Innovations in Psychiatry Newsletter

September 2021

Hot Topics in Psychiatry: 10 Questions With Dr. Henry A. Nasrallah

Introduction

We are back again this month with a candid interview with Henry A. Nasrallah, MD. Dr. Nasrallah is Vice-Chair for Faculty Development and Mentorship, Professor of Psychiatry, Neurology, & Neuroscience and Director, Neuropsychiatry and Schizophrenia Programs at the University of Cincinnati College of Medicine in Cincinnati, Ohio. In addition to keeping busy with those demanding roles, Dr. Nasrallah also serves as Editor-in-Chief of the journal Current Psychiatry, and he is also President of the American Academy of Clinical Psychiatrists (AACP).
Dr. Nasrallah also serves as Symposium Director for the 20th Annual Virtual Psychopharmacology Update, which is on October 23, 2021, with additional optional preconference workshops and keynote speaker on October 22. With this year’s focus of Rational Combination Therapies and Complexities in Psychotic and Mood Disorders, this full-day course will include nationally renowned faculty teaching a Master Class within this focus. 
For this issue, Dr. Nasrallah agreed to participate in a new 10 Questions With segment as we deviate from our normal interview format. In this new rapid-fire Q&A segment, we covered career challenges and accomplishments, Dr. Nasrallah’s favorite journals, his most frustrating treatment issue, thoughts on yoga for Parkinson’s, what treating BPD means, publication he is most proud of, and more. Read on for an inside look at some of these topics to keep current!
Our last issue included insights from Dr. Robert McCarron on several current topics, including his career challenges and accomplishments, asynchronous telepsychiatry (ATP), current guidance on diagnosis and treatment of MDD, and some of the latest research applicable to your practice. If you missed it, you can find that interview here.
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, New England Journal of Medicine, and JAMA Psychiatry—check them out below. 
On behalf of the University of Cincinnati and Current Psychiatry, you are invited to attend the Virtual 20th Annual Psychopharmacology Update MedscapeLIVE! event. It’s right around the corner on October 23, and you don’t want to miss it! Register here. 
Thank you to Dr. Nasrallah for his participation and perspectives this month. Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

10 Questions with Dr. Henry Nasrallah

Henry A. Nasrallah, MD, is Vice Chair for Faculty Development and Mentorship; Professor of Psychiatry, Neurology, & Neuroscience; Director, Neuropsychiatry and Schizophrenia Programs; Director, Psychiatry CME Programs, University of Cincinnati College of Medicine.

Role as AACP President: To develop clinical psychiatrists into hard-nosed, evidence-based practitioners, with life-long learning habits.

My most frustrating treatment issue: Severe forms of psychopathology that rarely achieve remission, especially with childhood onset: the anxieties, OCD, PTSD, mood disorders, schizophrenia, and personality disorders.

Most promising and useful recent research in schizophrenia treatment: Current drug development for negative symptoms and cognitive deficits.

My mentors: At different stages of my career—John Romano during residency; Chris Gillin during my NIH fellowship; and George Winokur during my academic psychiatry career.

Yoga for Parkinson’s disease: Useful but underutilized adjunctive physical therapy for both the motor and mood symptoms of this serious neuropsychiatric disorder.

Innovations in Psychiatry conference: The can’t-miss educational experience for psychiatrists to remain on the cutting edge and learn about future advances.

Publication you are most proud of: For clinicians: Current Psychiatry, where I have served as Editor-in-Chief for 15 years. Current Psychiatry is the most useful and practical journal for busy practitioners, with the latest advances about the phenomenology and multi-modal treatments of psychiatric disorders. For researchers: 2 journals I founded: Schizophrenia Research and Biomarkers in Neuropsychiatry

Treating BPD: Juggling multiple pharmacological and psychosocial therapies.

Biggest challenge: Dealing with frequent personal problems of the hundreds of staff I supervised over the years, which demanded time and distracted me from teaching, research, editorial responsibilities, and patient care.

Most rewarding accomplishment: Giving back… Philanthropic donations to establish 5 Endowed Lectureships and a Neuroscience Center at several universities.

 
Psychiatry Resource Section

JAMA Psychiatry Viewpoint: Transforming Mental Health Care Delivery Through Implementation Science and Behavioral Economics
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780654

MDEdge Clinical Psychiatry News Article Commentary: Is social media worsening our social fears? 
https://www.mdedge.com

APA Learning Center Free Members August Course of the Month: Computational Psychiatry and Future Perspectives—Credits CME:1.5, Participation:1.5
https://education.psychiatry.org/diweb/catalog/item?id=8278225

JAMA Psychiatry Special Communication: Pragmatic Precision Psychiatry—A New Direction for Optimizing Treatment Selection 
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2784467

MDEdge Clinical Psychiatry News Article: How to engage soldiers, veterans in psychiatric treatment
https://www.mdedge.com

New England Journal of Medicine Perspective: Criminalization of Gender-Affirming Care — Interfering with Essential Treatment for Transgender Children and Adolescents
https://www.nejm.org/doi/full/10.1056/NEJMp2106314

JAMA Psychiatry Original Investigation: Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2784468

 

August 2021

Hot Topics in Psychiatry: Dr. Robert M. McCarron on career challenges and accomplishments, asynchronous telepsychiatry (ATP), up-to-date guidance on diagnosis and treatment of MDD, and some of the latest applicable research.

