OK, so day two of the Academy of Psychosomatic Medicine (APM) 2015 Annual Meeting in New Orleans–and the saga of the APM App. Turns out it’s probably been around since last year, although I didn’t get to attend the previous meeting.
There was a bit of time devoted to apologizing about it at the pre-conference meeting, “Essentials of Psychosomatic Medicine,” I attended this morning, along with assurances that greater bandwidth would be added and a phone number to tech support as well.
I’ve had two people tell me that the APM App saga might fruitfully be dealt with by–buying a smartphone.
One of them was my wife; the other was one of the meeting organizers. OK, OK, I’ll think about it.
Regardless of the App situation, this morning’s session was excellent. There was an update on delirium, delivered by the matchless Dr. Jose Maldonado of Stanford University. He’s worked with other researchers developing a new delirium screening tool called the Stanford Proxy Test for Delirium. I may not have the name exactly right, but it’s mainly based on examiner observation rather than relying on participation of the patient–which you often can’t get in delirious patients.
Dr. Christina Wichman from the Medical College of Wisconsin talked about a lot of important updates in womens’ mental health including but certainly not limited to a new rating assessment for medications called Pregnancy, Lactation Labeling Rule (PLLR). This will eventually replace the FDA risk categories.
You will notice already that today’s post is much longer and has a bit more complex in sentence structure than yesterday’s, which is because I’m using a hotel computer, not my little iPOD, the operating system of which cannot be upgraded to version 7–if I haven’t mentioned that already.
Dr. Jeff Huffman did a bang-up job updating psychiatric assessment and treatment of patients with cardiac illness. It’s worth knowing that SSRIs really don’t prolong the QTc interval quite as much as most of us might be worried that it does. The antipsychotics that prolong QTc the least are aripiprazole and lurasidone. While methadone prolongs the QTc by a substantial amount, it’s still has many benefits for patients with opioid dependence.
Dr. Philip Muskin gave a virtuosos performance with his presentation on The Difficult Patient. One of the reminders: it’s health to acknowledge how you feel about patients who are demanding in a variety of ways.
Dr. Maryland Pao taught me there are useful screening tools for delirium in children and adolescents including the pediatric CAM-ICU and the Cornell Assessment of Pediatric Delirium (CAPD). Further, for adolescents and young adults, there is an assessment instrument for helping patients in this age group participate in end-of-life decisions: “Voicing My Choices.” It’s free to download. Another tool worth looking into is the “ASQ” (Ask Suicide Questions) for emergency department personnel to screen young people for suicide risk.
Dr. Scott Beach gave a top-notch talk about catatonia, which prompted so many questions from the audience that one of them introduced herself as a person who did not have a question about catatonia. Dr. Beach covered a lot of ground but mentioned akinetic mutism (usually caused by neurologic disease and, though related to catatonia, is considered distinct from it) which reminded me of the Telephone Effect, written about by neurologist, C. Miller Fisher. You stick a telephone by the ear of a mute, immobile patient, call him from just outside the room–the patient answers questions. Amazing–but not catatonia according to two experts I’ve heard from on the issue–including Dr. Beach and Dr. Andrew Francis.
I’m a little rushed; I have to get back for the afternoon session.