Substance Misuse among a Diverse Psychiatric Inpatient Sample: Suicidal Thoughts and Behaviors and Motivation to Change.

Suicidal thoughts and behaviors (STBs) are among the most common reasons for admission to psychiatric inpatient units and a large percentage of these patients also engage in substance misuse. Yet, no known studies have examined whether patients with STBs admitted to inpatient psychiatry units are motivated to change their substance misuse and, if so, whether they benefit from MET-CBT for substance misuse while on the inpatient unit. This study assesses the relationship between STB and motivation to improve substance misuse among 321 (61.1% male, Mage = 35.3 years, 59.8% non-Hispanic/Latin White) patients admitted to an inpatient psychiatric unit with a substance use disorder (SUD) or substance misuse who attended at least one group MET-CBT session, 50.2% of whom were admitted to an inpatient unit for STBs. Patients admitted for STBs reported greater motivation to reduce substance misuse than patients admitted without documented STB, and they did not differ from patients without documented STBs on the number of MET-CBT sessions attended, or ratings of session helpfulness (which were high). Patients admitted for STBs reported significantly increased motivation to change substance misuse after attending MET-CBT for SUD. These findings indicate that psychiatric inpatients with STBs report motivation to change substance misuse as well as willingness to attend MET-CBT for their SUD.

Factors Influencing Elevated Mortality Rates of Patients with Schizophrenia Hospitalized with COVID.

Work completed since the pandemic began has repeatedly demonstrated elevated mortality rates in people with schizophrenia hospitalized with COVID. They are a vulnerable group due to multiple issues-for example high co-morbidity rates of medical illness, often impaired insight and judgment, barriers to obtaining health care, and trouble understanding and implementing preventive measures. The objective of this study was to evaluate if a diagnosis of schizophrenia in the context of COVID-19 requiring hospitalization increased the risk for people with a diagnosis of schizophrenia to be intubated, admitted to the ICU or die when compared to people hospitalized with COVID-19 who did not have schizophrenia. This was accomplished by doing a retrospective chart review of 123 people with schizophrenia and matched controls. Although we found elevated rates of these outcomes in the patients with schizophrenia, our analysis attributed these differences to congregate living, rather than the illness itself.

Do they see dead people? Cultural factors and sensitivity in screening for schizophrenia spectrum disorders.

OBJECTIVE: Schizophrenia spectrum disorders (SSDs), are diagnosed more frequently among African-Americans (AAs) than Caucasians. It has been suggested that cultural differences in symptom presentation and endorsement (including reporting spiritual/religious experiences) may influence this disparity. The current study investigated the relationship between endorsement of spiritual auditory and visual hallucinations and subsequent diagnosis of SSD among AA patients. DESIGN: Participants (N = 471 AAs) completed the Mini International Neuropsychiatric Interview-Plus (MINI-Plus) Screening Interview as part of their intake to a HIV outpatient clinic. Endorsement of auditory or visual (A/V) hallucinations was explored with the MINI-Plus Psychotic Disorder Module and questions regarding the content of the unusual experience. RESULTS: Logistic regression indicated that endorsement of A/V hallucinations significantly predicted a SSD (OR = 41.6, 95% CI 13.7-126.0, p < .001). However, when hallucinations were spiritual in nature, odds of an SSD fell dramatically (OR = 0.22, 95% CI 0.07-0.64, p < .001). CONCLUSIONS: The current study indicates that not all visual and auditory hallucinations are symptomatic of a psychotic disorder in AA patients. Many of these experiences may be related to spirituality. Clinicians assessing AA patients need to query content of, meaning attributed to, and distress associated with A/V unusual experiences.

Using Mental Health Outreach Teams in the Emergency Department to Improve Engagement in Treatment.

