New research was presented at APA 2015, the American Psychiatric Association’s annual meeting, from May 16 to 20 in Toronto. The features below highlight some of the studies that emerged from the conference.
Anxiety & Suicide in Hospitalized Psychiatric Patients
The Particulars: Studies have shown that suicide risk is highest in the first 2 months after a psychiatric hospitalization. However, few studies have explored factors that may raise risks for return psychiatric visits.
Data Breakdown: For a study, patients hospitalized for suicidality were assessed for state and trait anxiety at admission and discharge. Patients who returned to the psychiatric emergency room within 2 months had significantly lower self-assessment scores on state and anxiety from admission to discharge. Those with a lifetime history of suicide attempts requiring major medical care had significantly greater decreases in self-assessed trait anxiety.
Take Home Pearl: Acute anxiety reactivity appears to predict returns to the emergency room following psychiatric hospitalization.
Delirium Poorly Detected
The Particulars: Delirium affects 10% to 30% of hospitalized patients, but the prognosis for these patients tends to be poor. Research shows that delirium detection rates are low among primary treating physicians.
Data Breakdown: Study investigators reviewed the charts of hospitalized patients diagnosed with delirium following a psychiatry consult for reasons other than delirium, confusion, or disorientation. Several delirium symptoms were not detected or misidentified by the primary treating physician but were later detected during the psychiatry consult. These included a reduced ability to focus or shifting attention, memory deficits, fluctuating symptoms during the course of the day, and psychomotor retardation.
Take Home Pearls: Subtle signs and symptoms of delirium appear to be poorly identified by primary treating physicians. Improving education and using standardized delirium checklists may be potential solutions to decreasing the burden of delirium.
UTIs & Worsening Psychosis
The Particulars: Some studies have suggested that there is a link between acute psychosis and urinary tract infections (UTIs). However, more thorough research on this relationship with meta-analyses is lacking.
Data Breakdown: Researchers conducted a literature review of studies assessing the relationship between psychosis and UTIs. In one study, 35% of inpatients with an acute relapse of schizophrenia had a UTI, compared with 5% of stable outpatients with schizophrenia and 3% of controls. Only 40% of the relapse group received antibiotics. In another study, patients with non-affective psychosis were 11 times more likely than controls to have a UTI.
Take Home Pearls: The association between UTIs and psychosis appears to be strong. Screening for UTIs during hospitalizations in patients with psychotic conditions may improve outcomes.
Trends in Acetaminophen Overdoses
The Particulars: Prior research shows that acetaminophen is the most common agent used in self-poisonings in the United States. It also ranks as the top reason for ED visits for overdoses and a leading cause of fatal hepatotoxicity. However, recent data are lacking on patients treated for excessive acetaminophen exposure.
Data Breakdown: In a retrospective analysis of more than 200 patients treated for excessive acetaminophen exposure, researchers found that 52% occurred in those with depression and 42% in those with alcohol dependence. In patients with pain disorders, 71% of acetaminophen overdoses were unintentional. Alcohol complicated 21% of intentional overdoses and 13% of those that were unintentional. Nearly 95% of outcomes were benign.
Take Home Pearls: More than half of acetaminophen overdoses appear to occur among patients with a psychiatric illness. Alcohol appears to play a role in many of these overdoses. However, the outcomes of most acetaminophen overdoses appear to be benign.
Anxiety & Suicide in Hospitalized Psychiatric Patients
The Particulars: Studies have shown that suicide risk is highest in the first 2 months after a psychiatric hospitalization. However, few studies have explored factors that may raise risks for return psychiatric visits.
Data Breakdown: For a study, patients hospitalized for suicidality were assessed for state and trait anxiety at admission and discharge. Patients who returned to the psychiatric emergency room within 2 months had significantly lower self-assessment scores on state and anxiety tests from admission to discharge. Those with a lifetime history of suicide attempts requiring major medical care had significantly greater decreases in self-assessed trait anxiety.
Take Home Pearl: Acute anxiety reactivity appears to predict returns to the emergency room following psychiatric hospitalization.
Mental Health-Related Admissions From the ED
The Particulars: Patients with mental health conditions (MHCs) are often hospitalized following an ED visits, according to previous studies. Whether or not patients with MHCs are more likely to be hospitalized following an ED visit than those without an MHC has not been well defined. Data are also lacking on whether or not hospitalization rates vary between EDs according to differences in patients’ diagnostic profiles.
Data Breakdown: Among 18 EDs included in a study, investigators found that all-cause hospitalization rates ranged from 1.0% to 48.5%. Patients with a primary diagnosis of a MHC were 3.8 times more likely to be hospitalized following an ED visit than those without an MHC.
Take Home Pearls: Patients with MHC are significantly more likely to be hospitalized following visits to the emergency room. Determining hospitalization rates and associated costs by tracking MHC prevalence among patients may enhance care in the ED setting.
Suicide Risk Factors Missed in the ED
The Particulars: Evidence suggests that current tools and assessments for identifying people at risk for suicide are oftentimes unreliable. Some suicide risk factors may not be consistently included in ED suicidal risk assessments.
Data Breakdown: For a study, researchers compared the charts of patients seen by a psychiatry team in the ED with the results of a survey of psychiatry and ED physicians that assessed their opinions on suicide predictors. Chart reviews showed that suicidal ideation was associated with bullying and childhood trauma. However, these predictors were not commonly assessed. Other predictors deemed important by physicians were also missed on actual assessments.
Take Home Pearls: Important suicidal risk factors appear to be missed in ED assessments. Bullying and childhood trauma appear to predict suicidal risk but are not commonly assessed in the ED.
