A & E Abstracts

Authors: Jeff Huffman, MD, FACLP, et al.

Abstract: Non-adherence to key health behaviors among patients with cardiac risk conditions (e.g., type 2 diabetes) is a major public health problem. Positive psychology (PP) interventions, which utilize short tasks (e.g., using personal strengths, recalling positive events) to cultivate well-being could help to effectively promote cardiac health behaviors in combination with traditional approaches, say the authors.

Text message interventions may represent a novel, accessible means to deliver a positive-psychology-based health care plan.

Importance: This randomized trial provides critical information regarding the feasibility, acceptability, and preliminary impact of a scalable, adaptive TMI for patients at elevated cardiac risk. If intervention shows potential benefit, the next step will be to test it in a larger randomized trial powered to detect changes in health behaviors and clinically relevant outcomes. Ultimately, this intervention could be broadly utilized to promote health and prevent cardiac events. 

Availability: Pre-publication by the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP) within 100 abstracts from the 2022 ACLP Annual Meeting.

Authors: Xiaorui Xiong, PhD, et al.

Abstract: Digital therapeutics can expand the reach and fidelity of behavioral treatment for substance use disorders (SUDs). This analysis evaluated real-world engagement and clinical outcomes in patients diagnosed with SUDs who were prescribed reSET®, an FDA-authorized prescription digital therapeutic (PDT).

Patients with SUDs exhibited robust engagement with a PDT, high rates of retention through 12 weeks, and substantial rates of abstinence at the end of treatment when the therapeutic was used in a real-world setting. PDTs hold promise as a new way to access effective SUDs treatment, say the authors.

Importance: Substance use disorder (SUD), which includes dependence on alcohol, cannabis, stimulants, sedatives, or opioids, affects up to 41 million people in the US, and yet recent data shows that only about 6.5% of these people ever receive SUDs treatment.

This study is the first to report real-world PDT engagement and clinical outcomes data from a large, geographically diverse population of patients with SUDs.

Patient attrition from SUD treatment is a common barrier to successful recovery, thus treatments or programs that increase engagement with, and retention in, treatment may support recovery from SUDs. This evaluation strongly suggests that adults of all ages who fill a prescription for a PDT to treat SUDs readily engage with the PDT, many at the recommended content dose.

Availability: Published by The American Journal on Addictions

Authors: Meredith Spada, MD, et al.

Abstract: In response to limited access to child and adolescent psychiatrists, the Children’s Telephonic Psychiatric Consultation Service (TiPS) provides real-time consultation to primary care providers for pediatric patients with behavioral health concerns.

It is estimated that 8-10% of children younger than age six experience clinically significant mental health problems.

Twenty-one consults on children under age six were completed. Average age was four years. Most common diagnoses included oppositional defiant disorder/behavior problems, autism/developmental disorder, attention deficit hyperactivity disorder, and trauma. Most common reasons for a consult included assistance with resources and medication questions.

Medications are used infrequently in this age range to assist with sleep and ADHD. Referral to specific therapy modalities is frequently recommended.

Importance: Given the nature of longitudinal relationships in pediatrics, pediatricians are especially well placed to promote early childhood mental health. Child Psychiatry Access Lines such as TiPS are one strategy to provide specialized mental health recommendations for young children.

Availability: Pre-publication by the Journal of the Academy of Consultation Psychiatry (JACLP) within 100 abstracts from the ACLP 2022 Annual Meeting.

Authors: Elizabeth Attaya, et al.

Abstract: Following Beth Israel Lahey Health Behavioral Services’ (BILH BS) launch of the CoCM Initiative in 2019, an annual evaluation survey was created to track provider satisfaction, productivity, and confidence with addressing their patients’ behavioral health needs in the primary care setting.

Survey results demonstrate a significant shift in the dispersion of response scores between PCPs within sites with access to CoCM and PCPs without access to CoCM. A larger percentage of PCPs with CoCM ranked their agreement higher than PCPs without CoCM on questions pertaining to their satisfaction, productivity, and confidence in addressing the needs of patients with mental health disorders, substance use disorders, and psychosocial needs.

Implementation of CoCM in a primary care practice correlates with an increased ability in assessing and managing behavioral health conditions, say the authors. Positive response scores of providers with CoCM also serve to bolster confidence in the CoCM model for the communities served.

Importance: CoCM implementation within primary care sites has created an effective intervention to expand the ability of PCPs, BHCs, and primary care teams in addressing behavioral health conditions.

Availability: Pre-publication by the Journal of the Academy of Consultation Psychiatry (JACLP) within 100 abstracts from the ACLP 2022 Annual Meeting,

Authors: Emily Kane, et al

Abstract: Missing signs and symptoms can lead to misdiagnosis of medical conditions presenting with psychiatric symptoms. Systemic lupus erythematosus is one disease that can present with neuropsychiatric symptoms including catatonia. An inaccurate diagnosis can delay critical treatment.

In the quoted case of a 16-year-old, diagnosis of an underlying medical condition was delayed partly due to the initial presentation being primarily psychiatric and a number of missed or ignored signs and symptoms. Vision and eye changes documented during the initial and subsequent admission, as well as leukopenia and anemia, were overlooked. In addition, given the acute onset two months prior, further initial work-up may have been warranted.

Importance: This case highlights the importance of a comprehensive review of systems and close attention to signs and symptoms while considering underlying medical causes for psychiatric symptoms to ensure an accurate and timely diagnosis.

Availability: Pre-publication by the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP) within 100 abstracts from the ACLP 2022 Annual Meeting.