Psychiatry Physicians Research Articles

Improving Patient Experience by Understanding Barriers and Incentives to Telehealth Adoption Among Physicians at a Large Academic Medical Center.

Patients benefit from and appreciate the option to use telehealth with their providers. Such patient expectations have therefore led to new questions about the factors that affect providers' willingness to adopt telehealth as part of their clinical practice. We interviewed 19 physicians across four specialties with differential rates of telehealth use (Psychiatry, Anesthesiology, Physical Medicine & Rehabilitation [PM&R], and Ophthalmology) to discern the barriers and incentives to telehealth adoption among physicians. We then conducted a qualitative analysis of interview transcripts, following precepts of Directed Content Analysis. Conclusions drawn from matrix building and thematic analysis were verified with negative evidence searches and if-then tests. Robust investigations for outliers and rival explanations in responses were used to disconfirm findings. The results of this analysis revealed distinct barriers and incentives to telehealth adoption for the four specialties. Physicians in psychiatry and anesthesiology are refining the strengths and applications of telehealth based on the characteristic needs of their specialties. Physicians in PM&R and ophthalmology face additional barriers to acquiring physical exam data, leading them to use telehealth as a supplement to, rather than as a replacement for, core functions of patient care. The insights stemming from these barriers and incentives can be used to build thoughtful telehealth applications for physicians, allowing them to provide effective clinical care while also improving the patient experience.

Prevalence and Correlates of Poor Sleep Quality Among Psychiatry Physicians in Saudi Arabia: A Cross-Sectional Study.

Sleep issues pose a significant burden to public health and well-being in Saudi Arabia. However, research evidence on sleep health among psychiatry physicians in this territory is limited. Therefore, to bridge the research gap, this study was designed to assess the prevalence and predictors of poor sleep quality among psychiatry physicians in the country. This cross-sectional study included 554 psychiatry physicians in Saudi Arabia from March to August 2023. Data were collected via online through a structured questionnaire (Google survey form). Sleep quality, the outcome variable of our study, was evaluated with the Pittsburgh Sleep Quality Index (PSQI; 19 items). Independent variables included sociodemographic and behavioral characteristics, sleep habits, major depression (assessed with Patient Health Questionnaire-9), and anxiety (measured with Generalized Anxiety Disorder-7) symptoms. Binary logistic regression analysis was performed to identify the correlates of poor sleep quality. Based on the PSQI, 61.3% of the study participants had poor-quality sleep (age range: 24-56 years, male: 48.0%). The adjusted model revealed that male participants (AOR = 2.80, 95% CI = 1.70-4.61) and those who had on-call duties ≥ 2 times per week (for three/four per week: AOR = 3.41, 95% CI = 1.89-6.14) were at higher risk of developing poor sleep quality compared to their respective counterparts. Participants with depressive symptoms (AOR = 3.46, 95% CI = 1.60-7.48) and smoking habits (AOR = 3.47, 95% CI = 1.32-9.08) had higher odds of developing poor sleep quality than their counterparts. Moreover, participants who always used their smartphone/laptop before going to bed were more likely to have poor sleep quality than those who never used such (AOR = 3.15, 95% CI = 1.31-7.60). Poor sleep quality is extremely prominent among psychiatry physicians in Saudi Arabia. Male sex, higher on-call duty, smoking habits, depression, and smartphone/laptop use before bedtime were significantly associated with poor sleep quality. These findings emphasize the need for sleep-health promotion interventions for Saudi psychiatry physicians.

Knowledge Gaps Identified in a Survey of Maine Physicians' Firearm Safety Counseling Practices.

