A&E Abstracts and Extracts

Authors: Lisa Charlotte Smith, PhD, et al., VIRTU Research Group, Copenhagen Research Center for Mental Health.

Abstract: All of the studies in this review applied interventions building on AVATAR therapy. In this type of psychotherapy, patients use computer software to create an avatar of the imagined source of their auditory verbal hallucinations.

Additionally, by using a voice transformation program, the therapist’s voice is transformed into sounding like the voice heard by the patient. If more than one voice is present, the patient is asked to identify and work on the most dominant or hostile voice.

In therapy role-plays, the patient engages in a dialogue with the avatar (displayed on a computer screen), while the therapist takes on the role of the avatar.

Such clinical trials employing immersive virtual reality (VR) to treat mental health disorders are emerging. This review provides an overview of VR trials specifically in the treatment of auditory verbal hallucination and documents knowledge gaps.

Sixteen papers were included, all originating from a high-income country: (Canada 11;  Switzerland one; Denmark one); or a middle-income country: (China three.) All studies recruited adults (≥18 years) and most focused on patients with schizophrenia spectrum disorders experiencing auditory verbal hallucinations that were treatment-resistant to some degree (patients heard voices despite treatment with antipsychotic medication.)

Importance: Such research is promising, but still in its infancy. Results from larger randomized clinical trials are needed to establish substantial evidence of therapy effectiveness. Additionally, the knowledge base would benefit from more profound qualitative data exploring views of patients and therapists.

Yet, say the authors: “It can be stated that VR therapy for auditory hallucinations has so far shown great potential. The method of employing an avatar to represent the most dominant voice appears to be a promising psychotherapeutic innovation for patients with psychosis….the evidence-base on the efficacy of VR therapy for AVH symptoms is accumulating.”

And they add: “Building on the evidence from studies using VR to treat AVH in schizophrenia, this type of treatment may possibly be modified for the treatment of other psychiatric disorders (e.g., PTSD or mood disorders), in which AVH may also be prevalent. Correspondingly, it might be possible to explore the use of VR to treat AVH in somatic illnesses (e.g., dementia or Parkinson disease).”

Availability: Pre-publication by Psychiatry Research.

Authors: Tara Petzke, MSc, et al.

Abstract:

• Asking people more often about their symptoms leads to them reporting more symptoms.
• Health anxiety and preexisting symptom burden intensifies this relationship.
• Symptoms are best predicted by earlier symptoms, less so by valence and arousal.

These are the findings of authors who explored negative affect, alexithymia, and other predisposing traits (such as health anxiety) which can influence an individual's symptom perception.

They used the affective picture paradigm (APP) (Bogaerts, et al., 2010) to induce symptoms using affective picture stimuli. They tested the effect of high vs low-frequency symptom queries, and analyzed the time course of the APP, including interactions with health anxiety and somatic symptom distress.

Next to the sensory processing aspect of symptoms, persistent somatic symptoms (PSS) typically consist of a cognitive-emotional component, such as excessive thoughts or worries about the symptoms. If individuals additionally show high health anxiety, they are likely to selectively allocate their attention to potential health threats and thus are more likely to report somatic symptoms.

In this study, participants completed a modified APP and filled out various questionnaires. Participants were randomized to either a highly-frequent-query condition or a less-frequent-query condition. Both groups had comparable symptom baseline values, but people in the highly-frequent as opposed to less-frequent condition reported significantly higher symptom levels once the experiment started.

“Symptom levels stayed stable over the course of the experiment and were best predicted by symptom levels at earlier timepoints in the experiment,” say the authors. “Health anxiety levels significantly predicted symptom levels and moderated the relation between condition and symptom levels.”

Importance: Persistent somatic symptoms, meaning ‘subjectively distressing somatic complaints, irrespective of their etiology’, present a public health burden. Around two-thirds of symptoms in primary care have no clear underlying cause which leads to a large associated health care cost.

Availability: Pre-publication in the Journal of Psychosomatic Research.

Authors: Hermioni Amonoo, MD, MPH, et al.

