the medical records were available for analysis: 455 without and 76 with referral to consultation–liaison psychiatry. A history of COVID-19 vaccination at least two times was used in the analysis of the odds for referral to liaison psychiatric consultation: 95% confidence interval (CI) in multivariable logistic regression. The adjustment factors included sex, age, body mass index (BMI), severity of COVID-19, C-reactive protein level, medical history, and therapeutic factors such as the use of remdesivir, steroids, or mechanical ventilation.ResultsThe prevalence of psychiatric consultation was 14.3%. Patients without vaccination had a 7-times greater OR (95%CI:2.08–23.58) than vaccinated patients for a referral for consultation–liaison psychiatry services after adjusting for confounding factors.ConclusionNon-vaccination was associated with a greater likelihood of referral for consultation–liaison psychiatry service among these hospitalized Japanese patients with COVID-19, even after adjusting for clinical and therapeutic factors. It is possible that vaccination greatly lessens the need for the referral of COVID-19 patients for consultation–liaison psychiatry services.

Characteristics and management of patients with substance use disorders referred to a consultation-liaison psychiatry service in Lebanon

BackgroundThis study explores the characteristics and management of individuals with substance use disorders (SUDs) who were referred to the consultation-liaison psychiatry (CLP) service in a tertiary care center in Lebanon. As part of the Consultation-Liaison at the American University of Beirut (CLAUB) analysis, we conducted a retrospective record review of patients referred to our CLP service between February 2019 and May 2020. We assessed differences between SUD and non-SUD consults using chi-square analysis, Fisher’s exact test, or Mann–Whitney U test, as appropriate.ResultsOf 1475 patients, 278 (18.8%) received a diagnosis of SUD. They were mostly males (73.7%) with an average age of 38.8 years. The most used substances were alcohol (60%) and cannabis (28.4%). Compared to non-SUD consults, patients with SUDs were more likely to be males (odds ratio OR = 3.18, p < 0.001) and to get intubated during admission (OR = 1.81, p = 0.048). Predictors of intensive care unit admission in patients with alcohol use disorder included pulmonary or endocrinological disease, benzodiazepine use disorder, and days until CLP referral.ConclusionsThe results of this study highlight the high prevalence of alcohol use among individuals with SUD referred to the CLP service. Additionally, they underscore the limited treatment avenues available in this part of the world. The institution of a comprehensive CLP service is crucial to address the unmet needs of patients with SUDs who present to a general hospital setting.

Broadening the state of play - the second national survey of Consultation-Liaison Psychiatry services in New Zealand, 2021.

The original national survey of Consultation-Liaison Psychiatry (CLP) services in New Zealand (NZ) that was undertaken in 2018 (CLPSNZ-1) established a baseline but was limited in scope. The aim of the current study was to conduct a more in-depth national survey. A 44-question survey was emailed to clinicians at each of the 16 general hospitals in NZ with specialist adult CLP services in 2021. Responses were obtained from all 16 CLP services. These services were found to be under-resourced (with mean total full-time equivalents of 0.26 psychiatrists and 1.10 clinicians per 100 inpatient beds, respectively), operate with highly variable service models (with major variations in operating hours and coverage of age groups, the Emergency Department and outpatients) and provide a predominantly consultation service. While many of the findings from CLPSNZ-1 remain relevant, the current survey has extended our understanding of the circumstances, achievements and challenges of this psychiatric subspecialty in NZ.

DESCRIPTIVE STUDY ON SUICIDE ATTEMPTERS ATTENDING CONSULTATION-LIAISON PSYCHIATRY SERVICES AT A TERTIARY CARE HOSPITAL

Aims and Objectives: Suicidal attempts are more common than suicides. Knowing the sociodemographic profile of patients, psychological causes, and mode of attempts helps gain insight into suicide attempts. This study aims to describe the profile of suicide attempters attending consultation-liaison psychiatry services. Methods: This was a prospective observational study conducted at the psychiatry clinic, Government Villupuram Medical College and Hospital, Tamil Nadu on suicide attempters between June 2019 and November 2019. Beck’s suicide intent scale was used to assess the level of intent. Results: Of the total of 610 study individuals, the mean age was 28.73±11.73 years, majority were females (57.70%), suicide attempt was more in young adults (59.18%), more in married (64.91%), more in those with secondary school education (54.91%), and more in skilled workers and homemakers. Poison consumption was the most common mode of suicide attempt (92.62%), predominantly insecticides. Alcohol intoxication (39.14%) was the most common psychiatric derangement. Interpersonal conflict (63.44%) was the most common precipitating factor. About 74.92% had less suicidal intent. Conclusion: Marital conflicts, interpersonal conflicts, and alcohol-related illnesses were the major precipitating factors. Restriction of the availability of alcohol and toxic insecticides can help reduce the incidence of suicide attempts and deaths. The promotion of healthy coping mechanisms and community-based mental care activities can help in suicide prevention.

A survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand.

The aim of this study was to conduct an in-depth survey of the psychiatric care provided for medically ill older adults in general hospitals in New Zealand (NZ). As part of a larger survey of Consultation-Liaison Psychiatry (CLP) services for all ages in NZ (CLPSNZ-2), a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for medically ill older adults at each of the 16 general hospitals with designated CLP services. Responses were obtained from 22 services at 16 hospitals - 14 CLP services and eight Psychiatry of Old Age (POA) in-reach services. These services were found to be under-resourced, operate with highly variable service models, and predominantly provide inpatient consultations. Services could be conceptualised as six prototypes with variations of POA in-reach to hospitals, scope of CLP cover and collaboration between services. The heterogeneity in the psychiatric care for medically ill older adults in NZ means that there is an urgent need to develop more consistent CLP service models that better serve the specialist needs of older adults, and establish the policies, resources and standards needed to support them.

Inpatient obstetric consultation-liaison services: Meeting unmet needs in perinatal mental health

Obstetric patients are at increased risk for psychological distress and the development or exacerbation of mental illness, particularly in the setting of pregnancy or delivery complications. Inpatient antepartum, labor and delivery, and postpartum hospitalization is an important opportunity for psychiatric support and intervention. The aims of this paper are to review the unmet mental health needs in obstetric inpatient care, examine the current state of obstetric consultation-liaison (OB CL) psychiatry services, present one existing model of such a service at the authors' institution, provide broad recommendations for the structure and implementation of this service, and detail areas of future research within the area of OB CL psychiatry. We argue that the inpatient obstetric setting is a critical space for mental health evaluation, education and intervention, and that dedicated OB CL psychiatry services are a potentially valuable tool in addressing the perinatal mental health crisis.

Frequency of delirium and its associated factors among COVID-19 inpatients in Iran.

Delirium has been presented as the leading cause of sudden change in the mental state of patients with coronavirus disease 2019 (COVID-19). Given that the delayed diagnosis of such a dysfunction is often associated with excess mortality, it seems essential to devote vastly more attention to this significant clinical characteristic. This cross-sectional study was performed on 309 patients [viz. 259 cases hospitalized in general wards and 50 individuals admitted to the intensive care unit (ICU)]. For this purpose, a Demographic-Clinical Information Questionnaire, the Confusion Assessment Method (CAM), the Confusion Assessment Method for the ICU (CAM-ICU), the Richmond Agitation-Sedation Scale (RASS) and face-to-face interviews were completed by a trained senior psychiatry resident. The data analysis was further done with the SPSS Statistics V22.0 software package. Out of 259 patients admitted to the general wards and 50 cases in the ICU due to COVID-19, 41 (15.8%) and 11 (22%) individuals were diagnosed with delirium, respectively. As well, a significant relationship was observed between the incidence rate of delirium and age (p< 0.001), level of education (p< 0.001), hypertension (HTN) (p= 0.029), a history of stroke (p= 0.025), a history of ischemic heart disease (IHD) (p= 0.007), a history of psychiatric disorders, a history of cognitive impairment (p< 0.001), use of hypnotic and antipsychotic medications (p< 0.001) and a history of substance abuse (p= 0.023). Among 52 patients with delirium, only 20 cases had received psychiatric consultation by consultation-liaison psychiatry service for the possibility of delirium. In view of the high frequency of delirium among COVID-19 inpatients, their screening for this important mental state should be a priority in clinical settings.

A framework for the implementation of consultation-liaison psychiatry from the characteristics of psychosomatic consultations at a general hospital in china.

