THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Session aims to help rheumatologists recognize psychiatric disorders in patients

Common psychiatric conditions, such as mood, anxiety, adjustment, and substance abuse disorders, can complicate or interfere with treatment for other medical conditions, including rheumatic diseases. A special session at this year’s Annual Meeting will address the epidemiology of psychiatric disorders in the U.S., with a focus on the prevalence of these problems in rheumatology encounters.

The session, Psychiatry for the Rheumatology Practice, will be held on Sunday, from 2:30 – 4:00 pm in Room W184d.

Daniel Albert, MD, Professor of Medicine and Pediatrics at the Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH, will begin the session with an appraisal of the scope of the problem in terms of the prevalence of psychiatric disease and its frequency in rheumatic disease settings.

“It is fairly common to encounter psychiatric disease in the clinical care of patients with rheumatic disease. However, rheumatologists receive very little training in this area,” Dr. Albert said. “When we talk about the prevalence, the prototype is fibromyalgia, where it’s estimated that 30 to 40 percent of patients have some sort of psychiatric disease, usually depression. But it’s also true in RA and lupus and other diseases that we commonly see.”

In addition to a lack of training, Dr. Albert said that a lack of access to psychiatric care is a problem nationwide.

“It can be very hard to get patients into psychiatric care—oftentimes there are long waits, if there’s any availability at all,” he said. “And for patients who are less well off financially and don’t have good insurance, psychiatric care is basically a nonoption.”

As a result, he said, rheumatologists end up treating depression, chronic anxiety disorders, and bipolar disorder that would under ideal circumstances be treated by a psychiatrist.

“One of the major disabling aspects of rheumatic disease is depression. And being able to deal with it, both by alleviating the underlying rheumatic disease, but also dealing directly with depression as an independent entity is really important,” Dr. Albert said. “It’s also important that we understand our limits—none of us are experts in this area. We don’t want rheumatologists dealing with people who are actively suicidal, for example, but on the other hand, we don’t want them ignoring depression and other remediable psychiatric conditions.”

Dr. Albert said that all providers of rheumatologic care can benefit from this session, and he thinks all healthcare professionals need to educate themselves on how to recognize and manage mental health issues in their patients.

Devendra Thakur, MD, will bring the psychiatrist’s perspective to the discussion, explaining what rheumatologists need to know about patient referral and emergency management of mental health disorders. Dr. Thakur is an Assistant Professor of Psychiatry at Dartmouth-Hitchcock Medical Center.

“There are many topics in psychiatry that nonpsychiatrists tend to get very little exposure to in their training, but in their clinical practice, they might see quite often,” Dr. Thakur said. “We know that there’s a higher comorbidity of psychiatric disorders in patients who present to a rheumatologist, making it very important for rheumatologists to have a general understanding of how to deal with things like depression, anxiety, and eating disorders—anything that could influence the patient’s overall health but also influence their rheumatological presentation.”

It is especially important, he said, to know what to do when a patient presents in any sort of serious mental health crisis.

“If you have a patient who perhaps makes a suicidal or homicidal statement, or seems incapacitated due to psychosis, you have to know how to assess the situation,” Dr. Thakur said. “You may need to get them to an emergency room or you may need to call 911, depending on where you’re located and the nature of the crisis, as they may need to be evaluated by a mental health professional to determine if they need to be considered for involuntary commitment or can be safely sent home.”

Also in this session, Nicole M. Orzechowski, DO, Assistant Professor of Medicine at the Geisel School of Medicine at Dartmouth and Section Chief of Rheumatology at Dartmouth-Hitchcock Medical Center, will offer tips on how to recognize and assess specific psychiatric conditions in patients with rheumatic diseases and discuss various behavioral and pharmacological approaches to treatment.