Psychiatric Complaints Research Articles

American emergency room wait times for psychiatric conditions from 2019 to 2021

Use of Emergency Departments (EDs) for psychiatric complaints has increased significantly in past decades. The onset of the COVID-19 pandemic saw large shifts in ED usage, with a relative increase in mental health complaints in EDs. This paper will investigate the difference in ED wait times for psychiatric and non-psychiatric complaints over this period. Utilized National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2019 to 2021, for average wait times for psychiatric versus non-psychiatric complaints. Compared the average wait times for psychiatric complaints by region, triage status, and ICD-10 F code. There was no significant difference in the average wait times overall between these conditions (P = 0.57). People with schizophrenia or psychosis had a significantly higher wait time (P = 0.03) compared to mental health symptoms secondary to physiologic conditions. Northeastern American EDs also had prolonged wait times for psychiatric conditions (P < 0.01) Research into factors of prolonged wait times can advise quality improvements such as the implementation of evidence-based triage and workup tools, and directed psychiatric education.

Effects of cognitive training and group psychotherapy on cognitive performance of post COVID-19 patients: an exploratory and non-randomized clinical trial.

Cognitive complaints are common signs of the Post COVID-19 (PC) condition, but the extent and type of cognitive impairment may be heterogeneous. Little is known about neuropsychological treatment options. Preliminary evidence suggests cognitive symptoms may improve with cognitive training and naturally over time. In this clinical trial, we examined whether participation in a weekly group consisting of cognitive training and group psychotherapy is feasible and would exert beneficial effects on cognitive performance in PC and whether improvements were associated with intervention group participation or represented a temporal improvement effect during syndrome progression. 15 PC patients underwent an 8-week intervention. Cognitive performance was assessed before and after each intervention group participation. A control group of 15 PC patients with subjective neurocognitive or psychiatric complaints underwent two cognitive assessments with comparable time intervals without group participation. To attribute changes to the intervention group participation, interaction effects of group participation and time were checked for significance. This is an exploratory, non-randomized, non-blinded controlled clinical trial. Within the intervention group, significant improvements were found for most cognitive measures. However, significant time x group interactions were only detected in some dimensions of verbal memory and visuo-spatial construction skills. Significant time effects were observed for attention, concentration, memory, executive functions, and processing speed. The intervention setting was feasible and rated as helpful and relevant by the patients. Our results suggest that cognitive symptoms of PC patients may improve over time. Patients affected by both neurocognitive impairments and mental disorders benefit from group psychotherapy and neurocognitive training. The present study provides evidence for a better understanding of the dynamic symptomatology of PC and might help to develop further studies addressing possible therapy designs. The main limitations of this exploratory feasibility trial are the small sample size as well as the non-randomized design due to the clinical setting.

124 External Validation of Shah’s Score for Emergency Department Patients Presenting With Psychiatric Chief Complaints

124 External Validation of Shah’s Score for Emergency Department Patients Presenting With Psychiatric Chief Complaints

The Multiple Sclerosis Prodrome in a Retrospective Pediatric Cohort

BackgroundEvidence suggests a prodromal phase in multiple sclerosis (MS), with increased health care use preceding the first demyelinating event (FDE). Although prior studies have explored this in adults, limited data exist for pediatric cases. We aimed to analyze health care utilization and prodromal symptoms in the two years before FDE in patients with pediatric-onset MS (POMS). MethodsFrom 122 patients at the Pediatric Multiple Sclerosis & Demyelinating Diseases Center at Washington University School of Medicine from 2011 to 2021, 37 POMS cases were identified. Of these, 21 with at least two years of records preceding FDE were included. Retrospective analysis covered symptoms and health care utilization in the two-year period before FDE, including ambulatory visits, hospital admissions, and office calls. ResultsPatients showed increased health care utilization in the year preceding FDE (period B; 96 interactions) compared with the prior year (period A; 77 interactions) and an increase in the percentage of neurology-related encounters (P < 0.001). There was an increase in all office calls from period A to period B (P = 0.01). Neurological complaints included headaches (28.6%), visual (19.0%), sensory (14.3%), and balance (14.3%) in the two years before FDE, and 28.6% of patients presented for psychiatric complaints. Common non-neurological complaints included infection, dermatologic, and musculoskeletal issues and injury. ConclusionsOur POMS cohort showed increased health care use before FDE, consistent with population-based data. This study emphasizes diverse symptoms in prodromal POMS, with headaches being the most common neurological symptom in the two-year period before FDE.