Introduction

We are back again this month with a candid interview with Robert McCarron, DO. Dr. McCarron is Professor, Department of Psychiatry and Behavioral Medicine, Director of UCI Train New Trainers Primary Care Psychiatry Fellowship, and Assistant Dean, Continuing Medical Education at the University of California, Irvine School of Medicine. He is also Director of Education for the UCI Susan Samueli Integrative Health Institute. Dr. McCarron is a past president of the Central California Psychiatric Society, California Psychiatric Association and the Association of Medicine and Psychiatry, and is the Medicine / Psychiatry Section editor for Current Psychiatry. Dr. McCarron has numerous publications in unexplained physical complaints; pain management; depression and anxiety in the primary care setting; preventive medicine; medical / psychiatric cross-disciplinary education and psychiatric integrated care. He spends much of his time consulting on how best to provide “cross disciplinary training” at the interface of primary care medicine, chronic pain management, psychiatry, and integrative medicine, and is a national thought leader in psychiatric integrated education care. With a dual residency in internal medicine and psychiatry, Dr. McCarron went on to start the only two California-based combined internal medicine / psychiatry residency programs. In these roles, he received grant support to create and implement a “Med Psych” curriculum that can be used in the public mental health system by psychiatry residency training programs.
Dr. McCarron and I covered several current topics including his career challenges and accomplishments, asynchronous telepsychiatry (ATP), current guidance on diagnosis and treatment of MDD, and some of the latest research applicable to your practice.
Read on for an inside look at some of these topics to keep current!
Our last issue included insights from Dr. Leslie Citrome on new research in schizophrenia treatment, tardive dyskinesia, and eating disorders. If you missed it, you can find that interview here.
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, and JAMA Psychiatry—check them out below. 
Don’t forget to check out details for Medscape’s upcoming virtual conference, Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care, a MedscapeLIVE! event. It’s right around the corner and you don’t want to miss it!
Thank you to Dr. McCarron for his participation and perspectives this month. Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 
Interview

Hot Topics in Psychiatry: Dr. Robert McCarron on career challenges and accomplishments, asynchronous telepsychiatry (ATP), up-to-date guidance on diagnosis and treatment of MDD, and some of the latest applicable research.
Robert M. McCarron, DO, is the Director of Education, Susan Samueli Integrative Health Institute, and also Assistant Dean, Continuing Medical Education, and Director, UCI Train New Trainers Primary Care Psychiatry Fellowship, at the University of California, Irvine School of Medicine.

Colleen: What has been your biggest challenge and your most rewarding accomplishment in your career?
Dr. McCarron:
My biggest challenge has been to continually reconfigure and focus my time and energy toward those professional roles and goals most important to me. As an internist / psychiatrist with experience in pain medicine, integrative care and underserved care, I have many interests and it has been difficult to not do critical care/hospitalist internal medicine or more psychotherapy, for example. On the flip side, my biggest accomplishment has been to use my broad-based clinical experience to teach students, residents, fellows, and community-based clinicians in a more holistic manner. I feel blessed to be in the position of having a long-term, clinically practical (and hopefully positive) influence on those who practice medicine, particularly those who choose to address disparities in medicine by working with disadvantaged patient populations.  

Colleen: What is some of the latest research that is applicable to the current psychiatrist practice?
Dr. McCarron:
Those who struggle with mental illness, particularly severe illness, are uniquely vulnerable due to the inherent complexity of psychiatric disorders and increased likelihood for premature morbidity and mortality. Many of these patients receive suboptimal mental health, preventive, and primary care. Most of the behavioral health care delivered in the US is done so in the primary care setting, by primary care clinicians. The University of California, Irvine, Train New Trainers Primary Care Psychiatry Fellowship provides targeted “primary care psychiatric” training to frontline PCPs. Preliminary data show this type of training can both optimize and expand psychiatric care, particularly in underserved settings.

Colleen: Your 2018 article on telepsychiatry and other technologies for integrated care in Int Rev Psychiatry was prescient given the pandemic that has necessitated telehealth to some degree for practicing clinicians. How would you characterize the psychiatrist community’s adoption, and how has it played out with regard to outcomes and integrated care with the primary care arm?
Dr. McCarron: I believe asynchronous telepsychiatry (ATP) is an important adjunct to collaborative care. ATP allows the psychiatrists to see the patient and perform a mental status exam as part of a collaborative care assessment. Peter Yellowlees, MD, is at the forefront of this type of evolving practice and has written extensively in the area. It’s important to note that ATP is designed to greatly expand access to care and serve as an important connector with primary care teams.

Colleen: Congratulations on your May 2021 publication in Annals of Internal Medicine (Depression. Ann Intern Med. 2021 May;174(5):ITC65-ITC80). Can you share some of the main pearls this article provides regarding up-to-date guidance on diagnosis and treatment of MDD?
Dr. McCarron: For some, depression can be difficult to treat. It’s important for psychiatrists to use both psychopharmacology and psychotherapy tools when partnering with patients to help manage complex mood disorders. Use of motivational interviewing, particularly assessment of willingness to change maladaptive behavior, is a critical component to the treatment of any medical condition, including depression.

 
Psychiatry Resource Section

JAMA Psychiatry Original Investigation: Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care—A Pragmatic Randomized Comparative Effectiveness Trial
https://jamanetwork.com

MDEdge Clinical Psychiatry News Article: Pandemic unveils growing suicide crisis for communities of color
https://www.mdedge.com

Current Psychiatry Article: Becoming vaccine ambassadors: A new role for psychiatrists
https://www.mdedge.com

APA Learning Center Free Members August Course of the Month: Computational Psychiatry and Future Perspectives—Credits CME:1.5, Participation:1.5
https://education.psychiatry.org/diweb/catalog/item?id=8278225

New England Journal of Medicine Perspective: Depression in Adolescents
https://www.nejm.org/doi/full/10.1056/NEJMra2033475

 

July 2021

Hot Topics in Psychiatry: Dr. Leslie Citrome on New Research in Schizophrenia Treatment, Tardive Dyskinesia, and Eating Disorders

Introduction

We are back again this month with a candid interview with Leslie Citrome, MD, MPH, MBA. Dr. Citrome is a Clinical Professor of Psychiatry and Behavioral Sciences at New York Medical College in Valhalla, New York and has a private practice in Pomona, New York. Dr. Citrome is on the Board of Directors of the American Society of Clinical Psychopharmacology and the Mental Health Association of Rockland County. He was the Founding Director of the Clinical Research and Evaluation Facility at the Nathan S. Kline Institute for Psychiatric Research in Orangeburg, New York, and has dedicated almost 20 years of government service researching the psychopharmacological treatment of severe mental disorders. His main research has been in psychopharmacologic approaches to schizophrenia and management of treatment-refractory schizophrenia, bipolar disorder, major depressive disorder, and aggressive and violent behavior management. He also currently serves as a consultant in clinical trial design and interpretation.
Dr. Citrome and I covered several current topics, including the most promising new research in psychopharmacology—specifically schizophrenia, recent updates he has published on eating disorders and tardive dyskinesia, and experience with mentorship—both being mentored and providing mentorship. Read on for an inside look at some of these topics to keep current!
Our last issue included insights from Dr. Brian Holoyda, including the new findings in psychedelics, violence, and psychiatric treatment, Oregon’s legalization of medicinal use of psychedelics, and his recently published update on sexsomnia. If you missed it, you can find that interview here.
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDEdge Psychiatry, and JAMA Psychiatry—check them out below. 
Thank you to Dr. Citrome for his participation and perspectives this month. Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

Interview

Hot Topics in Psychiatry: Dr. Leslie Citrome on promising research in psychopharmacology, an update on eating disorders, takeaways from his article on tardive dyskinesia, and his recently published update on eating disorders.
Dr. Citrome is Clinical Professor of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York. He is Current Psychiatry’s Section Editor, Psychopharmacology. Dr. Citrome also currently serves as a consultant in clinical trial design and interpretation.

