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Psychiatric symptoms are frequently reported in Wilson disease (WD); however, systematic assessments with validated measures are lacking.We aim to report the prevalence and clinical correlates for major depressive disorder (MDD) as resulting from a multisite international WD registry.All patients enrolled in the WD registry received structured psychiatric evaluations (MINI International Neuropsychiatric Interview, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, Perceived Stress Scale), laboratory tests, hepatology, and neurological assessments. We present the analysis of the data collected at enrollment for the first 3 years (N = 62).Thirty-seven percent (23) had a lifetime history (MDD), and 6% (4) met the criteria for an active major depressive episode. Depression was self-reported in 30.51% (19) at WD diagnosis. Patients with MDD had worse mental health quality-of-life (QOL) scores (median 43 vs 53.6, P = 0.006), higher severe anxiety (13.04% vs 0), higher perceived stress (median 18 vs 9, P0.003), and higher levels of neuroticism (median 8 vs 5.0, P = 0.002). We found no significant difference in physical health QOL and severity of neurological or liver disease. There was no significant difference in copper parameters or liver tests in those with MDD and without. The limitations of our study consist the small sample size, the cross-sectional report, and the lack of brain copper measurements.Lifetime MDD is highly prevalent in WD and associated with worse mental health QOL. We did not find a significant association among liver disease, neurological disease laboratory tests, and MDD. Screening for depression should be considered in patients with WD.

Wilson disease (WD) is a chronic disorder of copper metabolism which may affect patient's quality of life (QOL).Our aim was to assess the relationship between mental QOL (M-QOL) and physical QOL (P-QOL) and severity of the liver, neurological disease and mental health in patients with WD.At enrollment into our multisite international WD registry, adults (n = 62) were administered examinations assessing QOL (Short-Form 12-Item Health Survey), cognition, and mood. Patients also underwent hepatology and neurological assessments.Patients had lower M-QOL than P-QOL scores, P = 0.0006. Patients with major depressive disorder (n = 22) had worse M-QOL scores, P = 0.0017 but not P-QOL. We found no association with impaired cognition (n = 37) and QOL. The P-QOL scores have a moderate negative association with neurological disease severity based on the Unified Wilson Disease Rating Scale score (total [r = -0.38, P0.003], part 2 [r = -0.50, P0.0001], and part 3 [r = -0.37, P = 0.004]). M-QOL was not associated with Unified Wilson Disease Rating Scale scores. Worse P-QOL, but not M-QOL, was found in higher cirrhosis severity indicated by Child-Pugh (r = -0.80, P = 0.002) and Model for End Stage Liver Disease scores (r = -0.64, P = 0.03).M-QOL was associated with depression but not cognitive impairment, neurological disease, or liver disease severity, suggesting that mental health issues may affect overall QOL independent of the degree of liver or neurological disease. P-QOL was affected by the severity of neurological and liver disease but not mental health but also contributes to overall QOL in WD. An appreciation of the range of problems that affect QOL in adults with WD will help health care providers address issues that could improve overall well-being. The Short-Form 12-Item Health Survey may provide a useful instrument for QOL surveillance in WD.

Background As the science of consultation-liaison psychiatry advances, the Academy of Consultation-Liaison Psychiatry's Guidelines and Evidence-Based Medicine Subcommittee reviews articles of interest to help academy members remain familiar with the latest in evidence-based practice. Objective We identify the 10 most important articles for clinical practice in consultation-liaison psychiatry from 2020 using the new Importance and Quality instrument for assessing scientific literature. Methods The subcommittee published annotated abstracts for 97 articles on the academy website in 2020. Reviewers then rated all articles on clinical importance to practice and quality of scholarship using the Importance and Quality instrument. We describe the 10 articles with the highest aggregate scores and analyze the reliability of Importance and Quality instrument. Results Twenty-four raters identified the top 10 scoring articles of 2020. These articles provide practical guidance on key areas of consultation-liaison psychiatry including management of COVID-19, lithium treatment for complex patients, medical risks among patients with severe mental illness, and substance use disorders in medical settings. The assessment instrument demonstrated good to excellent interrater reliability. Conclusion These articles offer valuable guidance for consultation-liaison psychiatrists regardless of their practice area. Collaborative literature reviews with standardized assessments help clinicians deliver evidence-based care and foster a high standard of practice across the specialty.

