Psychiatry and Psychology Commons^™

Over The Counter Overdose: A Case Of Tylenol Toxicity, Swet M. Patel, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 51-year-old man presenting to the Emergency Department (ED) with suicidal ideations (SI) endorsing an intentional overdose of acetaminophen. Just as important is the clinical presentation; it is equally important to obtain a detailed history of patient's presentation leading to the ED visit when evaluating a suicide attempt. Tylenol (acetaminophen) is a common over the counter (OTC) medication available to the public. Management of Tylenol overdose follows a standard outline of things to observe and intervene on. In this case, we discuss how Tylenol overdose is managed in a clinical setting through a patient who …

Standardization Of Discharge Instructions For Mild Traumatic Brain Injury/Concussion In Children Presenting To Ed: A Qi Project, Niralee K. Rana, Nicole Gerber Md, Michael Alfonzo Md, Snezana Osorio Md, Deborah Levine Md

Rowan-Virtua Research Day

Background: Mild traumatic brain injuries (mTBI) or concussions account for high rates of emergency department (ED) visits. Concussion diagnoses are used less often in young children leading to a variability in parental education and discharge instructions. Lack of discharge guidance may increase parental anxiety, impact recovery, and increase ED visits.

Objectives: To increase the proportion of ED patients discharged with age-appropriate instructions for mTBI by 50% by June 1, 2024, and to determine the impact age-appropriate instructions have on decreasing parental anxiety.

Methods: This observational time series with planned sequential experimentation is in progress at a Pediatric ED affiliated with …

Previous Health Care Experiences’ Influence On Health Care Perceptions Among Residents In Six Homeless Shelters In Seattle, Washington, July–October 2021, Ashley A. Meehan, Sarah N. Cox, Nicholas B. Thuo, Julia H. Rogers, Amy C. Link, Miguel A. Martinez, Natalie K. Lo, Brian J. Manns, Melissa A. Rolfes, Eric J. Chow, Helen Y. Chu, Emily Mosites, Morhaf Al Achkar

Journal of Patient-Centered Research and Reviews

Purpose: The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care.

Methods: Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July–October 2021. All residents (age ≥ 18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose.

Results: Participants received health care …

Case Report: Abrupt Psychosis Or Nmda Receptor Encephalitis?, Alexis Dunn, Neelesh Parikh, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We report a case of a 46-year-old female who was initially committed to a psychiatric facility for new onset schizophrenia symptoms. She later had an extensive workup in the hospital due to leukocytosis and was believed to have NMDA Receptor Encephalitis as the cause for her new behavioral symptoms. This case report aims to educate EM (emergency medicine) physicians to keep a broad differential diagnosis on patients who present with new onset, unprovoked psychosis later in life.

Development Of Schizophrenia In A Genetically Predisposed Individual Following Covid-19, Sung Kang, Jonathan Yuh, Timothy Wong

Rowan-Virtua Research Day

We present a patient who is a 56-year-old female with a psychiatric history of anxiety disorder and a medical history of hypercholesterolemia and hyperthyroidism, who was admitted to the hospital after a witnessed seizure at an inpatient psychiatric facility. This patient’s family history is significant for her mother experiencing unspecified psychotic disorder that required psychiatric hospitalization. Our patient was first admitted to the psychiatric hospital after exhibiting worsening paranoid delusions and hallucinations that began several months prior. The patient had reportedly begun locking herself in the restroom and screaming “get out, they’re spying on me”, referring to her next-door neighbors …

Analysis Of Implementing Best Practices For Co-Prescribing Naloxone In Your Agency Online Cme Training Module Via Pre- And Post- Knowledge Assessment., Alicia Podwojniak, Arvind Venkataraman, Richard Jermyn

