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

{"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 M.D., M.S. ,&nbsp;Samuel T. Savitz Ph.D. ,&nbsp;Nicholas Allen M.D. ,&nbsp;Priya R. Gopalan M.D. ,&nbsp;Jeffrey P. Staab M.D., M.S. ,&nbsp;David C. Fipps D.O.","doi":"10.1016/j.jaclp.2025.02.006","DOIUrl":"10.1016/j.jaclp.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> = 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; <em>P</em> = 0.047), involuntary status (OR = 15.16; 95% CI = 6.14–37.45; <em>P</em> &lt; 0.001), and visit to the ED on the weekend (OR = 4.04; 95% CI = 1.61–10.11; <em>P</em> &lt; 0.01). Black race was not associated with the administration of intramuscular medications after controlling for covariates.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 195-203"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","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":"Treating to Capacity: A Case of Mesenteric Ischemia Complicated by Psychotic Depression","authors":"Arjun Mann D.O.,&nbsp;Flannery Merideth M.D.","doi":"10.1016/j.jaclp.2025.01.003","DOIUrl":"10.1016/j.jaclp.2025.01.003","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 266-267"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043333","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 M.D. ,&nbsp;Elizabeth Hovis M.D. ,&nbsp;Meredith L. Spada M.D., M.Ed. ,&nbsp;Li Li M.D., Ph.D.","doi":"10.1016/j.jaclp.2025.02.002","DOIUrl":"10.1016/j.jaclp.2025.02.002","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 241-250"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","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}

{"title":"Variation in Structural Characteristics Among 20 Medical Psychiatry Units in the United States: A Survey-Based Study","authors":"Petra J. Caarls M.D. ,&nbsp;Luc A.W. Jansen Ph.D. ,&nbsp;Jan J. van Busschbach Ph.D. ,&nbsp;Roger G. Kathol M.D., Ph.D. ,&nbsp;Maarten A. van Schijndel M.D., Ph.D.","doi":"10.1016/j.jaclp.2025.01.006","DOIUrl":"10.1016/j.jaclp.2025.01.006","url":null,"abstract":"<div><h3>Background</h3><div>Medical psychiatric units (MPUs) are specialized hospital units providing integrated care for patients with co-occurring medical and psychiatric illnesses. Despite their growing relevance, data on their structural characteristics in the United States remain sparse. This study aims to inventory and analyze the structural characteristics of 20 US MPUs, categorizing them using Kathol's and Van Schijndel's frameworks, and identifying shared components to inform future MPU design and quality standards.</div></div><div><h3>Methods</h3><div>A structured telephone survey was conducted with 20 MPUs from 15 states. Units were categorized as medical attending MPUs, psychiatric attending MPUs, or co-attending MPUs, based on physician involvement. Characteristics assessed included medical and psychiatric acuity capabilities, staffing, physical design, and diagnostic services. Data were analyzed for shared and variable characteristics, and findings were compared with prior studies.</div></div><div><h3>Results</h3><div>Most MPUs aligned with Kathol's Type III, characterized by medium to high medical and psychiatric acuity capabilities. Shared characteristics included integrated nursing practices, 24/7 diagnostic availability, and access to intensive care unit-level care. However, significant variation existed in location, staffing, and technical capabilities. Most units were psychiatry attending or co-attending MPUs.</div></div><div><h3>Conclusions</h3><div>The US MPUs included primarily serve patients with medium to severe medical and psychiatric illnesses. Our findings highlight shared and variable features across MPUs, emphasizing the role of contextual needs and financial incentives in shaping their design. This study provides the most comprehensive inventory of US MPUs to date and proposes features to guide future MPU development and standardization.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 204-214"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081985","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":"Mentorship in the Academy of Consultation-Liaison Psychiatry","authors":"Scott R. Beach M.D. ,&nbsp;David P. Kasick M.D. ,&nbsp;Priya Gopalan M.D. ,&nbsp;Carrie L. Ernst M.D.","doi":"10.1016/j.jaclp.2025.05.004","DOIUrl":"10.1016/j.jaclp.2025.05.004","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 191-194"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086925","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 ,&nbsp;Claire Merveilleux M.D. ,&nbsp;Maxime Tiberghien M.D.","doi":"10.1016/j.jaclp.2025.03.001","DOIUrl":"10.1016/j.jaclp.2025.03.001","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 230-240"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","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":"Describing Psychiatric Illness as “Terminal” Is Inaccurate and Potentially Harmful","authors":"Emily G. Holmes M.D., M.P.H.","doi":"10.1016/j.jaclp.2025.03.434","DOIUrl":"10.1016/j.jaclp.2025.03.434","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 270-271"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","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":"Palliative Electroconvulsive Therapy: A Descriptive Cohort Study","authors":"Gregg A. Robbins-Welty M.D., M.S. ,&nbsp;Ryan D. Slauer M.D. ,&nbsp;Madeline M. Brown B.S. ,&nbsp;Morgan M. Nakatani M.D. ,&nbsp;Dan Shalev M.D. ,&nbsp;Jacob Feigal M.D.","doi":"10.1016/j.jaclp.2024.12.001","DOIUrl":"10.1016/j.jaclp.