BACKGROUND: The prevalence of substance use disorders is higher among medical inpatients than in the general population, placing inpatient providers in a prime position to detect these patients and intervene. OBJECTIVE: To assess provider detection rates of substance use disorders among medical inpatients and to identify patient characteristics associated with detection. DESIGN: Data drawn from a cluster randomized controlled trial that tested the effectiveness of three distinct implementation strategies for providers to screen patients for substance use disorders and deliver a brief intervention (Clinical Trials.gov: NCT01825057). PARTICIPANTS: A total of 1076 patients receiving care from 13 general medical inpatient units in a large teaching hospital participated in this study. MAIN MEASURES: Data sources included patient self-reported questionnaires, a diagnostic interview for substance use disorders, and patient medical records. Provider detection was determined by diagnoses documented in medical records. KEY RESULTS: Provider detection rates were highest for nicotine use disorder (72.2%) and lowest for cannabis use disorder (26.4%). Detection of alcohol use disorder was more likely among male compared to female patients (OR (95% CI) = 4.0 (1.9, 4.8)). When compared to White patients, alcohol (OR (95% CI) = 0.4 (0.2, 0.6)) and opioid (OR (95% CI) = 0.2 (0.1, 0.7)) use disorders were less likely to be detected among Black patients, while alcohol (OR (95% CI) = 0.3 (0.0, 2.0)) and cocaine (OR (95% CI) = 0.3 (0.1, 0.9)) use disorders were less likely to be detected among Hispanic patients. Providers were more likely to detect nicotine, alcohol, opioid, and other drug use disorders among patients with higher addiction severity (OR (95% CI) = 1.20 (1.08–1.34), 1.62 (1.48, 1.78), 1.46 (1.07, 1.98), 1.38 (1.00, 1.90), respectively). CONCLUSIONS: Findings indicate patient characteristics, including gender, race, and addiction severity impact rates of provider detection. Instituting formal screening for all substances may increase provider detection and inform treatment decisions.

Background and objectives The number of patients with substance use disorders in need for organ transplantation is expected to increase. Patients with addictive disorders are considered a higher risk of negative outcomes after organ transplantation due to the impact of substance use upon medical status and adherence with treatment. The goal of this systematic review was to assess the current literature on treatment for addiction transplant candidates and recipients. Methods We conducted a literature search within four databases PubMed, MEDLINE, EMBASE, and PsycINFO for publications dated 1/1/1988 to 12/31/2018. Results Out of 3108 articles identified through database screening, 39 were included in the qualitative synthesis. Sixteen studies described addiction treatment in groups over five patients. All the articles included liver transplant patients, with only two studies including patients who needed a kidney or a heart transplant. Nine articles described treatment of alcohol use disorder exclusively, five focused on treatment of opioid use disorders. Although 9 of 16 studies were prospective, the variability of the treatment intervention, outcome measures, and control group when applicable prohibited a meaningful meta-analysis of the results. Eight articles that described the case reports are analyzed separately. Discussion and conclusions Promising treatment options for alcohol use disorder have been reported but more studies are needed to confirm their effectiveness and their feasibility. Methadone appears effective for opioid disorder in transplant patients. Scientific significance To the best of our knowledge, this is the first systematic review on the treatment of addictive disorders in transplant patients. (Am J Addict 2020;29:445-462).

Transplant patients are frequently treated with substances that have dependence potential and/or they may have a history of substance use disorders. The Psychosocial and Ethics Community of Practice of the American Society of Transplantation formed a Drug Testing Workgroup with participation from members of the Pharmacy Community of Practice and members of the Academy of Consultation-Liaison Psychiatry. The workgroup reviewed the literature regarding the following issues: the role of drug testing in patients with substance use disorders, for patients prescribed controlled substances, legal, ethical and prescription drug monitoring issues, financial and insurance issues, and which patients should be tested. We also reviewed current laboratory testing for substances. Group discussions to develop a consensus occurred, and summaries of each topic were reviewed. The workgroup recommends that transplant patients be informed of drug testing and be screened for substances prior to transplant to ensure optimal care and implement ongoing testing if warranted by clinical history. While use of certain substances may not result in the exclusion for transplantation, an awareness of the patient's practices and possible risk from substances is necessary, allowing transplant teams to screen for substance use disorders and ensure the patient is able to manage and minimize risks post-transplant.

