Phenobarbital vs Benzos for Alcohol Withdrawal – New Meta-analysis
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This systematic review and meta-analysis did not show significant improvement in measured patient outcomes for treatment of alcohol withdrawal syndrome with phenobarbital vs benzodiazepines.
Source
Phenobarbital Treatment of Alcohol Withdrawal in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2023 Nov 3. doi: 10.1111/acem.14825. Online ahead of print.
Catatonia – What You Need to Know
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
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Catatonia is a psychiatric condition with variable and unpredictable clinical features. Let's dive into how to recognize, diagnose, and manage it in the ED.
How to Help Hurting Colleagues – Suicide Risk in Healthcare Workers
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This cohort study of 1.8 million US healthcare workers (HCWs) found that registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide relative to non-HCWs.
Source
Suicide Risks of Health Care Workers in the US. JAMA vol. 330,12 (2023): 1161-1166. doi:10.1001/jama.2023.15787
It’s Not Me, It’s You – Personality Disorders
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Personality disorders are common and complex emotional difficulties that are challenging to identify, categorize, and manage. Language surrounding these often-stigmatized diagnoses is changing, as are the recommendations on treatment of individuals with personality disorders.
Does Suicide Risk Screening…Actually Reduce Suicide?
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Depression screening (with varying forms of intervention) reduces depression symptoms in follow up, and the screening tools are fairly accurate. Suicide screening (with various interventions) does not reduce suicidal ideation or suicide attempts and may actually increase attempts, though the evidence is very limited.
Source
Depression and Suicide Risk Screening: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023 Jun 20;329(23):2068-2085. doi: 10.1001/jama.2023.7787.
Pediatric Mental Health Related Visits Are Through the Roof
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From 2011 to 2020, the number of mental health visits in pediatric EDs increased from 7.7% to 13.1% of all encounters, with a significant increase in the proportion of suicide-related visits.
Source
National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. JAMA. 2023 May 2;329(17):1469-1477. doi: 10.1001/jama.2023.4809.
Can Kids Get Follow-Up After Emergency Mental Health Visits?
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Among Medicaid-enrolled children, rates of outpatient follow-up after discharge from the ED for a mental health (MH) diagnosis are low, particularly for children who are Black, have fee-for-service (vs. capitated) coverage, and without previous outpatient mental health visits.
Source
Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics. 2023 Mar 1;151(3):e2022057383. doi: 10.1542/peds.2022-057383.
Point-Counterpoint | IV Haloperidol Should be Avoided in the Emergency Department
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Here are the counterpoints for why these authors think intravenous (IV) haloperidol (Haldol) should be avoided in the emergency department setting.
Point-Counterpoint | IV Haloperidol is Safe for Emergency Department Use
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The next couple of reviews will look at different authors making their case for why intravenous (IV) haloperidol (Haldol) should or should not be used in the emergency department setting.
Source
Haloperidol May Be Safely Administered Intravenously in the Emergency Department. Annals of Emergency Medicine. 2023;81:95-96. doi: 10.1016/j.annemergmed.2022.07.004
Alcohol Withdrawal – Should We Reach for Phenobarbital?
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Hospital adoption of phenobarbital for severe alcohol withdrawal syndrome (SAWS) was associated with lower rates of invasive mechanical ventilation (IMV).
Source
Phenobarbital for Severe Alcohol Withdrawal Syndrome: A Multicenter Retrospective Cohort Study. Am J Respir Crit Care Med. 2022 Nov 1;206(9):1171-1174. doi: 10.1164/rccm.202203-0466LE.