Opioid prescriptions following behavioral health training among primary care providers.

Background: Overdose deaths due to opioids are a major concern in the United States. Physicians often report inadequate training in chronic pain and substance use disorder management. Here, we evaluate whether a specialized program, the Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship, affected opioid prescription practices among primary care physicians.

Improving Behavioral Healthcare Access Disparities by Training Providers in Disadvantaged Communities - Evidence of Strategy Effectiveness.

Background: Inadequate access to behavioral health services disproportionately impacts marginalized populations who live in disadvantaged areas. To reduce this gap, programs dedicated to optimizing behavioral health education and training must focus their efforts to enroll providers who practice in these disadvantaged areas.

Objective: The Train New Trainers (TNT) fellowship program aims to enhance behavioral health knowledge, skills, and attitudes of primary care providers (PCPs) who deliver care in disadvantaged communities.

Antidepressant Prescription Behavior Among Primary Care Clinician Providers After an Interprofessional Primary Care Psychiatric Training Program.

Primary care providers (PCPs) are increasingly called upon to screen for and treat depression. However, PCPs often lack the training to diagnose and treat depression. We designed an innovative 12-month evidence and mentorship-based primary care psychiatric training program entitled the University of California, Irvine (UCI) School of Medicine Train New Trainers Primary Care Psychiatry (TNT PCP) Fellowship and examined whether this training impacted clinician prescription rates for antidepressants.

Train New Trainers Primary Care Psychiatry Fellowship-Optimizing Delivery of Behavioral Health Care Through Training for Primary Care Providers.

Objective: To expand and optimize the behavioral health workforce, it is necessary to improve primary care providers' (PCPs) overall knowledge and clinical skills in primary care-based psychiatry. Studies on the effects of postgraduate psychiatric education programs for PCPs on psychiatric knowledge are limited.

Methods: A total of 251 PCPs completed a 1-year fellowship.

COVID-19 Transmission in a Psychiatric Long-Term Care Rehabilitation Facility: An Observational Study.

Objective: To report the clinical characteristics and transmission rate of coronavirus disease 2019 (COVID-19) in a community inpatient long-term care psychiatric rehabilitation facility designed for persons with serious mental illness to provide insight into transmission and symptom patterns and emerging testing protocols, as well as medical complications and prognosis.

Methods: This study examined a cohort of 54 residents of a long-term care psychiatric rehabilitation program from March to April 2020. Baseline demographics, clinical diagnoses, and vital signs were examined to look for statistical differences between positive versus negative severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) groups.

QTc monitoring in adults with medical and psychiatric comorbidities: Expert consensus from the Association of Medicine and Psychiatry.

Objective: Several psychiatric medications have the potential to prolong the QTc interval and subsequently increase the risk for ventricular arrhythmias such as torsades de pointes (TdP). There is limited guidance for clinicians to balance the risks and benefits of treatments.

Methods: After a review of the existing literature, clinical-educators from the Association of Medicine and Psychiatry developed expert consensus guidelines for ECG monitoring of the QTc interval for patients with medical and psychiatric comorbidities who are prescribed medications with the potential to prolong the QTc interval.

Real-time video detection of falls in dementia care facility and reduced emergency care.

An artificial intelligence-enabled video fall detection system using visual science reduced emergency department visits by 80% in 6 communities over 3 months.

The Communication Gap Between the Medical System and Community Resources for Dementia-Related Behavioral Symptom Management: Family Caregiver Perspectives.

Objective: To examine family caregiver perspectives on cooperative communication surrounding pharmacologic and nonpharmacologic resources for the treatment of dementia-related behavioral symptoms.

Methods: Personal narrative interviews were conducted by the primary investigator with 13 family caregivers from October 2014 to April 2015. The recorded interviews were then transcribed and coded.

Use of Preventive Health Services in People With Serious Mental Illness: Consumer Perspectives on Barriers and Solutions.

Objective: This study asked 350 consumers with serious mental illness (DSM-IV) (who are using community mental health services in Sacramento County, California) for their perspective about barriers and solutions to use of preventive health services.

Methods: Two questions were posed: (1) What do you think keeps you from getting preventive tests? (2) What do you think would help you complete the recommended tests? Participants were interviewed between October 2010 and December 2012. A mixed qualitative and quantitative data analysis method was used to examine participant responses.

Characteristics of Misdemeanants Treated for Competency Restoration.

