Psychiatric Considerations in Adult Sickle Cell Disease Treatments

Abstract: Sickle cell disease (SCD) is a known risk factor for reduced quality of life (QOL), low self-esteem, hopelessness, depression, anxiety, and cognitive impairment.^1,2 Chronic pain is known to be in a bidirectional relationship with severe depression, with up to 85% of pain sufferers developing depression,⁴ and depression increasing the risk of developing pain. Consult-Liaison Psychiatrists are likely to encounter patients with SCD in medical settings due to depression, concerns about opiate use, and team conflict, but very little training is available for specialty work in this area. Patients with SCD are often at an intersection of disparities including having an orphan illness, more commonly found in people of color, and having a combination of medical and neuropsychiatric comorbidities. This workshop aims to identify common psychiatric concerns for patients with SCD presenting for pain control, as they transition from pediatric to adult care, and in the stem cell transplant setting. Our presentations will include new data about suicidal ideation in transplanted patients with SCD, and integrated models of care to support these patients. We will discuss how CL psychiatrists can directly improve quality of life for these patients and support medical teams approaching SCD.

Dr. Carroll will discuss integrating psychiatric thought into the approach to SCD patients with treatment refractory chronic pain or frequent presentations for acute pain treatment. He will discuss behavioral input into disease-modifying therapy decisions, using operant principles to redesign the pain treatment paradigm, and prioritizing assessment for psychiatric comorbidities.

Dr. Prince will discuss unique psychiatric concerns and models of care delivery for patients transitioning to adult care. She will share cutting-edge data from Johns Hopkins’ integrated psychiatric care team for young adult patients with SCD including referral rates and prevalence of depression.

Dr. Mishkin will discuss quality of life issues in sickle cell disease such as pain, functionality, fertility, cognition, and personal effectiveness. She will describe current models of stem cell transplantation for sickle cell disease and will discuss criteria for this treatment. She will then revisit quality of life issues as they apply in the post-transplant setting, including pain trajectory, and social network expectations. She will reflect on which of these areas CL psychiatrists can best support.

Dr. Leimbach will present on depression and suicidality in SCD and will share preliminary data from Columbia University Medical Center about high rates of depression in patients with SCD presenting for transplant, and high rates of depression and suicidal ideation after transplant. She will discuss the role of CL psychiatrists in the interdisciplinary management of these patients moving between medical and psychiatric settings.