Numerous medical associations have identified firearm injuries as a public health issue, calling on physicians to provide firearm safety counseling. Data suggest that while many physicians agree with this, few routinely screen and provide counseling. We aimed to survey Maine physicians to assess their current firearm safety counseling practices and knowledge of a new state child access prevention (CAP) law. We conducted an anonymous cross-sectional survey of Maine primary care and psychiatry physicians. We recruited multiple statewide medical organizations, residency programs, and two major health systems to distribute the survey to their membership. Group differences were compared by physician rurality and years in practice using Fisher's Exact and Chi Squared tests. Ninety-five surveys were completed. Though most participants agreed that firearm injury is an important public health issue that physicians can positively affect (92%), few had received prior firearm safety counseling education (27%). There were significant differences in firearm screening frequency, with rural physicians screening more often. More rural physicians and physicians with > 10 years of clinical practice felt they had adequate knowledge to provide meaningful counseling, compared with non-rural and early career physicians, respectively. Overall, 62% of participants were unaware of the 2021 Maine CAP law. This study highlights significant differences in firearm safety counseling practices among Maine physicians based on rurality and years of experience. Participants also reported a significant gap in knowledge of a recent state child access prevention law. Next steps include development of firearm safety counseling education tailored to Maine physicians.

A Longitudinal Correlational Study of Psychological Resilience, Depression Disorder, and Brain Functional–Structural Hybrid Connectome in Breast Cancer

Purposes: To evaluate the association between psychological resilience, depression disorder (DD), and brain functional–structural hybrid connectome in patients with breast cancer before treatment (T0) and at 1 year.Methods: Between February 2017 and October 2019, 172 patients were longitudinally enrolled from a multicenter trial named as Be Resilient to Breast Cancer (BRBC) and completed resting‐state functional magnetic resonance imaging (rs‐fMRI) and diffusion tensor imaging (DTI) before the T0. Data‐driven multivoxel pattern analysis (MVPA) and correlational tractography (CT) were performed to identify distinct functional‐structural hybrid connectome. DD was diagnosed by psychiatry physicians according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5). Psychological resilience was collected by Resilience Scale Specific to Cancer (RS‐SC) and tested as the mediation variable between hybrid connectome and DD.Results: Of the total sample of 172, 14.5% (N = 25) were diagnosed with DD. High psychological resilience was associated with a lower risk of DD (hazard ratio (HR) = 0.37, 95% confidence interval (CI), 0.17–0.82, p = 0.0368). Frontal pole right (88.0%) in rs‐fMRI and arcuate fasciculus_L (75.2%) in DTI were identified as main significant brain areas. Psychological resilience accounted for 10.01%–12.14% of direct effect between brain functional–structural hybrid connectome and 1‐year DD.Conclusion: Psychological resilience predicts DD at 1 year and mediates the association between brain functional–structural hybrid connectome and DD at 1 year in patients diagnosed with breast cancer.Trial Registration: ClinicalTrials.gov identifier: NCT03026374

2.126 Developing a Model Curriculum to Improve De-Escalation Skills of Child and Adolescent Psychiatry Physicians in Training

Many studies have examined the effectiveness of de-escalation training in reducing the use of seclusion and restraint in adult inpatient psychiatry settings, but few have published their training materials or adapted these techniques to child and adolescent populations. This project applies de-escalation techniques to child and adolescent patients and creates a model curriculum accessible to residency and fellowship programs across the nation.

Psychiatry\u2019s role in the prevention of post-intensive care mental health impairment: stakeholder survey

BackgroundMany critical illness survivors experience new or worsening mental health impairments. Psychiatry consultation services can provide a critical role in identifying, addressing, and preventing mental health challenges during and after admission to the acute medical care setting. However, psychiatry involvement in the ICU setting is lower than in other hospital settings and the conventional process in many hospitals requires other care providers to request consultation by psychiatry. Despite these differences, no studies have sought ICU provider perspectives on psychiatry consultation’s current and desired role. We aimed to obtain stakeholder feedback on psychiatry’s current and desired roles in the ICU, and potential benefits and drawbacks of increasing psychiatry’s presence.MethodsA web-based survey obtained perspectives from 373 critical care physicians and advance practice providers, bedside nurses, physical and occupational therapists, pharmacists, and consultation-liaison psychiatry physicians and advance practice providers at a tertiary care center using multiple choice and open-ended questions. Descriptive information and content analysis of qualitative data provided information on stakeholder perspectives.ResultsPsychiatry’s primary current role was seen as assistance with management of mental health issues (38%) and suicide risk assessments (23%). 46% wished for psychiatry’s increased involvement in the ICU. Perceived benefits of increased psychiatry presence in the ICU included early psychological support in parallel with medical care, identification of psychiatric factors impacting treatment, and facilitation of family understanding of the patient’s mental state/delirium. An additional perceived benefit included reduction in provider burnout through processing difficult situations and decreasing family psychological distress. However, one concern included potential conflict among providers regarding treatment.ConclusionsThose who work closely with the critically ill patients think that increased psychological support in the ICU would be beneficial. By contrast, psychiatry’s current involvement is seen to be limited, perhaps driven by varying perceptions of what psychiatry’s role is or should be.

