Psychiatric Consultation Liaison Research Articles

The role of the mental health nurse in pediatric hematology-oncology - Part 1: Developing an innovative practice.

Pediatric hematological and oncological illnesses present many coping challenges. Mental health issues can arise during and after treatment, in both patients and their families. The current model of care does not always seem to meet the needs identified by some young patients. In Quebec, nurses are allowed to assess and care for patients experiencing physical and mental health difficulties (Ordre des infirmières et infirmiers du Québec, 2016). Therefore, a mental health nurse clinician (MHNC) with experience in pediatric hematology/oncology could provide care that is complementary to that offered by psychologists, social workers, and other psychosocial professionals in the pediatric hematology/oncology unit in order to meet any needs that remain unmet. The MHNC project has three stages: (1) role development, (2) role implementation, and (3) role assessment one year after implementation. In this first article, we explain how the MHNC role was developed. We used the participatory, evidence-based, patient-focused process for advanced practice nursing (APN) role development, implementation, and evaluation (PEPPA Framework; Bryant-Lukosius & Dicenso, 2004) to develop this model. The first five steps in the PEPPA Framework were applied in the creation of the MHNC role to (1) select the target population, (2) identify the stakeholders to be involved, (3) ascertain needs, (4) determine and prioritize problems and set goals, and (5) define a new model of care. After multiple meetings involving numerous health professionals and managers, the MHNC role was developed with a versatile, transdisciplinary perspective to address better the needs of young cancer patients (especially those in their teens) and their families. The role was developed around four main areas of practice: (1) interventions offered to patient-family, (2) interventions offered to health professionals, (3) psychiatric consultation-liaison, and (4) education and research. The next steps are to use a strategic plan to implement the role and then to evaluate the impact of the role one year after implementation.

Forensic-Psychiatric Consultations in General Psychiatry

A subgroup of psychiatric patients are at increased risk of committing interpersonal violence, which may lead to placements in forensic-psychiatric institutions. The majority of patients treated in forensic hospitals have had contact with the general psychiatric care system years before being forensically committed due to an offence. Nevertheless, attempts to establish models related to violence prevention in general psychiatry have remained sparse. In the Canton of Zurich, the forensic psychiatric consultation liaison service provides the general psychiatric clinics with access to forensic psychiatric expertise. In this paper, we describe the consultation service's diagnostic and advisory offers and aim to characterize the patient population seen by the service. We compared the three most common diagnostic groups (schizophrenic, affective and personality disorders) regarding reason for consultation, history of violence and substance abuse. In addition, we analyzed content and kind of the recommendations made. From 2013 to 2021, 188 patients in general psychiatric clinics in Zurich have been examined after informed consent. Most patients had a positive history of violence (72.7%) and substance use (66.1%). Almost half of the patients (48.4%) had been diagnosed with schizophrenia or a related disorder.

The body of evidence of late-life depression: the complex relationship between depressive symptoms, movement, dyspnea and cognition

ABSTRACT Background Physical symptoms play an important role in late-life depression and may contribute to residual symptomatology after antidepressant treatment. In this exploratory study, we examined the role of specific bodily dimensions including movement, respiratory functions, fear of falling, cognition, and physical weakness in older people with depression. Methods Clinically stable older patients with major depression within a Psychiatric Consultation-Liaison program for Primary Care underwent comprehensive assessment of depressive symptoms, instrumental movement analysis, dyspnea, weakness, activity limitations, cognitive function, and fear of falling. Network analysis was performed to explore the unique adjusted associations between clinical dimensions. Results Sadness was associated with worse turning and walking ability and movement transitions from walking to sitting, as well as with worse general cognitive abilities. Sadness was also connected with dyspnea, while neurovegetative depressive burden was connected with activity limitations. Discussion Limitations of motor and cognitive function, dyspnea, and weakness may contribute to the persistence of residual symptoms of late-life depression.

An overview of the rehabilitation and psychiatric diagnoses of patients referred to a psychiatry consult liaison service at an inpatient rehabilitation hospital.

