November 4, 2022 | Colorado Springs, CO & VirtualThe 2022 NEI Congress Scientific Poster Session was held on Friday, November 4th and featured 116 posters, with an additional 22 posters presented virtually, covering the full spectrum of mental health research and clinical data. Among them, three particularly stood out for the quality of their data and contributions to the field. Presented below are the winners of the 2022 NEI Congress Young Investigator Poster Competition.
Clinical Determinants, Patterns and Outcomes of Antipsychotic Medication Prescribing in the Treatment of Schizophrenia and Schizoaffective Disorder: A Naturalistic Cohort Study
Emily Groenendaal, MD, Sean Lynch, MD, Rhea Dornbush, PhD, MPH, Lidia Klepacz, MD, Stephen Ferrando, MD
Background: Schizophrenia affects individuals, families, and systems, with treatment primarily being antipsychotic medications. Long-acting injectable (LAI) antipsychotics are increasingly being used. This study sought to identify predictors of antipsychotic choice, in terms of formulation (LAI vs oral) and class (FGA vs SGA), and clinical outcomes.
Method: 123 patients who received LAI antipsychotics were diagnosis-matched to patients who received oral antipsychotics. Sociodemographic and clinical factors were extracted from the medical record, including indicators of illness severity. Groups were compared with Chi-Square and t-tests, and logistic regression models were used to identify independent predictors of antipsychotic choice.
Results: Patients that received LAIs had longer admissions, more complex discharges, and greater illness severity; however, there were no differences in readmission rates. Independent predictors of LAIs included younger age, being single, and longer admission. Patients who received FGA LAIs were more likely to use substances and be undomiciled compared to SGA LAIs, with the only predictor being older age. Oral FGAs were more likely than Oral SGAs to be prescribed to older and female patients, as well as those with co-occurring substance use, complex discharges, and longer admissions.
Conclusion: Illness severity and duration of illness appear to drive choice of LAI vs. oral antipsychotic medication and FGA vs. SGA. While LAIs were prescribed to patients with greater illness severity, readmission rates were equivalent to those receiving oral medication, supporting the use of LAI in patients with greater illness severity. Rationales for prescribing LAIs to younger patients and FGAs to older patients are discussed.
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Examination of Substance Use in Child and Adolescent Psychiatry Inpatients
Sean Lynch, MD, Parul Shanker, MD, Timothy Becker, MD, Dalton Martin, LCSW, Paige Staudenmaier, MD, Alicia Leong, BA, Timothy Rice, MD
Background: Substance use in the child and adolescent population is associated with significant psychological, neurological, and medical complications. Certain risk factors of substance use amongst children and adolescents have been identified in the general population, including having a psychiatric illness and history of maltreatment. Little research has been published on specifically the child and adolescent inpatient psychiatry population and substance use, as well as on the impact of the COVID-19 pandemic.
Method: Charts of 1101 child/adolescent psychiatry inpatients were reviewed for sociodemographic and clinical information. Data ranged from June 1 2018 – November 30 2021.
Results: Older age, white race, history of an impulsive or behavioral disorder, history of suicide attempt, history of ACS/CPS involvement, and a history of violence were all found to be predictors of substance use. Asian race was found to be a protective factor against substance use. COVID-19 did not have a significant impact on substance use. Sociodemographic and clinical differences between patients with and without substance use were explored.
Discussion/Conclusion: Multiple factors may predispose children and adolescents to substance use. Though no impact of COVID-19 was found in this sample, long-term studies are needed.
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Conducting women’s groups in the inpatient unit: Empowering a high risk population by preventing unplanned pregnancies
Avanti Puri, MD, Sirisha Iruvanti, DO, Patricia Abrudan, DO, Samantha Wargo, DO, Anna Huebschmann, MD
Introduction: Women with mental illness are 5x more likely to experience an unplanned pregnancy due to lower rates of effective contraception use; they also experience higher rates of adverse pregnancy outcomes. Education about women’s reproductive health and family planning are not routinely offered in inpatient mental health and addiction treatment settings.
Method: Weekly women’s groups on the inpatient psychiatry unit were led by psychiatry residents who were trained and provided a script. Groups focused on structured contraception education followed by an open-discussion format. Data collected included the percentage of women with history of contraception use, child protective service involvement, unplanned pregnancies, abortions, and percentage of women who found the group helpful. Special care was taken to discuss contraception as a tool for empowering women to make their own decisions about their contraceptive needs.
Results: 13 sessions were conducted, and attendance among women in the inpatient unit was 42%. Out of the 32 patients who participated, 100% found the group beneficial and responded they would share information they learned with women outside the group. 26.4% self-identified as using contraception, 50% had unplanned pregnancy, 23.6% have had an abortion, and 26.4% have had child protective services involvement.Dissemination of contraceptive information in these women’s groups effectively led women to consider options that were available to them and seek contraceptive methods that were appropriate to their situation. Women reported they gained a better understanding of the medical, emotional, and financial implications of unplanned pregnancies. The groups were conducted in an open-discussion format that allowed women to participate in shared experiences; in many cases, the discussions were therapeutic. Feedback from patients and unit staff was positive. Many patients requested further groups to discuss issues women face, such as domestic violence and experiences as a mother.
Conclusion: Conducting women’s groups on the inpatient unit is critical in view of the poor access to healthcare that vulnerable women who seek inpatient psychiatric care experience. The groups on the inpatient unit are unique because it is often the only time these women have an opportunity for crucial, gender-specific preventative healthcare. These groups should further lead to appropriate referral and follow up with primary care or women’s clinic providers. Ongoing efforts will be put forth to increase group attendance, to incorporate participation from unit staff, and to build this group into a resident curriculum for group therapy.
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