Body image (BI) concerns have been reported to play a significant role in the psychological adaptation after organ transplantation. There is a paucity of data about BI beliefs in liver transplant recipients. We report the results of a cross-sectional study of 177 liver transplant recipients for whom we assessed BI, anxiety, depression, and quality of life (QOL) using validated instruments. Our results indicate that higher BI concerns correlated with higher levels of anxiety and depression. BI concerns were more elevated in females, younger patients, and patients with a lower income. Patients with chronic liver disease had more BI concerns than patients who received liver transplantation for acute liver failure. Specific BI concerns also correlated independently with QOL scores. We conclude that BI concerns are significant in liver transplant recipients and should be evaluated by clinicians involved in the mental health care of this population.

There is a lack of guidelines for preoperative management of psychiatric medications leading to variation in care and the potential for perioperative complications and surgical procedure cancellations on the day of surgery. The Society for Perioperative Assessment and Quality Improvement identified preoperative psychiatric medication management as an area in which consensus could improve patient care. The aim of this consensus statement is to provide recommendations to clinicians regarding preoperative psychiatric medication management. Several categories of drugs were identified including antidepressants, mood stabilizers, anxiolytics, antipsychotics, and attention deficit hyperactivity disorder medications. Literature searches and review of primary and secondary data sources were performed for each medication/medication class. We used a modified Delphi process to develop consensus recommendations for preoperative management of individual medications in each of these drug categories. While most medications should be continued perioperatively to avoid risk of relapse of the psychiatric condition, adjustments may need to be made on a case-by-case basis for certain drugs.

We present a case of common challenges in assessment and treatment of substance use disorders in patients with advanced heart failure requiring left ventricular assist device (LVAD). Top experts in the field of consultation-liaison psychiatry, cardiology, and cardiac surgery provide guidance for this commonly encountered clinical case based on their experience and review of the available literature. Key teaching topics include the role of LVAD in heart failure management, the impact of substance use disorder on heart failure and LVAD patient outcomes, and recommendations for assessment and management of substance use disorder in a patient with LVAD. Specifically, we highlight the challenges of assessing for substance use disorder in LVAD candidates and the limited literature available to guide treatment in this challenging patient population.

Background Wilson Disease (WD) can result in a number of physical and mental health issues due to copper toxicity affecting the liver and brain. It is no longer acceptable to look at survival alone as an outcome measure in chronic disease. Our aim was to a) assess quality of life (QOL) in WD b) assess the relationship between mental health QOL (M-QOL) and physical health QOL (P-QOL) and severity of liver and neurological disease and mental health issues (major depressive disorder (MDD) and cognitive impairment). Methods Adult WD patients in the WD registry study (n=52), were evaluated at enrollment over 1.5 y using questionnaires and administered exams assessing QOL (SF-12), cognition (MOCA) and mood (MINI-7). Patients also underwent hepatology and neurological assessments (UWDRS). Results Adult patients with WD had lower M-QOL scores compared to P-QOL scores median 50.2 (range 19.3–62.2) vs. 56.0 (range 23.9–64.7), p=0.0018 indicating that the burden of mental health issues in WD is greater than that of physical health issues on quality of life. Eleven patients had cirrhosis based on review of imaging, APRI and Fib4 scores. There was no significant difference in M-QOL scores in patients with cirrhosis vs. those without (median 54.5 (range 26.2–59.7) vs 46.5 (range 19.3–62.2), p = 0.11. Similarly, there was no significant difference in P-QOL in patients with cirrhosis vs. those without (median 55.7 (range 44.4–59.9) vs. 56.3 (range 23.9–64.7), p = 1.00. In those with cirrhosis, higher Child-Pugh scores were associated with a worse P-QOL (r=-0.84, p=-.0011) and M-QOL (r=-0.60, p=0.0488). Patients with lifetime MDD (n=22) had worse M-QOL scores compared to those without MDD (median 42.3 vs 54.6, p The P-QOL scores have a moderate negative association with the neurological UWDRS II Score (r=-0.44, p=0.001), UWDRS III Score (r=-0.42, p= 0.002) and total UWDRS score (r=-0.44, p=0.001). There are no associations with M-QOL and neurological UWDRS scores. Conclusions While overall QOL in WD is affected by both mental and physical health, patients with WD have worse M-QOL than P-QOL scores and mental health issues may affect WD patient’s QOL independent of their degree of liver or neurologic disease. Multivariate regression will be performed to evaluate if mental health issues are independently associated with QOL.