Engagement in treatment for a person having a behavioral health crisis is critical to fully address the concerns of the individual as well as to prevent future crises. This study explored the benefits of establishing outreach visits from a local community mental health provider to psychiatric patients in an emergency department. Using retrospective analysis of data collected by a local mental health agency, the effect of receiving face to face contact in the emergency room with a community mental health worker (and/or telephone follow up) was compared to no outreach interaction. The effect of this intervention was a significant increase in initial appointment attendance at the local mental health clinic in the aftermath of a psychiatric crisis. Community mental health services provided in partnership with community emergency departments may improve patient engagement in aftercare and consequently help alleviate future behavioral health crises as well as return visits to the emergency department.

Factor Structure and Measurement Invariance of the Suicide Status Form-IV.

The Suicide Status Form-IV (SSF-IV) is the measure used in the Collaborative Assessment and Management of Suicidality (CAMS). The SSF-IV Core Assessment measures various domains of suicide risk. Previous studies established a two-factor solution in small, homogeneous samples; no investigations have assessed measurement invariance. The current investigation sought to replicate previous factor analyses and used measurement invariance to identify differences in the Core Assessment by race and gender. Adults (N = 731) were referred for a CAMS consultation after exhibiting risk for suicide. Confirmatory factor analyses indicated good fit for both one- and two-factor solutions while the two-factor solution is potentially redundant. Configural, metric, and scalar invariance held across race and gender. Ordinal logistic regression models indicated that neither race nor gender significantly moderated the relationship between the Core Assessment total score and clinical outcomes. Findings support a measurement invariant, one-factor solution for the SSF-IV Core Assessment.

The Role of Bias in Clinical Decision-Making of People with Serious Mental Illness and Medical Co-morbidities: a Scoping Review.

The aim of this review was to examine the evidence for the impact of explicit and implicit biases against mental illness on the clinical decision-making of primary care physicians, medical students, and nurses when they are providing care to individuals with serious mental illness for cardiovascular disease, diabetes, and cancer. Studies were identified by searching MEDLINE, EBSCO host, and PsychINFO. A total of 18 studies published between 1996 and 2020 were reviewed and summarized. The studies were divided into two groups-studies that used a simulation or vignette methodology and those with a qualitative approach (interviews and focus groups). Of the simulation/vignette studies that allowed participants to report what they would have done in various clinical scenarios, there were roughly equal numbers of neutral or negative clinical decisions that represented 80% of the relevant behavioral results. Only 21% of the findings demonstrated a clinical decision that was favorable towards people with mental illness. Of the qualitative studies, all of the studies reported behaviors (either self-reported or observed) that were likely to be biased against people with mental illness, while 3 of the studies reported mixed results. Healthcare provider bias against individuals with mental illness does exist and impacts clinical decisions negatively. Much more empirical work needs to be done to determine the full extent and impact of the problem, including how these decisions affect the lives of individuals with mental illness.

Group Cognitive Behavioral Therapy for Substance Use Disorders Among Psychiatric Inpatients in a Medically Underserved Area: An Intervention for Opioid Misuse.

OBJECTIVES: Opioid misuse is a serious public health concern, yet few people seek treatment for this condition. Hospitals may be one opportunity to identify those with opioid misuse and to teach them skills to help manage their opioid misuse upon discharge. We tested the relationship between opioid misuse status and motivation to change substance use among patients admitted with substance misuse to an inpatient psychiatric unit in a medically underserved area in Baton Rouge, Louisiana, who attended at least 1 group session of motivation enhancement therapy combined with cognitive behavioral therapy (MET-CBT) from January 29, 2020, through March 10, 2022. METHODS: Of the 419 patients in our sample, 86 (20.5%) appeared to misuse opioids (62.5% male; mean age, 35.0 y; 57.7% non-Hispanic/Latin White). At the beginning of each session, patients completed 2 measures of motivation-importance and confidence to change substance use-from 0 (not at all) to 10 (most). At the end of each session, patients rated perceived session helpfulness from 1 (extremely hindering) to 9 (extremely helpful). RESULTS: Opioid misuse was associated with greater importance (Cohen d = 0.12) and confidence (Cohen d = 0.13) to change substance use and with attending more MET-CBT sessions (Cohen d = 0.13). Patients with opioid misuse rated sessions as highly helpful (score of 8.3 of 9), and these ratings did not differ from patients who used other substances. CONCLUSIONS: Inpatient psychiatry hospitalizations may provide an opportunity to identify patients with opioid misuse and introduce these patients to MET-CBT to learn skills to manage opioid misuse upon discharge.