Profile and healthcare utilisation patterns of adolescent frequent attenders in Singapore primary care: a retrospective study

ObjectivesFrequent attenders (FAs) visit healthcare settings at higher rates compared with the general population and use disproportionate amounts of healthcare resources. Frequent attendance (FA) has also been associated with greater...

The intersection between menopause and depression: overview of research using animal models.

Menopausal women may experience symptoms of depression, sometimes even progressing clinical depression requiring treatment to improve quality of life. While varying levels of estrogen in perimenopause may contribute to an increased biological vulnerability to mood disturbances, the effectiveness of estrogen replacement therapy (ERT) in the relief of depressive symptoms remains controversial. Menopausal depression has a complex, multifactorial etiology, that has limited the identification of optimal treatment strategies for the management of this psychiatric complaint. Nevertheless, clinical evidence increasingly supports the notion that estrogen exerts neuroprotective effects on brain structures related to mood regulation. Indeed, research using preclinical animal models continues to improve our understanding of menopause and the effectiveness of ERT and other substances at treating depression-like behaviors. However, questions regarding the efficacy of ERT in perimenopause have been raised. These questions may be answered by further investigation using specific animal models of reduced ovarian function. This review compares and discusses the advantages and pitfalls of different models emulating the menopausal stages and their relationship with the onset of depressive-like signs, as well as the efficacy and mechanisms of conventional and novel ERTs in treating depressive-like behavior. Ovariectomized young rats, middle-to-old aged intact rats, and females treated with reprotoxics have all been used as models of menopause, with stages ranging from surgical menopause to perimenopause. Additionally, this manuscript discusses the impact of organistic and therapeutic variables that may improve or reduce the antidepressant response of females to ERT. Findings from these models have revealed the complexity of the dynamic changes occurring in brain function during menopausal transition, reinforcing the idea that the best approach is timely intervention considering the opportunity window, in addition to the careful selection of treatment according to the presence or absence of reproductive tissue. Additionally, data from animal models has yielded evidence to support new promising estrogens that could be considered as ERTs with antidepressant properties and actions in endocrine situations in which traditional ERTs are not effective.

Sleep profiles of different psychiatric traits

Disturbed sleep comes in many forms. While the key role of sleep in mental health is undisputed, our understanding of the type of sleeping problems that manifest in the early stages of psychiatric disorders is limited. A sample without psychiatric diagnoses (N = 440, 341 women, 97 men, 2 non-binaries; Mage = 32.1, SD = 9.4, range 18–77) underwent a comprehensive assessment, evaluating eight sleep features and 13 questionnaires on common psychiatric complaints. Results revealed that traits of affect disorders, generalized anxiety, and ADHD had the worst sleep profiles, while autism disorder, eating disorder, and impulsivity traits showed milder sleep issues. Mania was the only trait associated with an overall better sleep profile. Across traits, insomnia and fatigue dominated and sleep variability was least prominent. These findings provide support for both transdiagnostic and disorder-specific targets for prevention and treatment.

Differentiation between viral and autoimmune limbic encephalitis: a prospective cohort study with development and validation of a diagnostic model.