Comparison of emergency department and psychiatry physicians’ views on decision-making capacity cases in the grey zone (eng)

Comparison of emergency department and psychiatry physicians’ views on decision-making capacity cases in the grey zone (eng)

The Effect of Sertraline on Oxidative Stress in Patients with Depression

Background: There is effect of sertraline on oxidative stress in patients with depression. Objective: To assess the oxidative stress and total antioxidant capacity in patients with depression, and evaluate the effect of antidepressant (sertraline) on the oxidative stress and total antioxidant status. Design: comparative case-series study. Setting: The study was conducted in consultatory clinic outpatient departments of psychiatry physicians. Methodology: The study period between Nov.1st, 2020 and April.1st, 2021. Thirty female patients newly diagnosed with depression and thirty, sex and age-matched healthy volunteers as control group were participated in the study. Malondialdehyde (MDA) and total antioxidant status (T-AOC) were measured control group and also measured in patients with depression before and after taking sertraline therapy for two months duration. Results: Depressed patients have higher MDA values than that of the control group (9.191 ± 2.796 and 3.21 ± 0.94 nmol/ml respectively) (P-value = 0.001) and lower level of T-AOC (9.44 ± 3.210 U/ml) in depressed patients than that of control group (11.26 ± 2.98 U/ml) P-value = 0.027) MDA values of newly diagnosed patients(9.191 ± 2.796 nmol/ml) were significantly higher than that of patients taking sertraline treatment for 2 months (6.123 ± 1.889 nmol/ml) (p<0.001). The T-AOC values of newly diagnosed patients (9.444 ± 3.210 U/ml) were significantly lower than that of patients taking sertraline treatment for 2 months (10.142 ± 2.362 U/ml) (p<0.122). Conclusion: The present study demonstrated that depressed patients have increased level of malondialdehyde and decreased level of total antioxidants capacity than the control group while depressed patients treated with sertraline for two months have decreased level of MDA and increased levels of T-AOC than their levels before treatment. This result may give a new insight that sertraline may exhibit its effect in the management of depression by acting as an antioxidant. Keywords: Depression, Oxidative Stress, Sertraline.

Physicians\u2019 attitudes to disability pension \u2013 impact of diagnosis: an experimental study

BackgroundThe purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis. We hypothesize that physicians are more likely to think that patients with physical illnesses should get a disability pension than those with mental illness or alcohol dependence. Disability pension is an important source of income for those unable to work because of a disability and type of diagnosis should not impact accessing these benefits.MethodsWe conducted an experiment with a 2 by 3 factorial structure in Sweden. Each physician was randomly assigned one of six patient vignettes, with the same background description but with a different diagnosis. Each vignette had a diagnosis of either depression, alcohol dependence or low back pain, and was about a man or a woman. Logistic regression was used to examine the odds of a physician reporting that a patient should get a disability pension. Effects are reported in terms of odds ratios (ORs).Results1414 Swedish registered physicians in psychiatry or general practice (24% response rate) completed the survey. Physicians assigned the alcohol dependent vignette had OR 0.45 (95% CI: 0.34 to 0.60) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette. Physicians assigned the depression vignette had OR 1.89 (95% CI: 1.42 to 2.50) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette.ConclusionThe patient diagnosis was associated with the physicians’ response regarding if the patient should get a disability pension. A physician’s perception is likely to impact a patient’s access to disability pension.

International Medical Graduate Resident Physicians in Psychiatry: Decreasing Numbers, Geographic Variation, Community Correlations, and Implications.

