Implementation of Proactive Psychiatric Consultation With Cardiology Inpatients

AACN Advanced Critical Care · 2026-02-27

BACKGROUND: Cardiovascular disease is linked to mental health conditions. Patients with cardiovascular disease and comorbid psychiatric illnesses such as major depressive disorder or generalized anxiety disorder often experience greater physical limitations and decreased overall health. OBJECTIVE: To determine if proactive psychiatric interventions improve staff satisfaction and patient outcomes, such as reducing length of stay and decreasing the 30-day readmission rate, for patients hospitalized on cardiac units with psychiatric comorbidities. METHODS: The implementation of a proactive psychiatric consultation-liaison service, which included proactive screening of psychiatric needs among patients hospitalized on cardiac units, targeted support for cardiovascular staff, and supportive interactions for patients. RESULTS: Comparison between preintervention and postintervention periods indicated a 21% reduction in the 30-day readmission rate for patients hospitalized on cardiac inpatient units with psychiatric comorbidities without adversely affecting hospital length of stay. Staff satisfaction significantly increased with the availability of psychiatric resources. CONCLUSION: The implementation of a multi-disciplinary proactive psychiatric consultation-liaison service on inpatient cardiac units was associated with an increase in cardiovascular staff satisfaction with psychiatric services and a decrease in the 30-day readmission rate of patients with psychiatric comorbidities who were hospitalized for cardiovascular services without significantly affecting length of stay.

Health Disparities and Impact of Social Vulnerability on Diagnosis and Outcomes in Vestibular Disorders

Ear and Hearing · 2025-07-15

OBJECTIVES: Examining the effect of demographics and social vulnerability on diagnosis and management of patients with vestibular and balance disorders. DESIGN: Retrospective review of a database of patients presenting with vestibular symptoms to a multidisciplinary tertiary vestibular clinic between January and October 2021. Main outcomes included odds ratios of final diagnosis, treatment response, time to presentation by demographic variable, insurance status, residence, and social vulnerability factors according to the 2018 Centers for Disease Control Social Vulnerability Index. RESULTS: Five hundred thirty-six patients with definitive vestibular diagnoses and treatment outcome data were included. Mean age at presentation was 60.4 ± 16.5 years. Women (n = 389, 72.6%) outnumbered men (n = 147, 27.4%). Most patients self-identified as White (n = 440, 82.1%) and non-Hispanic (n = 521, 97.2%). Overall, 17.4% of participants belonged to a minority group. Socioeconomic status, household composition, geographic location, and insurance status were associated with patient diagnoses received. Patients from the lowest socioeconomic class were more likely to be diagnosed with Meniere's disease. In addition, patients with private insurance were more likely to be diagnosed with Meniere disease or vestibular migraine than those with Medicare insurance. Geographic distance greater than 60 miles from the clinic was associated with a higher likelihood to present >90 days since initial symptom onset. Housing and transportation vulnerabilities were associated with decreased treatment response. CONCLUSIONS: Diagnostic classification, time to presentation, and treatment outcomes differed according to demographic and social vulnerability factors. There was no single unifying theme among vulnerabilities, but the results of this study offer preliminary data to design future investigations on regional and national levels to understand and mitigate the effects of social vulnerability factors on access to specialty vestibular care and outcomes of treatment.

Suicidal Ideation, Behaviors, and Deaths in People With Ménière's Disease: A Systematic Review

Otolaryngology · 2025-03-10

OBJECTIVE: To assess relations between Ménière's disease and suicidality, measured by suicidal ideation, suicidal behaviors, and death by suicide. DATA SOURCES: CINAHL, Cochrane Library, PubMed, PsycINFO, and SCOPUS databases were searched from inception through July 2, 2024. REVIEW METHODS: Observational studies related to suicidality in patients with Ménière's disease were included. Non-English language papers, editorials, and studies on vestibular disorders not specified as Ménière's disease were excluded. The Risk Of Bias In Nonrandomized Studies-of Exposure tool was used for cohort and qualitative studies, and the Joanna Briggs Institute critical appraisal checklist was used for case-control studies. RESULTS: Four studies (n = 168,566) were included in our review. Two cohort studies found significantly increased adjusted hazard ratios of 2.1 (95% CI: 2.0-2.2) for death by suicide and 7.6 (95% CI: 4.4-13.3) for suicidal behaviors, respectively, in patients with Ménière's disease compared to the control population after their diagnosis. However, a case-control study found no significant difference in the prevalence of suicidal ideation or behaviors prior to the date of diagnosis in patients with Ménière's disease compared to the control population (0.9% vs 0.8%; P = .44). In addition, one patient with Ménière's disease expressed suicidal ideation in the qualitative study. CONCLUSION: Patients may experience variable responses to Ménière's disease. Thus, otolaryngologists should be mindful of the potential for suicidality in patients with Ménière's disease.