Rowan-Virtua Research Day

The opioid epidemic poses substantial risk to society. Providers must ensure that their patients understand the uses and risks of both opioids and naloxone. One way to analyze this concept is via metacognition. This refers to a person’s knowledge about cognitive phenomena, and thus it regulates self-awareness abilities in decision making, such as planning and evaluating. It is not only important for providers to have knowledge on best practices, but also to have self-awareness, and confidence in their decision making to ensure optimal patient outcomes. True-false confidence weighted scoring can be utilized, whereby various levels of confidence are assessed from …

Brief Review: Patient Pill Splitting. What Is The Appropriate Advice To Provide Patients In The Emergency Department?, Mohammad Rattu, James Espinosa, Gabriel Meister, Alan Lucerna

Rowan-Virtua Research Day

A number of patients have inquired about the practice of pill splitting. Cutting or splitting of pills can be used by patients to create an intermediate dose or to save on money where a higher dose is priced at relatively the same cost as a lower dose. In this review we discuss a number of issues related to medication safety and table splitting.

Effect Of Implementation Of Enhanced Management Processes For Behavioral Health Patients On Staff In The Urban Emergency Department, Michael Hasty, Scott Anderson, Rahul Kashyap, Sue Lynn Myhre

TriStar Division Research Day 2023

No abstract provided.

Patterns Of Suicide And Self-Harm In Pakistan: A Retrospective Descriptive Study Protocol, Nargis Asad, Shahina Pirani, Summaiya Tariq, Asra Qureshi, Mohammad Zaman, Mustafa Aslam, Farhat Mirza, Murad M. Khan

Department of Psychiatry

Introduction: Suicide is a major global public health problem. Low-income and middle-income countries contribute 78% of all suicidal deaths. Pakistan, a South Asian country, lacks official statistics on suicides at national level. Statistics on suicide are neither collected nationally nor published in the annual national morbidity and mortality surveys. Medicolegal reports on suicides and self-harm are extremely rich and important source of information but greatly underused in Pakistan. We aim to examine the patterns of suicides and self-harm retrospectively in patients who were registered with medicolegal centres (MLCs) in Karachi, during the period January 2017 to December 2021.
Methods and …

Emergency Medicine Clinician Experiences Addressing Uncertainty In First-Trimester Bleeding., Garrison Nord, Amanda Doty, Andrew J Monick, Danielle M Mccarthy, Robin J Casten, Amer Z Aldeen, Philip S Nawrocki, Kristin L. Rising

Department of Emergency Medicine Faculty Papers

The purpose of this work is to understand Emergency Department (ED) clinicians' experiences in communicating uncertainty about first-trimester bleeding (FTB) and their need for training on this topic. This cross-sectional study surveyed a national sample of attending physicians and advanced practice providers (APPs). The survey included quantitative and qualitative questions about communicating with patients presenting with FTB. These questions assessed clinicians' frequency encountering challenges, comfort, training, prior experience, and interest in training on the topic. Of 402 respondents, 54% reported that they encountered challenges at least sometimes when discussing FTB with patients where the pregnancy outcome is uncertain. While the …

Psychometric Properties Of The Urdu Version Of The Eortc Qlq-H&N35 (European Organization For Research And Treatment Of Cancer Head And Neck Module) Quality Of Life Tool, Nida Zahid, Russell Seth Martins, Wajeeha Zahid, Iqbal Azam Syed, Mubasher Ikram, Aneesa Hassan, Shireen Shehzad Bhamani, Adnan Abdul Jabbar, Nargis Asad, Shabbir Akhtar, Moghira Iqbaluddin Siddiqui, Mohammad Sohail Awan, Khabir Ahmad

Department of Surgery

Background: We translated and validated the Urdu version of the European Organization for Research and Treatment of Cancer Quality of Life (QoL) Questionnaire's Head and Neck (H&N) Cancer Module (EORTC QLQ-H&N35) and assessed its convergent and discriminant validity by examining correlations of QoL with depression, anxiety, and resilience.
Methods: We translated the EORTC QLQ-H&N35 according to EORTC instructions. Patients at a tertiary care hospital in Pakistan completed a survey consisting of Urdu versions of EORTC QLQ-C30 (core QoL tool), QLQ-H&N35, Hospital Anxiety and Depression Scale, and Wagnild and Young Resilience Scale (RS-14). Content validity, convergent validity, discriminant validity, and reliability …