Colleen: What is some of the most promising research in psychopharmacology on the horizon that you feel may make a significant difference for patients?
Dr. Citrome:
There are exciting new advances in the medication treatment of schizophrenia. In late stages of clinical development are novel compounds that work without directly blocking postsynaptic dopamine receptors, and thus these agents avoid the problem of drug-induced movement disorders such as tremor, rigidity and akathisia. Also avoided are elevations in prolactin and alterations in glucose and lipid metabolism. One of the agents is SEP-363856 and is a trace amine-associated receptor 1 (TAAR1) agonist, thought to work by modulating neurotransmission in monoaminergic neurons. SEP-363856 also has serotonin 5HT1D, 5HT1A, and 5HT7 receptor binding properties. In a phase 2, randomized, double-blind, 4-week study comparing effects of SEP-363856 to placebo in patients with schizophrenia, SEP-363856 was superior to placebo in reducing the symptoms of schizophrenia and was not associated with extrapyramidal symptoms, akathisia, or hyperprolactinemia. Adverse events included somnolence and gastrointestinal symptoms. Another agent that offers a different mechanism of action is the combination of xanomeline (a muscarinic M1/M4 agonist) and trospium (a muscarinic receptor antagonist that has minimal, if any, penetration of the blood brain barrier, blocking unwanted peripheral cholinergic side effects of xanomeline). This medication reduced the symptoms of schizophrenia to a greater extent than placebo in a phase 2, randomized, double-blind, 5-week study. The most common adverse events in the xanomeline–trospium group were constipation, nausea, dry mouth, dyspepsia, and vomiting. The incidences of somnolence, weight gain, restlessness, and extrapyramidal symptoms were similar for xanomeline–trospium as for placebo. Of note, both of these studies were published in the New England Journal of Medicine. 

Colleen: Regarding your recently published update on eating disorders, where do we stand in terms of diagnosis and treatment?
Dr. Citrome:
Eating disorders are more common than what most people and clinicians think. Although anorexia nervosa and bulimia nervosa may be more obvious to detect, binge eating disorder (BED) is generally invisible to others. People with BED generally binge eat in secret and are often unaware that their loss of control in how they eat is actually a treatable disorder. BED can occur in both men and women, and in any ethnic/racial group. BED is more common than anorexia nervosa and bulimia nervosa combined. BED is often comorbid with other psychiatric and non-psychiatric disorders, and screening for BED is a worthwhile endeavor for both psychiatric specialty care and primary care. It can be as simple as asking people about their appetite (a standard question when getting a history during any routine evaluation) followed by "Talking about appetite, have you ever eaten more than you intended?” or “Did you feel like it wasn’t possible to stop?’’ Available effective treatments include psychological treatments such as cognitive behavioral therapy and medication treatments such as lisdexamfetamine. 

Colleen: During your career, what has been your experience with mentorship—both being mentored and providing mentorship, and what advice do you have for medical school students seeking to become psychiatrists?
Dr. Citrome: Mentor-mentee relationships often emerge serendipitously, especially during clinical rotations and many medical students can identify influential teachers that they have interacted with and reach back out to them when pondering career choices post-graduation. For medical students contemplating a career in psychiatry, asking faculty for advice is a good start and it is not unusual for enduring collegial friendships to begin this way. Looking back at my own experience, it was contact with an attending psychiatrist during my psychiatry rotation that led me to a summer research project, additional contact with other members of the department, and ultimately to a recommendation to a residency program where one of my mentors had recently been a chief resident. Today I serve as a mentor/advisor/colleague/teacher to psychiatric residents and junior faculty across different institutions, sometimes by chance (networking at professional meetings and finding that we have similar interests) and at other times by design (programs designed to link up mentees with mentors through our local district branch of the American Psychiatric Association and through the American Society of Clinical Psychopharmacology).

 

Psychiatry Resource Section

JAMA Psychiatry Original Investigation Article: Three Important Considerations for Studies Examining Pathophysiological Pathways in Psychiatric Illness; In-depth Phenotyping, Biological Assessment, and Causal Inferences
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2777613

MDEdge Clinical Psychiatry News Article: Are you at legal risk for speaking at conferences?
https://www.mdedge.com

Current Psychiatry Pearls Article: Improving nonverbal communication during telepsychiatry sessions:
https://www.mdedge.com/psychiatry/article/242368/practice-management/improving-nonverbal-communication-during

APA Learning Center Free Members July Course of the Month: Seeing Through the Smoke: Medicolegal Implications of Medical Marijuana—Credits CME:1.75, Participation:1.75
https://education.psychiatry.org

New England Journal of Medicine Perspective: From Crime to Care — On the Front Lines of Decarceration
https://www.nejm.org/doi/full/10.1056/NEJMp2107013

 

June 2021

Hot Topics in Psychiatry: Dr. Brian Holoyda on psychedelics, violence, and psychiatric treatment, Oregon’s legalization of medicinal use of psychedelics, and sexsomnia