To understand the current situation and characteristics of consultation-liaison psychiatry (CLP) service in general hospital, to compare the results of the literature on CLP published in other hospitals in China and abroad, and to find deficiencies for the current differences. The medical records of all inpatients who had liaison consultations in the first year of the establishment of Xi'an International Medical Center Hospital, China, were collected. Statistical analysis was performed on the general demographic data, department origin, number of consultations, the reason for consultation, diagnosis of consultation, and follow-up of patients. A total of 630 patients were enrolled in the past 1year, of which, 45.23% were males and 54.8% were females. 89.2% of non-psychiatric departments applied for psychosomatic consultation. The percentage of middle-aged and elderly patients was 75.6%, including 61.6% of patients aged 45-74years. The internal medicine department had the highest number of consultations (48.2%), including respiratory medicine (12.1%), neurology (12.1%), gastroenterology (12.1%), and cardiology (12.1%). For surgical patients, orthopedic patients (rehabilitation, 6.5%) comprised the majority of consults. The main reasons for requesting psychosomatic consultations included depressive symptoms (139 cases, 22.8%), anxiety symptoms (137 cases, 22.5%), sleep problems (111 cases, 18.2%), as well as hallucinations and delusions or behavioral disorders (68 cases, 11.2%), accounting for a total of 74.59% (455/630). A significant gap exists between the level of CLP services in China and developed regions in Europe and the United States, mainly due to low consultation rates and referrals and imperfect CLP service.

Coronavirus Disease 2019 (COVID-19) Pandemic’s Effect on Child and Adolescent Mental Health: Analysis of Pediatric Intensive Care Unit and Consultation-Liaison Psychiatry Service

The Coronavirus Disease (COVID-19) pandemic has contributed to a co-occurring psychiatric epidemic. Children and adolescents have been particularly impacted, with disruptions in continuity of learning and healthcare. Psychological stressors such as fear of infection, boredom, decreased socialization, supply shortages, and incomplete information have contributed to low mood, irritability, insomnia, and emotional exhaustion. Our study contributes to this research by quantifying the devastating psychiatric toll that the COVID isolation period and virtual schooling had on the mental health of children. The Loyola University Medical Center (LUMC) Consultation-Liaison Psychiatry Service (CLP) (Maywood, IL) designed a study to identify and analyze data regarding the total number of CLP consult requests, patient presentations to the emergency department (ED), and admissions to the Pediatrics floor and Pediatric Intensive Care Unit (PICU) during the COVID pandemic. IRB approval was obtained for this retrospective chart review study. ED visits and Pediatric floor/PICU admissions of all pediatric patients (6-18 years old), specifically those related to mental health, were identified using ICD-9 diagnostic coding for the dates of March 2019 through February 2022. The total number of admissions and encounter diagnoses were analyzed and compared between 3 pandemic periods: Pre-pandemic phase (March 2019-February 2020), acute pandemic phase: isolation/virtual schooling (March 2020-February 2021), and chronic pandemic phase: post-isolation/virtual schooling (March 2021-February 2022). During the chronic pandemic phase, ED visits and Pediatric floor/PICU admissions of all pediatric patients were identified via manual chart review of existing CLP patient lists. The total number of admissions, along with diagnoses during encounters, were compared between the 3 periods and psychiatric admissions were further subcategorized into intentional drug overdoses. In the pre-pandemic phase, there were 39,304 total encounters for children (6-18 years), with 11,189 ED-only visits, and 3,043 inpatient admissions. In the acute pandemic phase, total encounters fell to 15,779, with 4,631 ED-only visits, and 2,578 inpatient admissions. Pre-pandemic, 0.55% of all pediatric encounters required psychiatry consults compared to 1.32% after the onset of the pandemic. During the pre-pandemic phase, there were 27 PICU admissions for psychiatric-related conditions (i.e. intentional ingestion) or 4.52% of all PICU admissions. During the acute pandemic period, there were 57 PICU admissions for psychiatric-related conditions or 11.19% of all PICU admissions. Specifically, there was a rise in intentional ingestion cases from 25 prior to the pandemic to 44 after the onset of the pandemic. During the chronic pandemic period, there were 43 PICU admissions for psychiatric-related conditions. Of those 43 admissions, 33 were intentional drug overdoses. Total encounters during this phase were comparable to the pre-pandemic phase (39,304 encounters pre-pandemic vs. 32,544 encounters in chronic pandemic phase).At this large academic medical center, the pandemic has had a clear impact on total pediatric encounters, with a rise in the number of PICU admissions for psychiatric-related conditions. Findings from this study can be used to inform public policy and develop guidelines in preparation for future pandemics. Safeguards should be put in place to address the significant effects that social isolation and virtual schooling have on the mental health of children, including but not limited to widespread therapy sessions incorporated into the virtual school day and socially distanced in-person activities when safe.

