Academy of Consultation-Liaison Psychiatry

IN THIS ISSUE: Election Win | Donation | Proactive | A&E | Abstracts

Selection from the latest research impacting C-L Psychiatry

‘The health of individuals and communities will not improve if root-cause social factors are not addressed’

Research: Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World

Authors: Eve Escalante, MSW, LCSW; Robyn Golden, MA, LCSW; Diana Mason, RN.

Abstract/Extract: In 2017, only 14% of older adults in the US were socially isolated, but accounted for $6.7 billion in additional Medicare spending. In a national survey in August 2020, 61% of those aged 50 years or older reported experiencing social isolation since the pandemic began. Isolation is compounded for those living in rural areas. Nonetheless, the US health care system seldom screens for, or discusses, social isolation with patients.

Importance: The importance of social determinants of health has been gaining traction in the health care sector during the last decade. Social determinants have been found to be responsible for 80% to 90% of health outcomes, and an abundance of research has demonstrated that no matter the advancements in medicine and health care, the health of individuals and communities will not improve if these root-cause social factors are not addressed. The COVID-19 pandemic is highlighting one of these factors: social isolation.

Availability: Published article from JAMA Health Forum.

JAMA Health Forum

‘Framework for mental health care delivery in the general hospital designed to enhance services’

Research: Proactive Consultation-Liaison Psychiatry: American Psychiatric Association Resource Document

Authors: Mark Oldham, MD; Paul Desan, MD, FACLP; Hochang B. Lee, MD, FACLP; James Bourgelois, OD, MD, FACLP; Sejal Shah, MD, FACLP; Patrick Hurley, MD; Sanjeev Sockalingam, MD, MHPE, FACLP; APA Council on Consultation-Liaison Psychiatry.

Abstract/Extract: This Resource Document describes the historical context and modern trends that have given rise to the model of Proactive C-L Psychiatry. Its four elements include systematic screening for active mental health concerns, proactive interventions tailored to individual patients, team-based care delivery, and care integration with primary teams and services.

Importance: Styled as an inpatient corollary to outpatient collaborative care models, Proactive C-L Psychiatry provides a framework of mental health care delivery in the general hospital designed to enhance mental health services to a broad range of patients.

Availability: Pre-publication extract from the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Psychosomatics journal cover

‘Little is known about the early life predictors of anxiety during the pandemic’

Research: A Developmental Pathway from Early Behavioral Inhibition to Young Adults’ Anxiety During the COVID-19 Pandemic

Authors: Selin Zeytinoglu; Santiago Morales; Nicole Lorenzo; Heather Henderson; Daniel Pine, MD; Nathan Fox.

Abstract/Extract: The COVID-19 pandemic has brought unprecedented changes to young adults’ lives, resulting in mental health difficulties for many; however, some individuals are particularly prone to heightened anxiety. Little is known about the early life predictors of anxiety during the pandemic. The researchers examined a developmental pathway from behavioral inhibition (BI), a temperament characterized by fearful responses towards novelty, to changes in young adults’ anxiety during the initial period of the pandemic. They hypothesized that a stable pattern of BI across early childhood would predict greater adolescent worry dysregulation, which in turn would predict increases in young adult anxiety during a stressful phase of the pandemic.

Importance: National Institutes of Health (NIH) says the study could help predict who is at greatest risk of developing anxiety during stressful life events in early adulthood and inform prevention and intervention efforts.

Availability: NIH-supported research published in the Journal of the American Academy of Child and Adolescent Psychiatry.

JAACAP

‘It is critical that C-L psychiatrists are able to identify a wide QRS complex on the ECG’

Research: Assessment of QTc and Risk of Torsades de Pointes in Ventricular Conduction Delay and Pacing: A Review of the Literature and Call to Action

Authors: Margo Funk, MD; Kevin Cates, MD, MPH; Aishwary Rajagopalan, DO, MHS; Chadrick Lane, MD; Junyang Lou, MD.

Abstract/Extract: The QT-interval is prolonged ipso facto in patients with a wide QRS complex from VCD/VP and must be adjusted for QRS duration. Multiple formulae have been proposed to account for wide QRS complex in this setting with no single universally accepted methodology. Researchers suggest the use of either the Bogossian formula or JT-interval followed by Hodges or Framingham heart-rate correction to adjust for a wide QRS complex.

Importance: The researchers say it is critical that C-L psychiatrists are able to identify a wide QRS complex on the ECG, understand implications for accurate assessment of prolonged depolarization, and apply an appropriate correction methodology.

Availability: Pre-publication extract from Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Psychosomatics journal cover

‘Emergency department priorities for care-seeking shifted during the COVID-19 pandemic’

Research: Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic

Authors: Kristin Holland, MPH; Christopher Jones. PharmD, DrPH, MPH; Alana Vivolo-Kantor, MPH; and colleagues.

Abstract/Extract: Question—Did US emergency department (ED) visits for mental health, suicide attempts, overdose, and violence outcomes change during the COVID-19 pandemic? Answer—This study of almost 190 million ED visits found that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March through October 2020, during the COVID-19 pandemic, compared with the same period in 2019.

Importance: These findings suggest that ED use and priorities for care-seeking shifted during the COVID-19 pandemic, underscoring mental health, substance use, and violence risk screening and prevention needs during public health crises. it is likely that COVID-19 and associated mitigation measures will have impacts that far outlast the short-term emergency period. Findings underscore the need for continued MHC, suicide, OD, and violence prevention messages, screening, and interventions at individual, relationship, community, and societal levels, as well as longitudinal surveillance to track the long-term impacts of COVID-19.

Availability: Published in JAMA Psychiatry.

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