Introduction

We are back again this month with a candid interview with Brian Holoyda, MD, MPH, MBA. Dr. Holoyda is a forensic and correctional psychiatrist. In his clinical practice, he treats inmates at a pre-trial detention facility in the Bay Area of California, and he also has a private forensic practice and conducts forensic psychiatric evaluations around the US. He specializes in the assessment of violence and sexual violence risk. His research interests include rare paraphilic disorders, psychedelic drugs, and atypical group beliefs
Dr. Holoyda and I covered several current topics regarding his research and expertise, including the new findings in psychedelics, violence, and psychiatric treatment, Oregon’s legalization of medicinal use of psychedelics, and his recently published update on sexsomnia.
Read on for an inside look at some of these topics to keep current!
Our last issue included insights from Dr. Diana Martinez, including the latest research on efficacy and application of cannabis, new findings in cocaine addiction treatment, advances in the study of transcranial magnetic stimulation for alcohol use disorder and also chronic pain, and the issue of women being underrepresented in academic research in the field of psychiatry. If you missed it, you can find that interview here.
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, and JAMA Psychiatry—check them out below. 
Don’t forget to check out details for Medscape’s upcoming virtual conference, Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care, a MedscapeLIVE! event. It’s right around the corner and you don’t want to miss it!
Thank you to Dr. Holoyda for his participation and perspectives this month. Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Interview

Hot Topics in Psychiatry: Dr. Brian Holoyda on new research in psychedelics, violence, and psychiatric treatment, Oregon’s legalization of medicinal use of psychedelics, and his recently published update on sexsomnia
Brian Holoyda, MD, MPH, MBA is a forensic and correctional psychiatrist. In his clinical practice, he treats inmates at a pre-trial detention facility in the Bay Area of California. He also has a private forensic practice and conducts forensic psychiatric evaluations around the United States. He specializes in the assessment of violence and sexual violence risk. He has served as a consultant to People for the Ethical Treatment of Animals (PETA) about animal cruelty and interpersonal violence. His research interests include rare paraphilic disorders, psychedelic drugs, and atypical group beliefs.

Colleen: You recently participated in an MDedge Psychcast, titled Psychedelics, violence, and psychiatric treatment: early and emerging research. What are the main take-home points for practicing clinicians?
Dr. Holoyda: Psychedelic drugs like psilocybin are receiving increasing research interest for the treatment of various psychiatric conditions. Psilocybin and related compounds may gain FDA approval as psychotherapeutic agents within the next 10 years. Oregon, however, has already passed legislation legalizing psychedelic-assisted psychotherapy before the compounds have been properly studied and approved, in part to circumvent their use under a medical model. This situation raises important issues regarding both the model of their administration, as well as how psychedelics may be administered in a psychiatric context.
 
Due to their risk for potential adverse effects, including agitation and violence, and liability concerns resulting from negative outcomes of psychedelic use, psychedelic-assisted psychotherapy should occur in a medically monitored setting. Recent research studies assessing psychedelics’ therapeutic potential have largely excluded individuals with a personal or family history of disorders like bipolar disorder and psychotic disorders that may predispose individuals to challenging experiences, otherwise known as “bad trips.” Individuals considering treatment with psychedelics for psychiatric indications therefore require proper screening by qualified medical professionals. In addition, psychiatrists involved in psychedelic-assisted psychotherapy should ensure that patients undergo a thorough informed consent procedure, since patients are likely to lose the capacity to make decisions regarding their care in the context of a high-dose psychedelic journey. For example, a patient may become agitated or aggressive during a psilocybin journey and require either physical restraint or the administration of a sedative, an intervention to which he may be unable to give or withhold consent in the moment. Adequate informed consent, then, will reduce the risk of potential malpractice litigation in such cases.

Colleen: While it can be considered progress that the state of Oregon recently legalized medicinal use of psychedelics, what are your thoughts on the proposed models for administration?
Dr. Holoyda: There are numerous legal considerations regarding psychedelic-assisted psychotherapy occurring in non-medically monitored settings. In Oregon, for example, the group responsible for coordinating regulations around psychedelic-assisted psychotherapy is considering offering an online course as the prerequisite before an individual can administer psychedelics to another person. Reportedly, the proposed level of necessary education would be high school graduation. This care model would be inappropriate for psychedelic-assisted psychotherapy in any context. If an individual is solely required to take an online course before administering psychedelics, then there would be limited or no professional oversight and no standard of care for their provision. Non-professionals administering psychedelics, then, will likely face civil lawsuits of battery and the negligent infliction of emotional distress, if they restrain patients or if their patients have a bad trip with lasting emotional harm, respectively. Furthermore, psychedelics have the potential to completely incapacitate individuals, raising the risk of homicide, physical assault, sexual assault, and theft by an allegedly qualified guide.
Colleen: What are the main pearls from your recently published update on sexsomnia, and where do we stand in terms of evaluation and management?
Dr. Holoyda: Sexsomnia refers to sexual behavior that occurs during sleep. Its use in court as a potential exculpatory condition for individuals charged with sexual offenses has made it a controversial diagnosis. Sexual acts performed during sleep include masturbation, spontaneous orgasm, sexual vocalization, oral sex, anal sex, fondling, attempted intercourse, and completed sexual intercourse. Men are affected more than women. The diagnosis of sexsomnia requires a thorough clinical history, sleep history, and collateral history. Individuals with sexsomnia often have a history of other parasomnic behaviors, such as sleepwalking or sleep talking. Video polysomnography, or the “sleep study,” may assist in diagnosing sexsomnia; however, research studies have not yet recorded sexual behavior in sleep in individuals presenting with a complaint of sexsomnia. The treatment of sexsomnia includes sleep hygiene, stress management, avoidance of alcohol and other drugs, and optimizing the sleep environment to reduce the recurrence of potentially unwanted sexual activity. Some reports indicate that benzodiazepines may be helpful to reduce its recurrence. In forensic contexts, evaluators should conduct a complete psychosexual assessment, potentially including psychophysiologic measures like virtual reaction time (VRT) and penile plethysmography (PPG), to assess for paraphilic disorders that an individual may attempt to obfuscate with a claim of sexsomnia.

