Recent Clinical Innovations in Consultation-Liaison Psychiatry and Telepsychiatry

November 15, 2021

This story was first published by the University of Pittsburgh Department of Psychiatry. To view the original article, click here.

Recent papers from the University of Pittsburgh Department of Psychiatry examine clinical initiatives around consultation-liaison psychiatry and first-episode psychosis, consultation-liaison psychiatry in the obstetrical setting, and the expansion of telepsychiatry during the COVID-19 pandemic.

First-Episode Psychosis and the Role of the Psychiatric Consultant

Timely recognition and treatment of first-episode psychosis (FEP) is critical to mitigating the risk for poor functional outcomes over time. Individuals with psychotic disorders have increased mortality, and the three-year period after the first diagnosis of a psychotic disorder can be high-risk for death, including by suicide.

Department of Psychiatry faculty members Meredith Spada, MD, Priya Gopalan, MD, and Deepak Sarpal, MD, published a study in the Journal of the Academy of Consultation-Liaison Psychiatry analyzing the medical records of 28 individuals who had received care for FEP to examine current practices and provide clinical guidelines for physicians working in the general medical setting. 

They found that FEP cases are rare overall (0.83%), but when present, “psychosis” is not always the reason for a consult. The most common reasons for FEP consults, aside from psychosis, were altered mental status, evaluation following involuntary commitment, suicidal ideation, and agitation. In addition, the team found no universally accepted recommendations for workup of FEP and limited referrals to specialized programs for FEP treatment.

“In recent years, coordinated specialty care has emerged as a treatment model that optimizes outcomes for people experiencing the onset of a psychotic disorder,” said Dr. Sarpal, the paper’s senior author. “These individuals can interface with psychiatric care in a variety of settings, including inpatient medical units. Results of this study highlight the opportunity for consultation-liaison psychiatry teams to advance care for first-episode psychosis in the hospital setting.” 

Esque J, Rasmussen A, Spada M, Gopalan P, Sarpal D. First-Episode Psychosis and the Role of the Psychiatric Consultant. J Acad Consultation-Liaison Psychiatry. 2021, ISSN 2667-2960, https://doi.org/10.1016/j.jaclp.2021.07.003

Telemedicine Psychiatric Consultation on an Inpatient Obstetrical Labor and Delivery Unit

During the perinatal period, individuals who are pregnant or have given birth can experience heightened vulnerability to psychiatric illness, particularly depression and anxiety. A team of physicians at UPMC Western Psychiatric Hospital, including Priya Gopalan, MD, Neeta Shenai, MD, and Ida Brockman, MD, analyzed data from the records of patients at risk for postpartum syndromes, who received telepsychiatry consults in rural hospitals. 

Of the 85 records studied, 63 patients received bedside psychotherapeutic interventions and education, 47 patients received outpatient referrals, and 32 patients were prescribed medication.
The aim of the study, recently published in the Journal of the Academy of Consultation-Liaison Psychiatry, was to evaluate the success of telepsychiatry consultation-liaison services in rural hospitals where access to mental health care can be limited.

The team found that inpatient consultation-liaison telepsychiatry provides benefits for postpartum obstetric patients in rural settings, including mothers with comorbid substance use disorders.

“Providing psychiatry consults to a rural OB-GYN unit allows for access to care in under-resourced settings. We were excited to find that this is a feasible and effective way to provide perinatal health care to rural populations,” said Dr. Gopalan, the study’s corresponding author. 

Gopalan P, Auster L, Brockman I, Shenai N. Telemedicine Psychiatric Consultation on an Inpatient Obstetrical Labor and Delivery Unit. J Acad Consultation-Liaison Psychiatry. 2021, ISSN 2667-2960, https://doi.org/10.1016/j.jaclp.2021.04.001

Transition to Telehealth for Mental Health Clinics: Future Considerations (Editorial) 

In a recent review published in the Journal of the American Academy of Child & Adolescent Psychiatry, Gina Perez, MD, and Eva Szigethy, MD, PhD, considered the extraordinary challenges of providing mental health care during the COVID-19 pandemic, and the ensuing, abrupt lifting of telehealth regulations that permitted a transition to virtual care.

The UPMC Western Psychiatric Behavioral Health Service Line, which averages more than 30,000 outpatient visits per month, successfully shifted more than 90% of group sessions to video visits during the initial months of the COVID-19 pandemic. Leadership effectively addressed many challenges, including existing platforms’ technological limitations, privacy concerns, and difficulties around engaging groups in a virtual setting. 

Dr. Perez leads telepsychiatry at UPMC Western Psychiatric Hospital and oversees the behavioral health services at UPMC’s network hospitals and community affiliates. 

“From the start of the COVID pandemic, our teams successfully transitioned many patients to video visits, while recognizing that this solution doesn’t fit everyone. Telephone and in-person visits also remained necessary options. It was energizing to work alongside a team of clinical and operational leaders who care about finding a way to deliver the best care to our patients,” she said.

Perez G, Szigethy E. Editorial: Transition to Telehealth for Mental Health Clinics: Future Considerations. J Am Acad Child Adolesc Psychiatry. 2021. https://doi.org/10.1016/j.jaac.2021.07.008