Consultation-liaison Psychiatry 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.

Annual Meeting Content Analysis: Leveraging Annual Meetings to Promote Diversity, Equity, Inclusion, and Belonging in the Academy of Consultation-Liaison Psychiatry

BackgroundThere is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education (CME). Although professional medical organizations' annual meetings play an instrumental role in CME for physicians, there are no studies describing DEI content in the annual meeting programming of professional medical organizations, including the Academy of Consultation-Liaison Psychiatry (ACLP), the primary professional organization for Consultation-Liaison (C-L) psychiatrists. MethodsWe examined the publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. National DEI leaders from ACLP’s DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting content was independently coded by two members of the DEI subcommittee with discrepancies adjudicated by two additional members. Descriptive statistics were used to characterize the annual meeting content. ResultsOf the 2615 annual meeting titles from 2010-2021 which were analyzed, 2531 were not coded to have DEI themes. 3% (n=84) of titles were coded to have a DEI theme as follows: Culture/Diversity (n=20, 24%), Bias/Disparities (n=17, 20%), Race/Racism (n=17, 20%), Social Justice (n=12, 14%), Gender/Sexism (n=10, 12%), and LGBTQ+ (n=8, 10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021) with an increase in DEI content in 2021 (n=24, 17%). ConclusionAlthough professional medical organizations like the ACLP are poised to leverage their CME platforms embedded in annual meeting programming to train CL psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI focused educational programming for their annual meetings.

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.

Catatonia in Preadolescent Children.

The aim of the study is to describe prepubescent catatonia in very young children, which is poorly documented in the current literature and, as a result, overlooked in medical settings. We examined a convenience sample of 10 patients at an academic center who were younger than 12 years and met criteria for catatonia. After institutional review board approval, we extracted from the electronic medical records demographic and diagnostic information, comorbidity, developmental history, and laboratory testing. Bush Francis Catatonia Rating Scales at initial presentation and other symptomatology were gathered in addition to treatment received. Fifty percent of patients in this group were seen and diagnosed with catatonia at their presentation in an outpatient clinic, whereas the remaining 50% were diagnosed upon hospitalization, by the psychiatry consultation liaison team. All patients but one was diagnosed with a comorbid condition before the diagnosis of catatonia, including 70% with a previous diagnosis of autism spectrum disorder. Three patients had concurrent anti-N-methyl-D-aspartate receptor encephalitis, and one initially presented with seizures. All patients were treated for catatonia with lorazepam, and two patients additionally received electroconvulsive therapy. Regardless of the presence of early regression invariably associated with an autism spectrum diagnosis, secondary symptoms of regression were noted in each case at the time of diagnosing catatonia. Similar to previous observations in adolescents, prepubescent catatonia seems strongly associated with neurodevelopmental disorders, secondary regression, variability in presentation, and comorbidity with other neurological conditions. Delayed recognition of catatonia can hinder rapid and effective treatment in young children.

Diagnostic concordance in consultation liaison psychiatry – Referring physicians to psychiatrists

Psychiatric co-morbidity in patients with physical illness is known to influence the course and outcome of both conditions. Consultation liaison psychiatry [CLP] can be regarded as an essential service between psychiatry and other medical specialties. Efficient communication between different levels of care is known to have an impact on the quality of health care. To study the patterns of referrals to the department of psychiatry and diagnostic concordance between referring physicians to CL-Psychiatrist.The present study was a cross-sectional study conducted in the Department of Psychiatry of a tertiary care hospital. All the patients referred to the Psychiatry department for 4 months were taken after excluding referrals sent for disability assessment. Socio-demographic details, source of referral, reason for referral, and the psychiatric diagnosis by both the referring doctor and CL-psychiatrist were recorded. Statistical analysis was done using SPSS 25.0 software and kappa value was used to estimate the diagnostic concordance.In the sample of 100 referrals studied, the mean age of the sample was 40.96±13.42 years. The majority of the cases referred were inpatients (61%), from the department of general medicine and allied branches (85%), (General medicine -55, Neurology- 21). The most common diagnosis was alcohol dependence syndrome 24 (24%), followed by depression (18%) and phobic anxiety (18%).The concordance of the diagnosis between the referral and the psychiatry team was in perfect agreement (κ=0.81- 1.00) for paranoid schizophrenia, bipolar affective disorder, delirium, dissociative disorder, delusional disorder, and alcohol dependence syndrome. Very low concordance was observed in diagnosing obsessive-compulsive disorder (k=0) and adjustment disorder (k=0).The overall diagnostic concordance was poor for adjustment disorder, OCD, and vascular dementia, and good for paranoid schizophrenia, delirium, dissociative disorder, delusional disorder, and BPAD.

