Dynamic Evolution of Catatonia in the Context of Cerebral Venous Sinus Thrombosis.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2023;25(4):22f03471. Author affiliations are listed at the end of this article.

Proactive use of QI methodology in consultation-liaison psychiatry to support the opening of a new COVID+ behavioral health inpatient unit during the omicron surge.

Inpatient consultation-liaison (CL) psychiatry teams routinely facilitate the transfer of medically stable patients in behavioral health crisis from the general hospital to inpatient psychiatric units. The COVID-19 pandemic had a significant impact on this process when inpatient psychiatric units were unable to provide care for patients with asymptomatic COVID-19 infection because of infection control concerns in units unable to accommodate isolation precautions. Similar to other disrupted hospital workflows, these clinical handoffs became more complicated by requiring COVID exposed or COVID+ patients in the midst of behavioral health crisis to quarantine or isolate on general hospital units if not otherwise stable for discharge to the community. To better respond to the growing number of patients isolating in the general hospital during the 2022 Omicron surge, we used quality improvement (QI) methodology to illustrate the need to create a COVID+ unit in the inpatient psychiatric hospital to care for the growing cohort of COVID+ patients in psychiatric crisis who were otherwise unable to access traditional psychiatric hospital care because of their isolation status.

Medical Student Utilization of a Novel Web-Based Platform (Psy-Q) for Question-Based Learning in Psychiatry: Pilot Questionnaire Study.

BACKGROUND: Medical students are turning to new and expanding web-based resources for learning during their psychiatry clerkships; however, there have not been concomitant efforts by educators to utilize web-based tools to promote innovative teaching. OBJECTIVE: Utilizing a free learning platform (Psy-Q) created by our team, we sought to explore how digital technology may engage medical student learners, promote colearning between educators and medical students, and support sustainability of web-based platforms through crowdsourcing. METHODS: Between 2017 and 2019, seven medical schools offered access to the platform during medical students' psychiatry clerkships. Use of the web-based platform was voluntary and not monitored or related to clerkship evaluation. Medical students completed a paper and pencil assessment of the platform at the end of their clerkship. Anonymous and aggregated website use data were gathered in accordance with institutional review board approval. RESULTS: A total of 203 medical students across seven distinct psychiatry clerkships completed the survey. Of these students, 123 (60.6%) reported using the platform and reported accessing a mean of 45 questions. The most common device used to access the platform was a laptop and the second most common was a smartphone. The most common location to access the platform was home and the second most common was the hospital. Although few students contributed new questions, website utilization data suggested that all rated the quality and difficulty of the questions. Higher quality questions were medical students' main suggestion for further improvement. CONCLUSIONS: Our results suggest the feasibility and potential of educator- and learner-created web-based platforms to augment psychiatry education and develop relevant accessible resources in the digital sphere. Future work should focus on measuring objective educational outcomes of question taking and writing, as well as optimizing technology and exploring sustainable trainee-faculty partnership models for the creation and curation of content.

Medical Student Experiences on Consultation-Liaison Psychiatry Rotations: A Nationwide Survey.

BACKGROUND: Consultation-liaison (C-L) psychiatry clerkship rotations may improve medical students' understanding of psychiatric principles relevant to the settings in which they will ultimately practice. This study aimed to characterize students' experiences on C-L rotations. METHODS: This cross-sectional survey study, sponsored by the Academy of Psychosomatic Medicine Subcommittee on Medical Student Education, was conducted at 5 US medical schools between 2012 and 2016. After the C-L rotation, students completed a voluntary 17-item survey. RESULTS: A total of 235 surveys were collected (mean response rate = 92%). The most frequently endorsed benefit of C-L was learning to manage psychiatric disorders in the context of medical illness (89%). The most frequently endorsed drawback was inconsistent/excessively variable workload (40%). Overall, 82% of respondents recommended C-L to other students; 80% reported that the ideal clerkship would include exposure to both C-L and inpatient psychiatry. Overall, 38% reported that their C-L experience increased their interest in psychiatry as a career. Effect of C-L on interest in psychiatry did not differ by study site, age, sex, clerkship length, or time spent on C-L. Respondents who noted more positive role-modeling on C-L compared to other clerkship rotations were more likely to report increased interest in a psychiatry career (odds ratio = 2.70). CONCLUSIONS: Most medical students perceive C-L rotations favorably. Positive role modeling may increase their consideration of psychiatry specialization. The findings that C-L rotation length did not correlate with attitudes and that most students preferred exposure to both inpatient and C-L psychiatry suggest that C-L exposure can beneficially be integrated into core clerkships containing other elements.