Introduction Mental health problems are underappreciated in Wilson disease (WD) (Schaefer et al. 2016). We aimed to determine: i) the prevalence and clinical features of major depressive disorder (MDD) in adults with WD ii) whether MDD correlates with liver and neurological disease and quality of life (QOL). Method A multi-site international WD registry was developed and initiated in December 2017. At enrolment adults (n=55) were evaluated using questionnaires and administered exams assessing cognition, mood, psychosis, substance use, anxiety, perceived stress, personality change and QOL. MDD was determined using the investigator led MINI-7 questionnaire. Patients also underwent hepatology and neurological assessments (UWDRS). We reviewed patient reported depression at first presentation and diagnosis. Statistical analysis using SAS9.4 (SAS Institute; Cary, NC) included summary statistics, Wilcoxon Rank Sum test and categorical comparisons using Chi-squared or Fisher’s exact test. Results Depression was reported in 26% at first presentation of WD (33% at diagnosis). At enrolment 35% had a lifetime history of MDD. At evaluation 5 patients with lifetime MDD took antidepressants; 1 without. At enrolment 36.33% were suffering from symptoms of current depression based on the PHQ-9 (self-administered). Cirrhosis was present in 24% based on imaging, APRI and Fib4 scores. There was no association between cirrhosis and depression symptomology (PHQ-9 score >9). In those with depression symptomology, 1 had cirrhosis and 6 did not. Liver disease severity did not differ in cirrhotics with MDD and those without (median Child-Pugh 5 (5–9) vs. 5 (5–9), p=0.13). Two patients (1 with MDD) took medication for hepatic encephalopathy. No significant difference in neurological total UWDRS scores was found in those with MDD vs. without (median 8 (0–73) vs. 4 (0–40), p=0.22). A neurological UWDRS total score >0 was not associated with lifetime MDD status (79% vs. 81%, p=1.00). Patients with MDD had worse mental health QOL (median 43 vs. 52.7 p=0.042), more suicidal ideation (32% vs. 8%, p=0.05), higher anxiety (p=0.008), higher perceived stress (median 19 vs. 9, p=0.007), and more neuroticism (median 7 vs. 4.5, p=0.006). We found no significant difference in physical health QOL in MDD (median 55.6 vs. 56.3, p=0.69). Conclusion MDD is highly prevalent in WD and associated with worse mental health QOL. The risk appears higher than other liver diseases (Lee et al. 2013. Psychosomatics, 4:52–9). We did not find an association between the severity of liver, neurological disease and MDD. Screening for depression should be considered in patients with WD.

Background As mental health services in outpatient medical clinics expand, psychiatrists must be trained to practice in these settings. Objectives The Academy of Consultation-Liaison Psychiatry residency education subcommittee convened a writing group with the goal of summarizing the current evidence about outpatient consultation-liaison psychiatry (CLP) training and providing a framework for CLP educators who are interested in developing outpatient CLP rotations within their programs. Method MEDLINE (via PubMed), Embase, and PsycINFO (via OVID) were reviewed each from inception to December 2019, for psychiatric CLP services in ambulatory settings that involved residents or fellows. The CLP education guidelines were reviewed for recommendations relevant to outpatient CLP. We also searched MedEd portal for published curriculums relevant to CLP. The group held 2 conferences to reach consensus about recommendations in setting up outpatient CLP rotations. Results Seventeen articles, 3 Academy of Consultation-Liaison Psychiatry–supported guidelines, and 8 online didactic resources were identified as directly reporting on the organization and/or impact of an outpatient CLP rotation. These manuscripts indicated that residents found outpatient CLP rotations effective and relevant to their future careers. However, the literature provided few recommendations for establishing formal outpatient CLP training experiences. Conclusions Outpatient CLP rotations offer multiple benefits for trainees, including exposure to specific clinical scenarios and therapeutic interventions applicable only in the outpatient setting, increased continuity of care, and the unique experience of providing liaison and education to non-mental health providers. The article outlines recommendations and examples for developing outpatient CLP rotations which CLP educators can incorporate in their programs.

Background The scientific literature in consultation-liaison psychiatry continually expands, and remaining familiar with the most current literature is challenging for practicing clinicians. The Guidelines and Evidence-Based Medicine Subcommittee of the Academy of Consultation-Liaison Psychiatry writes quarterly annotations of articles of interest to help Academy members gain familiarity with the most current evidence-based practices. These annotations are available on the Academy Website. Objective We identify the 10 most important manuscripts for clinical practice in consultation-liaison psychiatry from 2019. Methods Sixty-four abstracts were authored in 2019. Manuscripts were rated on clinical relevance to practice and quality of scholarship. The 10 articles with the highest aggregate scores from 19 raters are described. Results The resulting articles provide practical guidance for consultation psychiatrists on several topic areas including the treatment of substance use disorders. Conclusion We suggest that these clinical findings should be familiar to all consultation-liaison psychiatrists regardless of practice area. Regular article reviews and summaries help busy clinicians deliver cutting-edge care and maintain a high standard of care across the specialty.