A Resident Retreat With Emergency Medicine Specific Mindfulness Training Significantly Reduces Burnout And Perceived Stress, James O'Shea, Mark Dannenfelser, Melissa White, Anwar Osborne, Timothy P. Moran, Michelle D. Lall

Journal of Wellness

Introduction: We hypothesize that a resident retreat with mindfulness training tailored for Emergency Medicine (EM) physicians can significantly reduce levels of burnout and perceived stress in EM residents.

Methods: We conducted an intervention study of 60 EM residents undergoing an annual resident retreat with a 2.5-hour mindfulness training. The retreat was a department-funded 2-day off-site experience with a wellness theme. The training was developed and delivered by an EM physician (JO'S) who is a Mindfulness-Based Stress Reduction (MBSR) teacher trainee, and a certified MBSR teacher (MD). The training focused on techniques that can be used on shift, such as mindful …

An Interesting Case Of Factitious Disorder Superimposed On Self: Factitious Disorder Vs Somatic Symptom Disorder, Michaela Margolis, Logan Noone, Jessica Baaklini

Rowan-Virtua Research Day

Factitious disorder superimposed on self (FDIS) was first described in 1951by Richard Asher, who associated the disorder with Baron Munchhausen, who narrated unrealistic and exaggerated stories about his life.

Suspicion for FDIS should be raised when patients with atypical presentations of medical disorders seek excessive use of healthcare services despite ongoing lack of clinical evidence. Patients with FDIS often demand hospitalization for their symptoms, leading to unnecessary tests and treatments. These patients show signs of pathological lying, deceitfulness, are obstinate with medical staff, and display erratic behavior. When medical investigation does not support their symptoms, patients often develop new “symptoms” …

The Effect Of Education On The Nida Modified Assist (Nmassist) Tool On Knowledge And Screening For Substance Use Disorder Among Clinicians, Victoria Page Arnold

DNP Projects

Background: Substance use disorder (SUD) is a disparity affecting nearly 24 million individuals in the U.S., nearly 10% of the total population. Oftentimes, the emergency department (ED) is the only medical care this population receives. There is often a lack of screening for SUD in ED’s, therefore referred care may be limited for these individuals. The National Institute on Drug Abuse Modified Assist (NMASSIST) is an evidence-based tool developed to educate and screen for SUD. This tool can be completed in a timely manner and aid in the recommended referral of care for this select population.

Purpose: The purpose of …

Evaluating The 0–10 Point Pain Scale On Adolescent Opioid Use In Us Emergency Departments, Michael T. Phan, Daniel M. Tomaszewski, Cody Arbuckle, Sun Yang, Brooke Jenkins, Michelle A. Fortier, Theodore Heyming, Erik Linstead, Candice Donaldson, Zeev N. Kain

Pharmacy Faculty Articles and Research

Objective: To evaluate trends in national emergency department (ED) adolescent opioid use in relation to reported pain scores. Methods: A retrospective, cross-sectional analysis on National Hospital Ambulatory Medical Care Survey (NHAMCS) data was conducted on ED visits involving patients aged 11–21 from 2008–2017. Crude observational counts were extrapolated to weighted estimates matching total population counts. Multivariate models were used to evaluate the role of a pain score in the reported use of opioids. Anchors for pain scores were 0 (no pain) and 10 (worst pain imaginable). Results: 31,355 observations were captured, which were extrapolated by the NHAMCS to represent 162,515,943 …

Medical Schools Ignore The Nature Of Consciousness At Great Cost, Anoop Kumar

Journal of Wellness

The essential question of the relationship between consciousness and matter is ignored in medical school curricula, leading to a machine-like view of the human being that contributes to physician burnout and intellectual dissatisfaction. The evidence suggesting that the brain may not be the seat of consciousness is generally ignored to preserve the worldview of the primacy of matter. By investigating new frameworks detailing the nature of consciousness at different levels of hierarchy, we can bring intellectual rigor to a once opaque subject that supports a fundamental reality about our experience: We are human beings, not only human bodies.