References

  1. Holoyda. 2020. The psychedelic renaissance and its forensic implications. Journal of the American Academy of Psychiatry and the Law.
  2. Holoyda. 2020. Psychedelic psychiatry: Preparing for novel treatments involving altered states of consciousness. Psychiatric Services.
  3. Holoyda et al. 2021. The forensic evaluation of sexsomnia. Journal of the American Academy of Psychiatry and the Law. [online ahead of print] 

 
Psychiatry Resource Section

JAMA Psychiatry Original Investigation Article: Functional Connectivity in Antipsychotic-Treated and Antipsychotic-Naive Patients with First-Episode Psychosis and Low Risk of Self-harm or Aggression
A Secondary Analysis of a Randomized Clinical Trial
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2781373

MDEdge Current Psychiatry Article: Pharmacogenetic testing: Navigating through the confusion
https://www.mdedge.com

AGENDA: 2021 Psychiatry Update CME/CE Virtual Event (June 15-19): Solving Clinical Challenges -- Improving Patient Care:
https://na.eventscloud.com/website/21668/agenda/

Current Psychiatry Article: 4 tips for working with caregivers of children with somatic disorders
https://www.mdedge.com

APA Learning Center Free Members May Course of the Month: Correctional Psychiatry: Improving Access, Safety, and Efficacy—Credits CME: 1.0, Participation:1.0
https://www.psychiatry.org

Clinical Psychiatry News Article: Depression remains common among dystonia patients
https://www.mdedge.com/

 

MAY 2021

Hot Topics in Psychiatry: Dr. Diana Martinez on Her Latest Research 

Introduction

We are back again this month with a candid interview with Dr. Diana M. Martinez, Professor of Psychiatry at the Columbia University Medical Center, and Director of the Martinez Lab at New York State Psychiatric Institute, where she directs research on novel uses for existing therapies. 
Dr. Martinez specializes in addiction research and basic brain mechanisms of addiction studied with brain imaging methods, including PET scanning and MRI. She also conducts studies using established treatments for new indications. Some of her current research includes investigating ketamine for tinnitus, a clinical trial of cannabinoids for neuropathy, and transcranial magnetic stimulation for alcohol use disorder and chronic pain.
Dr. Martinez and I covered several current topics regarding her research, including the latest research on efficacy and application of cannabis, new findings in cocaine addiction treatment, advances in the study of transcranial magnetic stimulation for alcohol use disorder and also chronic pain, and the issue women being underrepresented in academic research in the field of psychiatry.
Read on for an inside look at some of her recent research and perspective to keep current on treatment strategies!
Last issue included insights from Dr. Jon E. Grant, including recent advances in neuropsychopharmacology, trichotillomania and excoriation disorders, and his publications on impulsive and compulsive behaviors, including measurement via self-report tools, firearm ownership, and brain micro-architecture and disinhibition. If you missed it, you can find that interview here.
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, and JAMA Psychiatry—check them out below. 
Don’t forget to check out details for Medscape’s upcoming virtual conference, Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care, a MedscapeLIVE! event. It’s right around the corner and you don’t want to miss it!
Thank you to Dr. Martinez for her participation this month. Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 
Interview

Hot Topics in Psychiatry: Dr. Diana Martinez on Her Latest Research
Dr. Diana M. Martinez, Professor of Psychiatry at the Columbia University Medical Center, and Director of the Martinez Lab at New York State Psychiatric Institute, New York, New York.

Colleen: What is some of the latest research on efficacy and application of cannabis that is applicable to the current psychiatrist’s practice?
Dr. Martinez:
There’s a lack of research when it comes to medical uses for cannabis, due to its status as a schedule I drug (cannabis researchers must abide by federal regulations, even if they work in a state with legalized cannabis). Nonetheless, there is data supporting medical uses for delta-9 THC, whether it’s from the plant or the FDA-approved drug dronabinol. The strongest support for delta-9 THC is for the following conditions: chronic pain, spasticity due to MS (multiple sclerosis), chemotherapy-induced nausea/vomiting, and weight gain in HIV.

When it comes to psychiatric disorders, we have some early evidence suggesting that delta-9 THC can help with sleep disorders, Tourette’s syndrome, PTSD, and OCD. Studies in medically ill patients (chronic pain and MS) indicate that THC helps to reduce anxiety, although there is a lack of large studies in patients with a primary diagnosis of an anxiety disorder. Notably, studies in medically ill patients show no difference between THC and placebo when it comes to symptoms of depression. 

On the other hand, there is data showing that cannabis use in psychiatric patients can worsen the course of illness, especially bipolar disorder and the early phase of psychosis. Furthermore, cannabis use can lead to a substance use disorder, and patients with an underlying psychiatric disorder are at a greater risk compared to the general population. This raises the question: at what point should the clinician worry about their patients’ cannabis use? In my mind, this is similar to alcohol: cannabis use that meets criteria for a substance use disorder or cannabis use in a refractory patient. It’s key to review the 11 criteria for substance use disorder, which are available online, and to intervene when criteria are met for even a mild disorder. In a patient who is refractory to treatment, it’s worth looking into their cannabis use to see if this is a factor. However, it’s key to know why the patient is using cannabis, since this is unlikely to change if their reason for using is not addressed by other means. Common reasons for patients’ cannabis use include: to ameliorate pain and anxiety, to improve sleep, and to increase social interaction. These factors would need to be addressed by other treatments or interventions in order to reduce or stop cannabis use. 
 
Lastly, there is data showing that heavy, regular cannabis use is associated with an increased risk of suicidal thoughts and attempts. However, it’s key to recognize that this risk is not specific to cannabis: drug use, especially alcohol and opioids, is associated with an increased risk of suicide. Nonetheless, this information indicates that suicide prevention must include addressing drug use with an open and frank conversation with our patients.

Colleen: You are involved in research in cocaine addiction. What is new in this area of study that you feel is going to be most rewarding to the practicing psychiatrist?
Dr. Martinez:
Finding pharmacologic treatments for cocaine addiction has been tough. Many clinical trials have been performed, but we still lack a formally FDA-approved medication for this disorder. Nonetheless, there are promising data. A recent meta-analysis showed that prescription psychostimulants can help patients with a cocaine use disorder achieve sustained abstinence. The most consistent positive results were seen with long-acting dextroamphetamine and long-acting mixed amphetamine salts. There is also data indicating that combining prescription psychostimulants with topiramate, a GABA agonist/glutamate antagonist, is effective in promoting sustained abstinence. 

