Journal of the Academy of Consultation-Liaison Psychiatry最新文献

{"title":"The C-L Psychiatrist's Practical Guide to Legislative Advocacy Skills-And why it is Imperative for C-L Psychiatrists to Utilize these Skills.","authors":"Patrick A Ho, Ava Hawkes","doi":"10.1016/j.jaclp.2025.03.435","DOIUrl":"https://doi.org/10.1016/j.jaclp.2025.03.435","url":null,"abstract":"<p><p>Consultation-liaison (C-L) psychiatrists are trained extensively in the clinical aspects of our work, but must work within the confines of the healthcare apparatus with overarching policies that dictate the affordability, accessibility, and quality of medical care. With the 2024 US elections occurring during our recent ACLP meeting, it became quite clear that a change in the US presidential administration will also affect healthcare policy. Local and state level elections, however, may have an even more profound impact on healthcare policy. With many C-L psychiatrists feeling trepidation about these changes, we call for C-L psychiatrists to take part in legislative advocacy activities, especially at the local/state levels that are more accessible and perhaps more impactful. We recognize that important barriers include lack of formal education, as well as time constraints and have devised the \"Hawkes Tiered State and Local Advocacy Activity List\" as a practical compendium of legislative advocacy actions that C-L psychiatrists can participate in, stratified by the amount of time required to take part in each activity. We hope that this will empower C-L psychiatrists to participate in legislative advocacy activities, as the stakes are higher than ever, and we cannot afford for our perspectives to not be included in policy and legislation that can have major consequences for our patients and our practice of medicine.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Describing Psychiatric Illness as \"Terminal\" is Inaccurate and Potentially Harmful.","authors":"Emily G Holmes","doi":"10.1016/j.jaclp.2025.03.434","DOIUrl":"https://doi.org/10.1016/j.jaclp.2025.03.434","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catatonia: The Phoenix Rises Again and Is Here to Stay.","authors":"Mark A Oldham","doi":"10.1016/j.jaclp.2025.03.433","DOIUrl":"https://doi.org/10.1016/j.jaclp.2025.03.433","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medically Unexplained Behaviors and Symptoms in Consultation-Liaison Psychiatry: Biopsychosocial and Psychodynamic Considerations.","authors":"Joseph M Flaxer, Anna L Dickerman, Samuel P Greenstein, Xavier F Jimenez","doi":"10.1016/j.jaclp.2025.03.002","DOIUrl":"10.1016/j.jaclp.2025.03.002","url":null,"abstract":"<p><p>Medically unexplained behaviors and symptoms are challenging for patients, families, and clinicians alike. They demand consideration of more than biological determinants, warranting biopsychosocial assessment as well as psychodynamic formulation. Here we present a case of an 80-year-old woman with a history of multiple oropharyngeal traumas who presented to the emergency department for a recently developed acute anorexia associated with fear of choking (phagophobia). She presented with complex psychological dimensions, such as survivor guilt related to losing her spouse to gastroesophageal cancer. Through a psychodynamic and biopsychosocial lens, we discuss how her predisposing developmental history of trauma and fear responses; perpetuating gastrointestinal issues, unresolved grief, and survivor guilt; and more recent age-related neurocognitive changes inform her presentation and response to treatment. Future directions include broader application of biopsychosocial assessments and psychodynamic formulations to medically unexplained behaviors and symptoms, with a special emphasis on education of trainees.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review of Neuropsychiatric Toxicity in Second Generation Antifungals With an Illustrative Case Report.","authors":"Justine Leveque, Claire Merveilleux, Maxime Tiberghien","doi":"10.1016/j.jaclp.2025.03.001","DOIUrl":"10.1016/j.jaclp.2025.03.001","url":null,"abstract":"<p><strong>Background: </strong>Second-generation triazole antifungals are extended-spectrum drugs that act against yeasts, molds, and dimorphic fungi. These agents include voriconazole, posaconazole, and isavuconazole. Voriconazole may cause neuropsychiatric toxicity such as hallucinations. However, regarding neuropsychiatric toxicity related to posaconazole and isavuconazole, the literature remains poor.</p><p><strong>Objective: </strong>The present study reports a case of neuropsychiatric toxicity induced by posaconazole and isavuconazole triazole antifungals as well as the results of a systematic review on neuropsychiatric toxicity related to second-generation triazole antifungals.</p><p><strong>Methods: </strong>A systematic search of Medline electronic databases used MeSH headings and equivalent terms for second-generation triazole antifungals, delirium, hallucinations, and neurotoxicity. The selection of relevant records was performed by 2 independent reviewers. Epidemiological studies, observational studies, and case reports were included.