The Guard, His Gauntlet and Goblet- An Atypical Presentation of Pellagra in a Chronic Alcoholic

Alcoholism a chronic condition affects multiple organ systems including skin. Dermatological markers of alcohol abuse are invaluable. Despite this, association of skin diseases and alcohol misuse maybe overlooked or physicians fail to explore. Pellagra is a multifactorial disease caused by Niacin/Tryptophan deficiency. It exhibits photodermatitis, gastrointestinal and neuropsychiatric manifestations. Chronic alcoholics are at risk. Considering pellagra as differential diagnosis in chronic alcoholics with these symptoms is crucial. This disease is easily treatable but if missed proves fatal. Hence, its recognition is important in other clinical settings for comprehensive treatment. The pathognomonic presentation of Pellagra is the Casal necklace, but here we present a case of 34year old alcoholic with an atypical presentation of Pellagra. Chronic alcoholics need evaluation for Pellagra amongst other nutritional deficiencies which due to diverse presentation can be missed. Early diagnosis and treatment can avoid impending neuropsychiatric complications. Due to participation of numerous disciplines consultation liaison psychiatry is vital here. Keywords: Alcohol dependence, Alcohol cutaneous manifestations, Pellagra, Niacin deficiency, Alcohol biomarkers

P41: Valladolid Multicenter Study: Factors related to time to referral and length of hospital stay in old psychiatry patients in seven general hospitals in Spain

Objective:Older patients (≥65yo) admitted to general hospitals have increased in the past years. This resulted in an increase in hospitalization periods, health costs, and morbi-mortality rates in this group of patients.Previous evidence points that the reduced time to referral (TTR) to Consultation-Liaison Psychiatry Units (CLP) leads to a reduced length of stay (LOS) in GH improving long-term prognosis of medical conditions.This study aims to explore whether a prior disability in older patients leads to delay the search for psychiatric help. And to explore whether early referral to CLP is associated with reduced LOS in general hospitals.Methodology:This is an observational, cross-sectional, multicentre study. We obtained a complete data set from a sample of 152 patients (≥65 years old) admitted to 7 general hospitals in Spain referred to CLP unit for 1,5 months.Results:Mean age of the sample was 76.3 (±6.4). TTR was 14.5 (±18.0) days. LOS was 26.7 (±22.4) days, and length of stay after consultation was 12.3 (±10.3) days. Barthel Index before admission was 87.3 (±18.0) and Lawton&Brody Index before admission was 5.3 (2.7). We found a significant positive association of Barthel Index (r=0.17, p=0.042) and Lawton&Brody Index (r=0.20, p=0.014) before admission with TTR, which indicates that patients with a worse clinical status were attended earlier. Similarly, antecedents of both falling episodes (r=-0.2, p= 0.013) and walking difficulties (r=-0.24, p= 0.003) were associated with shorter TTR. TTR in Medical Departments was 11.7 (±15.0) days and in Surgical Departments was 24.0 (±22.8) days (t=-3.5, p= 0.001). TTR showed a highly significant positive correlation with LOS (r=0.89, p<0.0001) and a more discrete positive correlation with length of stay after consultation (r=0.20, p=0.016).Conclusion:We confirm that a shorter TTR to CLP was related to a shorter LOS. Also, patients in medical wards had shorter TTR. In contrast to our hypothesis, we found that a higher disability prior to hospitalization led to earlier referral to CLP, meaning that these patients were assessed and treated earlier leading to better long- term prognosis and lower health costs.

Ethnoracial disparities in care on a consultation-liaison service at an academic hospital

BackgroundThere is currently an increasing recognition of and focus on structural and institutional racism and its impacts on health disparities. In psychiatry and mental health, research has focused on racial and ethnic disparities in the availability and utilization of mental health services, care in emergency departments, and inpatient psychiatric services. Little is known about disparities in care on general hospital psychiatry consultation-liaison (CL) services. MethodsIn this exploratory study, we conducted a retrospective chart review using electronic health record (EHR) data of all adults (≥ 18 years of age) admitted to inpatient medical or surgical floors at an urban academic medical center for whom a psychiatric consultation was requested during the study period. We examined differences by race and ethnicity in: rates of consultation requests; use of legal holds, constant observation, restraints; follow-up by the CL service; and ultimate disposition. ResultsThe service received 310 unique consults during the study period. Compared to hospital-wide numbers, Black-identifying patients were over-represented in our sample (11.9% vs 6.6%), while Latinx patients were underrepresented (6.1% vs 9.8%). Of the clinical and outcome variables collected, there were higher odds of being placed on a legal hold both prior to (OR 2.6) and after the consult question (OR 2.98) and in the odds of having a one-to-one observer prior to (OR 2.47) and after (OR 2.9) the initial consult visit for Black-identifying patients, when adjusting for confounders. There were no other measurable differences in care or outcomes by racial or ethnic categories. ConclusionBlack-identifying patients may be more likely to receive psychiatric consultation and be placed on legal holds because of a combination of chronic adverse social determinants of health and race-based bias. Conversely, Latinx patients may be less likely to receive psychiatric consultation because of language barriers among other factors. The lack of disparities identified in other domains may be encouraging, but larger studies are needed. Further research is also needed to identify causality and interventions that could help close the gap in care and outcomes for racial and ethnic minorities.