The number of International Medical Graduate (IMG) physicians matching into categorical psychiatry decreased steadily over the past decade. The authors sought to understand if this trend was occurring in other specialties, if US IMG physicians and non-US IMG physicians were equally affected, and if certain regions of the USA were more affected by this decrease than others. Finally, the authors compared the proportion of foreign-born individuals within a US census region to the proportion of non-US IMG physicians within that region. The authors analyzed data from the National Resident Matching Program from the years 2014-2020. Statewide data was aggregated into nine geographic regions, as per the US Census Bureau. The number of foreign-born individuals within each US census region was calculated from the 2018 American Community Survey data. In comparison to eight other specialties, psychiatry saw the greatest decrease (46.3%) in IMG physicians matching into PGY-1 positions. Both US IMG physicians and non-US IMG physicians were equally affected. The percentage of IMG physicians decreased in each of the nine US census regions. In six out of nine geographic regions, non-US IMG physicians were under-represented when comparing their proportion to the number of foreign-born people that lived within that region. Decreasing numbers of IMG physicians in psychiatry training may have long-term implications for cultural competency, serving underserved populations, and fellowship recruitment. We advocate for program directors to recognize IMG physicians as an important source of diversity and to recruit residents that reflect the communities they serve.

Estimation of the Development of Depression and PTSD in Children Exposed to Sexual Abuse and Development of Decision Support Systems by Using Artificial Intelligence

ABSTRACT The most common diagnoses after childhood sexual abuse are Post-Traumatic Stress Disorder and depression. The aim of this study is to design a decision support system to help psychiatry physicians in the treatment of childhood sexual abuse. Computer aided decision support system (CADSS) based on ANN, which predicts the development of PTSD and Major Depressive Disorder, using different parameters of the act of abuse and patients was designed. The data of 149 girls and 21 boys who were victims of sexual abuse were included in the study. In the designed CADDS, the gender of the victim, the type of sexual abuse, the age of exposure, the duration until reporting, the time of abuse, the proximity of the abuser to the victim, number of sexual abuse, whether the child is exposed to threats and violence during the abuse, the person who reported the event, and the intelligence level of the victim are used as input parameters. The average accuracy values for all three designed systems were calculated as 99.2%. It has been shown that the system designed by using these data can be used safely in the psychiatric assessment process, in order to differentiate psychiatric diagnoses in the early post-abuse period.

Inpatient Child and Adolescent Psychiatry as an Extracurricular Venue for Medical Student and Resident Education and Professional Development: Story Time and Teen Talk.

Comparatively little systematic data exists concerning medical student education from the inpatient child and adolescent psychiatry venue. Training in this venue is vulnerable to pressures including increasingly reduced lengths of stay and greater emphasis on clinical productivity. An extracurricular psychosocial opportunity during evening hours may be a productive means through which to provide meaningful patient exposure, training, and mentorship to trainees. We sought to evaluate the impact upon student beliefs and attitudes through participation in an initiative titled "Story Time and Teen Talk." Under the direct supervision of postgraduate resident physicians in psychiatry, students read fairy tales and children's literature to children and conducted group discussions with adolescents during weekly held evening hours. Students were invited to complete a 15-item questionnaire that surveyed the impact of their participation on their beliefs and attitudes concerning general medical education and patient care, the field of psychiatry, and training in child and adolescent psychiatry. A subset of students underwent a semi-structured interview which was evaluated via grounded theory analysis to determine qualitative themes related to impact of program participation. Thirty students (N = 30) completed the survey and five students (N = 5) completed the interview. The majority of students reported strongly agreeing or agreeing that participation impacted their attitudes and beliefs about general medical education and patient care in twelve of the thirteen assayed items. Themes from qualitative analysis supported these findings. Extracurricular opportunities may be a productive venue for graduate medical education and, specifically, child and adolescent psychiatry.

