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

{"title":"Evaluation and Management of Alcohol-Intoxicated Patients With Suicide Risk in the Emergency Department: A Scoping Review.","authors":"Priyanka Amin, Darya Dehkan, Jennifer Peltzer-Jones, Nasuh Malas, Victor Hong, Ahmad Shobassy, Keith Stowell","doi":"10.1016/j.jaclp.2025.08.012","DOIUrl":"10.1016/j.jaclp.2025.08.012","url":null,"abstract":"<p><strong>Background: </strong>The severity of suicide risk in patients who present to the emergency department (ED) with co-occurring complaints of suicidal ideation and alcohol intoxication is neither well-understood nor well-recognized by ED staff. While suicide screening has become a standard expectation in ED care, there lacks consensus on standard care practices for the evaluation and management of patients with suicidal ideation and/or attempt and alcohol intoxication.</p><p><strong>Objective: </strong>To conduct a scoping review of the care of ED patients with suicidality and alcohol intoxication.</p><p><strong>Methods: </strong>This is a scoping review describing the evaluation and management of ED patients with suicidality and alcohol intoxication. PubMed, Ovid MEDLINE, APA PsycInfo, and CINAHL were searched using relevant terms to describe this ED population. 110 total articles were found and underwent full-text review. Twenty-nine articles met criteria for inclusion.</p><p><strong>Results: </strong>Patients with suicide-related complaints while intoxicated are less likely to receive a psychiatric evaluation or to be admitted psychiatrically. This is concerning given that alcohol use is demonstrated to be both a proximal and long-term risk factor for suicide attempt(s). Existing literature includes recommendations to evaluate patients while intoxicated and to re-evaluate when sober. To create safe plans of care for these patients, clinicians need to identify the patterns of alcohol use: alcohol use to facilitate suicide, binge drinking episodes, or alcohol use disorder. ED interventions can then build from understanding of how the alcohol use and suicidality interact. Though no specific ED-based interventions were found for this patient subpopulation, interventions shown to mitigate suicide risk and/or decrease alcohol use include: brief interventions (e.g., Screening, Brief Intervention, and Referral to Treatment), peer navigators, crisis safety plans, discussion about restricting access to lethal means, and/or inpatient psychiatric admission.</p><p><strong>Conclusions: </strong>There is a lack of published guidelines, standards of care, and best practices to help consultation-liaison, emergency psychiatrists, and ED providers in the management of this population, despite overwhelming literature linking alcohol intoxication and suicide attempt/death. Further research is needed to (1) elucidate the core elements for standardized assessments and (2) develop evidence-based interventions to improve outcomes/decrease rates of intoxicated suicide completion.</p>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978294","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":"Diagnosis and Management of Medetomidine Withdrawal: Clinical Implications of the Shifting Illicit Opioid Landscape","authors":"Ross J. Johnson M.D.,&nbsp;Emily R. Casey Pharm.D.,&nbsp;Samantha J. Zwiebel M.D., M.A.","doi":"10.1016/j.jaclp.2025.06.005","DOIUrl":"10.1016/j.jaclp.2025.06.005","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 466-467"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327730","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":"Toward the 2025 ACLP Annual Meeting: Advancing Consultation-Liaison Psychiatry Through Inspiration, Investigation, Innovation, and Implementation","authors":"E. Sherwood Brown M.D., Ph.D., M.B.A., D.L.F.A.P.A., F.A.C.L.P.","doi":"10.1016/j.jaclp.2025.08.008","DOIUrl":"10.1016/j.jaclp.2025.08.008","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 377-379"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823179","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: Medically Unexplained Behaviors and Symptoms in Consultation-Liaison Psychiatry: Biopsychosocial and Psychodynamic Considerations","authors":"Joseph M. Flaxer M.D., M.P.H. ,&nbsp;Anna L. Dickerman M.D. ,&nbsp;Samuel P. Greenstein M.D. ,&nbsp;Xavier F. Jimenez M.D., M.A.","doi":"10.1016/j.jaclp.2025.03.002","DOIUrl":"10.1016/j.jaclp.2025.03.002","url":null,"abstract":"<div><div><span>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 </span>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 451-459"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","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":"Frailty and Its Association With Catatonia in the Intensive Care Unit: An Analysis of the Delirium and Catatonia Prospective Cohort Study","authors":"Chelsea K. Rick D.O., M.P.H. ,&nbsp;Patricia S. Andrews M.D. ,&nbsp;Kun Bai M.S. ,&nbsp;Fei Ye Ph.D., M.S.P.H. ,&nbsp;Mayur B. Patel M.D., M.P.H. ,&nbsp;Stephen Heckers M.D., M.Sc. ,&nbsp;Nathan E. Brummel M.D., M.S.C.I. ,&nbsp;Pratik P. Pandharipande M.D., M.S.C.I. ,&nbsp;Robert S. Dittus M.D., M.P.H. ,&nbsp;E. Wesley Ely M.D., M.P.H. ,&nbsp;Jo Ellen Wilson M.D., Ph.D., M.P.H.","doi":"10.1016/j.jaclp.2025.06.010","DOIUrl":"10.1016/j.jaclp.2025.