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Ferrando SJ, Klepacz L, Lynch S, Shahar S, Dornbush R, Smiley A, Miller I, Tavakkoli M, Regan J, Bartell A. Psychiatric emergencies during the height of the COVID-19 pandemic in the suburban New York City area. J Psychiatr Res 2021; 136:552-559. [PMID: 33158555 PMCID: PMC7992036 DOI: 10.1016/j.jpsychires.2020.10.029] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 10/16/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND This report characterizes patients presenting for psychiatric emergencies during the COVID-19 pandemic and describes COVID-19-related stressors. METHODS Patients seen for emergency psychiatric evaluation during the height of the COVID-19 period (March 1-April 30, 2020; N = 201) were compared with those in the immediate Pre-COVID-19 period (January 1-February 28, 2020; N = 355), on sociodemographic characteristics, psychiatric diagnoses, symptoms, and disposition. Patients tested positive for COVID-19 were compared with those that tested negative on the same outcomes. Prevalence and nature of COVID-19-stressors that influenced the emergency presentation were rated. OUTCOME The most common psychiatric diagnoses and presenting symptoms during both periods were depression and suicidal ideation. Comparing the Pre-COVID-19 and COVID-19 periods, a significant decline in emergency psychiatric volume was observed in children and adolescents (C/A), but not adults. COVID-19 period C/A patients had more new onset disorders and were more likely to be admitted to inpatient care, but were less likely to present with suicide attempts, impulse control disorders and agitation/aggression. Adults were more likely to have no access to outpatient care, present with anxiety disorders, and were also more likely to be admitted for inpatient care. COVID-19 directly affected the psychiatric emergency in 25% of patients, with the more severe stressors triggered by fear of COVID infection (including psychosis), actual COVID infection in self or family members, including death of a loved one. COVID-positive patients were more likely to have psychosis, including new-onset, and were less likely to be depressed/suicidal compared to their COVID-negative counterparts. CONCLUSION This report demonstrates the need for emergency psychiatric services throughout the COVID-19 pandemic and the need for clinical and diagnostic COVID-19 screening of psychiatric emergency patients. New and severe pathology underscore the need for enhanced outpatient access to tele-mental health, crisis hotline and on-line psychotherapeutic services, as well as psychiatric inpatient services with capacity to safely care for COVID-19 patients.
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Affiliation(s)
- Stephen J. Ferrando
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA,Corresponding author. Department of Psychiatry, Westchester Medical Health System, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - Lidia Klepacz
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
| | - Sean Lynch
- New York Medical College, Valhalla, NY, USA
| | | | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
| | - Abbas Smiley
- New York Medical College, Valhalla, NY, USA,Department of Surgery, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Ivan Miller
- New York Medical College, Valhalla, NY, USA,Department of Emergency Medicine, Westchester Medical Center Health System, Valhalla, USA
| | - Mohammad Tavakkoli
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
| | - John Regan
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
| | - Abraham Bartell
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA,New York Medical College, Valhalla, NY, USA
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Ferrando SJ, Klepacz L, Lynch S, Tavakkoli M, Dornbush R, Baharani R, Smolin Y, Bartell A. COVID-19 Psychosis: A Potential New Neuropsychiatric Condition Triggered by Novel Coronavirus Infection and the Inflammatory Response? Psychosomatics 2020; 61:551-555. [PMID: 32593479 PMCID: PMC7236749 DOI: 10.1016/j.psym.2020.05.012] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Stephen J Ferrando
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York.