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Palliative care (PC) is the standard of care for patients with serious medical illnesses, or those conditions associated with high risk of mortality and negative impact on quality of life (QOL). Electroconvulsive therapy (ECT) is the gold standard treatment for certain psychiatric conditions, which may co-occur with serious medical illnesses. However, the use of \"palliative ECT\" (PECT) in this context is understudied.</div></div><div><h3>Methods</h3><div>We conducted a descriptive retrospective cohort study reviewing the indications, outcomes, and regimens of PECT. We included patients who had an ECT consultation, in addition to either a PC consultation or a do-not-attempt-resuscitation code status between 2018 and 2023.</div></div><div><h3>Results</h3><div>Thirty-one patients met our inclusion criteria, and 21 received ECT. The cohort was predominantly female (70%) with a mean age of 67.6 (range 25–90). Catatonia (64.5%) and treatment-resistant depressive disorder (35.5%) were the most common indications for ECT. At the time of ECT consultation, 16 patients (51.6%) had a serious medical illness, including cancer (19.4%) or end-organ disease (22.6%). Fourteen patients had major neurocognitive disorder (MNCD) (45.2%). Surrogate decision-makers consented for ECT in 64.5% of cases. All 21 patients who received ECT experienced psychiatric symptom improvement. ECT was associated with reduced mortality risk in 5 (23.8%) cases. Five patients initially misdiagnosed with MNCD experienced recovery in cognitive function after ECT, and the diagnosis was revised to depression-related cognitive dysfunction. Eight patients retained a comorbid MNCD diagnosis but experienced a mean Montreal Cognitive Assessment (MoCA) improvement of 5 points (range 0 to 17) with ECT.</div></div><div><h3>Discussion</h3><div>This work highlights the use of ECT among patients with serious medical illnesses, identifying cases when ECT was beneficial or deemed unsuitable. Patients with serious medical illnesses who also had an indication for ECT experienced improved QOL with ECT. Misdiagnoses, such as confusing depression-related cognitive dysfunction and catatonia for MNCD, were effectively addressed through ECT. The findings underscore the importance of cross-specialty collaboration between C-L psychiatry and PC.</div></div><div><h3>Conclusions</h3><div>Patients who receive PECT experience reduced suffering and improved QOL. PECT may be helpful in scenarios of life-threatening psychiatric illnesses, terminal medical illnesses with comorbid treatment-refractory psychiatric illnesses, and diagnostic uncertainty with MNCD.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 215-223"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814838","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":"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 M.D., M.P.H. ,&nbsp;Ava Hawkes B.A.","doi":"10.1016/j.jaclp.2025.03.435","DOIUrl":"10.1016/j.jaclp.2025.03.435","url":null,"abstract":"<div><div>Consultation-liaison (C-L) psychiatrists are trained extensively in clinical aspects of our work, but must also work within the confines of the health care apparatus with overarching policies that dictate the affordability, accessibility, and quality of medical care. With the 2024 US elections occurring during our recent Academy of Consultation-Liaison Psychiatry meeting, it became quite clear that a change in the US presidential administration will also affect health care policy. Local and state level elections, however, may have an even more profound impact on health care 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.</div></div>","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 261-265"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","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":"Hartnup Disease-Associated Psychosis: A Dwindling Phenomenon or Just Underreported?","authors":"Mark Ainsley Colijn M.D., M.Sc., FRCPC, UCNS","doi":"10.1016/j.jaclp.2025.01.004","DOIUrl":"10.1016/j.jaclp.2025.01.004","url":null,"abstract":"","PeriodicalId":52388,"journal":{"name":"Journal of the Academy of Consultation-Liaison Psychiatry","volume":"66 3","pages":"Pages 272-274"},"PeriodicalIF":2.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076557","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}