IN THIS ISSUE: Academy Awards 2022 | Forced Migration & Climate Change | Posters | 2021 Plenary | Debate | A&E Abstracts
‘ACLP is the premiere venue for learning about subspecialized consultative care’
This year’s list of posters accepted for presentation at CLP 2022 exceeds 200. They are divided into 26 tracks. Here, we select more examples of what’s on offer to annual meeting attendees. They have been chosen at random from the top-scoring posters in their tracks. Chair of the Oral Papers & Posters Subcommittee, Michael Marcangelo, MD, FACLP, adds a commentary on each. Our first selection was here in ACLP News, September.
QUALITY AND SAFETY
Piloting a Standardized Documentation Protocol for Observational Sitters on Non-Psychiatric Units
Lead presenter: Audrey Chen, MD
One-to-one observation sitters are often utilized with delirious or behavioral crisis patients and may be a valuable source of clinical information. However, because there is no standardized job description or training for sitters, formal standardized documentation is lacking and much information is lost.
Data for this IRB-approved study is currently being collected. It pilots a standardized documentation template for sitters observing patients on non-psychiatric units. The presenters aim to evaluate feasibility and also hypothesize that, if successful, satisfaction among sitters providing data for medical decision-making will increase.
“Sitters represent an underutilized source of behavioral information for C-L psychiatrists with the potential to impact medical decision-making and ultimately patient outcomes,” say the presenters. “This study will provide practical information on the perceived utility and satisfaction of standardized sitter observations relative to feasibility, and thus inform future efforts in the development of standardized education and training protocols for observation sitters.”
Dr. Marcangelo: “One of the key differences between inpatient psychiatric services and consultation services is the quality of observational information that the psychiatric team receives. While inpatient staff are trained to watch for key signs and symptoms that can inform the team about the patient’s response to treatment, consultation teams often face a dearth of primary information. This study aims to standardized the documentation that observers in the hospital complete in order to improve the quality of information being fed forward. It is an intriguing and possibly low-cost way to understand patient’s presentations better and maybe even get people discharged more easily. This poster should provide guidance to attendees as to how they can improve their hospital’s internal communication.”
SUBSTANCE USE DISORDERS
Methadone Dosing for Opioid Use Disorder in the Setting of Infective Endocarditis and QTc Prolongation
Lead presenter: Dustin Todaro, PhD, MD
Injection drug use-associated infective endocarditis (IDU-IE) among patients with opioid use disorder (OUD) is associated with significant morbidity and mortality. Methadone is an effective treatment for OUD but carries a risk of QTc prolongation and torsades de pointes. Currently, limited data exists to guide methadone titration for concurrent OUD and QTc prolongation in the setting of surgically managed IDU-IE.
Guidelines for treatment of IDU-IE endorse surgery if medically indicated and incorporating addiction treatment. Many patients strongly prefer to start or continue methadone postoperatively. “Patients undergoing surgical management of IDU-IE may be at risk for QTc prolongation,” say the presenters. “It is important to use accurate correction formulas to assess QTc prolongation, which may reveal QTc ranges within normal limits.”
The presenters describe methadone dosing for three patients with IDU-IE complicated by QTc prolongation. The case series provides anecdotal observations to guide high-risk methadone titration in patients with IDU-IE while generating questions for future systematic evaluation.
Dr. Marcangelo: “The use of methadone to manage patients with opioid use disorder has become standard of care while they are in the hospital. This abstract looks at a series of patients with QTc prolongation and describes how methadone was titrated safely using appropriate correction factors. Given that methadone is known to prolong QTc this provides important clinical guidance for a high-risk patient population. Their efforts appear to have been successful because while the patients did not have great outcomes, they did not suffer consequences related to the QTc interval. This poster will help to further disseminate this life-saving intervention and hopefully lead to wider adoption of safe methadone use.”
TRAINING AND EDUCATION
Building Community Capacity: The Development of a TBI Behavioral Health ECHO
Lead presenter: Jennifer Erickson, DO
Traumatic brain injury (TBI) is a significant cause of disability. TBI increases the risk and complexity of multiple behavioral health conditions. Successful TBI recovery can largely depend on access to, and engagement in, behavioral health treatment.
