Pitt Psychiatry Faculty Develop Innovations in Medical Training and Patient Care
Department of Psychiatry clinician-educator faculty devote their time, energy and passion to treating patients and training medical students and residents at UPMC Western Psychiatric Hospital (WPH). To fulfill WPH’s mission of providing the highest quality psychiatric care for our patients, they seek opportunities, on an ongoing basis, to refine and improve our services and treatments, as well as our medical training. Recent publications reflect the valuable contributions of our faculty in medical training and patient care.
The continuing education of practicing clinicians is a critical area where novel approaches are particularly valuable. LalithKumar K. Solai, MD, Service Chief and Medical Director of Geriatric Psychiatry and Charles F. Reynolds, III, MD, Emeritus Professor of Psychiatry, in collaboration with colleagues at the University of California, San Diego, created an interdisciplinary fellowship to address the growing imbalance of geriatric psychiatry clinicians to the increasing population of older Americans. The mini-fellowship focused on three core mental health issues affecting geriatric patients: delirium, dementia and depression. Eighty-one trainees in medicine, nursing, social work, pharmacy and occupational/physical therapy increased their understanding of the important role of interdisciplinary collaboration in caring for older patients with mental disorders. In an article published in the American Journal of Geriatric Psychiatry, the study authors noted that this was the first interdisciplinary training specific to late-life mental health issues.
In addition to ongoing education for clinicians, providing opportunities for patients to become better informed about their own health can improve outcomes. Neeta Shenai, MD, Priya Gopalan, MD, and Jody Glance, MD, designed and implemented an education program for antepartum women, with a history of trauma, entering treatment for substance use disorder. For these women, the perinatal period is a critical time of vulnerability to obstetric complications and poor neonatal outcomes. It is also a time when women can experience greater motivation for change. Drs. Shenai, Gopalan and Glance recruited 31 antepartum women who participated in an educational session designed to increase their knowledge of the post-traumatic stress and substance use disorder diagnoses, including the link between post-traumatic stress and substance use, as well as safe coping skills. In a study published in Maternal and Child Health Journal, Drs. Shenai, Gopalan and Glance reported that participants thought the education session would increase their likelihood of pursuing further treatment for post-traumatic stress and substance use disorders.
Substance use treatment in perinatal women is a critical and rapidly changing concern. Physicians are increasingly required to manage co-occurring substance use disorders, particularly opioids and benzodiazepines. In a study published in General Hospital Psychiatry, Priya Gopalan, MD, Eydie Moses-Kolko, MD, Robin Valpey, MD, Neeta Shenai, MD, and colleagues assessed current practices in perinatal withdrawal management for opioid and sedative-hypnotic use disorder and analyzed neonatal outcomes. They found that symptom-triggered benzodiazepine withdrawal strategies were associated with lower benzodiazepine use, compared with gradually lowering the dose of the drug, and may minimize potential postnatal negative effects of benzodiazepine use. Additionally, women started on methadone during admission tended to receive lower benzodiazepine doses compared with women admitted on stable doses of methadone.
Increasingly, WPH clinicians are developing technology interventions to support patients who receive outpatient treatment after discharge. Many patients who receive substance use disorder treatment in emergency departments are extremely vulnerable to cravings and withdrawal symptoms before beginning outpatient treatment. Julie Kmiec, DO, developed a text-message intervention program to determine the potential usefulness of such a program for 167 adult patients. In an article published in the Journal of Substance Abuse Treatment, Dr. Kmiec reported that many patients with substance use disorder who opted in to the text-message program had higher rates of post-discharge treatment attendance.
Post-discharge telephone follow-up with patients exhibiting suicidal behaviors has been shown to decrease subsequent suicidal attempts. However, this strategy has not been examined among suicidal adolescents. Manivel Rengasamy, MD, and Garrett Sparks, MD, examined whether telephone interventions for 142 adolescents who had been hospitalized for suicidal behavior would lower the rate of suicidal behavior and contribute to patients’ confidence in their safety plan. In an article published in Psychiatric Services, they reported findings that patients who received six telephone calls over 90 days were four times less likely to exhibit suicidal behavior than patients who received only one phone call after 90 days.