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Home > Library > Annotated Journal Abstracts > 2017 Q1: Emergency Psychiatry

Annotated Abstracts of Journal Articles
2017, 1st Quarter

Emergency Psychiatry

Annotations by Naomi Schmelzer, MD MPH April 2017

  1. Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: A proof-of-concept randomized controlled trial
  2. Accuracy of clinician assessments of medication status in the emergency setting: A comparison of clinician assessment of antipsychotic usage and plasma level determination
Also of interest:
  • Anderson EL, Nordstrom K, Wilson MP, et al: American Association for Emergency Psychiatry Task Force on Medical Clearance of Adults Part I: Introduction, Review and Evidence-Based Guidelines
    West J Emerg Med 2017; 18(2):235-242
     
    In an effort to formulate consensus recommendations on the medical evaluation of patients presenting to the emergency department with psychiatric complaints, a task force of the American Association of Emergency Psychiatry reviewed existing literature on this topic for Part I of their series. This article presents a clarification of terminology and a thorough review of the existing literature on the topic as well as available protocols. In addition, it highlights points of controversy and areas where further data is needed. Part II of the series, which includes the consensus recommendations, will follow in a subsequent article.
PUBLICATION #1 — Emergency Psychiatry
Preventing intrusive memories after trauma via a brief intervention involving Tetris computer game play in the emergency department: A proof-of-concept randomized controlled trial
Iyadurai L, Blackwell SE, Meiser-Stedman R, et al
Mol Psychiatry 2017; Mar 28 [Epub ahead of print]
Annotation

The finding: A study comparing a Tetris-based behavioral intervention versus an attention-placebo control task was administered to patients presenting to an emergency room within 6 hours of a motor vehicle accident. The primary outcome, the number of intrusive memories logged over the subsequent week, was found to be reduced in the intervention condition when compared to the control group.

Strengths and weaknesses: An approach driven by a need for novel non-pharmacologic treatments, and stemming from cognitive science principles including memory consolidation theory and a prediction that cognitive tasks with high visuospatial demands will selectively disrupt sensory aspects of memory, this randomized control study supported the hypothesis that a behavioral intervention using the widely available video game Tetris, played for 20 minutes following presentation to the emergency department after a traumatic event, would reduce the number of intrusive memories in the following week. Additional strengths include the brief time-limited nature of the intervention, and that it was easy to engage patients in the task with no adverse side effects reported. The study overall has promising results, though it was a limited proof-of-concept study and requires a larger trial with greater participant numbers to demonstrate a lasting effect at one month.

Relevance: The emergency department is often providing psychological first aid immediately following a traumatic experience with the goal being to minimize symptoms of acute stress and prevent PTSD, though evidence-based preventive interventions from neuroscience translated into clinical care are lacking. This is a novel intervention strategy that is easy to administer, low-cost, and requires little staff training. This, and similar approaches, have the potential to be used as part of the emergency psychiatry armamentarium of PTSD treatment as a preventative strategy.

PUBLICATION #2 — Emergency Psychiatry
Accuracy of clinician assessments of medication status in the emergency setting: A comparison of clinician assessment of antipsychotic usage and plasma level determination
Lopez LV, Shaikh A, Merson J, Greenberg J, Suckow RF, Kane JM
J Clin Psychopharmacol 2017; 37(3):310-314
Annotation

The finding: Among patients presenting to an emergency room with exacerbation of psychosis, psychiatrists’ assessment of medication adherence was statistically independent of measured therapeutic plasma blood levels. For example, of the 97 patients included in the study, 33 patients were found to have therapeutic drug levels of which 11 were clinically assessed as having been non-adherent by the emergency physician. Of the 53 patients assessed to be adherent to their antipsychotic medication, 43 had detectable plasma levels and 10 patients had undetectable levels.

Strengths and weaknesses: This is a study aiming to assess the accuracy of emergency physicians’ clinical assessment of medication adherence by comparing findings with measured drug levels. Although factors such as periodic adherence and timing of dosages may have affected values, this measurement serves as a more objective indicator of medication use.

Relevance: The discrepancies between standard clinical assessment for medication adherence and serum drug level demonstrated by the outcome of the study suggests the potential for clinical utility of therapeutic drug monitoring via rapid assays in the ED setting, though more investigation is needed. Feedback and review of discrepant cases may guide improvement of clinical assessment techniques.

 


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