“Unfortunately, treatment of post-TBI symptoms often falls to community providers who have little support and are under-prepared to manage these complexities,” say the presenters. “We created the first program that leveraged the ECHO (Extension for Community Healthcare Outcomes) model to deliver an educational curriculum and support by experienced TBI experts to community providers who treat persons with TBI.”
The poster reviews literature for ECHO programs in special populations, the program development, community engagement, and the characteristics of the first group to complete the curriculum.
ECHO programs have supported multiple complicated medical and psychiatric populations. This is the first program to help patients with post-TBI behavioral health symptoms.
“C-L psychiatrists have increased opportunities and responsibility to contribute to the population health of communities,” say the presenters. “The TBI-Behavioral Health ECHO Program is a model for how C-L psychiatrists can approach developing and delivering this much-needed community support for complex patient populations.”
Dr. Marcangelo: “Traumatic brain injury (TBI) is a common problem on consultation services and the follow-up care for these patients is often fragmented. This poster discusses a program that was developed by experts to do community outreach around the care of post-TBI patients after they leave the hospital. By sharing the elements of their program, including how it was designed, how it was shared, and the impact, the presenters provide a blueprint for other consultation groups to develop their own post-discharge programs for patients with complex conditions. Just as important as the program’s successes will be learning about the places where it didn’t go smoothly—something that the poster session really facilitates through discussion and engagement.”
TRANSPLANT PSYCHIATRY
A Change of Heart: Psychiatric Considerations in the First Porcine to Human Cardiac Xenotransplantation
Lead presenter: Nithya Cherukuru, MD
Xenotransplantation has been regarded as a solution to the limited number of human organs available for the exceeding amount of people who need them. However, there is little guidance available regarding the selection and management of appropriate candidates.
The presenters report the first human recipient of a cardiac xenotransplantation, and the involvement of C-L psychiatrists during the process.
“Without a formal, multidisciplinary team to evaluate and develop care plans for future xenotransplantation recipients, the difficulties that arose in this case are very likely to recur with new and unforeseeable variations,” say the presenters. “As xenotransplantation continues to be developed, unanticipated difficulties are a certainty, and prospective, proactive involvement of psychiatric services will be necessary.”
Dr. Marcangelo: “One of the fastest-moving frontiers in organ transplantation is xenotransplantation. This poster provides a case report of the first human recipient of a porcine heart and raises a number of ethical and clinical concerns about the care of the patient. As new technologies are developed, C-L Psychiatry will surely be asked to participate to determine a patient’s capacity and suitability for new procedures. The poster will centralize the importance of a multidisciplinary approach in transplant to protect patients and ensure equity. This poster is also an example of a major medical news story coming to the conference with information from those involved in the patient’s care. This should allow attendees to dispel myths and learn about the actual facts of the case.”
WOMEN’S MENTAL HEALTH
Perspectives on Addressing and Treating Bipolar Disorder in the Obstetric Settings
Lead presenter: Grace Masters, MD
Mood and anxiety disorders, including bipolar disorder (BD), affect 20% of perinatal individuals. This period carries a high risk of new-onset or exacerbation of BD. Recommendations suggest obstetric clinicians screen for BD during the perinatal period, especially prior to initiating pharmacotherapy—“yet this is often challenging,” say the presenters.
Perinatal Psychiatry Access Programs have emerged across the US to help obstetric professionals meet the needs of perinatal individuals with mental health conditions.
This study aimed to elicit obstetric professional perspectives on barriers and facilitators to managing BD in perinatal patients, and show how such programs may help or hinder these processes.
The presenters conclude: “Perinatal Psychiatry Access Programs may be a useful tool to facilitate obstetric professionals in bridging gaps in mental health care for perinatal patients with BD.”
Dr. Marcangelo: “This poster reviews the impact of a Perinatal Psychiatry Access Program on the care that women with bipolar disorder receive. It is an elaboration on collaborative care programs in that it empowers obstetrical professionals to manage patients with bipolar disorder without the psychiatrist being directly involved. Participants who had completed the program screened more often for bipolar disorder but still felt they needed more information about the ongoing management of patients. Discussion around how programs such as this are designed and implemented can help attendees extend the work of other programs to their own. This poster also allows one of the discipline’s key subspecialties, women’s mental health, to play a prominent role at the meeting. ACLP is the premiere venue for learning about subspecialized consultative care.”