Treating Trauma- Evaluation of a multi-disciplinary psychiatry service for patients post major trauma

IntroductionResearch has shown 30-40 % of people who have experienced traumatic injury are at risk of developing mental illness. Some injuries may be the result of mental ill-health, including self-inflicted injury. Furthermore, the development of psychopathology after injury appears to be a major determinant of long term disability. Early intervention can reduce symptom severity and prevent development of mental illness.Ireland’s National Trauma System Implementation Programme, announced in April 2021, highlights the need for screening for mental disorders.The Mater Misericordiae University Hospital (MMUH) is designated as one of two national Major Trauma Centres in Ireland. Its trauma service will expand with an expectation of an additional 450- 500 major trauma patients over the next three years.The Consultation Liaison Psychiatry Service (CLP) currently provides expert mental health input to medical and surgical teams, in managing a range of patients with mental illnesses or psychological difficulties, including those with experience of major trauma.ObjectivesTo examine the current mental health service provision for trauma patients over a six-month period. We aimed to identify areas of need to inform future development of a psychiatry-led MDT service for trauma patients.MethodsA review of all patients admitted on the MMUH trauma pathway between January 2021 and June 2021 was performed. The following data were recorded: demographics, mechanism of injury and information on referrals to the liaison psychiatry service.ResultsThere were 105 trauma cases over the six-month period; 46 females and 59 males. The mean age was 58.4 years (SD 22.16). Twelve individuals were recorded as ‘No Fixed Abode’ or living in homeless accommodation(11.4%).In terms of mechanism of injury; 20 were assaulted of which 8 were stabbing/ knife injuries. There were 65 falls and 12 road traffic accidents. In 3 cases (2.8%), the mechanism of injury was self-inflicted. Twenty patients were admitted to critical care (19%).Of the 105 trauma patients, 19 (18%) were referred to CLP service; 2 (10.5%) were seen in the outpatient setting, the rest as inpatients (89.5%). At least one repeat review was indicated in 10 of the 19 patients (52.6%).ConclusionsTrauma patients have a high rate of comorbid mental illness. Nearly 1/5 are currently referred to the CLP service, which is likely an underestimation of the actual burden of mental health disorders and could be explained by the lack of dedicated services. The liaison psychiatry team provides valuable input into the multidisciplinary care of trauma patients and the demand for its services is likely to increase with the expansion under the Major Trauma Strategy for Ireland.Disclosure of InterestNone Declared

An Audit of Inpatient Consultation-Liaison Psychiatry Services at an Inner New York City Safety Net Hospital.

Background Our study's primary objective is to audit the resource utilization of a consultation-liaison (CL) psychiatry service in an inner New York City safety net hospital. This cross-sectional, observational study was conducted as a subset of a quality improvement project at the hospital to investigate the characteristics of the emergent nature of consults, types, and the specialty from which the referral was placed to the CL services. This study aims to improve the efficacy of our consult process by improving the appropriateness and precision of consult requests. Methodology This cross-sectional, observational study was reviewed and approved by the Institutional Review Board under a quality improvement exemption. The study investigated the EPIC electronic medical record data for characteristics of consult referrals in the third quarter of 2019 from July 1, 2019, to September 30, 2019. A total of 629 consults were recorded during this period. We excluded follow-up calls, duplicate data rows, and patients with missing data points; the final consults were 421. Patients who required more than one new consult (follow-up excluded) within 90 days were considered; thus, the total number of patients who were included in the study was 327. Results Of the 421 consults identified in the dataset for review, only 45.8% were valid consults, 32.8% were not valid, and 21.4% were uncertain. Further, the most common department from which consults were placed was Medicine (73.2%), followed by Surgery (12.8%), Obstetrics/Gynecology (9%), Critical Care (3.6%), and, finally, Pediatrics (1.4%). Conclusions The study overviews the quality of general consults for the CL psychiatry service and how the CL staff manages it. It also provides an idea about the number of consults that can be comprehensively addressed.

