Publications by authors named "Adrienne D Mishkin"

We present the fictional case of a 29-year-old man with sickle cell disease referred to psychiatry for evaluation of depression during an acute pain episode. Consultation-liaison psychiatrists with expertise in sickle cell disease provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the high prevalence of mood and cognitive disorders in this population, as well as pertinent issues related to chronic pain, opioids, and stigma.

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Background: Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation.

Methods: An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience.

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Article Synopsis
  • The text reviews the prevalence and impact of psychiatric conditions like depression, anxiety, and cognitive impairment in adults with sickle cell disease (SCD), which has been less explored compared to quality of life and mood reports.
  • It highlights the limitations in current research regarding psychiatric illness in this population and offers provisional recommendations for better understanding and treatment.
  • The authors call for more research opportunities to enhance care for adults with SCD and their psychiatric challenges.
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Assisted reproductive technologies (ART) are not yet systematically available to people with sickle cell disease or their parents. Fertility care for these groups requires addressing sickle cell disease-associated infertility risks, fertility preservation options, pregnancy possibilities and outcomes, and, when needed, infertility treatment. People with a chance of having a child with sickle cell disease can use in-vitro fertilisation with preimplantation genetic testing to conceive a child unaffected by sickle cell disease.

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Background: Telepsychiatry is now common practice. Within consultation-liaison psychiatry (CLP), previous work has shown that telepsychiatry is feasible and satisfactory. To date, there has not been qualitative work done within CLP to describe the clinician's experience with telepsychiatry.

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Data privacy in telemedicine has been extensively considered and reviewed in the literature, such as explorations of consent, who can access information, and the security of electronic systems. However, privacy breaches are also a potential concern in the physical setting and surroundings of the patient. Here we review clinical situations in which there is unanticipated loss of privacy, as well as potential physical and psychological safety concerns for the patient and others when privacy is limited.

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Background: The COVID-19 pandemic created pressure to implement telepsychiatry across practice models.

Objective: We sought to evaluate the overall success of this change and to identify what types of practice settings, provider groups, and patient groups were best served by telepsychiatry and telepsychotherapy utilization. We were particularly interested in how providers of consultation-liaison psychiatry adapted to remote care.

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Article Synopsis
  • - Delirium is a common and treatable condition in patients receiving stem cell transplantation (SCT), and identifying those at higher risk is crucial for prevention.
  • - The study assessed the connection between the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) scores and the occurrence of delirium in SCT patients, finding a significant association.
  • - Results showed that SIPAT scores can help predict which patients might develop delirium post-transplant, suggesting the potential for personalized preventative strategies in their care.
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Background: The COVID-19 pandemic created pressure to attempt remote consultation, but there are limited data on the use of telepsychiatry in general, and almost none about the experience of telepsychiatry in a consultation-liaison context.

Objective: We looked for attributes that correlated with satisfactory tele-encounters.

Methods: Eleven consultation-liaison attending surveys and 8 attendings' tele-encounter logs from March to June 2020 were completed and reviewed to assess for patient and provider characteristics associated with barriers to using telepsychiatry.

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Article Synopsis
  • * The only known cure for SCD is hematopoietic cell transplantation (HCT), but this can lead to chronic issues like depression, anxiety, and sterility for both genders.
  • * There is limited research on how HCT impacts fertility and mental health in SCD patients, revealing that those who face these combined challenges are more likely to experience poor overall quality of life and difficulties accessing affordable fertility services.
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In patients undergoing stem cell transplantation (SCT), nonadherence has potential for significant medical impact and potentially life-threatening complications. No study thus far has demonstrated an effective way to predict adherence in SCT recipients. A structured rating scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), has been shown to predict psychosocial outcomes and medical morbidity in solid organ transplant recipients.

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Background: In the United States, people with limited English proficiency (LEP) receive poorer medical care than those proficient in English. Few studies demonstrate how linguistic barriers complicate psychiatric care; in consultation-liaison (C-L) psychiatry, there are no published data about care disparities for patients with LEP or for whom English is not the preferred language (PL).

Objective: We sought to determine if PL affects the psychiatric consultation rate.

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