Pediatric Consultation-Liaison (C-L) Psychiatry Training Pathways

This perspective piece reviews the current training pathways for pediatric consultation-liaison psychiatry. Significant workforce shortages of child and adolescent psychiatry over the past 3decades have led to the creation of new training pathways between pediatrics and child and adolescent psychiatry training programs to care for children whose medical and psychiatric management has become increasingly complex. There are now several options available to receive excellent training in pediatric consultation-liaison. Efforts to foster continued interactions and shared education between adult and pediatric consultation-liaison providers are likely to be beneficial to both disciplines given the astonishing advances in technology over the years that have allowed many patients with complex childhood medical disorders to survive into adulthood today.

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.

Women's lived experience of endometriosis-related fertility issues.

The aim of the present study is to conduct a qualitative investigation to provide a deeper understanding of women's views about endometriosis, fertility and their perception of reproductive options. Semi-structured interviews were conducted by two female psychiatrists, specialized in gynecology and obstetrical consultation-liaison psychiatry, trained in qualitative procedures, with experience in qualitative studies and in psychological support of women attending infertility consultations. No prior relationship with respondents was established before data collection. Interviews were tape-recorded and transcribed. Interviews lasted 45-75 minutes. The transcripts were then analysed using thematic content analysis. Twenty-nine women were contacted. Twelve agreed to an interview at the hospital's infertility clinic. Eleven women with diverse sociodemographic characteristics were included. The key findings of thematic content analysis can be grouped into four topics: (1) Diagnostic announcement and initial delay; (2) Negative perceptions of initial care: pre-diagnosis phase; (3) Struggle with endometriosis and its treatment; (4) Issues related to health problems, fertility and reproductive options. Our analysis of the interviews corroborates the distressing impact of the trivialization of pain and the uncertainty of or the long quest for diagnosis. The findings also stress various associated issues, from the diagnostic delay to the low success rates of fertility treatments. This qualitative analysis contributes to better understand the accumulation of negative emotions within the illness trajectory and the poor dyadic adjustment within the couple.

Pattern of psychiatric referral in a tertiary care hospital

Introduction: Global mental health challenges persist amidst a rising trend of patients seeking consultations with non-psychiatric specialists, driven by stigma and a lack of awareness. This study aims to study the demographic profile of patients referred to the Department of Psychiatry and Mental Health from other departments, referral sources, prevalent psychiatric disorders, and explores potential associations with co-existing physical conditions. Material and Method: A six-month descriptive cross-sectional study (October 2022 to March 2023) was done at Birat Medical College Teaching Hospital using total enumeration sampling method. Patients referred to Psychiatry were assessed using the International Classification of Diseases, Tenth Revision, Diagnostic Criteria for Research (ICD-10 DCR). Data were analyzed with SPSS version 25, utilizing mean, standard deviation for continuous data, and frequency, percentage for categorical data. Odds ratios were computed for associations. Results: Among 160 patients, the majority were male (55%), Hindu (90%), married (78.1%), and educated up to secondary level. Department of Medicine accounted for the highest referrals (50%) primarily for fearfulness (21.3%). Neurotic, stress-related and somatoform disorders were most common (33.1%), followed by mood disorders (28.8%). No significant association was found between psychiatric disorders and physical illnesses. Conclusion: The Department of Medicine was the most common referring department, with neurotic stress-related and somatoform disorders being the prevalent diagnosis. Referral to Psychiatry facilitates early recognition and treatment of undiagnosed psychiatric conditions, advocating for routine practice among non-psychiatric specialists. Future research should target barriers and interventions to improve psychiatric service utilization in Consultation-Liaison Psychiatry settings.

Building Bridges: Collaborative Curriculum Development in Pediatric Consultation-Liaison Psychiatry

Building Bridges: Collaborative Curriculum Development in Pediatric Consultation-Liaison Psychiatry

6.1 Competencies and Training Needs Assessment in Pediatric Consultation-Liaison Psychiatry

6.1 Competencies and Training Needs Assessment in Pediatric Consultation-Liaison Psychiatry

24.4 Update on Gender-Affirming Surgical Care Options: Trends and Updates for the Child and Adolescent Psychiatry Consultation-Liaison Psychiatrist

24.4 Update on Gender-Affirming Surgical Care Options: Trends and Updates for the Child and Adolescent Psychiatry Consultation-Liaison Psychiatrist