2023 Resident Posters
Retrospective Chart Review: Anti-psychotic Prescribing Patterns at MAHEC
Author: Emily Kulpa, DO
Co-Author(s): Micha Belden, PhD
The aim of this research: (1) demonstrate there is variation in antipsychotic prescribing practices determined by patient age, race, ethnicity, gender, and insurance at MAHEC and (2) examine if antipsychotic prescribing practices vary by department at MAHEC. Modeled largely after the study by Lawson et al (2015), primary outcomes were demographic differences in antipsychotic use: (1) any use, (2) oral FGA, and (3) oral SGA. We excluded LAIs from this initial study given the low number of patients who receive LAI antipsychotic medication in our clinic. Secondary outcomes were differences in departmental prescribing patterns of antipsychotics: (1) number of antipsychotics prescribed by the department and (2) specific anti-psychotics favored by each department.
Understanding Clozapine Prescribing Patterns Among North Carolina Medicaid Adults with Schizophrenia and Schizoaffective Disorder from 2016 to 2020
Author: Connor Belson, MD
Co-Authors: Liana Bruce, PhD; John Gilmore, MD; Mindy Asbury, MD; Fred Jarskog, MD; Austin Hall, MD; Natalie Bareis, PhD; Xiaoming Xeng, MD
Clozapine is an atypical antipsychotic with demonstrated superiority for treatment-resistant schizophrenia but has been shown to have racial, ethnic, and gender disparities in its use, leading experts to press for improved access. Prior studies of national Medicaid claims data, most recently in 2011-2012, showed that North Carolina’s clozapine prescribing fell below the national average. This study aimed to examine clozapine prescribing patterns and demographic variability in its use within North Carolina using more recent data and county-level detail.
Psychiatry Consultation Clinic: A Model that Improves Access to Care and Corresponds to Decreased Depressive Symptoms
Author: Catherine Parker, MD
Co-Author(s): Sejal Mahajan, MA; Xioaming Zeng, MD PhD; Parvathi M. Meyyappan, BS; Christine B. Flicek, MD; Nate Sowa, MD, PhD
An outpatient Psychiatric Consultation Clinic (PCC) was established in 2019 at the University of North Carolina to provide specialty support to primary care clinicians through diagnostic clarification and treatment recommendations. To date, the characteristics and outcomes of an outpatient consultation model like PCC have not been well studied.
Did Children Manage Anxiety Well During COVID?
Author: Kaushal Shah, MD, MPH
Co-Author(s): Ashleigh Johnson, MD, Meghana Rao, MS, MD Candidate, Predrag Gligorovic, MD, MHA
Anxiety disorders are prevalent mental health conditions that can occur as a standalone or a comorbid condition. Unfortunately, they are frequently undiagnosed, even though it is accompanied by associated behavioral and physical symptoms. Per June 2023, the United States Preventive Services Task Force (USPSTF) latest anxiety disorder guidelines, it should be screened for asymptomatic adults aged 19 -64. This recommendation is an addition to existing anxiety screening recommendations for ages 8-18 years and none for under 7. Our goal is to assess the impact of COVID-19 on anxiety by examining the number of emergency department (ED) consultations related to psychiatry and determine whether the findings align with the current anxiety screening guidelines set by the USPSTF.
Breaking Bad: Unraveling the Acute Medical Consequences of Methamphetamine Use
Author: Huseyin Bayazit, M.D.
Methamphetamine (Meth) use has experienced a significant increase over the past decade and has become prevalent in certain areas of the US (1,2). This rise in Meth use has correspondingly led to an increase in Meth-related admissions to emergency centers (2). Acute Meth intoxication can present with both physical symptoms (e.g., heart racing) and psychiatric symptoms (e.g., delusion, hallucination, agitation, suicidal behavior) (3). While most patients present with psychiatric and behavioral symptoms, it is crucial to recognize the potential lethal medical complications that can arise. The aim of this study was to investigate the prevalence of medical comorbidities among individuals who presented to the psychiatric emergency and tested positive for Meth.
Quantifying Historic Racial Disparities in the Diagnosis of Psychotic Illness in North Carolina Utilizing a Machine Learning Model
Author: Philip Feibusch, MD
Co-Author(s): Robert Allen, PhD; Sarah Almond, MA, MSLS; Nathanael Nihart, MSLS; Leah Tams, MSLS; Abby Wooten, BA
The American Psychiatric Association issued a public apology in 2021 for systemic racist practices in the treatment of Black, Indigenous, and People of Color dating back to the founding of the profession in the 1840s. Approximately 20,000 clinical patient records dating from 1856 to 1923 have been collected from the now-closed Dorothea Dix Hospital in Raleigh, NC, which served primarily white patients, and what is now Cherry Hospital in Goldsboro, NC, which served exclusively African American patients until the hospital system was de-segregated in 1965. This purpose of this study is to characterize differences in the diagnosis of dementia praecox, a historical precursor to schizophrenia, between White patients at Dorothea Dix Hospital and African American patients at Cherry Hospital.
