Studying the Feasibility and Acceptability of an Interactive Web-based Lethal Means Safety Decision Aid for Hospitalized Adults With Suicide Risk (Lock to Live).

OBJECTIVE: Lock to Live is an interactive web-based lethal means safety decision aid that promotes temporary storage of firearms and medications. It has primarily been provided to suicidal patients in emergency department settings. The goal of this study was to evaluate the feasibility and acceptability of the Lock to Live decision aid with hospitalized adults at increased risk of suicide. METHODS: Subjects provided demographic information and completed the Columbia-Suicide Severity Rating Scale after which they completed the Lock to Live program followed by a survey. RESULTS: Twenty participants were recruited for this study, 5 of whom had access to firearms and 19 of whom had access to medications. Lock to Live was feasible to use as the mean length of time to complete the program was 10.0±5.3 minutes. It was acceptable to most participants as 75% of participants found it to be easy to use, and 65% of participants agreed that Lock to Live was helpful in making a decision about changing access to firearms/medications. CONCLUSION: Lock 2 Live decision aid appears to be a feasible and acceptable tool for hospitalized patients at risk for suicide.

Words Matter: Stylistic Writing Strategies for Racial Health Equity in Academic Medicine.

Many racialized health inequities in the USA have been known for decades. However, academic medicine, individual clinicians, and larger healthcare systems have not yet supported action towards sufficient and meaningful solutions, as evidenced by the persistence of racialized health inequities over time. Recently, academic medicine is increasing efforts to unequivocally identify systemic racism as a public health crisis because it drives health inequity to racially minoritized groups. A health equity emphasis in clinical education, practice, and research differs from a disparities approach because it seeks to dismantle the systems of racism that create inequitable health outcomes in the first place. Therefore, medical education, practice, and research are slowly transitioning from a lens of health disparities to one of health equity. In order to support this transition, authors and journals must restructure the depiction of health inequities caused by racism. Based upon the principles of the social medicine pioneer, Dr. Rudolph Virchow, the knowledge conveyed by scientific and medical academic writing must clearly name the drivers of social disease - which is generalized to the American landscape of racialized health inequity for the purposes of this manuscript - in order to inform action capable of stopping socially mediated health inequity. Yet, the language and construction of health disparities literature perpetuates colorblind and aversive racism by stylistically omitting the driver of inequity quite frequently, which renders such knowledge unable to support action. In this article, three academicians across the spectrum of social justice education identify and classify common writing styles of health disparities research in order to demonstrate how a writing style of racial health equity better supports true progress towards equity.

Management of SIADH-related hyponatremia due to psychotropic medications - An expert consensus from the Association of Medicine and Psychiatry.

OBJECTIVE: Hyponatremia is the most common electrolyte imbalance encountered in clinical practice and is associated with negative healthcare outcomes and cost. SIADH is thought to account for one third of all hyponatremia cases and is typically an insidious process. Psychotropic medications are commonly implicated in the etiology of drug induced SIADH. There is limited guidance for clinicians on management of psychotropic-induced SIADH. METHODS: After an extensive review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus recommendations for management of psychotropic-induced SIADH. A risk score was proposed based on risk factors for SIADH to guide clinical decision-making. RESULTS: SSRIs, SNRIs, antipsychotics, carbamazepine, and oxcarbazepine have moderate to high level of evidence demonstrating their association with SIADH. Evaluation for an avoidance of medications that cause hyponatremia is particularly important. Substitution with medication that is less likely to cause SIADH should be considered when appropriate. We propose an algorithmic approach to monitoring hyponatremia with SIADH and corresponding treatment depending on symptom severity. CONCLUSIONS: The proposed algorithm can help clinicians in determining whether psychotropic medication should be stopped, reduced or substituted where SIADH is suspected with recommendations for sodium (Na+) monitoring. These recommendations preserve a role for clinical judgment in the management of hyponatremia with consideration of the risks and benefits, which may be particularly relevant for complex patients that present with medical and psychiatric comorbidities. Further studies are needed to determine whether baseline and serial Na+ monitoring reduces morbidity and mortality.

Clinicians' Racial Bias Contributing to Disparities in Electroconvulsive Therapy for Patients From Racial-Ethnic Minority Groups.

Patients from racial-ethnic minority groups undergo disparate electroconvulsive therapy (ECT) treatment compared with Caucasian peers. One leading hypothesis is that clinicians may unknowingly display racial bias when considering ECT for patients of color. Studies have consistently shown that patients of color face numerous racially driven, provider-level interpersonal and perceptual biases that contribute to clinicians incorrectly overdiagnosing them as having a psychotic-spectrum illness rather than correctly diagnosing a severe affective disorder. A patient's diagnosis marks the entry to evidence-based service delivery, and ECT is best indicated for severe affective disorders rather than for psychotic disorders. As a consequence of racially influenced clinician misdiagnosis, patients from racial-ethnic minority groups are underrepresented among those given severe affective diagnoses, which are most indicated for ECT referral. Evidence also suggests that clinicians may use racially biased treatment rationales when considering ECT after they have given a diagnosis of a severe affective or psychotic disorder, thereby producing secondary inequities in ECT referral. Increasing the use of gold-standard treatment algorithms when considering ECT for patients of color is contingent on clinicians transcending the limitations posed by aversive racism to develop culturally unbiased, clinically indicated diagnostic and treatment rationales.

Coping with Racism: a Perspective of COVID-19 Church Closures on the Mental Health of African Americans.

Academic medical literature and news outlets extensively document how older individuals in communities of color, especially African American communities, are dying disproportionately of COVID-19 due to ongoing societal, racial, and healthcare disparities. Fear of death and suffering are acutely elevated in Black communities; yet, African Americans have been facing, coping with, and overcoming American societal racism and subsequent detriments to our mental health for centuries. Predominately African American churches (hereafter referred to as the "Black Church") have always served a historical, cultural, contextual, and scientifically validated role in the mental health well-being of African American communities coping with American racism. Nonetheless, buildings of worship closed due to the COVID-19 pandemic in mid-March 2020. This article is a first-hand perspective of five Black internists/psychiatrists who are deeply involved in both academic medicine and leadership positions within the Black Church. It will explore how the physical closure of Black Churches during this period of increased mental stress, as caused by healthcare inequities revealed by the COVID-19 epidemic, is likely to be uniquely taxing to the mental health of African Americans, particularly older African Americans, who must cope with American racism without physical access to the Black Church for the first time in history.

Achieving Equity in Informed Consent: A Culturally-Informed Perspective for the Consideration and Consent of Minority Patients for Electroconvulsive Therapy.

Electroconvulsive therapy (ECT) is highly efficacious to treat severe depression in older adults. Yet, patients of ethnic and racial minorities are consistently underrepresented amongst those who receive ECT across all age groups. One strong hypothesis to explain this disparity is that minority patients are less likely to trust medical professionals and are therefore less likely to consent for ECT. Increasing participation of depressed, elderly, minority patients is uniquely challenging. Senior minority individuals have survived decades of medical and social injustices that no other demographic, specifically younger minorities or clinically-matched Caucasian peers, can truly comprehend from a first-hand perspective. This article provides a perspective based in cultural translational science to conversations of informed consent for ECT that removes our self-imposed stigma against discussing past and ongoing injustices with minority patients. Reducing disparities to geriatric minorities through equity of informed consent means that clinicians must validate the unique minority experience in medicine as it pertains to agreeing to a treatment modality as emotionally, socially, and historically laden as ECT.