Vestibular symptoms, balance, and their disorders

2025-03-01

Abstract Classification and definitions for symptoms, syndromes, diseases, mechanisms, and outcomes are essential to high-quality clinical care and research in any branch of medicine. Clear definitions for clinical phenomena (i.e. symptoms, signs, and syndromes) are essential for promoting accurate and efficient diagnosis. Clear definitions for disease-related concepts (e.g. specific diseases and underlying pathomechanisms) are essential for the design of studies, definition of inclusion/exclusion criteria, and in developing and utilizing effective therapies. Definitions for vestibular and balance disorders have lagged behind those in other disciplines. The output of the International Classification of Vestibular Disorders (ICVD) initiative is presented. The history of classification is reviewed before focusing on vestibular disorders, including the genesis of the ICVD, its goals and scope, and the procedure of consensus finding developed by the Bárány Society. The overall structure of the ICVD before is outlined, detailing specific components, including already published definitions and outlooks on further developments.

Illness Perceptions and Emotional Experiences in Heart Failure: Qualitative Insights to Inform Personalized Psychosocial Care

Journal of the Academy of Consultation-Liaison Psychiatry · 2025-10-23

Prevalence and treatment outcomes of persistent postural‐perceptual dizziness after traumatic brain injury

PM&R · 2025-02-14 · 2 citations

BACKGROUND: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder that is a potential sequela of traumatic brain injury (TBI). Currently, little is known about how patients with TBI associated PPPD respond to typical PPPD treatment modalities. OBJECTIVE: To investigate the prevalence of TBI as a precipitant for PPPD and assess outcomes of usual treatment. DESIGN: Retrospective cohort study. SETTING: Electronic medical records from a tertiary care center. PARTICIPANTS: Patients ≥18 years of age diagnosed with PPPD secondary to TBI between January 2015 and December 2022 who underwent 6 months of treatment with at least one return clinic visit. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Patients' best clinical global impression-improvement scale (CGI-I) score following 6 months of treatment were collected and then compared with previously published literature, with CGI-I scores of 1 or 2 (indicating the patient was "very much" or "much" improved, respectively) considered treatment responders. RESULTS: In total, 134 (8.9%) of 1503 patients had a TBI as the triggering event for PPPD. The mean age of this cohort was 47.6 years with most of these cases occurring after a mild TBI (85.8%). The proportion of females with post-TBI PPPD (58.2%) was significantly lower than the proportion with PPPD due to all causes (p < .037). The most common treatment prescribed was vestibular therapy (82.2%), and 53.3% of patients were considered treatment responders after 6 months. Patients with TBI-induced PPPD had a significantly worse mean CGI-I score (2.49 ± 1.1) when compared to prior literature (1.71 ± 0.83) (p < .001). CONCLUSIONS: This study found a 9% prevalence of PPPD following TBI in the largest cohort studied to date. Patients who developed PPPD following TBI did not respond as well to standard treatments as patients with other causes of the disorder, and thus may require closer clinical follow-up to assess treatment efficacy.

Racial Disparities in the Use of Physical Restraints and Intramuscular Medications for Patients Awaiting Psychiatric Hospitalization in the Emergency Department

Journal of the Academy of Consultation-Liaison Psychiatry · 2025-03-01 · 1 citations

Psychosocial factors are associated with community mobility and participation in persons with dizziness