A study on how basic psychotherapy training is perceived by Swedish physicians in psychiatry

ABSTRACT In Sweden, physicians training to be psychiatrists must complete a basic course in psychotherapy. This study investigated the perceptions of this course by 18 physicians who completed a basic course in psychotherapy. All participants answered a paper-and-pencil questionnaire and four were also interviewed. The results show that most physicians were satisfied with the course, especially with its focus on different psychotherapeutic perspective that gave them the opportunity to train in both cognitive behavioural therapy and psychodynamic therapy. Continuing to offer physicians high-quality psychotherapy training, especially one that encourages knowledge of several theories and methods that will later be useful in clinical practice as a psychiatrist, will benefit future psychiatrists and their patients.

Issues In Pharmacogenetic Testing

In pharmacogenomics the amount of information from DNA studies of cohorts and clinical trials is growing rapidly. This large amount of data creates challenges in terms of how to wrangle the genomic and phenotypic (response) variables and perform the most appropriate analyses. The main phenotypic target is the inter-individual differences in response and side effects to antidepressant and antipsychotic medications. Our psychiatric pharmacogenetics study based in Toronto and across the province of Ontario (www.IM-PACT.ca; n=9,000 patients tested) has shown that the vast majority of physicians found our user-friendly genetic report to be easy to understand. We have surveyed over 200 psychiatrists and 100 family practitioners and over 90% believe that pharmacogenetics testing will become standard of care for medication treatment in psychiatry in the future. A practical question from regulatory authorities is: Are physicians able to efficiently translate complex genetic information into clinical decision-making? Our survey and results show that primary care and psychiatry physicians report no significant difficulty in ordering and interpreting the pharmacogenetic test. A particular challenge in psychiatry is that current medications are largely selected by trial and error. For example, the physician is forced to choose between risk for weight gain and diabetes with the newer generation drugs versus the risk of tardive dyskinesia and other motor side effects with first generation antipsychotics. We have developed a model of seven genes (melanocortin-4 receptor, serotonin 2C, neuropeptide Y, CNR1, GCG, HCRTR) that predicts 67% of the variance in risk for this weight gain (Tiwari et al, 2015). Regarding the imperfect success of antidepressant treatment, there are now several replicated studies showing significant benefit of genetic panel guidance of medication selection over treatment as usual (Altar et al, 2015). Genes tested include CYP2D6, CYP2C19, CYP1A2, CYP3A4, 5HT2A, and 5HTTLPR. Our Toronto study has shown a significant reduction (30%, p < 0.002) in BDI depression scores during 8 weeks of follow-up, in patients who are on a genetically appropriate medication as opposed to those who are not. In addition to significant clinical improvement and increased tolerability, there is also reduction in health care costs when genetic guidance is used in antidepressant treatment. While these findings are encouraging for the wider clinical application of pharmacogenetic testing, much more work needs to be done, including surveying the patients to determine if they have concerns regarding the collection, reporting, and storage of their genetic information.

Evaluation of empathy and biopsychosocial approaches of medical faculty assistant doctors.

INTRODUCTION AND AIM:Biopsychosocial approach suggests that the individual's health condition is partly influenced by the interactions of biological, psychological, and social processes. It also concludes that the clinical method should be patient-centered, which is based on the physician's involvement in the patient's world and the physician's ability to see the illness from the patient's view. In this study, we aimed to determine the extent to which medical faculty assistant doctors use the biopsychosocial approach in their clinical practice.MATERIALS AND METHODS:Our study is a cross-sectional type, descriptive, and analytical research. The sample size consisted of assistant doctors who met the inclusion criteria which were accepted to participate in the study between December 1, 2017, and March 1, 2018, at the medical faculty hospital of Dicle University. Two hundred and three physicians participated in our study. The Patient–Physician Orientation Scale (PPOS), The Jefferson Scale of Physician Empathy (JSPE), and a survey study including questions in relation with sociodemographic characteristics were conducted in our study. The reliability of the Patient–Physician Orientation Scale (PPOS) and JSPE used in our study was tested with Cronbach's alpha and found to be 0.878 and 0.931, respectively. Questionnaires were administered by a face-to-face interview method during interview. Information on the purpose and method of the study was given.RESULTS:A total of 203 physicians participated in our study. One hundred and forty-three (70%) participants were male and 60 (30%) were female. According to medical disciplines, eight physicians (3, 9%) from psychiatry, 21 (10, 3%) from family medicine, 104 (51, 2%) from other internal medical disciplines, and 70 (34, 5%) from surgical medical disciplines participated in the study. In the first subgroup of the PPOS, which is used in our study, the average score of psychiatry physicians was 3.67 ± 0.99, family medicine assistant doctors 3.92 ± 0.67, other internal medical disciplines 3.98 ± 0.65, and surgical medical discipline 3.83 ± 0.61. In the second subgroup, which is defined as the care in the same scale, the average score of psychiatry assistant doctors was found to be 3.20 ± 0.45, family medicine assistant doctors 3.68 ± 0.54, other internal medical disciplines 3.49 ± 0.60, and surgical medical discipline 3.68 ± 0.58. The results of the Jefferson Scale used to determine the level of empathy in our study are found as psychiatry 78.25 ± 14.78, family physician 67.71 ± 14.69, other internal medical disciplines 72.03 ± 13.46, and surgical medical discipline 70.87 ± 15.24.CONCLUSIONS:The biopsychosocial approach is primarily an elementary approach model in medical discipline such as family medicine and should be applied to other internal and surgical medical disciplines as well. With conducting this study, the awareness of this area will be increased and related issues in the literature will be enriched.

