Occult Untreated Alcohol Use Disorder in a Patient with Recurrent Pituitary Macroadenoma

Alcohol use disorder (AUD) is a chronic relapsing and remitting psychiatric condition associated with adverse health outcomes. Although common, AUD is underdiagnosed, and treatment is often overlooked. At times of increased risk, such as the postoperative period, it is imperative to screen for and treat AUD to improve patient outcomes. Psychiatrists can play an important role in addressing AUD in this patient population through addiction psychiatry consultation services. We present the case of a patient with occult alcohol use disorder (AUD) leading to hospitalization in the setting of depressive mood symptoms and personality changes after a repeat pituitary macroadenoma resection and radiation five months earlier. AUD was noted months prior to hospitalization but was not addressed despite regular interactions with the healthcare system. Evaluation by addiction psychiatry specialists during hospitalization prompted recognition and treatment of AUD, resulting in cessation of alcohol use and resolution of mood symptoms and personality changes. The patient was discharged 3 days after admission and maintained abstinence from alcohol at two months postdischarge without recurrence of psychiatric symptoms.

Seminars in Addiction Psychiatry

This extensively revised new edition provides a practical guide to understanding, assessing and managing physical, psychological and social complications related to drug and alcohol use. It presents a clear review of the aetiology, epidemiology, prevention and treatment of the problematic use of and dependence on alcohol, illicit and prescribed drugs. In doing so it strikes a balance between theory, recent research and practical clinical guidance. New chapters focus on novel psychiatric substances, smoking cessation interventions, mutual aid groups and family interventions. Written by leading specialists in the field and closely following the MRCPsych curriculum, this book is an ideal resource for trainees preparing for their RCPsych membership examinations, but is also relevant to psychiatrists at all career levels. It will also appeal to other healthcare professionals, all of whom should be able to screen for alcohol and drug use disorders, deliver brief interventions, and signpost those with more severe disorders to specialist care.

Decreasing Psychiatric Emergency Visits, but Stable Addiction Emergency Visits, During COVID-19—A Time Series Analysis 10 Months Into the Pandemic

Background: The COVID-19 pandemic has been suspected to increase mental health problems, but also to possibly lead to a decreased treatment seeking, for example due to fear of attending hospital. Early findings demonstrate decreased treatment seeking for mental health, which may differ across diagnostic groups. This study aimed to examine treatment uptake at a general psychiatry emergency unit and at an addiction psychiatry emergency unit in Malmö, Sweden, separately. In addition, the study aimed to investigate treatment uptake for different diagnostic groups—during and prior to the COVID-19 pandemic.Methods: Monthly data for number of unique patients and number of contacts were extracted for the three-year period of January 2018 through December 2020. Data from each facility were analyzed separately for women, men and patients with psychotic, affective, anxiety and substance use-related disorders. Interrupted time series were used to demonstrate possible effects of COVID-19.Results: COVID-19 was associated with a marked decrease in treatment contacts, both for women and men, in the general psychiatry emergency unit—driven by a significant decrease in anxiety-related disorders (p < 0.001) and affective disorders (p < 0.01)—but not in psychotic or substance use disorders (SUDs). Also, in the addiction psychiatry emergency unit, no significant impact of COVID-19 was seen.Conclusions: COVID-19 may decrease treatment uptake for acute affective and anxiety-related disorders. Given the hypothesized increase in the population regarding these conditions, societal efforts are needed to facilitate adequate treatment for these patients during the COVID-19 pandemic. Society should also remain vigilant with respect to SUDs during the pandemic.

The workplace culture in addiction psychiatry in Finland as described by healthcare personnel

Purpose The purpose of this study is to describe the workplace culture and factors associated with it from the viewpoint of the personnel providing care to patients with dual diagnosis. Design/methodology/approach Data were collected from six organizations using an electronic survey in 2019. The respondents (n = 75) worked in addiction psychiatry in specialized health care and provided care to patients. The data were statistically analyzed. Findings Workplace culture was evaluated as positive. Stress was experienced occasionally (Md = 2.58, Q1 = 1.96, Q3 = 3.03), job satisfaction levels were moderate (Md = 4.83, Q1 = 4.28, Q3 = 5.44) and the practice environment was evaluated as neutral (Md = 4.46, Q1 = 4.00, Q3 = 5.04). Gender, age in years, employment relationship, work time, staffing, number of patients and the participants’ experience in health care and experience in their current workplace had statistically significant associations with workplace culture. Originality/value In Finland, there have been attempts to reform service structures that also influence mental health and substance addiction services. Workplace culture is one approach to promote service development. Yet, there has been no research on workplace culture in the context of the care of patients with dual diagnosis. The results of this study bring knowledge about how health-care personnel perceives stress, job satisfaction and their practice environment in addiction psychiatry, which can be used to further develop services and workplace culture.

The challenges of delivering addictions psychiatry teaching in the COVID era

AimsDuring the pandemic, addiction psychiatry moved from face-to-face lectures (delivered by Addictions Psychiatrists) to bitesize pre-recorded lectures (delivered by clinical teaching fellows) alongside interactive tutorials (delivered by Addictions Psychiatrists). The Addictions Team developed an online tutorial (delivered via Blackboard Collaborate) containing a combination of information slides, case studies, interactive quizzes, and short videos. These were delivered ‘live’ to small groups of students in up to four simultaneous virtual classrooms on a 6-weekly rolling basis. We aimed to assess student and tutor feedback regarding the move to interactive online tutorials in addiction psychiatry.MethodTwo questionnaires sought feedback from students and tutors, focussing on the change from face-to-face to virtual teaching during a 20-week period.Result21 (of 161) students completed the questionnaire. •100% ‘strongly agreed’ or ‘agreed’ that the content of the tutorial was relevant to learning outcomes.•52% felt ‘somewhat comfortable’ unmuting their microphones to contribute verbally, contrasting to 24% feeling ‘not very’ or ‘extremely uncomfortable’. In practice, only 30% of students contributed verbally.•57% felt most comfortable contributing via the written ‘chat’ function (rather than audio or camera).•65% felt either ‘somewhat’ or ‘very comfortable’ turning their cameras on, but only 1 student turned their camera on across all tutorials.•48% felt the tutorial was more accessible virtually than face-to-face; 5% considered it less so.•When COVID restrictions are lifted, 14% would prefer the tutorial to remain virtual, 53% would rather it returned face-to-face, and 33% had no preference.7 (of 7) tutors completed the questionnaire. •100% felt that students having their camera on would make their experience of delivering teaching ‘much better’ or ‘better’.•71% of tutors felt that students contributed ‘slightly’ or ‘significantly’ less in the virtual classroom.•Only 29% of tutors found the experience of virtual teaching ‘very’ or ‘somewhat’ enjoyable, contrasting 43% finding it ‘somewhat’ or ‘very’ unenjoyable.•Several white space tutor comments suggested the lack of audio-visual engagement made teaching less rewarding, whilst also preventing them from adapting content, pace, and teaching style to suit the group's needs. Tutors felt that the ease of delivering teaching from any location was beneficial.ConclusionVirtual teaching has become embedded in medical education and will likely remain so post-pandemic. For it to be an effective and enjoyable experience, for both students and teachers, there needs to be adaptation of content, technology, etiquette and culture.