Distinguishing between viral encephalitis (VE) and autoimmune limbic encephalitis (ALE) presents a clinical challenge due to the overlap in symptoms. We aimed to develop and validate a diagnostic prediction model to differentiate VE and ALE. A prospective observational multicentre cohort study, which continuously enrolled patients diagnosed with either ALE or VE from October 2011 to April 2023. The demographic data, clinical features, and laboratory test results were collected and subjected to logistic regression analyses. The model was displayed as a web-based nomogram and then modified into a scored prediction tool. Model performance was assessed in both derivation and external validation cohorts. A total of 2423 individuals were recruited, and 1001 (496 VE, 505 ALE) patients were included. Based on the derivation cohort (389 VE, 388 ALE), the model was developed with eight variables including age at onset, acuity, fever, headache, nausea/vomiting, psychiatric or memory complaints, status epilepticus, and CSF white blood cell count. The model showed good discrimination and calibration in both derivation (AUC 0.890; 0.868-0.913) and external validation (107 VE, 117 ALE, AUC 0.872; 0.827-0.917) cohorts. The scored prediction tool had a total point that ranged from - 4 to 10 also showing good discrimination and calibration in both derivation (AUC 0.885, 0.863-0.908) and external validation (AUC 0.868, 0.823-0.913) cohorts. The prediction model provides a reliable and user-friendly tool for differentiating between the VE and ALE, which would benefit early diagnosis and appropriate treatment and alleviate economic burdens on both patients and society.

The Tell on Telehealth.

Telehealth in epilepsy care is not new. During the COVID-19 public health emergency, telehealth became more readily used to deliver epilepsy care. However, a summarized guidance of use in caring for people with epilepsy utilizing telehealth is needed. Existing literature was reviewed to provide guidance on various aspects of telehealth. Billing aspects are reviewed. Recommendations and considerations along with benefits and barriers to telehealth are provided. Telehealth can be a preferred delivery route of care for people with epilepsy in specific situations. Examples include psychiatric complaints, medication management, and follow-up visits for noncomplicated epilepsy care. In addition, telehealth is useful for patients who need postoperative visits, are not able to travel, or live in residential facilities. In-person care may be more suitable for patients who are medically complex, have language barriers or difficulty with resource access, hearing impaired, or have neurostimulation devices where remote monitoring or programming options are infeasible. Telehealth care for people with epilepsy can be a useful and important method of care delivery. It should remain an option for providers to use in epilepsy clinical care. It is important for the neurology provider to understand the benefits, billing, and barriers to providing telehealth.

Cannabidiol Compared to Pharmacological Treatment as Usual for Crack Use Disorder: A Feasibility, Preliminary Efficacy, Parallel, Double-Blind, Randomized Clinical Trial

AbstractCannabidiol (CBD) has been studied for substance use disorders treatment due to its anxiolytic effects, for sleep, appetite, reduction of craving, and maintenance of abstinence. The study aims to assess CBD’s feasibility, safety/tolerability, and preliminary efficacy compared to pharmacological treatment as usual for reducing crack use in people with crack use disorder (CUD) and investigate other parameters: adverse events, physical health symptoms, and craving. A double-blind, randomized clinical trial (RCT) with two treatment arms (CBD and control group) was conducted. Ninety participants were randomized and 73 were allocated: 37 control group and 36 CBD group for a 10-week treatment, comparing CBD (600 mg) with three drugs (fluoxetine, valproic acid, and clonazepam). The per-protocol analysis of participants who did not deviate from the study protocol compared the control and CBD treatment groups. Thirty-four completed at least half of the study and 25 finished. Participants attended weekly meetings for the study procedures (e.g., to receive the medication and provide urine for toxicological tests). Inter-group differences were performed with the Mann–Whitney test, the Wilcoxon test for differences intra-group, and Pearson’s Chi-square test or Fisher’s exact test to compare inter-group demographic data. The significance level was 5%. A “veracity index” (VI) was created as counterevidence (questionnaire data vs. the toxicological test result). Medications were considered safe/tolerable. The CBD group presented significantly fewer adverse events compared to the control group [e.g., dizziness (p = 0.001), memory impairment (p = 0.043)], which performed better in the reduction of clinical and psychiatric complaints (p = 0.008). In the intra-group analyses, the CBD group performed better in more parameters than the control group [e.g., reducing crack use (p = 0.016; T0 to T1)]. Data questionnaires were reliable regarding the use/non-use of crack (VI = 0.787). CBD is a safe/tolerable product. The CBD group manifested fewer adverse events than the control group, which had better clinical and psychiatric complaints results. There are some advantages for the CBD group in the intra-group analysis. Drug use self-report methodologies can be reliable. Trial registration details: This study is registered with Universal Trial Number (UTN) code: U1111-1234-0806. Available at https://ensaiosclinicos.gov.br/rg/RBR-4stgs8 (Effect of cannabidiol in the treatment of crack dependents)

