Thursday, March 26, 2020

Psychiatrists Can Take Proactive Steps to Help Patients During COVID-19 Crisis

As health care workers at hospitals and emergency departments (EDs) focus greater attention on diagnosing and treating patients with coronavirus (COVID-19), psychiatrists across the country are bracing for the inevitable impact on their patients. Psychiatric News asked experts in the field what psychiatrists can do to help identify and address the needs of patients experiencing a worsening of psychiatric symptoms before they seek care in the ED.

It’s not whether EDs have the capacity to conduct assessments and crisis evaluations for patients with psychiatric conditions that worries Scott Simpson, M.D., medical director of psychiatric emergency services at Denver Health and an associate professor of psychiatry at the University of Colorado Anschutz Medical Campus. It’s what will happen to patients after such assessments are made that worries him. “I think there are going to be [many] challenges coming up related to transitions of care,” he said.

To help reduce the need for crisis services, psychiatrists and mental health professionals working in outpatient services should be connecting with patients, particularly those most vulnerable, explained Kim Nordstrom, M.D., J.D., an associate clinical professor of psychiatry at the University of Colorado School of Medicine. “This is paramount. Outpatient psychiatrists may be able to prevent crisis stabilization unit and ED visits, which in turn may reduce secondary exposure to the virus.”

Physicians should anticipate which of their patients are at risk for acute exacerbations of their symptoms during the pandemic and reach out to them, said Jon Levenson, M.D., an associate professor of psychiatry at Columbia University and chair of APA’s Council on Consultation-Liaison Psychiatry. Physicians may want to consider scheduling more frequent visits with these patients or arranging for other clinical staff to reach out via telemedicine or phone, as well.

“People with pre-existing psychiatric disorders are even more vulnerable with the uncertainty associated with the COVID-19 pandemic,” he said. “Many patients with psychiatric disorders who are already somewhat stigmatized and marginalized will feel even further isolated with the enforced quarantine, and they may start having more active symptomatology.”

Some patients may benefit from a reassessment of their psychotropic medicines and dosage, as well, he continued. Those who are acutely symptomatic might need a dosage increase to effectively treat their symptoms, he said.

Despite these efforts, some patients will continue to experience psychiatric crises requiring hospitalization during the COVID-19 pandemic.

“[Physicians on] inpatient psychiatric units are going to have to make hard decisions about what kinds of patients they’re going to accept and how they’re going to handle patients with even suspected coronavirus,” Simpson said.

Physicians also need to be flexible about the types of patients they treat, Simpson said, and inpatient units must be prepared to accept patients they may not otherwise, as capacity throughout the health care system shifts to care for COVID-19 patients.

It’s better to figure out how to safely treat a patient experiencing manic episodes who is COVID-19 positive in an inpatient psychiatric unit, rather than in a medical bed where they may be under continuous restraints, Simpson pointed out.

“There are hard times ahead,” said Jack Rozel, M.D., M.S.L., president of the American Association for Emergency Psychiatry, medical director for resolve Crisis Services, and an associate professor psychiatry at the University of Pittsburgh. “But psychiatrists got into this work because we care about people, and we want to help people. Now, more than ever, we’re needed. If not us, then who?”

(Image: iStock/MJFelt)

DEA, FTC Issue Warning: Beware of Scammers

Be aware: Scammers posing as representatives from the Drug Enforcement Administration (DEA) and officials from other agencies are targeting physicians.

It was recently brought to the attention of the Massachusetts Board of Medicine that Massachusetts licensees have been receiving scam calls from individuals posing as investigators of the Massachusetts Board of Medicine of the DEA. In these cases, the impersonator falsely stated that the licensee is under investigation and that their medical license is in jeopardy or has been suspended. Impersonators may demand money and/or seek additional information about the licensee’s DEA registration number and financial information. Physicians from other states received similar scam calls from individuals purporting to be FBI and DEA. The DEA webpage includes information for reporting the threat online.

Additionally, the Federal Trade Commission is warning the public on how best to avoid coronavirus scams, including recorded scam calls on “fake tests for Medicare recipients” and “free test kit scam.”


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