Table of Contents - Academy of Psychosomatic Medicine

50. Identification of Characteristics of
Providers that Influence Prescription
of Analgesics for Patients With Pain: A
Systematic Review of the Literature.
Presenting Author: Lauren Franz, MBChB, MPH
Co-Authors: Deepmala Deepmala, MBBS, Carolina Aponte
Urdaneta, MD, Wei Jiang, MD
Purpose: Pain is a co-morbid and aggravating symptom
in many conditions which can be perceived differently, and
therefore, managed differently. Numerous factors, in particular
social and cultural factors, are thought to influence analgesic
prescription. However, elucidation of such areas is limited.
Therefore, we conducted a systematic literature review
to test the hypothesis that variations in provider characteristics
predict prescription of analgesics for patients with pain.
Methods: A MEDLINE and Psychinfo database search from
1960 to 2009 was conducted using the search terms of pain
treatments, culture, ethnicity, race, gender, and physician
practices. A total of 142 articles were initially identified, but
only 12 articles were included in the final analysis following
consensus by three independent reviewers based on inclusion
criteria. For inclusion the studies needed to contain information
on both provider demographic characteristics and
analgesic prescription practices for pain in the analysis section
of the paper.
Results: Of the 12 studies, all were cross-sectional in design,
and 10 used a survey instrument to measure quantitative
responses. A randomized sampling methodology was
used in 5 of the studies and a convenience sample was used
in 4. A great heterogeneity existed among all the studies in
terms of population, and purpose. A total of 3531 providers
were identified among the 11 studies that presented data.
The majority of providers who participated in these studies
were male (64.9% in 8 studies that presented data), Caucasian
(73.5% in 5 studies), internal medicine physicians and
primary care providers (65.25% in 10 studies) and located
in the United States (75% across all 12 studies). Of the 12
studies 10 identified at least one provider characteristic that
influenced prescription practices. Age, level of experience,
and gender were listed most frequently as contributing factors.
The interplay between the gender of providers and patient
characteristics appeared to be an important variable in
pain management as well.
Conclusions: Our systematic review of existing literature
highlights that a provider’s age, gender, experience, specialty
and the interplay between provider and patient characteristics
are important variables in pain management. We also
found lacunae in the literature on the influence of physician’s
ethnicity or primary medical training in various cultures or
global regions on pain management practices. A homogeneity
of provider profiles was noted, which limits generalizability
of data from these studies. A systematic approach to evaluate
the influence of provider’s characteristics on pain management
is essential and imperative.
21
51. Encephalitis Associated with NMDA
Receptor Antibodies
Presenting Author: Abdul Khalid, MD
Co-Author: David Straker, DO
Background: Paraneoplastic encephalitis associated with
N-methyl-D-aspartate receptor antibodies is a rare syndrome
that should be considered in the differential diagnosis of a
young, female patient with no prior psychiatric history who
has a sudden change in mental status, exhibits bizarre behavior,
and has prominent psychiatric symptoms accompanied
by seizures, autonomic instability, hypoventilation and
dyskinesias.
Objective: The authors hope to increase the awareness of
such a syndrome as demonstrated in the case presented.
Method: The authors report on a 20 year old previously
healthy female with no past psychiatric history who presented
with a sudden onset of change in behavior, mutism, agitation,
staring spells, and dis-inhibited behavior, accompanied
by seizures, hyperthermia and prominent autonomic instability.
She also had muscle rigidity, frequent facial grimacing
and kicking motions of the legs.
Results: The patient was treated with anticonvulsant medication
to control her seizures. She was then placed on high
dose steroids with small improvement noted. Subsequently
a vas cath was placed for plasmapheresis. IVIG was given
and by Day 3 the patient was much more interactive with
significant overall improvement by Day 5. The patient was
discharged 3 days later. Two months after discharge the
patient’s family reported that she was back to her baseline
functioning.
Conclusion: Paraneoplastic anti-NMDA receptor encephalitis
is a potentially lethal syndrome, but is usually reversible
if promptly recognized and treated. Early recognition and
awareness can lead to appropriate treatment and resolution
of symptoms.
52. Disordered Eating in Schizophrenia and
Superior Mesenteric Artery Syndrome - A
Psychosomatic Case Study
Presenting Author: Khyati Brahmbhatt, MD
Co-Author: Geraldine Mayor, MD
Purpose: The purpose of this poster is to analyze the relation
between psychosis and disordered eating, demonstrate
the relation of disordered eating to Superior Mesenteric Artery
Syndrome (SMAS) and appreciate Confounding effects
of Psychiatric diagnosis on medical care using a clinical case
report.
Methodology: Case report
Introduction: SMAS is a form of upper intestinal obstruction
caused by compression of the third part of the duodenum by
the superior mesenteric artery due to loss of peritoneal fat.
Most cases in psychiatry are related to Anorexia Nervosa.