</p><p><strong>Results: </strong>A total of 20 articles were included in the systematic review, comprising 11 case reports and 9 observational studies. All observational studies were related to voriconazole neuropsychiatric toxicity, particularly hallucinations; the estimated frequency of occurrence varied from 13.9% to 24%. Putative mechanisms of second-generation triazole antifungals neuropsychiatric toxicity include a disruption of cholesterol homeostasis in the brain, an inhibition of transient receptor potential melastatin 1 in retinal cells, and a drug-induced phospholiposis. A supra-therapeutic blood concentration of these agents as well as a drug interaction could also be involved.</p><p><strong>Conclusions: </strong>In the present study, we reported for the first time, to our knowledge, a patient presenting with neuropsychiatric toxicity potentially related to posaconazole and isavuconazole. In a systematic review, we identified various mechanisms involved in the development of second-generation triazole antifungals neuropsychiatric toxicity. However, there remains to be extensive investigation.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zuranolone for Postpartum Depression After Highly Lethal Suicide Attempt: Two Case Illustrations and a Narrative Literature Review.","authors":"Anne Ruminjo, Parisa R Kaliush, Emily M Pisetsky, Crystal E Schiller, Samantha Meltzer-Brody, Riah Patterson","doi":"10.1016/j.jaclp.2025.02.004","DOIUrl":"10.1016/j.jaclp.2025.02.004","url":null,"abstract":"<p><strong>Background: </strong>In the United States, suicide is one of the leading causes of death in the first year postpartum, possibly accounting for up to 20% of deaths. The Food and Drug Administration recently approved 2 fast-acting medications, brexanolone and zuranolone, for the treatment of postpartum depression (PPD), which shares many clinical features with postpartum suicidality.</p><p><strong>Objective: </strong>Determining the efficacy of zuranolone in the treatment of severe PPD in the context of highly lethal suicide attempts.</p><p><strong>Methods: </strong>We describe 2 illustrative cases of zuranolone treatment of PPD after a gunshot suicide attempt. Following treatment, both women demonstrated a rapid reduction in depressive symptoms and readiness for safe discharge. We also conducted a review of the literature on suicide attempts associated with PPD.</p><p><strong>Results: </strong>Our case series demonstrated that zuranolone may effectively treat PPD with rapid-onset highly lethal suicide attempts.</p><p><strong>Conclusions: </strong>Postpartum suicidality is complex and often emerges rapidly. We advocate for more research on fast-acting novel treatments, such as zuranolone and brexanolone, for PPD and postpartum suicidality.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial Disparities in the Use of Physical Restraints and Intramuscular Medications for Patients Awaiting Psychiatric Hospitalization in the Emergency Department.","authors":"Jin Hong Park, Samuel T Savitz, Nicholas Allen, Priya R Gopalan, Jeffrey P Staab, David C Fipps","doi":"10.1016/j.jaclp.2025.02.006","DOIUrl":"10.1016/j.jaclp.2025.02.006","url":null,"abstract":"<p><strong>Background: </strong>Racial disparities within health care practices have drawn increasing attention. In psychiatric emergencies, patients may exhibit severe agitation necessitating the application of physical restraints and administration of intramuscular medications to ensure patient and staff safety and reduce acute symptoms. While previous studies have explored racial disparities in these interventions within the general emergency department (ED) settings, there remains a paucity of data about their use specifically in patients awaiting psychiatric hospitalization in the ED.</p><p><strong>Objective: </strong>We investigated disparity in the application of physical restraints and administration of intramuscular medications to Black versus non-Black patients awaiting psychiatric hospitalization in the ED.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of adults admitted to an acute inpatient psychiatric unit through an academic tertiary care center's ED over a 1-year timeframe. Sociodemographic data, including age, sex, marital status, race (classified as Black or non-Black), and insurance types were collected. Clinical variables including primary psychiatric diagnosis, current suicide attempt or self-injurious behaviors, history of suicide attempts, history of psychiatric hospitalizations, involuntary status, application of physical restraints, and administration of acute intramuscular medications were extracted. Data on time of presentation were collected. Two logistic regression models were constructed with physical restraints and intramuscular medications as the outcomes, race as the independent variable, and other variables as covariates.</p><p><strong>Results: </strong>A total of 525 patient encounters were included in the study (mean age = 34.4 ± 11.0) with a female-to-male ratio of 0.82 (236:289). Seventy-eight (14.9%) encounters involved a patient identified as Black. Physical restraints were used in 35 encounters (6.7%). Black race (odds ratio [OR] = 2.84; 95% confidence interval [CI] = 1.03-7.84; P = 0.04) was associated with an increased likelihood of receiving physical restraints after controlling for covariates including current self-injurious behaviors (OR = 4.15; 95% CI = 1.02-16.88; P = 0.047), involuntary status (OR = 15.16; 95% CI = 6.14-37.45; P < 0.001), and visit to the ED on the weekend (OR = 4.04; 95% CI = 1.61-10.11; P < 0.01). Black race was not associated with the administration of intramuscular medications after controlling for covariates.