Frontiers in Neurology · 2025-01-29 · 1 citations

Introduction Among individuals with dizziness, there is an increased prevalence of psychosocial comorbidity compared to the general population. Increased psychosocial comorbidity among people with dizziness is associated with disability and poorer outcomes in vestibular rehabilitation. However, there is less knowledge regarding the association between psychosocial factors and mobility outcomes in people with dizziness. Therefore, the purpose of this study was to assess the association between psychosocial factors and future activity, participation, and community mobility among people with dizziness. The secondary aim of this study was to explore the constructs measured using patient-reported outcomes associated with psychosocial factors in this population. Materials and methods We conducted a prospective cohort study with an in-person baseline assessment and a follow-up assessment completed at 3-months via computerized questionnaires. We measured psychosocial factors at baseline using the Hospital Anxiety and Depression Scale (HADS), the Patient Health Questionnaire 4-item (PHQ-4), the Vestibular Activities Avoidance Instrument (VAAI), and the Dizziness Catastrophizing Scale (DCS). We measured community mobility and participation at baseline and 3-month follow-up using the Life Space Assessment (LSA) and Vestibular Activities and Participation Measure (VAP). To determine the associations between baseline anxiety and depression symptoms, fear avoidance, catastrophizing beliefs and mobility and disability measures, we used simple linear regression and repeated measures ANOVA. We used exploratory factor analysis to identify constructs measured using patient-reported outcomes of psychosocial factors. Results There were 100 participants who completed the baseline assessment [mean age (SD) = 49.2 (15.7) years; 73% female] and 68 participants completed the questionnaire at the 3-month follow-up. In bivariate analyses, baseline VAAI, HADS-A, HADS-D, PHQ-4 depression, and VAP were associated with LSA, and baseline VAAI, HADS-D, PHQ-4 depression, and LSA were associated with VAP at 3-month follow-up (all p &amp;lt; 0.05). In adjusted multivariate analyses, baseline VAP had a large effect ( F = 11.65, p = 0.001, η 2 = 0.18) and HADS-D had a moderately large effect ( F = 4.09, p = 0.048, η 2 = 0.07) on LSA score at 3-month follow-up. Baseline VAAI had a large effect ( F = 23.35, p &amp;lt; 0.001, η 2 = 0.3) on VAP at 3-month follow-up. The exploratory factor analysis of the VAAI, HADS, PHQ-4, and DCS resulted in 4 factors measuring constructs of fear avoidance, anxiety, depression, and catastrophization. Discussion We found that baseline psychosocial factors were related to future measures of activity and participation as well as community mobility in people with dizziness. Specifically, baseline activity and participation levels and depressive symptoms were significantly associated with future community mobility and baseline fear avoidance beliefs were significantly associated with future activity and participation. Patient-reported outcome measures of psychosocial factors appear to measure unique constructs, which may indicate that a small number of different outcome measures may be needed to gather important prognostic information to manage individuals with dizziness well.

Clinical effectiveness of best-evidence cancer distress management in a real-world practice setting

Translational Behavioral Medicine · 2025-01-01

BACKGROUND: Despite 40 years of evidence supporting psychosocial interventions as a component of comprehensive cancer care, patients continue to report vast unmet psychosocial needs and distress. Cognitive behavioral therapies for cancer distress (CBT-C) are the most rigorously tested class of psychosocial interventions for cancer care. PURPOSE: To report clinical effectiveness outcomes of cancer-related distress and self-efficacy following implementation of best-evidence CBT-C, adapted for a real-world, billable practice setting. METHODS: Patients who completed group-delivered, CBT-C (10 intervention hours, 5 sessions) in the practice setting were invited to enroll in a research study to document cancer distress across the year following CBT-C. Participants (n = 65) were primarily middle-aged (mean 50.5 years, 17% were young adults ≤40 years), female, and White. Analyses utilized mixed linear models with intent-to-treat procedures. Given group delivery and social skills training content within CBT-C, social self-efficacy was assessed as a potential treatment mechanism. RESULTS: Distress decreased across the year following CBT-C (mean score change of 20 points for YAs, 6 points for non-YAs), with statistically significant age x time effects. Within-person improvements in social self-efficacy scores were related to reductions in cancer distress, including distress subscales of intrusive thoughts, avoidant coping, and hyperarousal. The model explained 76.6% of the total variance in cancer distress. CONCLUSIONS: This study demonstrates the effective translation of CBT-C from controlled research trials to the practice setting. CBT-C effectiveness within a mixed-cancer population and relatively rural region of the US is also supported. CBT-C can be effectively translated to the practice settings for which it is intended.

Update on functional vestibular and gait disorders

Current Opinion in Neurology · 2025-11-27

PURPOSE OF REVIEW: Three functional neurological disorders are encountered in neuro-otologic practice, persistent postural-perceptual dizziness (PPPD), which is the commonest cause of chronic vestibular and balance symptoms, mal de debarquement (MdDS), a rarer but potentially debilitating disorder, and functional gait disorder, an often overlooked but treatable condition. RECENT FINDINGS: Recent investigations of PPPD suggested that there may be subtypes or subthreshold variants that merit further investigation. Studies of pathological mechanisms continue to offer new insights into the complex processes that initiate and sustain the disorder, which will require nuanced models to bring together disparate findings. Evidence continues to accumulate in support of vestibulo-ocular reflex readaptation therapy for MdDS, with pilot studies offering refinements and possible alternatives. Functional gait disorder is one of the commonest manifestations of functional neurological disorder, often presenting with other functional neurological symptoms including PPPD. Specialized methods of physical and occupational therapy continue to mature. Optimal outcomes may require short and focused periods of intensive treatment. SUMMARY: Evolving theories and continuing emergence of new data are beginning to make functional vestibular and gait disorders a manageable part of neuro-otologic practice.