Background Many liver transplantation programs require documented alcohol sobriety prior to United Network for Organ Sharing (UNOS) listing. This pilot study examined the feasibility of the first mobile, alcohol relapse prevention intervention for liver transplant patients with alcoholic liver disease (ALD). Methods This was a randomized 8-week pilot feasibility trial of a text message-based alcohol intervention. In-treatment assessment was conducted at 4 weeks (4W), and immediate posttreatment assessment was conducted at 8W. Participants were liver transplant candidates (N = 15) diagnosed with ALD who reported at least 1 drinking episode in the past year. Primary feasibility outcomes were percent of messages responded to and posttreatment intervention satisfaction ratings. Preliminary clinical efficacy outcomes were any biologically confirmed alcohol consumption, stress, abstinence self-efficacy, and alcohol craving. Results On feasibility outcomes, participants responded to 81% of messages received and reported high rates of intervention satisfaction, looked forward to receiving the messages, and found it easy to complete the intervention. On preliminary efficacy outcomes, zero participants in the text message (TM) had positive urine alcohol tests at 8W. Two of the 6 participants in standard care (SC) tested positive at 8W. No effects were seen on craving. For stress, a condition × time interaction emerged. TM participants had less stress at 4W and 8W compared with SC at baseline. They maintained their stress level during the intervention. For self-efficacy, a trend for condition effect emerged. TM participants had higher self-efficacy than SC participants. Conclusions Participants reported high satisfaction with the intervention, looked forward to the messages, and found it easy to complete. Participants who received the intervention had better treatment outcomes than those who received standard care. They maintained higher levels of self-efficacy and lower stress. Mobile alcohol interventions may hold significant promise to help ALD liver transplant patients maintain sobriety.

Recent work has shown improved outcomes with new models of psychiatric consultation in the general medical hospital. Classic studies demonstrated that psychiatric consultation can improve hospital length of stay. New models emphasize proactive consultation in which all patients are screened for needed care, embedded consultation where providers interact closely with the medical team, and multidisciplinary consultation that uses the skill sets of different types of providers efficiently. The latest work has expanded the consultative role further, emphasizing coordination with outpatient care, other hospital services, and diagnosis-specific pathways. Similar trends are evidenced in geriatric medical consultation in hospitals. New collaborative and integrated care approaches will transform hospital consultation. These new approaches re-emphasize the traditional “liaison” component of consultation-liaison psychiatry. [ Psychiatr Ann . 2017;47(7):355–361.]

Transplant patients face challenging medical journeys, with many detours to the intensive care unit. Before and after transplantation, they have significant psychological and cognitive comorbidities, which decrease their quality of life and potentially compromise their medical outcomes. Critical care staff are essential in these journeys. Being cognizant of relevant psychosocial and mental health aspects of transplant patients' experiences can help critical care personnel take comprehensive care of these patients. This knowledge can empower them to understand their patients' psychological journeys, recognize patients' mental health needs, provide initial interventions, and recognize need for expert consultations.

Understanding why individuals opt out of living donation is crucial to enhancing protections for all living donors and to identify modifiable barriers to donation. We developed an ethical approach to conducting research on individuals who opted out of living kidney donation and applied it in a small-scale qualitative study at one US transplant centre. The seven study participants (64% response rate) had varied reasons for opting out, the most prominent of which was concern about the financial burden from lost wages during the postoperative period. Several reported feeling alone during their decision-making process. Although no participants used an alibi, a centre-provided statement of non-eligibility to donate, all believed that centres should offer alibis to help preserve donor autonomy. Given the complexity of participants' decisions and the emotions they experienced before and after deciding not to donate, we suggest approaches for independent living donor advocates to support this population. This study demonstrates that research on individuals who opt out of donation is feasible and yields valuable insight into methods to improve the evaluation experience for potential living donors.