26 Avoiding Death From Stimulant Toxicity: Resiliency Among People Who Use Stimulants

OBJECTIVES/GOALS: The project investigates the role that resiliency may play within individual, interpersonal, social, and structural contexts in protecting against acute lethal stimulant (meth/amphetamine or cocaine) toxicity. Identifying preventative factors is crucial in developing and implementing risk reduction strategies for people who use stimulants. METHODS/STUDY POPULATION: This is a qualitative study involving in-depth interviews via questionnaire assessing resiliency factors among persons living in San Francisco who have used primarily either meth/amphetamine or cocaine for at least 5 years. The interviews will be coded for salient and recurrent themes and analyzed for code frequency, cooccurrences, clustering of themes and representative excerpts to highlight emergent themes as well as stressors and resilience factors at multiple levels. We aim to assess for substance use patterns, multiple domains of resiliency, medical and psychiatric complaints, and risk reduction strategies. We will recruit participants to match recent decedents from acute stimulant toxicity in various domains including salient demographic information and neighborhood characteristics. RESULTS/ANTICIPATED RESULTS: The anticipated results include a qualitative interview guide for living persons using stimulants in San Francisco to be used to gain insight into the community, illustrate participants’ substance use practices, and allow for better characterization of several discrete resiliency factors that have protected the participants and other community members from suffering lethal stimulant toxicity. We expect to identify individual components (e.g. use patterns, use of harm reduction supplies), interpersonal/social factors (e.g. drug using network, friendships, community connection), and structural influences (e.g. access to care, safe use sites, house and economic stability) that all play a role in resiliency against lethal stimulant toxicity. DISCUSSION/SIGNIFICANCE: Stimulant use is common, along with rising deaths involving stimulants in urban counties and in smaller rural/non-metro counties which are disproportionately affected, posing a public health challenge. We will find discrete, modifiable risk and resiliency factors that can be manipulated to minimize the chances of outcomes like overdose and death.

