Identifying the Most Important Consultation-Liaison Psychiatry Publications in 2020 Using a Novel Literature Assessment Instrument.

BACKGROUND: As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-Based Medicine Subcommittee reviews articles of interest to help academy members remain familiar with the latest in evidence-based practice. OBJECTIVE: We identify the 10 most important articles for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality instrument for assessing scientific literature. METHODS: The subcommittee published annotated abstracts for 97 articles on the academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the Importance and Quality instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of Importance and Quality instrument. RESULTS: Twenty-four raters identified the top 10 scoring articles of 2020. These articles provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. CONCLUSION: These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.

Interventions for posttraumatic stress disorder symptoms induced by medical events: A systematic review.

OBJECTIVE: Medical events such as myocardial infarction and cancer diagnosis can induce symptoms of posttraumatic stress disorder (PTSD). The optimal treatment of PTSD symptoms in this context is unknown. METHODS: A literature search of 6 biomedical electronic databases was conducted from database inception to November 2018. Studies were eligible if they used a randomized design and evaluated the effect of treatments on medical event-induced PTSD symptoms in adults. A random effects model was used to pool data when two or more comparable studies were available. RESULTS: Six trials met full inclusion criteria. Studies ranged in size from 21 to 81 patients, and included patients with PTSD induced by cardiac events, cancer, HIV, multiple sclerosis, and stem cell transplantation. All trials assessed psychological interventions. Two trials comparing a form of exposure-based cognitive behavioral therapy (CBT) with assessment-only control found that CBT resulted in lower PTSD symptoms [Hedges's g = -0.47, (95% CI -0.82 - -0.12), p = .009]. A third trial compared imaginal exposure (another form of exposure-based CBT) with an attention control and found a trend toward reduced PTSD symptoms. Three trials compared eye movement desensitization and reprocessing (EMDR) with active psychological treatments (imaginal exposure, conventional CBT, and relaxation therapy), and found that EMDR was more effective. CONCLUSION: CBT and EMDR may be promising approaches to reducing PTSD symptoms due to medical events. However, additional trials are needed in this patient population.

Early interventions to prevent posttraumatic stress disorder symptoms in survivors of life-threatening medical events: A systematic review.

Post-traumatic stress disorder (PTSD) induced by life-threatening medical events has been associated with adverse physical and mental health outcomes, but it is unclear whether early interventions to prevent the onset of PTSD after these events are efficacious. We conducted a systematic review to address this need. We searched six biomedical electronic databases from database inception to October 2018. Eligible studies used randomized designs, evaluated interventions initiated within 3 months of potentially traumatic medical events, included adult participants, and did not have high risk of bias. The 21 included studies (N = 4,486) assessed a heterogeneous set of interventions after critical illness (9), cancer diagnosis (8), heart disease (2), and cardiopulmonary surgery (2). Fourteen psychological, 2 pharmacological, and 5 other-type interventions were assessed. Four of the psychological interventions emphasizing cognitive behavioral therapy or meaning-making, 1 other-type palliative care intervention, and 1 pharmacological-only intervention (hydrocortisone administration) were efficacious at reducing PTSD symptoms relative to control. One early, in-hospital counseling intervention was less efficacious at lowering PTSD symptoms than an active control. Clinical and methodological heterogeneity prevented quantitative pooling of data. While several promising interventions were identified, strong evidence of efficacy for any specific early PTSD intervention after medical events is currently lacking.

Patient-targeted googling and psychiatric professionals.

OBJECTIVE: This is a pilot study which assesses the beliefs of psychiatric professionals regarding obtaining patient information via the Internet as well as the frequency with which they do it in a variety of clinical settings. METHODS: Psychiatry faculty and residents were asked to participate in an anonymous online survey about their use of the search engine Google to find information about their patients. Data were analyzed with Microsoft Excel. RESULTS: The participants included 48 faculty and 34 residents (118 faculty and 44 residents were surveyed) with response rates of 41% and 77%, respectively. Majority of attending physicians and residents reported engaging in patient-targeted googling with no significant difference between the groups. Residents were most likely to search for patient information online in the psychiatric emergency room (45%). Psychiatric emergency room (36.8%) and private practice (31.6%) were notable clinical settings for obtaining further patient information on the Internet for the faculty. When describing reasons for engaging in patient-targeted googling, "patient care" was cited about twice as often as "curiosity" in the psychiatric emergency room, whereas "curiosity" and "patient care" were reasons mentioned in other clinical settings. In general, neither faculty nor residents report informing their patients of their Internet searches either before or after engaging in patient-targeted googling. CONCLUSION: This study raises important questions about education for trainees and faculty regarding patient-targeted googling.

Cannabinoid Hyperemesis Syndrome and the Consulting Psychiatrist: A Case Study of Diagnosis and Treatment for an Emerging Disorder in Psychiatric Practice.

The increasing prevalence of cannabis use in the United States requires awareness of cannabis-related disorders and familiarity with treatment options. We present a case of cannabinoid hyperemesis syndrome that required psychiatric consultation for diagnostic clarification and effective treatment with intravenous haloperidol. Literature from emergency medicine, toxicology, and gastroenterology is reviewed, including proposed diagnostic criteria for cannabinoid hyperemesis syndrome and reported off-label treatment options, with a specific focus on clinical questions facing the practicing psychiatrist regarding this emerging disorder.