Background This study conducted cost and cost-effectiveness analyses of three strategies for implementing motivational interviewing for substance misuse on general medical inpatient units: workshop, apprenticeship, and consult. Methods The economic analyses were conducted prospectively alongside a type 3 hybrid effectiveness-implementation randomized trial comprising 38 medical providers, 1173 inpatients, and four consultation-liaison motivational interviewing experts. The trial took place in a university affiliated teaching hospital in New Haven, CT, USA. After completing a 1-day workshop on motivational interviewing, providers were randomized to conditions. The primary outcome measure was the number of study-eligible patients who received a motivational interview. The economic analyses included the costs of both start-up and on-going activities in each condition. Incremental cost-effectiveness ratios were used to determine cost effectiveness. Results are presented from the healthcare provider (i.e., hospital) perspective in 2018 US dollars. Results The total cost per patient receiving a motivational interview averaged $804.53, $606.52, and $185.65 for workshop, apprenticeship, and consult, respectively. Workshop and apprenticeship were extended dominated by the combination of consult and doing nothing. Doing nothing is cost effective when the willingness-to-pay for an additional patient receiving a motivational interview is less than $185.65, and consult is cost-effective when the willingness-to-pay for an additional patient receiving a motivational interview is greater than $185.65. Conclusions Given that typical reimbursements for brief intervention services for substance misuse are $35-$65, none of the three implementation strategies is likely to be economically viable from the healthcare provider perspective.

Refugees face many challenges in their path of migration putting them at risk for mental distress. Prevalence of mental illness varies across different studies of refugees due to methodological differences and heterogeneity among refugees. Overall, posttraumatic stress disorder (PTSD) and major depression are the most common mental illnesses seen in refugees. Somatic manifestations of mental distress are also seen, sometimes manifesting as specific cultural syndromes. Risk factors for mental illness can be categorized into premigration, migration, and post-migration phases. The chapter starts with a brief review of overseas mental health screening and then summarizes the available literature on risk factors and prevalence of mental illness in refugees. Resilience and posttraumatic growth in refugees are also discussed.

Background Transplant psychiatry is a subspecialty of consultation-liaison psychiatry that focused on evaluation, treatment, and research of mental health problems in organ transplant recipients and organ donors. To date, there is no literature about training programs that would ensure psychiatrists acquire the necessary knowledge and skills required to meet the clinical needs of these patients. Objectives The author describes the implementation of an online curriculum in transplant psychiatry created at the request of physicians located outside the United States. Method A 3-session online interactive course focused on knowledge relevant to transplant psychiatry was held in the fall of 2018. While the instructor was based in the United States, all attendees were located in Pakistan. The impact of the course was evaluated via precourse and postcourse surveys assessing knowledge level, interest in transplant psychiatry, and level of comfort with transplant psychiatry evaluations in the pretransplantation and posttransplantation settings. Results Nine participants attended at least one of the 3 sessions, and 6 attended all 3 sessions. There were no significant events regarding the implementation of the curriculum. The response rate to the questionnaire was 100% before the course and 88.8% after the course. Precourse and postcourse tests indicated the curriculum had a positive impact on the level of knowledge and level of confidence in addressing problems relevant to transplant psychiatry. Conclusions Online curriculum for highly specialized areas of psychiatry is feasible and can have a positive impact on knowledge levels and confidence in addressing clinical challenges.

BACKGROUND: General medical hospitals provide care for a disproportionate share of patients who misuse substances. Hospitalization provides a unique opportunity to identify and motivate patients to address their substance misuse. OBJECTIVE: To determine the effectiveness of three strategies for implementing motivational interviewing for substance misuse with general medical inpatients. DESIGN: Type 3 hybrid effectiveness-implementation randomized controlled trial (Clinical Trials.gov: NCT01825057). PARTICIPANTS: Thirty-eight providers (physicians, physician assistants, nurses) from 13 general medical inpatient services, and 1173 of their patients admitted to an academically affiliated acute care hospital. INTERVENTIONS: Implementation strategies included (1) a continuing medical education workshop on detection of substance misuse and provision of a motivational interview; (2) workshop plus bedside supervision (apprenticeship condition); and (3) a workshop plus ability to place a medical order for an interview from a consultation-liaison service (consult condition). MAIN MEASURES: Primary outcomes were the percentage of study-eligible patients who received an interview for substance misuse and the integrity (adherence, competence) of the interviews. The secondary outcome was the percent of patient statements within the interviews that indicated motivation for reducing substance misuse. KEY RESULTS: 20.5% of patients in the consult condition received an interview, compared to 0.8% (Hedge’s g = 1.49) and 3.0% (Hedge’s g = 1.26) in the respective workshop only and apprenticeship conditions (p

Cognitive and psychiatric presentations may occur at any point in the course of the Wilson disease (WD) or its treatment. The most common presentation comprises variations in mood. Mood instability and bipolar-like presentations are particularly common in WD, much more frequent than in the general population. Cognitive deficits may be subtle. Most challenging are the psychiatric presentations that occur without hepatic or neurological findings and are mislabeled as functional psychosis. These symptoms can have a negative impact on the quality of life and may delay the diagnosis. With current treatments for WD, remission of these symptoms is the goal of care and irreversible cognitive decline is no longer expected. New psychotropic medications allow symptomatic treatment with fewer secondary effects and can have a positive impact on the quality of life of WD patients.