Early Onset Schizo-Obsessive Disorder: A Case Series of 7 Inpatient Children

IntroductionSchizo-obsessive disorder (SOD) is a complex psychiatric condition characterized by exhibiting symptoms of schizophrenia and obsessive-compulsive disorder (OCD)(Schirmbeck et al. Front Pharmacol. 2013 Aug 9;4:99). Some researchers prefer to describe this condition as a spectrum called “schizo-obsessive spectrum” and state that clinical represantations such as OCD with poor insight, OCD with schizotypal personality disorder, schizophrenia with obsessive-compulsive symptoms and schizophrenia with OCD are included in this spectrum(Poyurovsky et al. J Psychiatr Res. 2005 Jul;39(4):399-408). There is limited literature available on early on-set schizo-obsessive disorder in child and adolescent sample.ObjectivesThis case series aimed to describe the clinical characteristics, phenomenology, diagnostic process and treatment response of SOD in a sample of inpatient adolescents and illuminate the intricate symptomatology between schizophrenic and obsessive-compulsive features.Methods A retrospective review was conducted of 7 adolescent patients who met DSM-V criteria for both schizophrenia and OCD in our inpatient clinic over the past year. Data were collected from medical records, including demographic information, clinical presentation, treatment history and response to treatment. All data were anonymized to maintain patient confidentiality.ResultsThe sample consisted of 5 females and 2 males, with a mean age of 15,4 years. All patients presented with a mixed symptomatology of hallucinations, delusions and obsessive-compulsive symptoms. Many common points observed about clinical characteristics and psychiatric history of the patients. In most of the patients, the first psychiatric complaints started with obsessive-compulsive symptoms. It was observed that obsessions evolved into over-valued ideas and delusions in the course of time. Patients responded late and inadequately to pharmacological treatment, multiple drug use was necessary. Hospitalization lasted longer, the average time was 53 days. Most of the patients required augmentation with cognitive-behavioral therapy due to partial response or intolerable side effects. Unfortunately, no patient experienced full remission or returned to premorbid functioning.ConclusionsThis case series underscores the complexity of diagnosing and treating schizo-obsessive disorder in a pediatric population. It appears that a combined approach using both pharmacotherapy and psychotherapy may yield the most beneficial results. However, given the small sample size and retrospective design, these findings need to be interpreted with caution. Further research are crucial to corroborate our findings and refine treatment strategies.Disclosure of InterestNone Declared

Management of suicidal risk in the emergency department: A clinical pathway using the computerized adaptive screen for suicidal youth.

Given the critical need for efficient and tailored suicide screening for youth presenting in the emergency department (ED), this study establishes validated screening score thresholds for the Computerized Adaptive Screen for Suicidal Youth (CASSY) and presents an example of a suicide risk classification pathway. Participants were primarily from the Study One derivation cohort of the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) enrolled in collaboration with Pediatric Emergency Care Applied Research Networks (PECARN). CASSY scores corresponded to the predicted probabilities of a suicide attempt in the next 3 months and risk thresholds were classified as minimal (<1%), low (1%-5%), moderate (5%-10%), and high (>10%). CASSY scores were compared to risk thresholds derived from clinical consensus and ED complaints and dispositions. CASSY risk thresholds were also examined as predictors of future suicide attempts in the Study Two validation cohort of ED-STARS. A total of 1452 teens were enrolled with a median age of 15.2 years, 59.5% were female, 55.6% were White, 22% were Black, 22.3% were Latinx, and 42.8% received public assistance. The clinical consensus suicide risk groups were strongly associated with the CASSY-predicted risk thresholds. Suicide attempts in the Study Two cohort occurred at a frequency consistent with the CASSY-predicted thresholds. The CASSY can be a valuable tool in providing patient-specific risk probabilities for a suicide attempt at 3 months and tailor the threshold cutoffs based on the availability of local mental health resources. We give an example of a clinical risk pathway, which should include segmentation of the ED population by medical versus psychiatric chief complaint.

Influence of affective instability on suicidal ideation beyond traumatic brain injury and posttraumatic stress disorder in veterans

ObjectiveMild traumatic brain injury (TBI) is associated with long-term consequences, including greater risk for posttraumatic stress disorder (PTSD) and suicidal ideation. Affective instability is also independently related to PTSD and suicidality, which may explain why some individuals continue to experience chronic psychiatric complaints following mild TBI. The purpose of the present study was to evaluate affective instability as a key factor for PTSD and suicidal ideation among Veterans with and without TBI. MethodParticipants (N = 299 Veterans; 86.96% male) completed the Personality Assessment Inventory (PAI) and structured clinical interviews for TBI and psychiatric diagnoses. Hierarchical linear regression was used to evaluate main and interaction effects. ResultsThere were no significant differences in affective instability (p = 0.140) or suicidal ideation (p = 0.453) between Veterans with or without TBI. Individuals with TBI were more likely to have a PTSD diagnosis (p = 0.001). Analyses evaluating PTSD diagnosis as an outcome indicated a main effect of affective instability (p < 0.001), but not TBI (p = 0.619). Analyses evaluating suicidal ideation as an outcome demonstrated an interaction effect between PTSD and affective instability beyond the effects of TBI (p = 0.034). ConclusionsSevere Affective instability appears to be a key factor in suicidal ideation among Veterans beyond TBI or PTSD history. PTSD was more strongly associated with suicidality at lower and moderate levels of affective instability. At severe levels of affective instability, however, Veterans with and without PTSD experienced suicidal ideation at similar rates. Findings suggests that high levels of affective instability not better explained by other psychiatric conditions confers similar suicidality risk to that of PTSD in a Veteran population.