Maintaining Personal Safety: Understanding and Addressing Aggression and Violence in the Health Care Setting.

Introduction: A 2-hour introductory lecture-discussion curriculum was developed to provide medical students and residents with education about personal safety in the health care setting. The course focused on providing learners with proactive and practical advice for understanding, recognizing, and responding to difficult patients or others who may pose risks of violence. It was designed for participants to gain knowledge about initial management of often unfamiliar situations before untoward behaviors escalate to violence. Methods: Eight hundred thirty-eight medical students participated in this required element of the third-year psychiatry clerkship experience. Sixty first-year through fourth-year psychiatry residents participated as part of departmental orientation. Instructors provided the same seminar for both learner groups throughout the project's duration. In addition to a PowerPoint presentation, learners participated in discussion about personal safety threats in the health care setting. Evaluations were obtained, and more recent cohorts also completed a postcourse assessment of knowledge. Results: Results suggested that learners from both groups viewed the session favorably, indicating the personal safety curriculum was beneficial and practical and helped increase their knowledge about this important topic. The session received a high number of positive comments from learners, reinforcing its valuable take-home message. Discussion: Given the growing magnitude and understanding of risk of aggression and violence in health care settings, we incorporated a required personal safety session into our psychiatry residency and medical school curricula. The session's emphasis was on preventative and proactive strategies to employ with patients before and during escalation of potentially violent situations.

"Bath salt" ingestion leading to severe intoxication delirium: two cases and a brief review of the emergence of mephedrone use.

BACKGROUND: Recreational use of designer substances containing synthetic cathinones such as mephedrone, commonly sold as "bath salts," has recently been increasing in the United States (National Institute on Drug Abuse. Available at: http://www.nida.nih.gov/about/welcome/MessageBathSalts211.html. Accessed March 25, 2011; The Washington Post. Available at: http://www.washingtonpost.com/national/officials-fear-bath-salts-becoming-the-next-big-drug-menace/2011/01/22/ABybyRJ_story.html. Accessed March 25, 2011). "Bath salt" ingestion can generate an intense stimulant toxidrome and has been associated with significant morbidity. OBJECTIVES: The authors seek to alert clinicians to the potential for profound delirium, psychosis, and other medical and behavioral sequelae of "bath salt" use. METHODS: Case series. RESULTS: We describe our recent experience with two highly agitated and delirious patients following "bath salt" ingestion and offer a brief review of the emergence of this phenomenon. CONCLUSIONS: Challenges and strategies surrounding diagnosis and treatment are described, which may be useful as "bath salt" use becomes more widespread. SCIENTIFIC SIGNIFICANCE: As an emerging trend, bath salt intoxication delirium appears to cause intense psychosis that can be managed with antipsychotic medications. Clinicians should be aware of this phenomenon until more precise detection methods are available.

Effect of curriculum change on exam performance in a 4-week psychiatry clerkship.

OBJECTIVE: The authors investigated whether curriculum change could produce improved performance, despite a reduction in clerkship length from 8 to 4 weeks. METHODS: The exam performance of medical students completing a 4-week clerkship in psychiatry was compared to national data from the National Board of Medical Examiners' Psychiatry Subject Examination and the United States Medical Licensure Examination Step 2 CK psychiatry and mental disorders subtests. RESULTS: Curriculum change and restructuring to a 4-week psychiatry clerkship resulted in above-average and sustained improvement on nationally standardized assessment measures. CONCLUSION: Examination performance can be optimized despite a 50% reduction in the duration of a psychiatry clerkship.

Factitious disorders and cardiothoracic surgery: the ongoing multidisciplinary challenges of a complex case.

Chronic factitious disorder, Munchausen's syndrome, can be challenging to manage-particularly when complaints and symptoms suggest medical or surgical emergencies. We present a patient whose problems have spanned many years and a great distance. Hopefully, with a greater awareness of this disease, as this patient continues to seek health care in many different hospitals, the implications of timely access to information, good histories and physical exams, and an index of suspicion can assist in potentially avoiding unnecessary, expensive, and invasive evaluations.