| | - Lidia Klepacz
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Sean Lynch
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Mohammad Tavakkoli
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Rhea Dornbush
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Reena Baharani
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Yvette Smolin
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
| | - Abraham Bartell
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY; Department of Psychiatry, New York Medical College, Valhalla, New York
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Bylund CL, Banerjee SC, Bialer PA, Manna R, Levin TT, Parker PA, Schofield E, Li Y, Bartell A, Chou A, Hichenberg SA, Dickler M, Kissane DW. A rigorous evaluation of an institutionally-based communication skills program for post-graduate oncology trainees. Patient Educ Couns 2018; 101:1924-1933. [PMID: 29880404 PMCID: PMC6755908 DOI: 10.1016/j.pec.2018.05.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Integrating education about physician-patient communication into oncology specialists' education is important to improve quality of care. Our aim was to rigorously evaluate a 4-year institutionally-based patient communication skills program for oncology post-graduate trainees. METHODS Trainees from 10 specialties in the U.S. participated in patient communication skills modules tailored to sub-specialties. The program was evaluated by comparing pre-post scores on hierarchical outcomes: course evaluation, self-confidence, skills uptake in standardized and real patient encounters, and patient evaluations of satisfaction with communication. We examined breadth of skill usage as key outcome. Generalized estimating equations were used in data analysis. RESULTS Two hundred and sixty-two trainees' data were analyzed, resulting in 984 standardized and 753 real patient encounters. Participants reported high satisfaction and demonstrated significant skill growth with standardized patients, but transfer of these skills into real patient encounters was incomplete. Participants with lower baseline scores had larger improvements with both standardized and real patients. CONCLUSION The program was well received and increased participant skills in the simulated setting without effective transfer to real patient encounters. PRACTICE IMPLICATIONS Future work should allocate proportionally greater resources to trainees with lower baseline scores and measure breadth of participant skill usage as an outcome.
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Affiliation(s)
- Carma L Bylund
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States.
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Philip A Bialer
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Ruth Manna
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Tomer T Levin
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Elizabeth Schofield
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Abraham Bartell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Alexander Chou
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States
| | - Shira A Hichenberg
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
| | - Maura Dickler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue New York, NY 10065, United States
| | - David W Kissane
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, New York, NY 10022, United States
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Sands SA, Mee L, Bartell A, Manne S, Devine KA, Savone M, Kashy DA. Group-Based Trajectory Modeling of Distress and Well-Being Among Caregivers of Children Undergoing Hematopoetic Stem Cell Transplant. J Pediatr Psychol 2017; 42:283-295. [PMID: 27543915 DOI: 10.1093/jpepsy/jsw064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/21/2016] [Indexed: 02/04/2023] Open
Abstract
Objective To examine the trajectories of caregiver psychological responses in the year following their child's hematopoetic stem cell transplant (HSCT), and whether cognitive and social processing strategies differentiated between trajectories. Method One hundred and eight caregivers randomized to the control condition of a cognitive-behavioral intervention study completed measures of distress, coping, and social support at baseline, 1 month, 6 months, and 1 year post HSCT of their child. Results The majority reported moderate or low anxiety, depression, or distress that decreased over time, but a small group demonstrated high anxiety, depression, or distress that persisted or increased over time. Maladaptive coping was highest among caregivers in the high-persistent distress subgroup compared with the moderate-decreasing and low-stable groups. Adaptive coping was minimally associated with trajectory subgroups. Conclusions Screening HSCT caregivers for distress and maladaptive coping may be useful in identifying caregivers likely to experience persistently high distress who may benefit from psychological intervention.
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Affiliation(s)
- Stephen A Sands
- Clinical Psychology Departments of Pediatrics and Psychiatry, Columbia University School of Medicine, New york, USA
| | - Laura Mee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Sharon Manne
- Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Katie A Devine
- Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Mirko Savone
- Clinical Psychology Departments of Pediatrics and Psychiatry, Columbia University School of Medicine, New york, USA
| | - Deborah A Kashy
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Manne S, Mee L, Bartell A, Sands S, Kashy DA. A randomized clinical trial of a parent-focused social-cognitive processing intervention for caregivers of children undergoing hematopoetic stem cell transplantation. J Consult Clin Psychol 2016; 84:389-401. [PMID: 26913620 PMCID: PMC5580924 DOI: 10.1037/ccp0000087] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Providing care to one's child during and after a hematopoietic stem cell transplant (HSCT) is a universally stressful experience, but few psychological interventions have been developed to reduce caregiver distress. The goal of this study was to test the efficacy of a brief cognitive-behavioral intervention delivered to primary caregivers. METHOD Two hundred eighteen caregivers were assigned either best-practice psychosocial care (BPC) or a parent social-cognitive intervention program (P-SCIP). The 5 session P-SCIP was delivered during the HSCT hospitalization. Caregivers completed measures of distress, optimism, coping, and fear appraisals preintervention, 1, 6 months, and 1 year. RESULTS P-SCIP reduced caregiver's distress significantly more than BPC between the pretransplant assessment (Time 1) and 1-month follow-up assessment (Time 2). P-SCIP had a stronger effect than BPC among caregivers who began the hospitalization reporting higher depression and anxiety, and among caregivers whose children developed graft-versus-host disease (GvHD). Long-term treatment effects of P-SCIP were seen in traumatic distress among caregivers who reported higher anxiety pretransplant as well as among caregivers whose children had GvHD at HSCT discharge. CONCLUSIONS Screening caregivers for elevations in pretransplant anxiety and targeting interventions specifically to these caregivers, as well as targeting caregivers to children who develop GvHD, may prove beneficial.
