Methamphetamine-related Psychiatric Visits to an Urban Academic Emergency Department: An Observational Study

Background

Methamphetamine, a stimulant of abuse, is associated with a significant number of Emergency Department (ED) visits. Methamphetamine use may produce psychiatric symptoms including acute psychosis, depression, and anxiety disorders.

Study Objectives

To characterize psychiatric emergencies either directly or indirectly attributable to methamphetamine use in an urban academic ED.

Methods

We analyzed a database of patients determined to have an ED visit that was either methamphetamine related or non-methamphetamine related. We retrospectively reviewed the records of the subset of ED visits from this database with psychiatric diagnoses. We compared the characteristics of patients with methamphetamine-related psychiatric visits (MRPVs) and non-methamphetamine-related psychiatric visits (non-MRPVs).

Results

We identified 130 patients with MRPVs. This represented 7.6% (130 of 1709) of all psychiatric visits. Patients with MRPV, compared to non-MRPV patients, were younger (34.4 years vs. 39.1 years, respectively, p = 0.0005), more likely to be uninsured (55% vs. 37%, respectively, p = 0.001), and less likely to have a past history of depression (10% vs. 19%, respectively, p = 0.011). Many characteristics between the two groups (MRPV vs. non-MRPV) were similar: likelihood of patient being placed on a psychiatric hold; hospital charges; previous histories of psychiatric visits; and history of anxiety, bipolar disorder, or schizophrenia.

Conclusions

Methamphetamine may be related to a significant proportion (7.6%) of psychiatric ED visits. Furthermore, patients with methamphetamine-associated psychiatric visits are younger, have lower rates of depression, are more likely to be uninsured, and are less likely to have a substance abuse-related chief complaint than patients with non-methamphetamine-associated ED psychiatric visits.     

Implementation of an Interdisciplinary Communication Workgroup on an Acute Psychiatric Unit

Communication among Interdisciplinary Healthcare Teams is an essential component of providing optimal patient care. Staff members at one U. S. Department of Veterans Affairs on an Acute Psychiatric Unit identified fragmented communication on the unit and expressed interest in forming an interdisciplinary communication workgroup. This quality improvement (QI) project was designed to enhance communication among the Interdisciplinary Healthcare Team on the Acute Psychiatric Unit. A workgroup was formed and met four times at 1-hour intervals. A pre/post-test was used to determine the initial effectiveness of the intervention. The results of the intervention suggested increased communication among the Interdisciplinary Healthcare Team as an upward trend of the mean scores was noted.     

Psychiatric Comorbidities and BMI: An Exploratory Analysis

Years of research and clinical practice have demonstrated that individuals with certain mental health conditions are at an increased risk of obesity. However, no identified research has examined associations between multiple comorbid psychiatric disorders and body mass index (BMI). This study uses a secondary analysis to examine associations between a large number of combinations of various mental health conditions and BMI. Surprisingly, the results of this study indicate that the most comorbid psychiatric disorders are not associated with an increased risk of elevated BMI. However, bipolar disorder, agoraphobia, attention-deficit hyperactivity disorder, and panic disorder had the greatest number of comorbid disorder associations linked with elevated BMI. The effect sizes ranged from a significant but relatively small Cohen's d of 0.3 to a more notable effect size of 0.7. The results of this study indicate that practitioners should be especially vigilant in helping their patients to avoid weight gain when they have one of the four identified disorders in combination with at least one other disorder. Future research is needed to understand the mechanisms underlying this increased risk and evaluate targeted interventions that would be the most effective for people with these diagnoses.     

Features of Everyday Life in Psychiatric Inpatient Care for Self-harming: An Observational Study of Six Women

This study aimed to describe the features of everyday life in psychiatric inpatient care as experienced by women who self-harm. Participant observations and informal interviews were conducted with six women and were subjected to qualitative content analysis. The major feature of everyday life in psychiatric inpatient care was ‘being surrounded by disorder’, which consisted of ‘living in a confusing environment, being subject to routines and rules that offer safety but lack consistency’ and ‘waiting both in loneliness and in togetherness’. The nursing staff spent minimal time with the patients and the women turned to each other for support, care and companionship.     