Patients presenting for inpatient rehabilitation following injury or illness are commonly affected by comorbid psychiatric illness. Currently, little is known about the utilization of a psychiatry consult service in an inpatient rehabilitation hospital. To identify which rehabilitation patient populations most frequently received psychiatric consultation and recognize the most common psychiatric comorbidities after the implementation of a psychiatry consult liaison (PCL) service. A retrospective observational study in the form of a chart review examining the utilization patterns of a psychiatric consultation liaison service in the inpatient rehabilitation setting. Chart review was performed to extract patient demographics (age and sex), rehabilitation diagnosis, cause of rehabilitation diagnosis (intentional, accident, self-inflicted, or disease), reason for referral to psychiatry, and psychiatric diagnosis on initial consultation. Statistical software was used for statistical analysis to answer the pre-specified research questions. A 178 bed, free-standing, academic rehabilitation hospital located in an urban Canadian center. Any patient admitted to the inpatient rehabilitation hospital who received a psychiatric consultation between September 2016 and December 2019 was eligible for inclusion. A total of 1016 charts were reviewed in the initial chart review and 1008 were included. The most common rehabilitation diagnoses that were associated with a psychiatric consult were (% admissions receiving consultation): amputations (38%); burns (35%), neurologic disorder (28%), deconditioning (14%), and musculoskeletal injury (7%). Although 20% of patients did not meet criteria for a psychiatric diagnosis, most common psychiatric diagnoses included mood disorder, adjustment disorder, neurocognitive disorder, and delirium. There are significant perceived needs for psychiatric services in the inpatient rehabilitation setting. Although some patient groups such as patients with amputations, burns, and trauma may exhibit the highest utilization, the service supports mental health needs from many patient groups.

Management of Dental Patients With Mental Health Problems in Special Care Dentistry: A Practical Algorithm.

Introduction Individuals with mental health problems have poor oral health affecting their quality of life with an increased burden on their well-being. Dentists find treating them challenging due to a lack of training and awareness in modifications of dental care delivery in special needs patients. Also, polypharmacy is common in psychiatric care, further complicating dental care while prescribing routine medications as potential drug interactions must be considered. Methods Due to a lack of clinical practice guidelines in the literature and the absence of guidelines issued by dental governing bodies, we attempted to consolidate the existing challenges and propose a model for managing psychiatric special needs patients. Results and discussion Based on the current evidence, we hereby recommend 'psychiatric dental consultation liaison' (PDCL) services as the acceptable framework for the management of dental patients with mental health problems in special care dentistry. Conclusion PDCL services will favour both dentists and patients as it includes psychiatric consultation and interventions that will result in the positive execution of comprehensive dental treatment care.

Factors Predictive of Psychiatric Consultation-Liaison Practice in the Gynecology Clinic of a Nigerian Teaching Hospital

There is a high rate of psychological distress among women attending gynecology clinics. Psychiatric morbidity among this group of patients has been studied but no clear-cut delineations in the association between psychiatric morbidity, established gynecological diagnosis and ongoing gynecological symptoms especially as guidelines for consultation-liaison practice in the gynecological unit. The objectives of this study therefore were to determine the prevalence of psychiatric disorders in this group of patients; to determine the association of psychiatric morbidity with ongoing gynecological complaints, gynecological diagnosis and psychosocial factors; and to delineate factors predictive of psychiatric consultation-liaison need in the gynecological clinic. Using structural questionnaires and employing a 2-stage screening methodology for patients attending the gynecological clinic of Ladoke Akintola University of Technology Teaching Hospital for about 12 weeks consecutively, a total of seventy eight patients were recruited invariably. The mean age of the study population was 35.9 years. Overall prevalence of psychiatric disorder was 55.3%. Depressive illness occurred in about 42.8% of the study population. No significant association between psychiatric morbidity, ongoing gynecological symptoms and established gynecological diagnosis. The commonest diagnosis was infertility. However, specific ongoing gynaecological complaints with psychiatric morbidity had 49.7% of those with inability to conceive (primary), 57.1% of those who had pains during intercourse, 71.4% of those with cessation of menses and 60% of those with irregular menses as opposed to lower scores among those with established gynecological diagnosis. Specific on-going gynecological complaints may impose graver consequences on the psychological wellbeing of a woman than established gynecological diagnosis. The consideration and management of ongoing gynecological complaints and social support may be issues for psychiatric consultation-liaison crucial in the management of such patients to reduce psychiatric morbidity amongst them.