Additional studies have also shown positive results with ketamine and transcranial magnetic stimulation (TMS). Ketamine was shown to reduce craving and improve abstinence from cocaine in a study that administered a single intravenous infusion combined with mindfulness-based behavioral modification. Early studies indicate that transcranial magnetic stimulation (TMS) might help with cocaine use disorder. These studies have included imaging studies, small trials, and observational studies, but the results are promising. Additional clinical trials are now being done to look into this question.

Lastly, a number of studies support the use of behavioral therapies, including cognitive behavioral therapy (CBT), community reinforcement approach (CRA), and contingency management (CM). While CBT emphasizes the use of cognitive control to counteract the impulse to use drugs, CRA focuses on replacing the positives of drug use with positives from the person’s environment, like family, friends, work or school. CM uses rewards to deter drug use, like vouchers or gift cards that are used for non-drug social activities. Research studies show that CM is effective for treating addiction especially when combined with CRA.

References

  1. Tardelli VS, Bisaga A, Arcadepani FB, Gerra G, Levin FR, Fidalgo; Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis..Psychopharmacology (Berl). 2020 Aug;237(8):2233-2255. doi: 10.1007/s00213-020-05563-3. 
  2. Dakwar E, Nunes EV, Hart CL, Foltin RW, Mathew SJ, Carpenter KM, Choi CJJ, Basaraba CN, Pavlicova M, Levin FR. A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial. Am J Psychiatry. 2019 Nov 1;176(11):923-930.
  3. Hanlon CA, Kearney-Ramos T, Dowdle LT, Hamilton S, DeVries W, Mithoefer O, Austelle C, Lench DH, Correia B, Canterberry M, Smith JP, Brady KT, George MS. Developing Repetitive Transcranial Magnetic Stimulation (rTMS) as a Treatment Tool for Cocaine Use Disorder: a Series of Six Translational Studies. Curr Behav Neurosci Rep. 2017 Dec;4(4):341-352. doi: 10.1007/s40473-017-0135-4. Epub 2017 Oct 23.

Colleen: You’ve become a known researcher in the area of transcranial magnetic stimulation for alcohol use disorder and also chronic pain. What have you discovered that is most promising?
Dr. Martinez:
Transcranial magnetic stimulation (TMS) has been used to treat depression for some time. More recently, TMS has been FDA-cleared for obsessive compulsive disorder (OCD) and tobacco use disorder. Thus, it’s an exciting time for TMS research, because there’s a lot of interesting work to be done. In my lab, we are looking into TMS for alcohol use disorder and chronic pain. We are targeting the medial prefrontal cortex and anterior cingulate because imaging studies show that these brain regions are implicated in these disorders. Our study in alcohol addiction is well under way, although we don’t have results yet because it is a sham-controlled and double-blind study. We have begun a study in chronic pain, although we are doing only pilot work right now because we need to find funding to move this along.

Colleen: While potentially more pronounced in other disciplines of medicine, it is fair to say women are underrepresented in academic research in the field of psychiatry. Why do you think this is, and do you see improvement on the horizon?
Dr. Martinez: Overall, women are underrepresented in academic medicine. According to a recent AAMC report, women make up half of medical school students but represent just 25% of full professors at academic centers and only 18% of department chairs. While psychiatry usually has more even distribution of men and women in residency, there’s still a disparity when it comes to careers in academic research. There are a number of reasons behind this, including work-life issues, salary differences, and the need for improved mentorship.

At my institution, we are working to address this issue. We have a fellowship program, funded by the National Institute on Drug Abuse and our department of psychiatry, that provides both research and clinical training in addiction psychiatry. However, we realized that we can’t expect to enroll more women in our fellowship if we wait until they’ve almost completed residency. Thus, we are developing a program where we connect with medical students in order to foster mentorship at this early stage. This will include introducing students to research design and helping them get published early in their careers. Our goal is to improve the recruitment and retention of women in academic research by improving early mentorship.

We are using this same approach to recruit fellows from under-represented minority (URM) groups. We are working with a program that’s funded by the National Institute on Drug Abuse to encourage URM students to think about pursuing a career in academic addiction research. Through this program, we pair students attending the City College of New York with researchers to develop early and productive mentoring relationships. Our goal is to expand this plan to additional medical schools, in order to reduce the disparity that exists in academic research.

 

Psychiatry Resource Section

JAMA Psychiatry Original Investigation Article: Continuation of Antidepressants vs Sequential Psychological Interventions to Prevent Relapse in Depression—An Individual Participant Data Meta-analysis
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780290

MDEdge Current Psychiatry Article: Cannabinoid-based medications for pain
https://www.mdedge.com/psychiatry/article/239193/pain/cannabinoid-based-medications-pain

AGENDA: 2021 Psychiatry Update CME/CE Virtual Event (June 15-19): Solving Clinical Challenges -- Improving Patient Care:
https://na.eventscloud.com/website/21668/agenda/

Current Psychiatry Article: A clinical approach to pharmacotherapy for personality disorders
https://www.mdedge.com

JAMA Psychiatry Original Investigation Article: Suicide Risk in Medicare Patients with Schizophrenia Across the Life Span
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780429

APA Learning Center Free Members May Course of the Month: "Doctor, Are You Sure I Am Bipolar?" Challenges in the Differential Diagnosis of Bipolar Disorder
https://www.psychiatry.org

Clinical Psychiatry News Article: The end of happy hour? No safe level of alcohol for the brain
https://www.mdedge.com

 

April 2021

Hot Topics in Psychiatry: Dr. Jon Grant Weighs in on New Advances in Neuropsychopharmacology and Other New Research in Addictive, Compulsive, and Impulsive Disorders

Introduction

We are back again this month with a candid interview with Dr. Jon E. Grant. Dr. Grant is a Professor of Psychiatry & Behavioral Neuroscience at the University of Chicago, where he directs a clinic and research lab on addictive, compulsive, and impulsive disorders. Dr. Grant’s research has focused on various aspects of obsessive-compulsive disorder (OCD) and related disorders, such as neurocognition, neuroimaging, and pharmacological treatment of these problems. Dr. Grant and I covered several current topics, including the most recent meaningful advances in neuropsychopharmacology, the evolution of understanding of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorders and advances in treatment options, and his publications on impulsive and compulsive behaviors, including measurement via self-report tools, firearm ownership, and brain micro-architecture and disinhibition.