Cognitive and psychiatric presentations may occur at any point in the course of Wilson disease (WD) or its treatment. Mood symptoms, such as depression, mood instability, and bipolar-like presentations, are particularly common, much more frequent than in the general population. Cognitive deficits may be subtle. The psychiatric presentations that occur without hepatic or neurological findings are the most challenging, often mislabeled as functional psychosis. These symptoms have a negative impact upon patient’s quality of life and may delay the diagnosis. With current treatments for WD, remission of these symptoms is the goal of care, and irreversible cognitive decline is no longer expected. New psychotropic medications allow symptomatic treatment with less severe side effects and can have a positive impact upon quality of life of WD patients.

Neurosurgical treatment for conditions such as epilepsy, traumatic brain injury, or brain tumor is often accompanied by perioperative psychiatric symptoms regardless of preexisting psychiatric conditions. These symptoms may be related to the underlying neurosurgical condition, the neurosurgical intervention itself (e.g., resection), or the medications used in the perioperative setting (e.g., anesthesia or corticosteroids). Comorbid neurological conditions may further complicate the management of the psychiatric presentations in this setting due to increased sensitivity to psychotropic medications or to the psychoactive effects of other agents. This chapter reviews the literature relevant to the perioperative psychiatric assessment and management in patients undergoing the most common neurosurgical procedures.

This chapter begins with a brief review of the history of organ transplantation and a description of the process of transplantation listing and postsurgical care, which are relevant to understand the patient’s journey through this complex process. We will then present the most important findings regarding prevalence of psychiatric problems in transplant candidates and recipients, followed by a review of the evidence about the impact of psychiatric presentations upon the post specific transplantation outcomes. This chapter will focus on the psychiatric implications of transplantation among recipients and donors of solid organs—specifically, the kidney, pancreas, liver, heart, lung, and intestine. The procedures involving other human tissues (such as the cornea, skin, bone marrow, and vascularized composite allographs) will not be addressed. A separate section in this chapter is dedicated to the most important psychiatric aspects of living organ donors.

Center for Disease Control (CDC) estimates that 16.8% of US adults over age 20 have chronic kidney disease (CKD). CKD is the ninth cause of death in the United States. Patients with CKD have a high prevalence of psychiatric concerns. The most common psychiatric presentations in this population are depressive disorders, cognitive difficulties, sleep disorders, and psychosis. In addition to metabolic and cardiovascular changes, patients with CKD also undergo major psychological adjustments, especially in preparation for renal replacement therapies which include dialysis or transplantation. This chapter will focus on mental health presentations in patients with CKD before the beginning of renal replacement therapy. After a brief overview of the mechanisms of psychiatric presentations in CKD, we will discuss the epidemiology and the impact of the most common mental health concerns in this population. The chapter will also discuss the evidence to date in regard to treatment for psychiatric conditions in CKD. Specific mental health considerations, including psychopharmacology, in patients on dialysis will be discussed in Chap. 7.

Currently, 500,000 people in the United States are treated for stage 5 chronic kidney disease (CKD) or end-stage renal disease (ESRD) with dialysis, with this number increasing by 30,000 each year. In addition to in-center hemodialysis, in-home dialysis and peritoneal dialysis are gaining popularity. While the mortality rates for patients on dialysis have been improving with a 30% decline since 1999, it is still severalfold higher than age-matched cohorts in the general population. Adapting to the demands of dialysis can be difficult both physically and psychologically, further burdening patients with poorer quality of life and worse outcomes. Patients on dialysis suffer from increased rates of depression, anxiety, sleep disorders, and cognitive challenges. They are also at increased risk for suicide. Finally, there are important decisions to be made regarding initiation and discontinuation of dialysis.