2.26 Impact of the COVID-19 Pandemic on the Child and Adolescent Psychiatric Consultation-Liaison Service (CL) in a Large Urban Hospital

The objective is to assess the impact of the pandemic on patients seen by the Psychiatry Consultation-Liaison (CL) service in a tertiary care hospital in Dallas, Texas. Our hypothesis was that an increased number of patients diagnosed with depression, anxiety, and suicidal ideation (SI) with and without attempts were seen during the pandemic.

(PO-154) Impact of COVID-19 Pandemic on the Quality of Psychiatric Consultation-Liaison Work

(PO-154) Impact of COVID-19 Pandemic on the Quality of Psychiatric Consultation-Liaison Work

Patient Satisfaction with a Psychology Consultation-Liaison Service at an Academic Medical Center.

One to two-thirds of all medically admitted patients have comorbid psychiatric concerns. To address the cognitive, behavioral, and emotional factors that affect medical hospitalization, psychological or psychiatric consultation-liaison (CL) services are consulted. The current study was designed to understand patient satisfaction with a CL psychology service and how it was associated with satisfaction with overall hospitalization, taking into consideration relevant factors. Adults medically admitted to an academic teaching hospital (N = 220), who were seen at least once by the CL psychology service, completed satisfaction and demographic questionnaires. Most patients reported being satisfied with the CL psychology service, with women reporting higher satisfaction than men. Satisfaction with the CL psychology service was associated with satisfaction with overall hospitalization, but did not differ based on age, race/ethnicity, education, income, length of stay, number of visits, or presence of psychiatric diagnosis. The results suggest that CL psychology services may contribute to improving overall patient experience.

70.6 BRINGING SUBSTANCE SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) TO THE HOSPITAL FLOOR

This brief presentation will describe psychiatric consultation-liaison (CL) procedures for evaluating substance use disorders in medically hospitalized adolescents and the limitations of current procedures for referring such youth to specialized substance treatment. The Teen Recovery Program at Children’s Health is designed to provide specialized services for adolescents with mental health diagnoses and problematic substance use. Established collaboration between medical providers at Children’s Medical Center Hospital in Dallas and the Teen Recovery Program allows for inpatient evaluation of medically hospitalized substance-involved youth on the psychiatry CL service. David Atkinson, MD, will discuss current challenges associated with substance treatment referral and engagement. He will also consider ways in which the Screening, Brief Intervention, and Referral for Brief Consultative Evaluation (SBIRE) model may be adapted to enhance treatment engagement in the Teen Recovery Program at Children’s Health providing specialized services for adolescents with co-occurring mental illness and substance use disorders. Dr. Atkinson will present data on the current rates of substance treatment engagement among medically hospitalized youth with problematic substance use referred to the Teen Recovery Program. He will also discuss how the SBIRE model may be adapted in this setting to enhance substance treatment engagement compared to poor rates of treatment engagement using a more conventional Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol used currently. The SBIRE model may be modified or adapted to increase substance treatment engagement among medically hospitalized youth referred to a subspecialty substance treatment program.

Adaptation of an Academic Inpatient Consultation-Liaison Psychiatry Service During the SARS-CoV-2 Pandemic: Effects on Clinical Practice and Trainee Supervision