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a syndrome characterized by the loss of physiologic reserve and is predictive of subsequent cognitive impairment, disability, and mortality. Catatonia is an underrecognized form of acute brain dysfunction in critical illness.</div></div><div><h3>Objective</h3><div>To describe association between baseline frailty and catatonia development in the context of critical illness.</div></div><div><h3>Methods</h3><div>This is a prospective cohort of critically ill adults from a single academic medical center. We included those assessed for pre-existing frailty within 72 hours of study enrollment using the Clinical Frailty Scale. Patients with moderate to severe cognitive impairment at baseline were excluded. Participants were assessed for catatonia using the Bush-Francis Catatonia Rating Scale mapped to Diagnostic and Statistical Manual of Mental Disorders, 5th edition criteria, within the first 14 days of critical illness. To examine the association between baseline frailty and catatonia, we used a chi-square test to evaluate trends in proportions performed for catatonia. To describe measures of association between frailty state along the fitness-frailty continuum and presence of catatonia, we used logistic regression, adjusting for cofounders of interest.</div></div><div><h3>Results</h3><div>Of 170 patients with a median age of 62 years, 47 (28%) were considered frail and 49 (29%) developed catatonia. In a logistic regression model, frailty was not significantly associated with catatonia presence or absence in the Intensive Care Unit (ICU) (odds ratio = 1.064 [95% confidence interval: 0.805, 1.405], <em>P</em> = 0.664].</div></div><div><h3>Conclusions</h3><div>Our study did not demonstrate an independent association with increasing levels of frailty along a fitness-frailty continuum and the presence of catatonia. More research is needed to determine if pre-existing frailty may be a predisposing factor for catatonia in the setting of critical illness.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 401-408"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531030","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":"Emergency Department Presentations for Catatonia: A 2019–2021 National Emergency Department Sample Study","authors":"James Luccarelli M.D., D.Phil. ,&nbsp;Mark Kalinich M.D., Ph.D. ,&nbsp;Jonathan P. Rogers M.B.B.Chir., Ph.D. ,&nbsp;Abigail L. Donovan M.D. ,&nbsp;Felicia A. Smith M.D. ,&nbsp;Scott R. Beach M.D. ,&nbsp;Joshua R. Smith M.D.","doi":"10.1016/j.jaclp.2025.08.006","DOIUrl":"10.1016/j.jaclp.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>Catatonia is a neuropsychiatric disorder characterized by motor, affective, cognitive, and behavioral disturbances. Despite its association with significant healthcare costs, morbidity, and preventable mortality, catatonia remains underdiagnosed, particularly in emergency department (ED) settings. Limited data exist on the demographics, diagnostic patterns, and outcomes of catatonia in the ED. This study aims to characterize the epidemiology and healthcare utilization of ED visits associated with catatonia using the National Emergency Department Sample.</div></div><div><h3>Methods</h3><div>We analyzed the National Emergency Department Sample for ED visits with a discharge diagnosis of catatonia between 2019 and 2021, with visits weighted to provide national estimates.</div></div><div><h3>Results</h3><div>An estimated 51,671 visits (0.013% of all ED presentations) included a diagnosis of catatonia. ED presentations with a diagnosis of catatonia had a bimodal age distribution, with peaks for patients aged 20–29 and 55–64 years, although there were presentations for patients as young as 2 and as old as 90+. Catatonia was disproportionately diagnosed in Black patients (27.6%). Psychiatric conditions including schizophrenia spectrum disorders, depressive disorders, and bipolar disorder, were the most common primary diagnoses (55.5%). Catatonia-related ED visits had an 82.6% hospital admission rate. Physical restraints were documented in 5.6% of ED presentations involving catatonia.