A mixed-methods evaluation of a state-wide outreach perinatal mental health service

BackgroundAccess to perinatal mental health services in rural and remote areas is scarce, particularly perinatal psychiatry services. Telehealth, together with psychiatry consultation-liaison services are one way to improve access to areas of need. The New South Wales State-wide Outreach Perinatal Services – Mental Health (SwOPS) program is a Sydney-based program, offering specialist perinatal consultation-liaison services to rural and remote community mental health clinicians caring for perinatal women with significant mental health problems. This study aimed to evaluate healthcare practitioners’ perceptions of the SwOPS program.MethodHealthcare practitioners (N = 31) were purposely recruited to participate in the study. Data were analysed using a mixed-methods cross-sectional design.ResultsMost participants reported being familiar with and satisfied with the service. As a result of accessing the service, participants reported an increase in knowledge and confidence regarding caring for women with moderate-to-severe or complex mental health conditions. Qualitative comments highlight the participant’s perceptions of the program.ConclusionThis study provides useful insights about a state-wide telehealth psychiatry consultation-liaison service from the perspective of practitioners. It highlights the benefits, facilitators, and barriers associated with implementing such services.

Psychiatric morbidities in respiratory disorders: a cross sectional report providing insight into consultation-liaison psychiatry services in India

Psychiatric morbidities in respiratory disorders: a cross sectional report providing insight into consultation-liaison psychiatry services in India

Document Provides Inpatient Guidelines for Medication Treatment of Opioid Use Disorder

Back to table of contents Previous article Next article Clinical & ResearchFull AccessDocument Provides Inpatient Guidelines for Medication Treatment of Opioid Use DisorderAbhisek Chandan Khandai, M.D., Josie Francois, M.D.Abhisek Chandan KhandaiSearch for more papers by this author, M.D., Josie FrancoisSearch for more papers by this author, M.D.Published Online:21 Dec 2022https://doi.org/10.1176/appi.pn.2023.01.1.39AbstractA new resource document will help strengthen psychiatrists’ capabilities to be team leaders in the treatment of hospitalized patients with opioid use disorder. This article is one of a series coordinated by APA’s Council on Consultation-Liaison Psychiatry and the Academy of Consultation-Liaison Psychiatry.The prevalence, morbidity, mortality, and costs of opioid use disorder have dramatically increased over the past 20 years. While there are several effective and evidence-based medications for opioid use disorder (MOUD), less than 20% of Americans with opioid use disorder receive MOUD. The inpatient general hospital setting represents a critical point of access to MOUD, given the significant medical comorbidities of patients with opioid use disorder and the increased time to engage patients in treatment, better monitoring capabilities, and opportunities to reduce the monetary impact of the disorder on the health care system.Psychiatrists are an integral part of the hospital treatment team. However, they are often excluded for many reasons, including stigma toward opioid use disorder, lack of consultation-liaison (C-L) psychiatry services, and discomfort with managing opioid use disorder.To help address this care gap, APA’s Council on C-L Psychiatry, in collaboration with the Council on Addiction Psychiatry, convened a multispecialty expert workgroup to prepare a resource document related to the medication treatment of patients with opioid use disorder. The workgroup discussed several barriers to medication treatment and factors limiting the involvement of psychiatrists in the treatment of opioid and other substance use disorders in the inpatient hospital setting. Among the barriers they identified were stigma associated with substance use disorders (SUD) and a knowledge gap among psychiatrists regarding SUD treatment. The workgroup then created a resource document that seeks to address these barriers and guide general psychiatrists.The document includes an overview of OUD and its management in adults, explores the pharmacology of MOUD, describes barriers to care and specialty-specific concerns, and provides approaches to reducing stigma. The resource document also compares current medications to treat patients with opioid use disorder (naltrexone, buprenorphine, and methadone), walks psychiatrists through the medications’ initiation and titration in the general hospital setting, and provides recommendations on how to transition patients taking these medications from inpatient to outpatient settings.The resource guide is designed to educate and empower psychiatrists to take a larger role in MOUD in the general hospital setting to save more lives at reduced cost. Psychiatrists are in a strong position to oversee the use of MOUD in hospital settings and are best equipped to lead MOUD treatment and reduce stigma, given our relative expertise in the area of SUDs, comorbid psychiatric illnesses, and harm reduction strategies. As such, it is important that psychiatrists stay up to date on evidence-based MOUD and work with other specialties to promote psychiatric involvement in the care of those with opioid use disorder in the general hospital setting. ■Resource Document on the Treatment of Opioid Use Disorder in the General HospitalAbhisek Chandan Khandai, M.D., is a consultation-liaison psychiatry attending at UT Southwestern Medical Center and a member of APA’s Committee on Consultation-Liaison Psychiatry.Josie Francois, M.D., is a first-year psychiatry resident at Brigham and Women’s Hospital. ISSUES NewArchived