BackgroundThe SARS-CoV-2 pandemic has led to drastic changes in how psychiatric consultation-liaison (C-L) services conduct business and required rapid transition to telepsychiatry. We describe the practice changes implemented to rapid transition to virtual care in a large, academic psychiatry C-L service in response to the pandemic.ObjectiveTo describe clinical service structural changes, timelines and impacts on consultation volume as well as present quantitative and qualitative data regarding the experience of this transition from the standpoints of both psychiatric trainees and attending physicians.MethodsWe present the narrative descriptions of transition details based on focused interviews with inpatient C-L leadership. Inpatient consult volume and charge data were gathered using analysis of health system data. Attending and trainee experience of the transition to virtual care were assessed using anonymous, online surveys.ResultsDuring the pandemic, the average weekly consultation volume and average weekly charges were significantly lower compared with prepandemic. Both volume and charges were affected by addition of video consultation capability. Both attendings and trainees had moderate or high comfort and moderate satisfaction with telephone and video consultations. Overall, the trainee satisfaction with supervision, learning, and their consult psychiatry experience did not seem to be affected by the pandemic.ConclusionsOur results support the feasibility of the rapid implementation of virtual care in a psychiatric academic C-L service without negatively impacting the learner's consult psychiatry experience. This should provide comfort to academic C-L services that required rapid implementation of virtual care.

Psychiatric comorbidities in cancer patients: acute interventions by the psychiatric consultation liaison service.

The aim of this study was to explore the psychiatric comorbidities in cancer patients examined by the psychiatric consultation liaison services (CLP) in ageneral hospital. Furthermore, we intended to examine associations between certain cancers types and psychiatric disorders as well as to give an overview of the psychiatric treatments options that were recommended by the CLP. This retrospective analysis investigated 119 psychiatric consultations for cancer patients in aone year period. The assessment covered demographics and cancer diagnosis, psychiatric diagnosis and proceedings. One third of all patients were treated for hematological cancer, followed by lung cancer. Depression was the most common psychiatric disorder. One third of all patients with hematological cancer were diagnosed with depression, followed by delirium. Inpatient psychiatric treatment and psychotherapy were most commonly recommended by the consultant psychiatrist. Furthermore, 80.2% of all patients received recommendations for medication with antidepressants. Our data showed that the CLP provides an important service of detecting and initiating early and appropriate treatment for cancer patients with comorbid psychiatric disorders by directing patients to the relevant treatment procedure or facility.

“The System of Accompanying Psychiatrists” Will Replace “Psychiatric Consultation Liaison Nurse”- Reconstruction of Professional Ability and Post Reorganization Under the New Medical Reform

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73.1 PSYCHOPHARMACOLOGY IN COMPLEX MEDICALLY ILL YOUTH: WHAT IS THE ROLE OF ANTIPSYCHOTICS?

Treatment of debilitating anxiety, depression, delirium, or psychosis with psychotropic medications for symptomatic and syndromic relief during complex medical treatment may be necessary to assist medically ill children through difficult or prolonged medical treatments. Antipsychotic medications often are used by pediatric psychiatric consultation-liaison (CL) psychiatrists. Drug-drug interactions, elevated liver enzymes, pancytopenia, and cardiac arrhythmias during a developmentally sensitive period are some of the factors considered by CL psychiatrists. However, co-administration of antipsychotic medications may be indicated when concurrent use of a medication (eg, steroids) provokes symptoms of mental illness but is necessary for medical treatment of a condition. This talk will address the use of judicious antipsychotic medication use in pediatric medical patients.

Impact of an Innovative Psychiatric Consultation Liaison Model on Provider Satisfaction with Care of Behaviorally Complex Patients.

The increasing behavioral acuity and complexity of hospitalized patients overwhelms providers' capacity to effectively manage their behaviors. Hospitals must train their providers in how to cope with these behaviors to provide high-quality care. In addition to improved patient care, increased capacity to manage these challenging patients may improve resilience and reduce the risk and rates of provider burnout. We created a novel service to address this need via point-of-care resources. This service dually helped providers manage disruptive behaviors while training them to manage these behaviors more autonomously in the future. We tracked the impact of this service on physician and staff satisfaction. We sent pre- and postimplementation surveys consisting of five-point Likert and free-response questions to a convenience sample of providers to assess their attitudes and perceived comfort level, as well as their subjective strengths and weaknesses when managing complex behaviors. Pre- and postintervention analyses of qualitative data revealed that staff members were more satisfied with the available resources for managing disruptive patients following implementation of this service than before its implementation. The majority of respondents believed previously unmet needs were frequently addressed through service involvement and consultation. In University Hospital at Michigan Medicine, this novel service improved physicians' and staff's perceptions of available education and supportive resources for patients' behaviors, as well as their comfort in psychiatric and behavioral symptom management, including nonpharmacologic and pharmacologic interventions.