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …

Laypeople Perception And Interpretation Of Simulated Life-Threatening Bleeding: A Controlled Experimental Study, Erik Prytz, Rachel Phillips, Susanna Lönnqvist, Marc Friberg, Carl-Oscar Jonson

Psychology Faculty Publications

Introduction

First aid performed by immediate responders can be the difference between life and death in the case of trauma with massive bleeding. To develop effective training programs to teach bleeding control to laypersons, it is important to be aware of beliefs and misconceptions people hold on bleeding and severity of bleeding situations.

Method

A controlled study was conducted in which 175 American college students viewed 78 video clips of simulated bleeding injuries. The volume of blood present (between 0 and 1900 ml), rate of blood flow, and victim gender were systematically varied within participants. Participants were asked to rate …

The Role Of Mindset, Impostorism, And Irrational Beliefs In Resident Wellness: Results From The Hca Nationwide Longitudinal Resident Wellness Study, Gregory Guldner, Jason Siegel, Brendon Ellis, Anne Brafford

Teaching & Learning

Background The significant proportion of residents reporting poor levels of well-being has appropriately fueled a call for interventions. Yet the specific constructs that impact well-being have not been well researched and validated in the resident population. Mindset (fixed versus growth), impostorism (the belief that one’s success is fraudulent) and irrational beliefs (dysfunctional beliefs that contribute to emotional pain and anguish) are among individual variables postulated to relate to well-being in a high-pressure educational environment. Each of these constructs is amenable to interventions should they have causal relationships to well-being.

Objectives Our prior research resulted in a statistically validated model of …

An Exploration Of Why Healthcare Professionals Under-Report Observed Patient Aggression, Sydney Bonta

UNO Student Research and Creative Activity Fair

An Exploration of Why Healthcare Professionals Under-Report Observed Patient Aggression

Authors: Sydney Bonta & Lisa L. Scherer, Ph.D.

Advisor: Lisa L. Scherer, Ph.D.

According to the 2011 US Bureau of Justice Statistics report, medical professionals experienced the third highest proportion of workplace violence (WPV), with violence primarily emanating from patient. In a national survey of nurses employed in hospitals, 76% stated that they had encountered some sort of violence in their workplace (Speroni, Fitch, Dawson, Dugan, Atherton, & Leesburg, 2014). Similarly, patient aggression against physicians has long been a problem (Morrison, Lantos, Levinson, 1998). Despite this widespread exposure to WPV …

Risk Perceptions Of Cellphone Use While Driving: Results From A Delphi Survey, Motao Zhu, Toni M. Rudisill, Kimberly J. Rauscher, Danielle M. Davidov, Jing Feng

Faculty & Staff Scholarship

Cellphone use while driving has been recognized as a growing and important public health issue by the World Health Organization and U.S. Center for Disease Control and Prevention. Surveys typically collect data on overall texting while driving, but do not differentiate between various forms of cellphone use. This study sought to improve the survey indicators when monitoring cellphone use among young drivers. Experts and young drivers were recruited to propose behavioral indicators (cellphone use while driving behaviors) and consequential indicators (safety consequences of cellphone use while driving) in 2016. Subsequently, experts and young drivers selected the top indicators using the …

Method Overtness, Forensic Autopsy, And The Evidentiary Suicide Note: A Multilevel National Violent Death Reporting System Analysis, Ian R. H. Rockett, Eric D. Caine, Steven Stack, Hilary S. Connery, Kurt B. Nolte, Christa L. Lilly, Ted R. Miller, Lewis S. Nelson, Sandra L. Putnam, Paul S. Nestadt, Haomiao Jia

Faculty & Staff Scholarship

Objective

Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note.