Effects of Music Therapy on Self- and Experienced Stigma in Patients on an Acute Care Psychiatric Unit: A Randomized Three Group Effectiveness Study

Stigma is a major social barrier that can restrict access to and willingness to seek psychiatric care. Psychiatric consumers may use secrecy and withdrawal in an attempt to cope with stigma. The purpose of this study was to determine the effects of music therapy on self- and experienced stigma in acute care psychiatric inpatients using a randomized design with wait-list control. Participants (N = 83) were randomly assigned by cluster to one of three single-session group-based conditions: music therapy, education, or wait-list control. Participants in the music therapy and education conditions completed only posttests while participants in the wait-list control condition completed only pretests. The music therapy condition was a group songwriting intervention wherein participants composed lyrics for “the stigma blues.” Results indicated significant differences in measures of discrimination (experienced stigma), disclosure (self-stigma), and total stigma between participants in the music therapy condition and participants in the wait-list control condition. From the results of this randomized controlled investigation, music therapy may be an engaging and effective psychosocial technique to treat stigma. Limitations, suggestions for future research, and implications for clinical practice and psychiatric music therapy research are provided.     

Evaluation of Treatment Integrity on a Child Psychiatric Unit: An Illustration

The authors present a systematic evaluation of the implementation of a token economy protocol on a child psychiatric inpatient unit. Unobtrusive observations and staff responses to vignettes that depicted child behavior indicated that staff members did not always distribute tokens as scheduled and were inconsistent in their judgments about which behaviors should be rewarded. The results highlight the need for child psychiatric nurses to monitor systematically the implementation of care for which they are responsible.     

An Attempt to Stem the Tide: Exploring the Effect of a 90-Day Transitional Care Intervention on Readmissions to an Acute Male Psychiatric Unit in South Africa

Introduction

Pressure on inpatient beds often results in premature discharges, which may precipitate early readmission. This has prompted an increased interest in transitional care interventions to bridge the gap between in- and outpatient care to reduce such readmissions. Our study aimed to assess the effect of a Transitional Care Service (TCS) on readmission rates in a high pressure inpatient service which utilizes a premature discharge policy to address bed pressures.

Observational Study of Intravenous versus Oral Corticosteroids for Acute Asthma: An Example of Confounding by Severity

Objectives: To demonstrate the problem of "confounding by severity" using the example of intravenous (IV) versus oral corticosteroids for the treatment of acute asthma. Double-blind, randomized trials have clearly demonstrated that IV and oral corticosteroids have comparable efficacy. Methods: Using a standardized protocol, 64 emergency departments enrolled 1,847 patients, aged 18–54 years, with acute asthma. Because route of corticosteroid therapy was not randomized, potential confounders of the association between corticosteroid route and hospital admission were controlled for by multivariate logistic regression and stratification. Results: Among the 1,193 patients, 383 (32%) received IV corticosteroids and 810 (68%) received oral corticosteroids. The two groups differed markedly at baseline, with patients receiving IV corticosteroids having more severe asthma. Overall, patients receiving IV corticosteroids were more likely to be admitted or experience a relapse event within 48 hours (51% vs. 19%; p < 0.001). On multivariate analysis, patients receiving IV corticosteroids remained more likely to be admitted or experience a relapse event within 48 hours (odds ratio = 2.6; 95% confidence interval = 1.2 to 6.0). Conclusions: In this observational study, patients with worse asthma exacerbations were more likely to receive IV corticosteroids as compared with oral corticosteroids. Although we controlled for many markers of asthma severity, we were unable to completely control for baseline differences between the IV and oral corticosteroid groups. Observational research continues to serve as an important tool for describing problems and for understanding many exposure–disease associations. For examining the impact of treatments on adverse outcomes, randomized trials are often required to avoid intractable confounding by severity.     

Changes in Medical Students' Emotional Intelligence: An Exploratory Study

Background: The ability to recognize and adapt to affective states in one's self and others, emotional intelligence is thought to connote effective, compassionate doctor–patient communication. Unfortunately, medical training has been shown to erode some of the very attributes it purports to instill in students. Purpose: The objective is to examine changes in students' emotional intelligence and empathy across an undergraduate medical curriculum. Methods: During M1 orientation and again following M3 clerkship training, students in the University of Kentucky College of Medicine Class of 2004 completed the Trait Meta-Mood Scale (TMMS) and Davis' Interpersonal Reactivity Index (IRI). Baseline changes in specific dimensions were examined for both male and female students. Results: Reliability of subscales was generally acceptable (α ≥ .70). Sixty-four students provided data at both time points. Compared to baseline, two of three TMMS dimensions—attention to feelings and mood repair—were significantly ( p ≤ .05) lower at follow-up. One IRI dimension—empathic concern—was also significantly lower at Time 2, whereas another, Personal Distress, was significantly higher. However, differences generally reflected only small effect sizes. No significant gender interactions were noted. Conclusions: Despite quite modest effect sizes, findings suggest that students' abilities to effectively manage affective states may be subject to some minor fluctuation across the undergraduate educational continuum. However, whether these observed declines constitute meaningful, clinically relevant changes remains unclear.