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Pediatric consultation-liaison (CL) psychiatry focuses on the treatment of mental health difficulties in physically ill children. This article focuses on three diagnoses that a pediatric CL psychiatrist commonly encounters: delirium, somatic symptom and related disorders (SSRD), and pediatric medical traumatic stress (PMTS). Delirium is an acute cerebral dysfunction secondary to an organic cause and can present with agitation, sleep disruption, disorientation, inattention, perceptual disturbances or apathy, and withdrawal. The management of delirium involves the treatment of underlying medical causes by environmental modifications and pharmacological strategies. SSRDs present with medically unexplained symptoms in which physical examination and laboratory testing do not justify a diagnosis of a known medical illness. Cognitive-behavioral therapy has the most evidence for the treatment of SSRDs, whereas pharmacological interventions have insufficient evidence in improving core symptoms of SSRDs. PMTS is defined as a set of posttraumatic stress symptoms (PTSS) in response to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. Brief, focused cognitive-behavioral strategies delivered in a family-centered approach can prevent or reduce symptoms. [ Psychiatr Ann . 2021;51(10):473–481.]

ObjectiveSuicide is a leading cause of death among children and adolescents. Suicide risk screening tools can detect the risk of suicide among patients presenting to healthcare settings. The aim of this review was to describe the effectiveness of universal suicide risk screening (all patients) compared with selective screening (behavioural health patients only) in children and adolescents in emergency departments (EDs).MethodA literature search was conducted on PubMed for articles related to suicide risk screening in paediatric EDs between January 2016 and February 2022.Results8 studies met the selection criteria. The review showed that 46%–93% of patients that screened positive for suicide risk had presented with a medical concern. These patients would have been missed without universal suicide risk screening. In both selective and universal screening scenarios, use of a suicide risk screening tool was better at detecting suicide risk compared with use of presenting problem alone. Suicide risk screening was found to be acceptable without increasing length of stay in the ED.ConclusionBased on this review, using a suicide screening tool can help detect patients at risk who would otherwise have been missed.

Background & Objective: The Coronavirus disease 2019 (COVID-19) pandemic has caused widespread psychological distress. The aims of the study were a) to assess mental health symptoms experienced by expatriate hospital staff and b) to determine the impact of staff wellbeing interventions specific to pandemic related stress. Methods: The study was conducted from June 2020 until August 2020. A 16-question survey was disseminated online via Survey Monkey to assess the mental health needs of hospital staff during the pandemic. Based on results, a virtual, tiered mental health support model was developed, and staff feedback was collected. Results: Almost 46.2% of respondents (N: 1001) reported at least one mental health symptom in the initial survey. The most common symptoms were anxiety, low mood and feelings of isolation. Being single and in poor health status were predictors of developing mental health symptoms (P

The creation of personalized avatars that may be morphed to simulate realistic changes in body size is useful when studying self-perception of body size. One drawback is that these methods are resource intensive compared to rating scales that rely upon generalized drawings. Little is known about how body perception ratings compare across different methods, particularly across differing levels of personalized detail in visualizations. This knowledge is essential to inform future decisions about the appropriate tradeoff between personalized realism and resource availability. The current study aimed to determine the impact of varying degrees of personalized realism on self-perception of body size. We explored this topic in young adult women, using a generalized line drawing scale, as well as several types of personalized avatars, including 3D textured images presented in immersive virtual reality (VR). Body perception ratings using generalized line drawings were often higher than responses using individualized visualization methods. While the personalized details seemed to help with identification, there were few differences among the three conditions containing different amounts of individualized realism (e.g., photo-realistic texture). These results suggest that using scales based on personalized texture and limb dimensions are beneficial, although presentation in immersive VR may not be essential.

This chapter provides a wide overview of the molecular and biochemical aspects of psychiatric illness and treatment. In the first section we describe current evidence for pharmacogenetics and pharmacogenomics in psychiatry. Practical applications of pharmacogenetic testing in clinical settings is discussed. In the second section, we focus on psychiatric medication and provide guidelines for therapeutic drug monitoring (TDM) of psychiatric medications. We discuss the evidence behind TDM and its relationship with treatment efficacy. Additionally, we give laboratory monitoring guidelines for safety and minimization of drug-related adverse effects. In the last section we discuss the role of laboratory testing in an emergency setting. We discuss the laboratory workup of new-onset psychosis, differentiation between primary and secondary psychosis, and review common medical problems that can be confused with primary psychiatric illnesses. Next, we discuss psychiatric medication–related emergencies, that is, serotonin syndrome and neuroleptic malignant syndrome. We outline how to differentiate these syndromes from each other and other drug-induced adverse reactions. Finally, the role of medical clearance in the emergency department is discussed. The evidence behind “clearing” a patient without laboratory or imaging studies is discussed as well as indications for laboratory testing in this setting.

OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation. RESULTS: Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment. CONCLUSIONS: A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.

Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.

Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.

Although much has been written about the psychological impact of natural disasters, the impact of nuclear disasters has not been extensively studied in children. Nuclear disasters are unique because they are man-made and represent a failure of the safety systems put in place to contain dangerous radioactive materials. This article summarizes the available literature on 3 of the biggest nuclear disasters in history. There is a need for further investigation not only of the impact on children but also of whether the consequences are a direct result of the disaster, radiation exposure, or the psychosocial disruptions resulting from the disaster.