Last issue we gave you key insights from George Grossberg, MD, on several current topics, including the link between antidepressants and Alzheimer’s, the utility and safety profile of cholinesterase inhibitors for treatment of Alzheimer’s and the role of rivastigmine, dietary restrictions to prevent or delay Alzheimer’s, the issue of polypharmacy and deprescribing, and defining psychosis in major and mild neurocognitive disorders. If you missed it, you can find that interview here.

Make sure to check out the Suggested Reading from Dr. Grant on identifying subtypes of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. 

This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, and JAMA Psychiatry, as well as April’s free learning course from the APA. 

Don’t forget to check out details for the Medscape’s upcoming virtual conference, Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care, a MedscapeLIVE! event. 

Thank you to Dr. Grossberg for his critical contribution and candor. Please contact me at [email protected] with any comments and/or suggestions. 

–Colleen Hutchinson

 

Interview

Hot Topics in Psychiatry: A Candid Chat with Jon E. Grant, MD
Dr. Grant is a Professor of Psychiatry & Behavioral Neuroscience at the University of Chicago where he directs a clinic and research lab on addictive, compulsive and impulsive disorders.  Dr. Grant’s research has been funded by the NIMH, NIDA, the Wellcome Trust, and private foundations. His research has focused on various aspects of OCD and Related Disorders, such as neurocognition, neuroimaging, and pharmacological treatment of these problems. Dr. Grant is the author of over 400 peer-reviewed scientific articles, 15 books, and is on the editorial board of 10 journals.

Colleen: What are the most recent advances in neuropsychopharmacology that you believe will be most meaningful to your patient population?
Dr. Grant:
In the case of OCD and related disorders, such as trichotillomania and skin picking, the field of neuropsychopharmacology moves extremely slowly. We still have nothing FDA approved for trichotillomania and skin picking, and have really had nothing new for OCD for decades. Having said that, there is some potential promise in glutamate modulators for OCD, and we are almost finished with a new study of a cannabinoid agonist in trichotillomania and skin picking. So there might be potentially promising new options, but we need more.

Colleen: Trichotillomania (hair pulling disorder) and excoriation (skin picking) disorders have been the subject of research and publication for two decades. How would you characterize the evolution of understanding of these disorders and advances in treatment options?
Dr. Grant: Our understanding of these two disorders continues to advance, albeit slower than many other mental health disorders, due to the passionate research of a small number of folks around the world. Although we have developed fairly detailed knowledge about trichotillomania and skin picking disorder, our treatments options have lagged behind largely due to lack of funding for well-powered treatment studies. This is a shame, in my opinion, because understanding how to treat trichotillomania and skin picking disorder could provide a window into managing not only these two disorders but habit/compulsivity more broadly.

Colleen: You have recently published on several aspects of impulsive and compulsive behaviors, including measurement via self-report tools, firearm ownership, and brain micro-architecture and disinhibition. Among these, what have you found most surprising in findings of this body of research?
Dr. Grant: When we set out to examine self-report tools on impulsivity and compulsivity, I was struck by how little there is available to assess compulsive behaviors and how virtually none of the instruments are trans-diagnostic. If we really want to determine pathophysiology of psychiatric disorders, I think we need to be continuously aware of the potential overlap of these illnesses and how we measure that overlap.

 

Suggested Reading

Article: Identifying subtypes of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder using mixture modeling in a multicenter sample. Grant JE, Peris TS, Ricketts EJ, Lochner C, Stein DJ, Stochl J, Chamberlain SR, Scharf JM, Dougherty DD, Woods DW, Piacentini J, Keuthen NJ. J Psychiatr Res. 2020:S0022-3956(20)31057-8. PMID: 33172654.
https://pubmed.ncbi.nlm.nih.gov/33172654/
Dr. Grant: This article is important for two reasons, I believe. First, on a scientific level, it is the first article to demonstrate that trichotillomania and skin picking disorder have subtypes that may necessitate different treatment approaches. And second, on a social/public health level, the article reflects the end result of years of fundraising by a non-profit organization for a multi-center research project. Because research funds in this area have largely not been available from the NIH, the TLC Foundation for Body-Focused Repetitive Behaviors undertook fundraising at the grass roots level and raised almost 3 million dollars for a research project that took place at the University of Chicago, UCLA, MGH/Harvard, and the University of Stellenbosch South Africa. The money was raised from people with these disorders or their loved ones. That is a success story in research, independent of the actual scientific findings.

 

Psychiatry Resource Section

MDedge Current Psychiatry Article: Switching antipsychotics: A guide to dose equivalents
https://www.mdedge.com/

AGENDA: 2021 Psychiatry Update CME/CE Virtual Event (June 15-19): Solving Clinical Challenges -- Improving Patient Care:
https://na.eventscloud.com/website/21668/agenda/

Current Psychiatry Article: Steroid-induced psychiatric symptoms: What you need to know
https://www.mdedge.com

JAMA Psychiatry Original Investigation Article: Association of Age, Antipsychotic Medication, and Symptom Severity in Schizophrenia with Proton Magnetic Resonance Spectroscopy Brain Glutamate Level—A Mega-analysis of Individual Participant-Level Data
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2778479

APA Learning Center Free Members April Course of the Month: Pharmacological Approaches to Treatment-Resistant Depression
https://www.psychiatry.org

Clinical Psychiatry News Article: Psilocybin matches SSRI for moderate to severe depression in phase 2 study
https://www.mdedge.com

Current Psychiatry Article: A clinical approach to pharmacotherapy for personality disorders
https://www.mdedge.com

 

 

March 2021

Hot Topics in Psychiatry: Dr. George T. Grossberg Weighs in on Alzheimer’s, Polypharmacy, and Defining Psychosis in Major and Mild Neurocognitive Disorders