</div></div><div><h3>Conclusions</h3><div>Catatonia is rarely diagnosed in the ED setting but is identified in patients of all ages and results in a strikingly high rate of hospital admission, similar to those of well recognized life-threatening medical conditions. The high utilization of inpatient resources underscores the need for improved recognition and management of catatonia in the ED.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 380-388"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818197","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":"Pharmacologic Management of Skin-Picking Disorder: An Updated Review","authors":"Nina Modanlo M.H.S. ,&nbsp;Xiaofeng Yan M.D., Ph.D. ,&nbsp;James A. Bourgeois O.D., M.D.","doi":"10.1016/j.jaclp.2025.05.002","DOIUrl":"10.1016/j.jaclp.2025.05.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Skin-picking disorder (SPD), defined as a psychocutaneous condition that involves excessive picking at the skin causing marked impairment in quality of life, is commonly seen in both dermatology and psychiatry. As such, therapeutic intervention—both nonpharmacologic and pharmacologic—is essential. Given the rising prevalence of SPD and the tremendous impact it can have on quality of life, an updated review, specifically on pharmacologic options, is very much needed.</div></div><div><h3>Objective</h3><div>The aim of this scoping review is to provide a detailed compilation of updated pharmacologic treatments for SPD based on evidence from recent studies and trials.</div></div><div><h3>Methods</h3><div>A search through PubMed was conducted using the key words “treatment” and “skin picking” or “excoriation” in November 2024. Articles were limited to those that solely address pharmacologic treatments in skin-picking for individuals older than 18 years, were published in the last 20 years, in the English language, and can be classified as a clinical trial, case report/series, or cohort study.</div></div><div><h3>Findings</h3><div>Of the 192 articles extracted from PubMed, 13 studies (289 patients) met the inclusion criteria. These articles consist of 7 case reports/series and 6 randomized controlled trials. The following medications were evaluated for treatment of SPD: selective serotonin reuptake inhibitors, glutamatergic drugs (N-acetyl cysteine, memantine), antiepileptics (lamotrigine, topiramate), lithium, antipsychotics (olanzapine, aripiprazole), opioid antagonists (naltrexone), and mirtazapine.</div></div><div><h3>Conclusion</h3><div>Of the medications evaluated for use in SPD, selective serotonin reuptake inhibitors show the most promising results in terms of mitigating the severity and frequency of skin-picking symptoms. Although habit-reversal psychotherapy has traditionally been first-line treatment, selective serotonin reuptake inhibitors are now increasingly being used in combination with psychotherapy when a patient presents with SPD. N-acetyl cysteine has also been well-established in the treatment of SPD. Other classes of medications that have been studied in SPD include the use of antipsychotics (often combined with antidepressants) and naltrexone. Additional studies are indicated to further expand on the current research and definitively establish the role of the less common medications, such as antiepileptics, in SPD.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 417-428"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008073","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":"Atypical Neuroleptic Malignant Syndrome Without Rigidity and With Cardiac Troponin Elevation","authors":"Chanel Zhan M.D.,&nbsp;Tyler Zahrli M.D.,&nbsp;Benjamin Hoover M.D.","doi":"10.1016/j.jaclp.2025.08.001","DOIUrl":"10.1016/j.jaclp.2025.08.001","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 5","pages":"Pages 460-463"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849599","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":"Maintaining Consultation-Liaison Services Through Emergency Downtime: Lessons Learned From a Cybersecurity Incident.","authors":"Jonathon W Wanta, Moshe Bitterman, Alba Pergjika, Raymond Gonzales, John Walkup","doi":"10.1016/j.jaclp.2025.08.011","DOIUrl":"10.1016/j.jaclp.2025.08.011","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978263","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":"Commentary on Paradichlorobenzene Toxicity by Clark et al.: A Hypothetical Interaction Between Iron Deficiency Anemia, Pica, and Substance Use Disorder.","authors":"Matthew Robert Dernbach, Emily Anne Kiernan, Ziad Kazzi","doi":"10.1016/j.jaclp.2025.08.009","DOIUrl":"10.1016/j.jaclp.2025.08.009","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978313","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}