There are an estimated 60,000 evaluations annually for competence to stand trial for felony indictments and likely more for misdemeanor indictments. Thus, there is an increasing interest in determining factors associated with a defendant's likelihood of being restored to competence to stand trial. Although previous studies have found that a misdemeanor charge predicts significantly less likelihood of restoration of competence when compared with felony charges, states typically allow treatment facilities less time to restore misdemeanor defendants than felony defendants.

Antipsychotic Use in a Diverse Population With Dementia: A Retrospective Review of the National Alzheimer's Coordinating Center Database.

A cross-sectional analysis examined medication records in the National Alzheimer's Coordinating Center Database for community-dwelling patients with dementia who visited an Alzheimer's Disease Center between 2008 and 2014. Hispanic participants had a 1.62-fold greater use of antipsychotic medications, which was largely accounted for by a higher prevalence of neuropsychiatric symptoms and more severe dementia compared with non-Hispanic whites.

Inflammation Markers and Major Depressive Disorder in Patients With Chronic Heart Failure: Results From the Sertraline Against Depression and Heart Disease in Chronic Heart Failure Study.

Background: Major depressive disorder (MDD) and chronic heart failure (CHF) have in common heightening states of inflammation, manifested by elevated inflammation markers such as C-reactive protein. This study compared inflammatory biomarker profiles in patients with CHF and MDD to those without MDD.

Methods: The study recruited patients admitted to inpatient care for acute heart failure exacerbations, after psychiatric diagnostic interview.

Lactulose-associated lithium toxicity: a case series.

Background: Lactulose is commonly used for constipation and hepatic encephalopathy. Its adverse effects of dehydration and serum electrolyte imbalances are widely known.

Objective: This study aimed to describe a case series of 3 patients receiving lactulose who developed lithium toxicity.

Delirium and hypovitaminosis D: neuroimaging findings.

The authors examined the frequency of neuroimaging findings of cortical atrophy and/or cerebrovascular disease in patients with delirium with hypovitaminosis D and normal vitamin D levels. Of 32 patients with delirium with hypovitaminosis D who were neuroimaged, 91.4% had neuroimaging findings, despite only five cases having a comorbid diagnosis of dementia.

Combination phentermine/topiramate for obesity treatment in primary care: a review.

The treatment of obesity is often met with a myriad of challenges in the primary care setting. Nevertheless, a modest 5% weight loss is considered clinically significant and may be associated with health benefits. Phentermine/topiramate (Qsymia), available in the United States since September 2012, achieves clinically meaningful weight loss along with improvements in weight-related comorbidities.

Understanding preventive health screening services use in persons with serious mental illness: how does integrated behavioral health primary care compare?

Objective: People with serious mental illness have reduced life expectancy, in large part due to reduced access to medical services and underutilization of preventive health services. This is a cross-sectional study that compared preventive services use in an integrated behavioral health primary care clinic (IBHPC) with two existing community mental health programs.

Methods: Participants completed questionnaires about preventive health services use that contained 33 questions about demographic clinical information, and use of preventive health services, from October 2010 to December 2012.

Hypovitaminosis D in Delirium: a Retrospective Cross-sectional Study.

Background: As vitamin D may have a neuroprotective effect, the authors studied the association of biomarkers of vitamin D status and delirium to see if low vitamin D status was common in delirium cases.

Methods: Biochemical measures of vitamin D (25-hydroxyvitamin D [25-OHD]) and calcium metabolism were used in this retrospective cross-sectional analysis of adult in-patients with delirium, admitted at three Canadian academic hospitals from January 2011 to July 2012. Primary outcome was to determine estimates of the prevalence of hypovitaminosis D in this group in whom vitamin D was checked.

Lessons from psychiatry and psychiatric education for medical learners and teachers.

Medical learners, teachers, and institutions face significant challenges in health care delivery and in training the next generation of clinicians. We propose that psychiatry offers lessons which may help improve how we take care of patients and how we teach others to care for patients. Our objective is to discuss what learners and teachers can learn from psychiatry, organized around (1) how we make decisions, (2) how we learn, and (3) how we reflect on our practice.

Health status and depression remission in patients with chronic heart failure: patient-reported outcomes from the SADHART-CHF trial.

Background: Depression is a common comorbidity in heart failure and is strongly associated with increased mortality, morbidity, and reduced health status. Whether depression treatment may result in improvement of health status in heart failure patients with comorbid depression remains unknown.

Methods And Results: The Sertraline Against Depression and Heart Disease in Chronic Heart Failure study randomized 469 participants with chronic heart failure (left ventricular ejection fraction 45% and New York Heart Association class II) and major depressive disorder based on Diagnostic Statistics Manual fourth edition criteria to sertraline or placebo for 12 weeks.