Clinical Outcomes of a Primary Care Liaison Psychiatry Service for Patients with Complex Persistent Physical Symptoms.

Background: Patients with Persistent Physical Symptoms (PPS) may have chronic physical disorders such as diabetes, COPD, Crohn’s, MS and/or ongoing medically unexplained symptoms, and in either case there can be both physical and [psychiatric aetiologies combined. Such co-morbidity tends to be chronic and hard to manage in any healthcare setting and therefore frequent attendance in healthcare settings is present for these patients. We rolled out a primary care based integrated multidisciplinary liaison psychiatry team to 3 CCG areas in Nottinghamshire in October 2019 to see this patient group and have taken patient reported outcome measures from baseline up to 15 months later as part of normal service evaluation. Results: We show here that there are clinically relevant and statistically significant improvements in depressive symptoms (PHQ-9), anxiety symptoms (GAD-7) and physical symptoms (PHQ-15). The improvements in the EQ-5D-5L shows that in a whole health measure there are significant improvements over all and specifically in the anxiety/depression and usual activity domains. Conclusion: This is clinically very relevant especially when seen in the context that these results were achieved despite a pandemic affecting the whole population. This model is scalable and integrated providers should look to implement it.

Bewildered and alone: supporting people with cognitive impairment on COVID isolation wards

SUMMARY Managing isolation protocols for distressed, cognitively impaired COVID-19-positive patients presented a range of new challenges to our liaison psychiatry for the elderly service. In this article we present some of the scenarios we have experienced, our own reflections on the needs of this specific group and how this has challenged us in terms of tolerating risk, prescribing off-label, collaborating with distressed colleagues, professional boundaries and being creative in non-pharmacological interventions.

Liaison Psychiatry During the Peak of the Coronavirus Pandemic: A Description of Referrals and Interventions

Introduction: The novel coronavirus SARS-CoV-2 belongs to the coronavirus family, a group of viruses that can cause upper respiratory infections in humans. Among other symptoms, it can present as an asymptomatic infection or as a more severe disease requiring hospitalization. Neuropsychiatric symptoms have been described in the acute phase of the illness and as long-term repercussions. We describe the characteristics and interventions in those COVID-19 patients referred to our liaison psychiatry service.Materials and Methods: This is a cross-sectional descriptive study. This study was carried out within the Department of Psychiatry of Cruces University Hospital (Basque Country, Spain). Data from each psychiatric consultation within our consultation-liaison service were consecutively obtained for 1 month from March 17 to April 17, 2020. We recruited data regarding clinical and referral characteristics and psychiatric interventions.Results: Of a total of 721 SARS-CoV-2 hospitalizations, 43 (5.6%) patients were referred to our psychiatry liaison service. The median age was 61 years old, and 62.8% were women. The infectious disease department was the most frequent petitioner (37.2%), and the most common reason for referral was patient anxiety (25.6%). A total of 67.4% of patients received psychological counseling and 55.8% received some pharmacological approach, with a median of 3.7 visits/calls per patient. In addition, 20.3% needed a medication switch due to potential interactions between psychotropics and drugs used to treat SARS-CoV-2.Discussion: In our study, up to 5.6% of SARS-CoV-2 hospitalized patients needed a psychiatric evaluation, especially for anxiety and mood symptoms. Psychosocial factors associated with the pandemic, drugs used to treat the infection, or a direct causative effect of the virus may explain our findings.

Burnout and Moral Injury Among Consultation-Liaison Psychiatry Trainees

Burnout and moral injury within medicine have steadily increased over the last decades, especially among those providing care during the COVID-19 pandemic. The term burnout has been used to describe clinician distress and a syndrome of emotional exhaustion, a diminished sense of personal accomplishment, and depersonalization. Burnout has a significant impact on both job performance and patient care. Moral injury occurs when external circumstances interact with a person's cherished beliefs and standards. When the tension between them cannot be reconciled, the felt integrity of the individual is disrupted and the person experiences distress. The consultative aspect in consultation-liaison psychiatry (CLP) presents challenges that may predispose the young clinician to burnout and moral injury, especially during fellowship training. CLP psychiatrists also have a liaison role that could catalyze systemlevel change to enhance the mental well-being of their colleagues. This article reviews clinically relevant psychodynamic aspects of burnout and moral injury during CLP training. In addition, the authors propose strategies to enhance career growth and prevent and address moral injury during training to generate fulfilling professional development.