Female Insanity Acquittees Charged with Violent Offenses in the State of North Carolina: An Analysis of 25 Years of Data
Author: Sara Feizi, MD
Co-Author(s): Nicole Wolfe, MD
There is a general lack of research on the unique factors associated with women who end up forensically hospitalized for violent offenses, which is likely due to women making up a minority of patients in this subset population. A history of past homicide is viewed as evidence of dangerousness for NC NGRI commitments. We conducted a qualitative review of female patients records who had been found NGRI for violent offenses in the state of North Carolina over the last two decades to better understand violence risk assessment among the female population.
Assessing the Impact of Research Interest Group (RIG) to Increase Scholarship in Psychiatry Residency: A Quality Improvement Project
Author: Samantha Ongchuan Martin, MD
Co-Author(s): Sahil Munjal, MD
Learning about research and quality improvement to practice evidence-based medicine are considered important milestones (SBP 1 and PBLI 1) for residency training. The NIMH has determined the decline in psychiatrist-researcher and appointed National Psychiatry Training Council (NPTC) to implement recommendations provided by the Institute of Medicine (IOM). However, the most common barriers for a resident not engaging in research activities include lack of time, lack of interest, inadequate or no mentoring support, lack of research skills, and insufficient technical support. To address these barriers, we introduced a research interest group (RIG) for psychiatry residents and medical students interested in psychiatry. Our goal is to assess the role of RIG in remediating known barriers.
Use of Dual Long-Acting Injectable Antipsychotic Therapy for Treatment-Resistant Schizophrenia: A Case Series
Author: Katrina Hazim, MD
Co-Author(s): Alana Parker, MD; Tyler Dodds, MD
Schizophrenia is a chronic, debilitating mental illness that can severely impact daily functioning, frequently with difficulty maintaining relationships, jobs, and hygiene. Patients require life-long treatment with antipsychotic medications, but many patients have difficulty with adherence, typically due to side effects, poor insight, and cost. The development of Long-Acting Injectable Antipsychotics (LAIA) has aided with adherence and decreased rates of re-hospitalization. Currently, there are no guidelines on the use of dual LAIA therapy for treatment-resistant schizophrenia (TRS), and current research on this is limited to case reports and case series. In this case series, we present nine patients with TRS trialed on dual LAIA therapy and assessed both tolerability and efficacy.
Netflix and Homicidal Ideation: Case Series
Author: Tyler Thompson, MD
Co-Author(s): Brandon Chen, MD; Tanner Mabry, DO; Sahil Munjal, MD
Within twenty-eight days of its release, the Netflix series, Dahmer-Monster: The Jeffrey Dahmer Story became Netflix’s second highest viewed English-language show. With growing interest in true crime and the accessibility of media via streaming services, adolescents are increasingly exposed to dramatizations of criminal violence. Prior research has shown a relationship between consuming media containing suicide and increased risk of suicidal ideation. Consumption of violent media by at-risk individuals could result in distressing intrusive thoughts of violence and lead to increased psychiatric emergency department presentations with what initially appears to be homicidal ideation.
A Consult Conundrum - What to Do When the Treatment of Choice in Catatonia Worsens Delirium: Case Series
Author: Jordan Midkiff, DO
Co-Author(s): Sahil Munjal, MD
There is little research about the overlap of Catatonia and Delirium, as well as its treatment. We present two cases detailing effective alternative strategies in treating co-occurring catatonia and delirium.
Medical Student Posters
A Systematic Review on Bupropion “Poor Person’s Cocaine”: Revisiting its Prescription Management and Potential for Misuse
Author: Greg Noe
Co-Author(s): Kaushal Shah, MD; Sam Ong-Martin, MD
Among prescribers, bupropion is considered a substance of low abuse potential, with some studies showing lesser abuse potential than caffeine. However, several case reports exist of recreational bupropion misuse and diversion. Our goal is to understand clinical courses, interventions after acute ingestion of bupropion via oral, intravenous route, and insufflation. Through this systematic review, we hope to identify populations at increased risk to create clinically relevant screening and management strategies for bupropion misuse.
A Novel Case Report and Systematic Review of Clinical Course and Management of Ketamine Induced Psychosis
Author: Connor Dean MD Candidate
Co-Author(s): Samantha Ongchuan Martin, MD; Sahil Munjal, MD, Kaushal Shah, MD
Ketamine is seeing a rise in utility as an anesthetic in procedural sedation due to its advantages in preserving hemodynamic stability, analgesic properties, and minimal respiratory depression. In psychiatry, ketamine has been shown to have rapid and sustained antidepressant anti-suicidal effects. Ketamine is well known to have psychiatric side effects of hallucinations and emergence agitation. However, protracted psychosis is rare, as highlighted in our initial case report that inspired this systematic review. We aim to study the clinical course, mechanism of action, and management for ketamine induced psychosis through systematic review.