Comparison of Patients Presenting to the Emergency Department with Psychiatric Complaints Before and After the COVID-19 Pandemic

Objective: This study aims to investigate whether there was a difference in the psychiatric complaints of patients presenting to the emergency department before and after the COVID-19 pandemic.&#x0D; Methods: All patients aged 18 years and over who presented to the adult emergency department of the University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital between 11.03.2019 and 11.03.2021 with psychiatric complaints, for whom psychiatry consultation was requested, and whose complete study data were available were retrospectively included in the study.&#x0D; Results: There were 1508 patients in the study. Of the patients, 50.9% (n=768) were in the pre-pandemic group, 54.0% (n=815) were single, and 77.4% (n=1167) were unemployed. As a result of the statistical analysis, a significant correlation was found between diagnosed psychiatric diseases, depression, anxiety disorder, post-traumatic stress disorder, alcohol-substance withdrawal, panic disorder, delirium, and other psychiatric diseases with the pre-pandemic and post-pandemic periods respectively [(p=0.001), (p

Adult Onset Acute Disseminated Encephalomyelitis (ADEM): A Comprehensive Case Repot

INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated condition affecting the central nervous system, characterized by acute encephalopathy and multifocal neurological deficits. This disorder predominantly impacts children but here, we document a rare adult case, emphasizing the necessity for considering organic causes in psychiatric symptomatology [1 ; 2]. AIMS / OBJECTIVES: A detailed review of literature was conducted through PubMed focusing on the atypical presentations of ADEM and the incidence of organic diseases manifesting psychiatric complaints. This approach informed our diagnostic strategy and management of an unusual adult case of ADEM, underscoring the importance of maintaining a wide differential diagnosis in emergency medicine [3 ; 4] CASE DESCRIPTION: A 22-year-old female presented with generalized weakness, confusion, apathy, and reduced appetite, following an upper respiratory tract infection and a distressing dental visit. Her neurological examination revealed dysarthria, dysmetria, and ataxia, with a significant reduction in motor strength and generalized hyperreflexia. Laboratory tests were largely unremarkable except for elevated ESR and CRP. MRI findings were consistent with a demyelinating process, See Figure 1A and 1B, fulfilling the criteria for ADEM diagnosis [5 ; 6]. RESULTS: Results: Initiation of a steroid regimen led to significant clinical improvement, and by day 11 of hospitalization, there was a marked improvement in the patient&amp;apos;s condition, enabling discharge with outpatient neurology and ophthalmology follow-ups. A six-week steroid taper was prescribed. Follow-up MRI confirmed resolution of the demyelinating lesions, confirming the effectiveness of the treatment protocol [7 ; 8]. DISCUSSION: This case underscores the complexity of diagnosing ADEM in adults, particularly when presenting with psychiatric symptoms. It highlights the critical importance of comprehensive evaluation in emergency settings to identify rare organic causes of psychiatric presentations. This report reinforces the need for awareness among clinicians to consider ADEM in differential diagnoses, ensuring timely and appropriate management for affected patients [9; 10; 11]. REFERENCES: 1. [Pohl D, Alper G, Van Haren K, Kornberg AJ, Lucchinetti CF, Tenembaum S, Belman AL. Acute disseminated encephalomyelitis: Updates on an inflammatory CNS syndrome. Neurology. 2016 Aug 30;87(9 Suppl 2):S38-45. doi 10.1212/WNL.0000000000002825. PMID: 27572859.] 2. [De Fino C, Nociti V, Modoni A, Bizzarro A, Mirabella M. An atypical case of acute disseminated encephalomyelitis associated with cytomegalovirus infection. Mult Scler Relat Disord. 2016 Jan;5:70-2. doi: 10.1016/j.msard.2015.11.003. Epub 2015 Nov 10. PMID: 26856946.] 3. [Kamel MG, Nam NT, Han NHB, El-Shabouny AE, Makram AM, Abd-Elhay FA, Dang TN, Hieu NLT, Huong VTQ, Tung TH, Hirayama K, Huy NT. Post-dengue acute disseminated encephalomyelitis: A case report and meta-analysis. PLoS Negl Trop Dis. 2017 Jun 30;11(6):e0005715. doi: 10.1371/journal.pntd.0005715. PMID: 28665957; PMCID: PMC5509372.] 4. [Obermeier PE, Karsch K, Hoppe C, Seeber L, Schneider J, Muhlhans S, Chen X, Tief F, Kaindl AM, Weschke B, Bottcher S, Diedrich S, Rath B. Acute Disseminated Encephalomyelitis After Human Parechovirus Infection. Pediatr Infect Dis J. 2016 Jan;35(1):35-8. doi: 10.1097/INF.0000000000000928. PMID: 26741581.] 5. [Neeki MM, Au C, Richard A, Peace C, Jaques S, Johansson J. Acute Disseminated Encephalomyelitis in an Incarcerated Adolescent Presents as Acute Psychosis: Case Report and Literature Review. Pediatr Emerg Care. 2019 Feb;35(2):e22-e25. doi: 10.1097/PEC.0000000000000919. PMID: 27749808.] 6. [Chaudhry LA, Babur W, Chaudhry GA, Al-Atawi FE, Robert AA. Acute disseminated encephalomyelitis: a call to the clinicians for keeping this rare condition on clinical radar. Pan Afr Med J. 2018 M