Impact of a Brief Mindfulness Intervention on Psychiatric Consult Patients’ Symptoms

Psychiatric patients in the hospital suffer from stressors and challenges that may contribute to their hospitalization. They also suffer additional stressors related to being an inpatient. The psychiatric consultation liaison service of a hospital or health system is designed to respond to patients when stressors have accumulated, and patients are deemed to be at risk or when patients are suspected of having a psychiatric condition. This service provides necessary evaluation and treatment of patients who are acutely distressed, and often the focus is on diagnosing and stabilizing the patient and keeping them safe. Due to time constraints on medical residents, there is often no time for a professional to implement an appropriate and effective therapeutic intervention in the moment. We developed and conducted pilot testing of a brief mindfulness intervention for psychiatric consult patients that could be ordered by the consultation liaison physician or team and be implemented immediately by a trained nurse. This intervention consisted of offering a range of guided mindfulness techniques to the patient in real time response to patients and evaluated the impact on symptoms pre-and post-intervention. Results demonstrate significant improvements in self-reported anxiety, stress, uncomfortable thoughts, and pain after the intervention. Other symptoms of low mood, restlessness, and body tension were not significantly improved post intervention. We briefly discuss the intervention, its impact and potential reasons for the mixed findings

Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: Systematic Review and Meta-Analysis of Effects on Depression and Anxiety

Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: Systematic Review and Meta-Analysis of Effects on Depression and Anxiety

Issues and Challenges in Psychiatric Consultation-Liaison nurse (PCLn)

Mental health problems are not currently given the same importance as physical health. Nurses, particularly those working in non-psychiatric settings, report that they do not feel adequately prepared to meet the mental health needs of patients. The psychiatric consultation-liaison nursing role has arisen in part, as a response to these difficulties and aims to facilitate access to mental health nursing expertise for general hospital patients and staff.

Intensive Care Unit delirium: A wide gap between actual prevalence and psychiatric referral.

Background and Aims:The study aimed to assess the rates of delirium in an Intensive Care Unit (ICU) prospectively assessed with a delirium screening instrument and confirmed through psychiatrist evaluation. In addition, the referral rate to psychiatric consultation liaison services from the same ICU was assessed through the rates of psychiatric referral over the previous 10 years.Material and Methods:In the prospective part of the study, consecutive patients aged 16 years or more admitted to the ICU of a tertiary care hospital were assessed daily for delirium using confusion assessment method for the ICU, a validated instrument that can be used for both mechanically ventilated and nonventilated patient by trained heath care personnel. Retrospectively, records of patients referred to psychiatric referral team for delirium from the ICU over the last 10 years were drawn out and the referral rate was calculated.Results:In the prospective study, 109 patients were recruited of which 43 patients remained comatose throughout their ICU stay and could not be assessed for delirium. Of the 66 assessable patients, 45 (68.2% prevalence rate) patients developed delirium. Incidence rate of delirium was 59.6%. In contrast, the retrospective study showed that only 53 cases out of 3094 admissions in ICU over 10 years (1.71%) were referred to psychiatry consultation liaison team for management of delirium. In the prospective study, hypoactive delirium was the most common subtype of delirium.Conclusion:There is a mismatch between the incidence and prevalence of delirium in ICU patients prospectively diagnosed with structured, validated instruments and the diagnosis of delirium in cases referred to psychiatry consultation-liaison services.

精神科コンサルテーション・リエゾンチームにおける各職種の役割構築に向けたパイロットスタディ : リエゾンナースと臨床心理士に焦点をあてて

精神科コンサルテーション・リエゾンチームにおける各職種の役割構築に向けたパイロットスタディ : リエゾンナースと臨床心理士に焦点をあてて