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Affiliation(s)
- Sharon Manne
- Department of Medicine, Rutgers Cancer Institute of New Jersey
| | - Laura Mee
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Abraham Bartell
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Stephen Sands
- Department of Pediatrics, Columbia University School of Medicine
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Virtue SM, Manne SL, Mee L, Bartell A, Sands S, Gajda TM, Darabos K. Psychological distress and psychiatric diagnoses among primary caregivers of children undergoing hematopoietic stem cell transplant: an examination of prevalence, correlates, and racial/ethnic differences. Gen Hosp Psychiatry 2014; 36:620-6. [PMID: 25246347 PMCID: PMC4329245 DOI: 10.1016/j.genhosppsych.2014.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/08/2014] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aims of the study were to examine the prevalence of self-reported psychological distress, examine the prevalence of interview-rated psychiatric diagnoses, identify correlates of psychological distress and psychiatric diagnosis and examine racial/ethnic group differences on measures of psychological distress among primary caregivers of children preparing to undergo hematopoietic stem cell transplant (HSCT). METHODS Caregivers (N = 215) completed the Beck Anxiety Inventory, Beck Depression Inventory (BDI), Impact of Events Scale, and a psychiatric interview assessing major depressive disorder, generalized anxiety disorder and panic disorder. Regression analyses examined correlates of distress and psychiatric diagnosis. Comparisons were made between racial/ethnic groups. RESULTS Posttraumatic stress symptoms were reported by 54% of caregivers during the time preparing for the child's HSCT. Twenty-seven percent of caregivers met diagnostic criteria for at least one of the psychiatric diagnoses during this time. Few factors were associated with distress or psychiatric diagnosis, except the child scheduled for allogeneic transplant, being married and prior psychological/psychiatric care. Sociodemographic factors accounted for racial/ethnic group differences, except that Hispanic/Latino caregivers reported higher BDI scores than non-Hispanic white caregivers. CONCLUSION Caregivers may be at greater risk of posttraumatic stress symptoms than anxiety or depression. Prior psychological/psychiatric treatment is a risk factor for greater psychological distress and psychiatric diagnosis during this time. Racial differences are mostly due to sociodemographic factors.
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MESH Headings
- Adolescent
- Adult
- Black or African American/psychology
- Black or African American/statistics & numerical data
- Anxiety Disorders/epidemiology
- Anxiety Disorders/ethnology
- Anxiety Disorders/psychology
- Caregivers/psychology
- Caregivers/statistics & numerical data
- Child
- Child, Preschool
- Depressive Disorder, Major/epidemiology
- Depressive Disorder, Major/ethnology
- Depressive Disorder, Major/psychology
- Female
- Hematopoietic Stem Cell Transplantation
- Hispanic or Latino/psychology
- Hispanic or Latino/statistics & numerical data
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Panic Disorder/epidemiology
- Panic Disorder/ethnology
- Panic Disorder/psychology
- Parents/psychology
- Prevalence
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Post-Traumatic/ethnology
- Stress Disorders, Post-Traumatic/psychology
- Stress, Psychological/epidemiology
- Stress, Psychological/ethnology
- Stress, Psychological/psychology
- White People/psychology
- White People/statistics & numerical data
- Young Adult
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Affiliation(s)
| | - Sharon L Manne
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Laura Mee
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Stephen Sands
- Columbia University Medical Center, New York, NY, USA
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Abstract
The consequences of depression in medically ill children include the disability and morbidity that is associated with depression in any patient. They also include an exacerbation of the underlying medical disease and nonadherence to treatment. Thus, medically ill children who are depressed constitute a special, high-risk group of patients who may suffer from severe consequences above and beyond those that are expected in a medically sound population. This manuscript reviews methodologic and practical difficulties that are associated with the diagnosis and treatment of depression in this group of patients. Because treatment of depression in medically ill children may well lead to improvement in medical and psychiatric outcome, there is pressing need for the careful study of potential treatment options in this specific group of patients.
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Affiliation(s)
- Eyal Shemesh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA.
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