Parents' perspective on pediatric emergency department visits for low-acuity conditions before and during the COVID-19 pandemic: a cross-sectional bicentric study.

The primary objective of this study was to describe and compare the motivation of parents/guardians to bring children with low-acuity conditions to a tertiary-care pediatric emergency department (ED) versus a clinic before and after the pandemic. The secondary objectives were to describe and compare the demographic and clinical characteristics of the population studied and the impact of the pandemic on their access to primary care services. This is a cross-sectional study based on a survey administered to parents/guardians of patients presenting with low-acuity conditions at one of two EDs. The respondents numbered 659. Children were brought to a pediatric ED generally because of the perceived urgency of the condition, the presumed resource availability in the pediatric ED and the unavailability of the primary care physician. However, most respondents (n = 438, 66.5%) indicated preference for a clinic. More respondents before than during the pandemic reported they had been unable to find a doctor outside the ED (48.6% before COVID vs 26.8% during COVID, p < 0.001) but patients during the pandemic were less likely to seek care in a primary care practice or walk-in clinic (30.0% during COVID vs 48.6% before COVID, p < 0.001). In addition, the number of respondents presenting with symptoms of infection decreased by more than half after the pandemic began while the proportion of musculoskeletal and psychiatric complaints doubled. Although the pandemic has altered the landscape of presenting complaints and pediatric healthcare-seeking behaviors, most respondents indicated they would prefer to receive care in a clinic. This finding contradicts the view that most pediatric ED visits for low-acuity conditions are by choice rather than perceived necessity. Prioritizing improved access to primary care resources would better address the preferences and expectations of parents/guardians.