Shame in Health Professions Students: An Exploratory Epidemiological Study
Author: Franz Belz, MPH MS4
Co-Author(s): William E. Bynum, MD/PhD
Shame is a negative emotion arising from the inability to meet one’s idealized standards. Shame can promote destructive behaviors (e.g., self-sabotaging) and constructive behaviors (e.g., helping strangers)1–6 pending individual (e.g., self-efficacy) and contextual factors 2,7,8. Negative self-perceptions of shame can manifest in a globalized and uncontrollable manner, leading to feelings of helplessness and hopelessness 7, and are associated with anxiety, depression, and suicidality 9–11. Though increasing qualitative research is showing how shame affects medical learners 12–14, we lack an epidemiological understanding of shame in health profession students. Thus, we investigated how shame differs across student demographics, learning settings, and minority status.
Management of Catatonia in Huntington: A Systematic Review
Author: Haley Park, BS
Co-Author(s): Kaushal Shah, MD, MPH; Sahil Munjal, MD
Huntington’s Disease (HD) is a neurodegenerative disease characterized by a decline in motor, cognitive and psychiatric functioning. Psychiatric symptoms, particularly depression, mania, psychosis, and suicidality, are common manifestations of the condition. Catatonia, however, is relatively rare in this population. Due to limited data, there is no standardized treatment for catatonia in the HD population. Our goal is to explore the management of catatonia among individuals with Huntington's Disease and associated psychiatric comorbidities.
South Asian Attitudes Toward Mental Health
Author: Akshita Paruchuri
Co-Author(s): Dr. Karlene Cunningham, Michael Larkins, Ananya Koripella, Pankti Sheth
Existing data on South Asian (SA) healthcare disparities in the US, particularly in the realm of mental health, is very limited. Research suggests that SAs have higher rates of suicide when compared to other subgroups in the Asian diaspora, yet SAs are less likely to seek professional help for their mental ailments. With Asian populations being identified as one of the fastest growing foreign-born populations in the US, concerns regarding their mental health and wellbeing will only be exacerbated if not adequately addressed. An exploratory study seeking to understand SA attitudes toward mental health will provide a framework of understanding that could encourage the development of community-based and culturally sensitive programs that are informative to SA populations.
Course and Response to Immunotherapy in Children with Childhood Disintegrative Disorder: A Retrospective Case Series
Author: Meghan Sullivan, BA
Co-Author(s): Megha Gupta, MD; Kathryn Taylor, MD; Heather Van Mater, MD, MSc; Carolyn Pizoli, MD, PhD
Disease Childhood Disintegrative Disorder (CDD) is a poorly understood neurobehavioral disorder of early childhood characterized by acute to subacute profound regression in previously developed language, social behavior, and adaptive functions. It is currently categorized under autism spectrum disorders (ASD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The etiology of CDD remains unknown and treatment is focused on symptomatic management. Similarities between the presenting symptoms of CDD and pediatric autoimmune encephalitis (AE) have led to concern for inflammatory mechanisms and treatment with immunomodulation. Ultimately, after initial regression children develop an autistic phenotype, leading to its categorization under ASD.
Is There an App for That? Selecting Apps That are Safe and Effective
Author: Ashish Khanchandani, MS
Co-Author(s): Sy Atezaz Saeed, MD, MS
COVID-19’s increased demands on the mental health care delivery system led to increased utilization of technology-based solutions. Numerous web-based or mobile-based apps are available to aid in the treatment of various psychiatric conditions. Clinicians may find it challenging to choose the best psychiatry-related apps to recommend to patients. This dilemma calls for an approach to help clinicians select apps that are safe and effective. The American Psychiatric Association provides information to help mental health professionals navigate these issues and identify which aspects to consider when selecting an app for clinical use. The M-Health Index and Navigation Database also provides a set of objective evaluative criteria and offers guidance on choosing apps.
A Case Appreciating the Peculiarity of Pediatric Acute-Onset Neuropsychiatric Syndrome
Author: Maya Fisher
Co-Author(s): Jordan Midkiff, DO
Pediatric acute-onset neuropsychiatric syndrome (PANS) is a diagnosis of exclusion among grade-school children who present with symptoms meeting specific psychiatric, behavioral, and postinfectious criteria. We present a case detailing the evaluation and diagnosis of a patient who presented with signs of catatonia and unspecified psychosis who met the criteria for suspected PANS.
Pilot Project for Unmet Health Related Social Needs Screening and NCCARE360 Referrals at the Duke Behavioral Health Inpatient Unit
Author: Nicholas T. Hastings, BA, MS
Co-Author(s): Esme D. Trahair, BA; B. Lynette Staplefoote-Boynton, MD, MPH; Leslie L Bronner, MD, MPH
The influences of health-related social needs (HRSN) on patient health outcomes are well documented in the literature, and there is growing consensus that healthcare systems must take a more active role in addressing them. Furthermore, in 2022, the Center for Medicare and Medicaid Services (CMS) announced the addition of HRSN reporting as a mandatory quality measure beginning in 2024. The pilot phase of this project aimed to establish and optimize a process for systematically screening for and addressing HRSN for patients admitted to the Duke Behavioral Health Inpatient Unit (BHIP). The data collected in the pilot phase was analyzed and will inform future cycles of this project. |
