The coronavirus disease 2019 (COVID-19) pandemic has resulted in nationwide stay-at-home orders in an effort to slow the spread severely impacting the healthcare sector. Telepsychiatry provides a platform bridging the gap through advanced technologies connecting mental health providers and patients who need their services, overcoming previous barriers of great distances, lack of transportation, and even time constraints. The most obvious benefit is increased accessibility to mental healthcare, especially in underserved and remote areas where there is no easy access for in-person care. It is important to note that benefits are not limited to patients, but also allow clinicians greater flexibility in scheduling and reduced practice overhead costs, both of which aid with physician burnout and burden. Telepsychiatry during COVID-19 provides its own unique advantages over in-person visits. The risk of exposure to healthcare workers and patients receiving care is reduced, allowing immunocompromised patients to receive muchneeded psychiatric care. Without the need to meet in person, self-isolating psychiatrists can still provide care, decreasing strain on their co-workers. Although telepsychiatry is relatively new, it has already exhibited considerable success in its effectiveness at treating psychiatric conditions and widespread corollary benefits. Telepsychiatric consults may be carried out synchronously and asynchronously, each having benefits and setbacks. Different mobile application interventions have been explored, which are available for the purpose of both monitoring/assessing patients and/or providing treatment. The scope of conditions these applications address is broad, from anxiety disorders to schizophrenia to depression. As promising and beneficial telepsychiatry may seem, it is necessary to recognize that building the program can be challenging. It involves adapting to new methods in medicine. We highlighted barriers to general telepsychiatry, the most prominent being technological literacy of both physician and patient, and possible negative effects of eliminating the in-person patient-doctor interaction.
Background: Bright light therapy (BLT) has been increasingly used as an experimental treatment in non-seasonal unipolar depression. While clinical trials have demonstrated the efficacy of BLT in ameliorating depression for outpatients, studies examining BLT in the psychiatric inpatient setting are currently lacking. Aim: The purpose of this study is to explore whether BLT as adjunctive treatment for depressive symptoms on an acute psychiatric floor is feasible and explore associated changes in depressive symptoms. Methods: An observational, cross-sectional study was conducted at State University of New York (SUNY) Upstate 4B acute inpatient psychiatric unit. BLT was administered to participating patients as adjunctive therapy to their psychopharmacological and psychotherapy treatments on a daily basis throughout their hospitalization. Beck Depression Inventory-II (BDI-II), Hamilton Rating Scale for Depression (HAM-D), and Outcome Questionnaire-45.2 (OQ-45.2) were administered before commencing BLT and after their last BLT session. Changes to the aforementioned measures before and after BLT treatment, the dose response of measure changes based on number of sessions, and the hospital length of stay along with the secondary factors such as age, gender, other psychiatric comorbidities, social factors, and psychiatric medications were analyzed. Results: BLT is feasible on acute psychiatric inpatient floor with adherence of 94% and has very few side effects. The repeated measures of depression and functioning demonstrated significant decrease in depression and improvement in functioning. Although not statistically significant, clinical meaningful dose-response relationship was found between a number of BLT sessions and improvement in depressive symptoms with five BLT sessions being an optimal amount for depression amelioration. Conclusion: BLT combined with the ongoing psychopharmacological treatment was well tolerated and easy to administer. It offers a simple, safe, and cost-effective approach to augmenting depressive treatment on an acute psychiatric floor.
Background: Agitation is a significant challenge to mental healthcare. This project aims to examine the effects of implementing an interactive mental flexibility group to decrease incidences of agitation in the inpatient psychiatric population during nursing shift change.Methods: This observational study, conducted on the acute inpatient psychiatric unit of an academic hospital in Central NY, USA. This 23-bed unit admits psychiatric patients from the E.D. and local hospitals. The art-based interactive group was implemented during the critical period of nursing shift change, which is known for having an increased agitation due to caregiver changes. We tracked group attendance, incidences of agitation, and as-needed medication administration for agitation. We administered a Likert-type scale to rate emotions before and after each session.Results: We observed a dramatic decrease in as needed medications for agitation 1 month prior to group (n = 576) compared to 3 months during group (n = 120). The new group constitutes a significant decrease in agitation incidents. Patients indicated an increase in happiness (mean = 0.46, SD = 0.978), decrease in sadness (mean = 0.44, SD = 1.078), and decrease in anger (mean = 1.15, SD = 1.984).Conclusions: Our project indicates that the patients and staff well receive interactive group sessions in an acute psychiatric unit. The group sessions helped to decrease agitation and medication administration.Future directions: We recommend the utilization of interactive mental flexibility groups on acute psychiatric units to promote emotional regulation, especially during nursing shift change.
Background: Evaluation of mental health of acute ischemic stroke (AIS) patients is crucial to reduce health care burden. Objective: Aim of this study was to evaluate the prevalence and outcomes [morbidity, disability (APRDRG loss of function) and discharge disposition] of DOA amongst AIS patients. Methods: A cross-sectional study was conducted on Nationwide Inpatient Sample from 2003-2017. Adult primary hospitalizations with AIS were extracted and concurrent DOA were identified using ICD-9/10-CM codes. Weighted analysis using Chi-square test and mixed-effect multivariable survey logistic regression was performed to evaluate prevalence and role of DOA to predict the outcomes. Definitions of outcomes were mentioned in Table 1 . Results: Out of a total 5,690,773 AIS hospitalizations, 2.65%, 3.1% and 4.37% had depression, OSA, and anxiety, respectively. In AIS patients, females had higher prevalence of depression [3.43 vs 2.25%] and anxiety [5.92 vs 3.04%] and lower prevalence of OSA [2.21 vs 4.40%] in comparison to males. (p<0.0001) Caucasians had a higher prevalence of depression [3.11 vs 2.12 vs 2.84 vs 1.81 vs 2.54%], OSA [3.43 vs 3.27 vs 2.42 vs 1.60 vs 3.24%], and anxiety [5.26 vs 2.48 vs 3.75 vs 2.13 vs 3.59%] in comparison to AA, Hispanic, Asian, and Native American, respectively. (p<0.0001) Depressed patients had a higher prevalence of morbidity (9 vs 8 vs 5 vs 7%), disability [46 vs 46 vs 35 vs 37%], transfer to non-home [69 vs 58 vs 61 vs 63%] in comparison with OSA, anxiety and non-DOA patients, respectively. (p<0.0001) Depression was associated with 40% higher chance of severe disability (aOR 1.4; 95%CI 1.38-41), morbidity (1.36; 1.33-1.38) and discharge to non-home (1.54; 1.52-1.56). OSA and anxiety had higher odds of non-home discharge amongst post-AIS hospitalizations. (Table 1) Conclusion: DOA is associated with poor outcomes amongst post-AIS patients. Prompt recognition by screening and timely management of DOA may mitigate the adverse outcomes.
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