Why psychiatry as a career: Effect of factors on medical students' motivation.

Context:The number of Saudi psychiatrists in Saudi Arabia is not sufficient to keep up with the increasing need.[1] Approximately out of 6873 physicians, only 148 are psychiatrists, which is barely 2.1%.[2] Despite the high number of medical students graduating each year and the high demand for psychiatry physicians, only few medical graduates choose psychiatry as a career option.[3]Aims:To investigate the profile of final year medical students of both sexes at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. In terms of their decisions regarding specialization, this study aimed to identify the motivators and deterrents that impact the choice of psychiatry as specialty.Subjects and Methods:Students filled in a self-reported questionnaire focusing on the several factors that act as motivators, deterrents, or have no impact on psychiatry career choice.Statistical Analysis Used:Statistical analysis was done using Statistical Package for Social Sciences (SPSS)® version 20. Different factors were expressed in terms of numbers and percentages. Chi-square test was used to compare responses to the questionnaire between male and female students and whether the GPA had an effect on their choice. P value less than 0.05 was considered significant.Results:It was noted that 85% did not choose psychiatry, with the most important deterrent being “Family member is psychologically ill” and “Available job position” being the most common motivator for choosing a specialty.Conclusion:In conclusion, there are many factors that play an important role in career choice. No difference was found among male and female students, and no effect was identified while comparing GPA with career choice.

Survey of physician attitudes towards psychogenic nonepileptic seizures and driving

BackgroundPhysicians from various disciplines encounter patients presenting with psychogenic nonepileptic seizures (PNES) as part of their routine clinical practice. Recommendations towards assessing fitness to drive and reporting are clearer for conditions such as neurocognitive disorders and epilepsy, but such guidelines do not exist for patients with PNES. Here, we assess physicians' attitudes towards driving for patients diagnosed with PNES. MethodsElectronic questionnaires were sent to Neurology and Family Medicine physicians practicing at Creighton University Medical Center and Psychiatry physicians practicing at Creighton-Nebraska Psychiatry Residency Program to assess their opinion regarding driving risk when encountering PNES. ResultsThe survey request was sent to 125 physicians, of which close to 60% completed the survey. Eighty-eight percent of participants encountered PNES in their clinical practice, and 69.1% agreed it was a difficult problem to assess, with only 8.3% endorsing a belief that these patients should drive without restrictions. Ninety-three percent felt having guidelines would help them assess the driving risk in this population. ConclusionPsychogenic nonepileptic seizures are common across neurology, psychiatry, and primary care, and most physicians find assessing driving risk in such individuals highly warranted yet difficult. Developing such assessment guidelines and recommendations is of great need for clinicians.

Improving suicide risk assessment in the emergency department through physician education and a suicide risk assessment prompt.