Abstract: There is an increasing need to promote diversity, equity, and inclusion (DEI) in all aspects of academic medicine, including through continuing medical education (CME). Although professional medical organizations' annual meetings play an instrumental role in CME for physicians, there have been no studies describing DEI content in the annual meeting programming of professional medical organizations, including ACLP.

So the authors examined publicly available ACLP annual meeting content titles on the ACLP website from 2010 to 2021. Members of the Academy’s DEI subcommittee iteratively generated keywords that covered a broad scope of DEI-related themes. Each annual meeting content was independently coded by two members of the DEI subcommittee with discrepancies adjudicated by two additional members. Descriptive statistics were used to characterize the annual meeting content.

Of the 2,615 annual meeting titles from 2010-2021 analyzed, 2,531 were not coded to have DEI themes. 3% of titles were coded to have a DEI theme as follows: culture/diversity (24%); bias/disparities (20%); race/racism (20%); social justice (14%); gender/sexism (12%); and LGBTQ+ (10%). The frequency of DEI titles each year ranged from 1% (2010, 2018) to 17% (2021, when DEI content increased).

The authors conclude: “Although professional medical organizations like the ACLP are poised to leverage their CME platforms embedded in annual meeting programming to train C-L psychiatrists on DEI topics, our findings suggest more work is needed to develop and promote DEI-focused educational programming for their annual meetings.”

Importance: As the authors say, disparities in mental health outcomes persist for minoritized populations despite ongoing advances in the diagnostic and therapeutic offerings for psychiatric disease. While the structural and systemic factors that drive health care disparities (e.g., unequal access to mental health care) are complex, there is consensus that all mental health clinicians, including psychiatrists, have a responsibility to reduce mental health care inequities and promote equitable mental health care for all.

ACLP’s goal is to advance and integrate DEI into all aspects of the Academy. One step has been setting up the DEI subcommittee which contributed this research—and which has inspired greater DEI content in our annual meeting programs.

Availability: Published by the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Authors: Mark Oldham, MD, FACLP, et al.

Abstract: Manually screening for mental health needs in acute medical-surgical settings is thorough but time-intensive. Automated approaches can enhance efficiency and reliability, but the predictive accuracy of automated screening remains largely unknown.

This research developed an automated screening list using data from the electronic medical record that identified medical inpatients with psychiatric needs—then evaluated its ability to predict the likelihood of psychiatric consultation.

An automated screening list was incorporated into an existing manual screening process for one year. Screening items were applied to the year's implementation data to determine whether they predicted consultation likelihood. Consultation likelihood was designated high, medium, or low. The prediction model was applied hospital-wide to characterize mental health needs.

Importance: Electronic medical record discrete data elements predict the likelihood of psychiatric consultation. Automated approaches to screening deserve further investigation.

Availability: Published by the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Authors: Elena Bennecke, Dipl.-Psych., et al.

Congenital conditions with atypical development of chromosomal, gonadal, or anatomic sex characteristics are referred to as differences of sex development (DSD). Psychosocial care is recommended to be an integral part of clinical management for individuals with DSD. Few studies have examined the perceived need for, utilization of, and the opinions of individuals with DSD regarding psychological support.

This study was part of a European multi-center study in 14 different medical centers in six countries. In total, 1.040 individuals with DSD participated in a patient-reported outcome questionnaire asking about experiences and opinions regarding psychological support in DSD care.

A majority of the participants reported that they had not received psychological support, in childhood and/or adolescence, nor in adulthood. Need for psychological support in childhood and/or adolescence was reported by 51.3%; need for psychological support in adulthood was reported by 49.5%.

The majority (80.2%) agreed with the statement that people with DSD should always be offered psychological support. According to 78.7% of participants, parents of children with DSD should also always be offered psychological support.

Importance: As the authors say: “The discrepancy between received and perceived need for psychological support suggests that individuals with DSD experience barriers to access mental health care services. Psychosocial and psychological services for children, adolescents, and adults should therefore be available and offered throughout the lifespan to individuals with DSD.”

Availability: Pre-publication in the Journal of Psychosomatic Research.