Psychiatric presentation in undiagnosed intracranial space-occupying lesions: A case series

Intracranial space-occupying lesions (SOLs) account for about 5–10 deaths per 100,000 in India. They present with physical symptoms such as headache, nausea, vomiting, and weakness; neurological symptoms such as seizures, and focal neurological deficit; and behavioral changes manifesting as depression (15–20%), anxiety (30–50%), psychosis (&lt;5%), and personality changes (16–76%). Therefore, it is necessary to do an appropriate general, neurological, and behavioral examination for proper diagnosis and management. A series of four cases who reported to psychiatric outpatient with behavioural complaints and no focal neurological deficits were reported. The most common presentation of SOLs is seizure, headache, vomiting, and loss of consciousness. Along with this complaint, some patients may present with abnormal behavior. However, it is very rare for a SOL to present solely with psychiatric or behavioral complaints. Therefore, it becomes imperative to keep a close watch on the symptoms and send for timely investigations.

Mikrodiskektomi ile Opere Edilen Lomber Disk Hernili Hastalarda Anksiyete ve Depresyon Düzeylerinin Değerlendirilmesi

Aim: Studies examining the effect of microdiscectomy and surgical treatment on the psychiatric complaints of patients with lumbar disc herniation are new and few. Although the international literature reports that depression and anxiety decrease in the long term after microdiscectomy, we observed that these complaints were resolved much earlier in our clinical practice. We aimed to determine depression, anxiety, and pain levels in the preoperative period and in the first month postoperatively with validated scales for the documentation of these observations. Method: After eliminating patients with comorbid pathologies that may affect pain and psychiatric factors, pain levels in 31 patients with lumbar disc herniation were evaluated with the Visual Analog Scale (VAS) and depression and anxiety levels were evaluated with the Hospital Anxiety and Depression (HAD) scale. Statistical comparisons were made with the Student-T test in NCSS (2020, Utah, USA). Results: It was observed that the low back and leg pain scores improved significantly after microdiscectomy, and the preoperative anxiety and depression scores were widely distributed, but both were significantly reduced in the postoperative period. Conclusion: The decrease in depression and anxiety levels after microdiscectomy earlier than international observations can be explained by the higher surgical anxiety in the Turkish population and the higher correlation between mood and pain levels. Since pain and psychiatric complaints have the feature of increasing each other, more successful management of these factors by clinicians will contribute to more effective treatments.

Child and adolescent psychiatric emergency admissions before, during and after the Covid-19 pandemic: An Interrupted time series analysis from Turkey.

Acute psychiatric care of youth is paramount as prompt evaluation is known to mitigate potentially catastrophic outcomes in the future. The aim of this study was to analyze changes in child and adolescent psychiatric (CAP) emergency admissions within a 4-year period, including the pandemic course. Electronic patient health records of children and adolescents aged 0-18 years, admitted to the pediatric emergency department (ED) for psychiatric complaints between January 2018-December 2021, were retrospectively reviewed (n=2014). Data including the age, sex, presenting complaint and preliminary diagnosis, length of stay in the ED, and history of previous psychiatric outpatient/emergency admissions were recorded. Interrupted Time series analysis was conducted to detect changes. During the first month of the COVID-19 pandemic period (March 2020); low-risk suicide attempts (60.6%;IRR=0.394;CI=0.216-0.718), high-risk suicide attempts (82.2%;IRR=0.178;CI=0.070-0.457), manic symptoms (87.9%;IRR=0.121;CI=0.016-0.896), and total CAP emergency admissions were found to have decreased (30.7%;IRR=0.693;CI=0.543-0.885). CAP consultations due to general medical conditions were found to have increased by 7.3% (IRR=1.073;CI=1.019-1.130), and total CAP emergency admissions showed a mild increase of 1.8% (IRR=1.018;CI=1.001-1.036) through April 2020 to December 2021. While suicide attempts, manic symptoms, and total CAP emergency admissions decreased during the first month of the pandemic, there was an increase in total CAP emergency admissions, especially in general medical conditions presenting with psychiatric symptoms during the following pandemic period. This study highlights the importance of accounting for underlying medical conditions in patients presenting with psychiatric complaints to the ED in the normalization phase. The datasets generated and/or analyzed during the present study are available from the corresponding author on reasonable request.