To determine the efficacy of two interventions on suicide risk assessment within emergency departments (EDs) on improving the documentation of suicide risk factors by emergency medicine and psychiatric physicians during suicide risk assessment. An educational intervention on suicide was provided to all emergency medicine and psychiatry physicians and was followed by the placement of a suicide risk assessment prompt within local EDs. The medical charts of all ED patients presenting with suicidal ideation or behaviours were reviewed immediately and six months after the interventions and compared to pre-intervention. Differences in the documentation of 40 biopsychosocial suicide risk factors between specialties and after the interventions were determined. The documentation of 34/40 (p ≤ 0.008) and 33/40 (p ≤ 0.009) suicide risk factors was significantly improved by emergency medicine and psychiatry physicians, respectively, after the interventions and maintained six months later. Immediately and six months after the interventions, the documentation of 8/40 (p ≤ 0.041) and 14/40 (p ≤ 0.048) suicide risk factors, respectively, significantly differed between specialties. This suggests that providing a brief educational intervention on suicide to emergency medicine and psychiatry physicians followed by placing a prompt for important, yet commonly undocumented risk factors within the ED is a low-cost and effective intervention for improving documentation of suicide risk assessments within the ED.

Serviço de avaliação de sintomas cognitivos e prevenção de demência: o programa "cuide da sua memória do CECOM-UNICAMP"

Atualmente, verifica-se aumento significativo na prevalência de demência, causada pela doença de Alzheimer (DA) e outros transtornos neurocognitivos, patologias progressivas, irreversíveis e sem tratamentos curativos. Sendo assim, o foco dos estudos recentes está na identificação de pessoas com alto risco para demência, possibilitando diagnóstico e tratamento precoces com propósito de prevenir e/ou retardar a instalação de demência. O programa “Cuide da sua Memória” do CECOM-UNICAMP oferece à população universitária avaliação de queixas de memória ou outros domínios cognitivos, com objetivo de identificar, acompanhar e tratar indivíduos com condições pré-demenciais, prevenindo o avanço da perda cognitiva e a conversão para demência. As ações do programa são: educação da população, consultas multidisciplinares de diagnóstico e acompanhamento, tratamento com estimulação cognitiva multimodal em grupo, treinamento de outros profissionais e produção científica. O programa conta com médicos especialistas, psicólogos e equipe de enfermagem treinados em saúde cognitiva. Após aproximadamente 1 ano de trabalho, foram realizadas palestras unidades do campus de Campinas e de Limeira, cerca de 200 pacientes foram avaliados e a maioria está em seguimento semestral, a cada 10 semanas novos grupos de estimulação cognitiva são abertos, são oferecidos estágios anuais para dois médicos residentes de Psiquiatria Geriátrica e um psicólogo e foi estruturado um grupo de pesquisa sobre condições pré-demenciais com cinco projetos de pós-graduação. Entende-se que esse programa pode servir de modelo para estruturação de outros serviços públicos e privados de atenção à saúde cognitiva com foco na prevenção de demência.

New synthetic cannabinoid intoxications in emergency department (It's grass, Its no sin)

Objective: The aim of this study is to evaluate prognosis and clinical futures of the subjects who use new synthetic cannabinoid products (SCPs) with Poisoning Severity Score (PSS) in the Emergency Department (ED). Methods: We retrospectively reviewed 272 cases which resorted, to our ED between 2012 and 2014. All patients’ clinical, laboratory levels and the PSS were studied. Results: The average age of the subjects was 25.1±7.1 years and 97.4% of them were male. 44.1% of all SCPs patients came to hospital during Ramadan. Of the 272 patients using SCPs, 83.5% used Bonsai-18 while 16.2% of them used Jamaica gold. Agitation was the most common psychoactive finding while dizziness was the most common physical finding. The most common symptoms and findings were seen in the gastrointestinal system. Most of the patients were found to be in the moderate PSS group. There was no patient in the non PSS group. While one patient in the fatal PSS group died in the 96th hour due to failure of multiple organs, the others had been discharged. Conclusion: SCPs cases have been increasing gradually in EDs including Ramadan. Our study has shown that SCPs have different physical and psychoactive effects, changeable from minor-PSS to fatal PSS (death). Therefore ED and psychiatry physicians should have much more knowledge about these new SCPs.