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals. ispartof: JOURNAL OF HEART AND LUNG TRANSPLANTATION vol:37 issue:7 pages:803-823 ispartof: location:United States status: published

Background— Psychotic disorders are considered a relative or absolute contraindication to organ transplant, but information about their impact on transplant is limited. Objective— To describe the clinical course of psychotic patients while they were on the waiting list and the outcomes of patients with psychotic disorders undergoing evaluation for organ transplant. Methods— Thirty-eight transplant candidates with a diagnosis of psychotic disorder were analyzed in this descriptive study. The following variables were collected before transplant: demographics, type of transplant, cause of organ failure, medical comorbid conditions, and psychiatric variables (diagnosis, hospitalizations, treatment, substance abuse, family history, suicide attempts). For transplant recipients, the following posttransplant variables were recorded: rejection, toxic effects of medication, nonadherence, psychotic episodes (number, time interval after transplant), and number of hospitalizations. Results— Of the 38 transplant candidates, 34 had a history of psychotic disorder before transplant. Nineteen (56%) of the 34 were listed for transplant, and 10 (29%) underwent transplant. Median follow-up time was 1.9 (IQR, 0.16–17.9) years. Among organ recipients with a history of psychotic disorders, psychiatric hospitalizations were 0.42 per patient per year (PPY), psychotic episodes 0.68 PPY, rejection 0.21 PPY, and toxic effects of immunosuppressants 0.05 PPY. None of the recipients lost their graft. Conclusions— Patients with a history of psychotic disorder can do well after organ transplant. Further studies are needed with factor analyses including severity of psychosis, medication adherence, and associated comorbid conditions.

Received May 8, 2015; revised July 17, 2015; accepted July 27, 2015. From the Child Study Center, Yale School of Medicine, New Haven CT (HM, AM); Psychiatry, Yale School of Medicine, New Haven CT (PZ). Send correspondence and reprint requests to Hun Millard, M.D., M.A., 230 South Frontage Road, New Haven, CT 06519; e-mail: hun. millard@yale.edu, hunmillard@gmail.com & 2015TheAcademy of PsychosomaticMedicine. Published by Elsevier Inc. All rights reserved. Introduction

Background The amount of literature published annually related to psychosomatic medicine is vast; this poses a challenge for practitioners to keep up-to-date in all but a small area of expertise. Objectives To introduce how a group process using volunteer experts can be harnessed to provide clinicians with a manageable selection of important publications in psychosomatic medicine, organized by specialty area, for 2014. Methods We used quarterly annotated abstracts selected by experts from the Academy of Psychosomatic Medicine and the European Association of Psychosomatic Medicine in 15 subspecialties to create a list of important articles. Results In 2014, subspecialty experts selected 88 articles of interest for practitioners of psychosomatic medicine. For this review, 14 articles were chosen. Conclusions A group process can be used to whittle down the vast literature in psychosomatic medicine and compile a list of important articles for individual practitioners. Such an approach is consistent with the idea of physicians as lifelong learners and educators.

Psychiatric disturbances represent an important diagnostic and therapeutic issue in Wilson disease (WD). They represent a significant part of the clinical presentation of WD and can present at any point in the course of the illness. In this chapter, we are going to discuss relevant aspects of the clinical evaluation of psychiatric symptoms in WD, prevalence of psychiatric symptoms, significance of psychiatric symptoms, and treatment considerations.

The number of living kidney donations is increasing in many countries, in response to increasing demand, lengthening waiting lists for transplants from deceased donors, and, in some areas, cultural or religious resistance to deceased donation. In most such donations the donor and recipient are related genetically or emotionally, but there are various routes by which a donor may give a kidney to a recipient who is a stranger. The practice of paired, pooled or chained donation - in which a recipient receives an organ from a stranger, in return for which that recipient‘s emotionally or genetically related (but incompatible) donor gives a kidney to another stranger - is accepted and growing. In contrast, the selling of organs by donors is controversial and generally illegal, except in a few countries.

Wilson's disease (WD) is a relatively rare autosomal recessive inherited disorder causing copper accumulation in different organs, mainly the liver and brain. Psychiatric disturbances represent a diagnostic and therapeutic issue in WD. A search for relevant articles was carried out on PubMed/Medline, Scopus, and Google Scholar, for papers focused on psychiatric disorders in WD published between 1985-2016. Ninety-two articles were included in this review, showing the findings from 35 observational and case-control studies and 57 case reports. This study discussed the findings on the prevalence of psychiatric symptoms in WD, their impact on the life of those diagnosed, and the efficacy of available treatments on the psychiatric outcomes of WD. Psychiatric disorders are confirmed frequent in WD, with a high prevalence of mood disorders, and contribute to worse Quality-of-Life and psychosocial outcomes. Because specific therapies for WD lead to a good life expectancy, adherence to medicaments and clinical monitoring should be warranted by a multidisciplinary approach, including a hepathologic, neurologic, and psychiatric careful evaluation and education of those affected and their relatives.