Methods

This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States …

Discerning Suicide In Drug Intoxication Deaths: Paucity And Primacy Of Suicide Notes And Psychiatric History, Ian Rh Rockett, Eric D. Caine, Hilary S. Connery, Gail D'Onofrio, David J. Gunnell, Ted R. Miller, Kurt B. Nolte, Mark S. Kaplan, Nestor D. Kapusta, Christa L. Lilly, Lewis S. Nelson, Sandra L. Putnam, Steven Stack, Peeter Varnik, Lynne R. Webster, Haomiao Jia

Faculty & Staff Scholarship

Objective

A paucity of corroborative psychological and psychiatric evidence may be inhibiting detec- tion of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods.

Methods

This observational multilevel (individual/county), multivariable study employed a general- ized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System …

Computer Administered Safety Planning For Individuals At Risk For Suicide: Development And Usability Testing, Edwin D. Boudreaux, Gregory K. Brown, Barbara Stanley, Rajani S. Sadasivam, Carlos A. Camargo Jr, Ivan W. Miller

Rajani S. Sadasivam

BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. METHODS: We employed a user-centered software design strategy led by a …

Geriatric Psychology, Robert D. Barraco Md

Robert D Barraco MD, MPH

No abstract provided.

Psychiatric Boarding In New Hampshire: Violation Of A Statutory Right To Treatment, James A. Mcclure

The University of New Hampshire Law Review

[Excerpt] "New Hampshire law provides for the involuntary commitment of a patient such as Jane when she is a danger to herself or others as a result of mental illness. The patient has a right to treatment under N.H. Rev. Stat. Ann. § 135-C:1, et seq. Specifically, the patient should receive "adequate and humane treatment" pursuant to an "individual service plan" and "in the least restrictive environment necessary." However, appropriate facilities often are not available for patients waiting in emergency rooms, and patients can become trapped for hours or even days. This phenomenon is called "psychiatric boarding."

New Hampshire is …

Mental Health Disorders In Child And Adolescent Survivors Of Post-War Landmine Explosions., Mohammad Ali Hemmati, Hamid Shokoohi, Mehdi Masoumi, Shahriar Khateri, Mohammadreza Soroush, Ehsan Modirian, Mahtab Poor Zamany Nejat Kermany, Maryam Hosseini, Batool Mousavi

Emergency Medicine Faculty Publications

BACKGROUND: To describe the mental health status of 78 child and adolescent survivors of post-war landmine explosions.

METHODS: Child and adolescent survivors of landmine explosions who were younger than 18 years old at the time of the study were identified and enrolled in this study. The mental health status of the participants was assessed by general health assessment and psychiatric examinations. Psychiatric assessment and diagnosis were undertaken using the Diagnostic and Statistical Manual for mental disorders (DSM-IV) criteria. A psychiatrist visited and interviewed each survivor and identified psychiatric disorders.

RESULTS: Seventy-eight child and adolescent survivors with a mean age of …

Using Portable Computers To Increase The Efficiency Of Evaluating Psychiatric Emergencies – A Pilot Program, Anthony Buchman Lcsw, Edward R. Norris Md, Fapa, Fapm, Rosanne Teders Lcsw, Michael Kaufmann Md

Edward R Norris MD, FAPA, FAPM

No abstract provided.

Using Portable Computers To Increase The Efficiency Of Evaluating Psychiatric Emergencies – A Pilot Program, Anthony Buchman Lcsw, Edward R. Norris Md, Fapa, Fapm, Rosanne Teders Lcsw, Michael Kaufmann Md

Department of Psychiatry

No abstract provided.

Psychosocial Support Programme To Reduce Stress Among Emergency Physicians, Muhammad Shahid

Department of Emergency Medicine

No abstract provided.