Impact of a Mental Health Diagnosis on Emergency Department Adherence to Sepsis Care Guidelines.

Background: Previous work has found that clinical care for a variety of health conditions varies depending upon the mental health status of the patient. Sepsis, a condition with an algorithm-driven care plan, has not yet been investigated. This study sought to determine if disparities in care exist for people with mental illness and suspected sepsis. Methods: We conducted a retrospective medical records review of patients presenting to the emergency department with a clinical suspicion of sepsis from June 1, 2017, to January 31, 2018. Extracted data included clinical care decisions consistent with the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) national guidelines and information from the problem list and encounter notes about the presence of mental illness. Results: Seven hundred ninety-eight patient encounters were included in the study. Sixty-eight percent of these encounters had care that met the 3-hour SEP-1 bundle guidelines. The presence of a psychiatric diagnosis was not significantly related to failure of SEP-1 criteria, χ2(1)=1.01, P=0.315. Conclusion: This study showed no differences in clinical decision-making for patients with sepsis and a psychiatric diagnosis of mental illness. The presence of objective guidelines may have lessened the potential role of biases among clinicians toward patients with mental illness.

The association between perceived stigma and substance use disorder treatment outcomes: a review.

Substance use disorders (SUDs) take a heavy toll on those who have them and on society more broadly. These disorders are often difficult to treat, and relapse is common. Perhaps, because of these factors, these disorders are highly stigmatized worldwide. The purpose of this study is to examine empirical work intended to determine the impact of perceived social stigma and self-stigma on the process of recovering from SUDs with the assistance of formal treatment services. Qualitative studies confirmed that stigma experiences are common among those with these disorders and that these experiences can negatively impact feelings and beliefs about treatment. One quantitative study provided good statistical support for a direct effect of stigma on outcomes, but this was contradicted by other longitudinal data. In general, quantitative articles suggested an indirect effect of stigma on treatment outcomes, via negative emotions and cognitive mechanisms such as feelings of self-efficacy. However, it was notable that there was little consistency in the literature as to definitions and measurement of the constructs of recovery, perceived social stigma, and self-stigma. Future work should focus on bringing clarity, and validated measures, to this problem in order to better determine the nature of these relationships.

Integrated cognitive behavioral therapy for comorbid cannabis use and anxiety disorders: A pilot randomized controlled trial.

Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. The current study tested the acceptability and efficacy of the integration of a transdiagnostic anxiety CBT (i.e., treatment of patients with any anxiety disorder) with MET-CBT (integrated cannabis and anxiety reduction treatment, or ICART) for CUD compared to MET-CBT alone. Treatment-seeking cannabis users (56.4% male, Mage = 23.2, 63.3% non-Hispanic White) with CUD and at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Patients in the ICART condition attended significantly more treatment sessions than those in the MET-CBT condition. Patients in the ICART condition were more likely to be abstinent post-treatment than those in MET-CBT. Further, treatment produced decreases in cannabis use and related problems. Notably, therapy type did not moderate the impact of treatment on frequency of use and related problems. Together, these data suggest that ICART may be at least as efficacious as a gold-standard psychosocial CUD treatment, MET-CBT, for a difficult-to-treat subpopulation of cannabis users.

Catamenial psychosis in an adolescent girl.

We report the case of an adolescent girl who was 14 years old at initial presentation. A shy, immature and timid individual, she began to have recurring, progressive episodes characterised by insomnia, paranoia, distorted thinking and mood instability with a mix of depressive and manic-like symptoms. An extensive medical work up was unrevealing. Her family noted a pattern that coincided with her menstrual cycle. An endocrine consult was obtained, and the diagnosis of catamenial psychosis was performed. After treatment with leuprolide, resulting in a shutdown of the hypothalamic-pituitary-ovarian axis, the patient's symptoms were resolved completely.