</p><p><strong>Conclusions: </strong>Our findings indicate a racial disparity in the application of physical restraints in patients awaiting psychiatric hospitalization in the ED. The odds that Black patients experienced physical restraints were three times higher than for non-Black patients, even after adjusting for sociodemographic and clinical factors.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consultation-Liaison Case Conference: Assessing Psychosis in Context of Religious Beliefs.","authors":"Justin Hoffman, Mary Lynn Dell, Godfrey Pearlson, Benjamin Anderson","doi":"10.1016/j.jaclp.2025.02.005","DOIUrl":"10.1016/j.jaclp.2025.02.005","url":null,"abstract":"<p><p>We present the case of a 75-year-old female presenting with an acute mental status change during which she abruptly became nonresponsive and collapsed to the floor. History revealed years of similar episodes in the context of religious beliefs regarding demonic possession and hearing the voices of God and the Devil. Top experts in the field provide perspective and guidance for diagnosing and managing psychiatric illness involving religious themes based on their experience and a review of available literature. Key teaching points include the challenges and limitations of current diagnostic tools, the nature of religious delusions, and engagement strategies for clinicians when dealing with patients exhibiting symptoms overlapping with religious experiences.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unnecessary Use of Medications for Alcohol Withdrawal Among Hospitalized Patients: A Retrospective Study of Phosphatidylethanol Testing in Patients With Suspected Alcohol Use Disorder.","authors":"Pooja R Sarkar, Amber N Edinoff, Joji Suzuki","doi":"10.1016/j.jaclp.2025.02.003","DOIUrl":"10.1016/j.jaclp.2025.02.003","url":null,"abstract":"<p><strong>Objectives: </strong>Alcohol withdrawal is frequently encountered in hospital settings, but the decision to treat the withdrawal with pharmacotherapy is often made without knowing if treatment is even necessary. Testing for phosphatidylethanol (PEth), results of which correlate well with recent alcohol consumption, may allow hospital teams to avoid treating alcohol withdrawal unnecessarily. To investigate PEth values of those suspected of alcohol withdrawal syndrome (AWS) among hospital inpatients, we conducted a retrospective study to determine the prevalence of hospitalized patients who received pharmacotherapy for withdrawal who also demonstrated PEth values suggesting minimal recent drinking.</p><p><strong>Methods: </strong>This retrospective study examined the electronic health records of hospitalized adult patients suspected of recent heavy alcohol use for whom PEth tests were ordered. PEth tests were ordered at the time to inform treatment decisions such as the provision of naltrexone or referral to ongoing psychosocial treatments, but not to inform the decision to treat AWS given that results would only be available 3 or more days later. Hospital inpatients, excluding emergency room encounters, for whom PEth was ordered at 2 affiliated academic hospitals from January 2021 to April 2024 were included.</p><p><strong>Results: </strong>The included cohort was composed of 73 individual encounters. Among the 45 (62%) encounters where pharmacotherapy for AWS was administered, 14 (31%) had PEth values (≤200 ng/ml) inconsistent with heavy alcohol use.</p><p><strong>Conclusions: </strong>Results suggest that a substantial proportion of hospital inpatients may have received pharmacotherapy for AWS despite PEth levels inconsistent with recent heavy alcohol use. If PEth results are available in real-time, results could help clinicians decide if pharmacotherapy is warranted. Further study of PEth testing and its role in the care of hospitalized patients is recommended.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CL Case Conference: Managing Substance Use and Agitation in Pregnancy.","authors":"J Reid Black, Elizabeth Hovis, Meredith L Spada, Li Li","doi":"10.1016/j.jaclp.2025.02.002","DOIUrl":"10.1016/j.jaclp.2025.02.002","url":null,"abstract":"<p><p>We present the case of a 29-year-old G1P0 female at 21 weeks of gestational age with stimulant use disorder, substance-induced psychosis, and agitation who is admitted to obstetrics and gynecology. During her hospitalization, consultation-liaison psychiatry plays an important role in managing her psychotropic regimen and determining appropriate safety precautions. Subject matter experts examine critical aspects of psychiatric care in pregnancy and liaising with obstetric services, including protocols for unit placement, suicide risk assessment, and medicolegal considerations such as involuntary commitment, medical decision-making capacity, and mandated reporting. Special attention is given to the management of agitation as an obstetric emergency, with detailed guidance on both nonpharmacologic and pharmacologic treatment strategies. We also discuss stimulant use disorder in pregnancy, including epidemiology, risk factors, potential treatment options, and barriers to receiving care.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}