In this newsletter, we touch on APA’s guidance on the discharge of psychiatric patients during COVID-19; provide interview highlights on the cardiac side effects of psychotropics; and address a few clinical pearls on managing agitation in autism. We also comment on tobacco use disorder and e-cigarettes, as well as 2 article reviews for our Quick Takes: One on tardive dyskinesia and 1 on TMS for OCD.
APA Guidance on Admittance and Discharge of Psychiatric Patients During COVID-19
“It is simply irresponsible to prematurely release patients with serious mental illness from psychiatric inpatient settings into communities ill prepared to treat them,” said APA President Jeffrey Geller, M.D., M.P.H.
This guidance addresses the issue of denying admittance or prematurely releasing psychiatric patients with the pretext of avoiding COVID-19 infection. It states the following:
- “Premature discharge of patients from psychiatric hospitals and inpatient psychiatric units is unreasonable as this practice exposes patients, families, and the community at large to the risks of harmful and adverse outcomes irrespective of communicable disease outbreaks.”
- “…referral of patients to any psychiatric setting should balance efforts to match patients’ mental health needs with the appropriate level of care while considering the potential risks of the communicable disease at each level of care.”
- “Each level of psychiatric care during such outbreaks should provide safe and appropriate treatment…”
Expert Consultations: Cardiac Side Effects of Psychiatric Medications With Scott R. Beach, M.D.
In this interview, Dr. Beach discusses the cardiovascular effects of antidepressants, antipsychotics, stimulants, and sleeping aids.
Interview highlights:
- Venlafaxine may only have a small hypertensive effect at dosages below 300 mg.
- The risk of sudden cardiac death from an episode of torsade is difficult to estimate, but it may be higher in patients who are silent carriers of QT mutations.
- It is recommended that patients on stimulants be periodically monitored for changes in heart rate or blood pressure.
Learn more and earn 0.5 CME credits here
Podcast: Case Discussion: Managing Agitation in Autism Spectrum Disorder
A 14-year-old patient with autism spectrum disorder presents to the emergency room with aggressive and agitated behavior. In this podcast episode, Dr. Wegdan Rashad discusses with Dr. Gonzalo Laje (pediatric and adolescent psychiatrist; Chevy Chase, MD) how to work up and manage a clinical case like this.
Key points:
- Observe for signs of pain that the patient may not be able to verbalize.
- In a patient with autism and agitation, consider drug-induced causes, like akathisia.
- Start by reducing sensory stimulation, and then establish a set routine and structure to the day.
- Consider short-term benzodiazepines or beta-blockers; however, keep in mind the effect beta-blockers have on sleep.
Listen to the full discussion here
Video Lecture: The Clinical Guide on Tobacco Use Disorder
Nicotine and tobacco smoke have noticeable effects in the body. Treatment approaches for smoking cessation include pharmacologic options, such as bupropion, varenicline, nicotine replacement therapies, and e-cigarettes. Psychosocial interventions, such as motivational interviewing, are also discussed.
You can earn 1.0 CME credit here.
Using E-Cigarettes: What Clinicians Must Know
- E-cigarettes may be safer than cigarettes but are not risk free.
- Clinicians and patients must be aware of the emergence of vaping-related lung disease.
- E-cigarettes may be a viable smoking cessation strategy compared with NRT. Learn more.
Quick Takes: Informing Your Practice
Treatment Recommendations for Tardive Dyskinesia
- Second-generation antipsychotics still produce TD rates around 20%. What can be done? VMAT2 inhibitors emerge as first-line treatments in a recent review. Learn more.
Efficacy and Safety of Deep TMS for OCD
- In subjects who had a poor response to at least 1 previous SRI, deep TMS for obsessive-compulsive disorder was better than sham TMS but not by much. There was company sponsorship for the study. Learn more. Listen to or read the full volume, and earn 0.5 CME credits here.