Introduction

We are back again this month with a candid interview with Dr. George T. Grossberg, Director of the Division of Geriatric Psychiatry at St. Louis University School of Medicine. Dr. Grossberg and I covered several current topics, including between antidepressants and Alzheimer’s, the utility and safety profile of cholinesterase inhibitors for treatment of Alzheimer’s and the role of rivastigmine, dietary restrictions to prevent or delay Alzheimer’s, the issue of polypharmacy and deprescribing, and defining psychosis in major and mild neurocognitive disorders.
Last issue we gave you key insights from Craig Chepke, MD, FAPA, on the role and use of pharmacogenomics, trends in people newly seeking care during COVID who have undiagnosed ADHD, how COVID has changed the way we practice, and telemedicine as the new paradigm shift in patient treatment and communication. If you missed it, you can find that interview here.
Make sure to check out the Suggested Readings from Dr. Grossberg in the areas of polypharmacy, antidepressant use and Alzheimer’s, cholinergic drugs as a standard pharmacological approach in Alzheimer's, and diet interventions to prevent Alzheimer’s in this issue. 
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, and JAMA Psychiatry, as well as a free learning course from the APA. 
Don’t forget to check out details for the Medscape’s upcoming virtual conference, Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care, a MedscapeLIVE! event. 
Thank you to Dr. Grossberg for his critical contribution and candor. Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

Interview

Hot Topics in Psychiatry: A Candid Chat with George Grossberg, MD, FAPA
George T. Grossberg, MD, is the Samuel W Fordyce Professor and Director of the Division of Geriatric Psychiatry at St Louis University School of Medicine. He has edited and authored 15 textbooks and contributed more than 500 scholarly papers, abstracts, and chapters to the geriatric medical literature.

Colleen: What is the state of polypharmacy in the geriatric population? Is enough deprescribing going on?
Dr. Grossberg:
Polypharmacy, or taking multiple prescribed and or over-the-counter (OTC) medications, is a particular problem among those over the age of 65 (older adults).
Older adults often take 4 to 6 different prescription and OTC medications daily. In the long-term-care (LTC) environment, they may take 8 to 10 or more medications daily.
The risk of side effects or drug-drug interactions is nearly 100% in patients taking 6 or more medications daily. Health care providers need to emphasize the importance of deprescribing. Communicate the notion that “less is more.” Communicate that taking less medication often improves quality of life and functional abilities of older adults by diminishing the risk of often disabling side effects and of adverse drug-drug interactions.

Colleen: What is the utility and safety profile of cholinesterase inhibitors for treatment of Alzheimer’s? What about for use in non-Alzheimer’s dementia patients? What about the role of rivastigmine?
Dr. Grossberg:
Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine are still the mainstays of FDA-approved symptomatic therapies for Alzheimer’s disease (AD). When started early in the course of AD and continued over time, they can improve functions in some AD patients for short periods of time and possible slow their rate of decline.
Cholinesterase inhibitors are mostly associated with gastrointestinal (GI) side effects such as nausea, dyspepsia, and diarrhea. The rivastigmine skin patch was developed to minimize GI side effects versus the oral preparation. This agent is also FDA-approved for dementia in Parkinson’s disease. The cholinesterase inhibitors are not approved for other common dementias, such as vascular dementia, Lewy body dementia, or frontotemporal dementia.

Colleen: Where do we stand with regard to current research on dietary restrictions to prevent or delay Alzheimer’s?
Dr. Grossberg:
Lifestyle modification, including exercise, control of hypertension, diabetes, and other cardiovascular risk factors, avoiding smoking, quality sleep, avoiding excessive stress, keeping mentally active (challenging the brain), social and spiritual activity, as well as proper dietary habits may delay the onset of AD in at-risk individuals and slow progression in those diagnosed with AD. Relative to dietary recommendations, the strongest evidence to date is for the Mediterranean diet. This is not a restrictive diet, but one which emphasizes fresh fruits and vegetables, whole grains, fish, extra virgin olive oil as the shortening of choice, some poultry, less red meat, minimally processed foods, and mild alcohol intake.
Obviously, fast foods are not part of the Mediterranean diet.

Colleen: The literature is conflicting. What is the relationship, as you see it, between antidepressants and Alzheimer’s?
Dr. Grossberg:
Yes—the literature is complex. There is evidence that some antidepressants, particularly the older tricyclics that are anticholinergic, may increase the risk of AD. However, there is also growing evidence that depression may be a risk factor for AD and treating depression, in particular with the newer SSRI’s, may be protective. These antidepressants may not only have mood-elevating effects but may also have anti-inflammatory effects in the brain and may decrease amyloid plaque formation. Both are associated with AD and neuronal death.
What is non-controversial is the notion that depression is quite common in AD patients and is a source of excess disability. Consequently, it is important to diagnose and treat depression in AD patients. Prompt recognition and effective treatment improve quality of life in AD patients and may slow disease progression.

Colleen: What was the most critical thing that came out of the 2020 IPA Consensus?
Dr. Grossberg:
Last year, the International Psychogeriatric Association (IPA) published criteria for psychosis in dementia. This recent update of the Jeste and Finkel criteria for psychosis in AD (year 2000) broadens the criteria to apply to all major and minor neurocognitive disorders. Examples are provided of psychosis in these disorders as well as differential diagnoses to consider, a timeline of symptom emergence, and exclusionary criteria.
The IPA revised criteria to also serve as a template for further research in the field.

 
Suggested Readings

Article: The cholinergic system in the pathophysiology and treatment of Alzheimer’s disease. Hampel H, Mesulam MM, Cuello AC, et al. Brain 2018;141(7):1917-1933.
https://pubmed.ncbi.nlm.nih.gov/29850777/
Dr. Grossberg: This is a thorough review by international experts on the topic.

Text: Psychiatric consultation in long-term care. Desai A, Grossberg GT. Cambridge University Press, 2017.
Dr. Grossberg: This text contains extensive materials on polypharmacy and deprescribing. 

Article: Dietary interventions to prevent or delay AD: What the evidence shows. Bartochowski Z, Conway J, Wallach Y, et al. Curr Nutr Rep. 2020 Sep;9(3):210-225.
https://pubmed.ncbi.nlm.nih.gov/32681411/
Dr. Grossberg: Recent review of interventions, including the Mediterranean diet.

Article: Impact of Antidepressant Use on the Trajectory of AD: Evidence, Mechanisms, and Therapeutic Implications. Khoury R, et al. CNS Drugs 2019; Jan;33(1):17-29
https://pubmed.ncbi.nlm.nih.gov/30456746/
Dr. Grossberg: This is an up-to-date relevant review.

 

Psychiatry Resource Section

MDedge Psychiatry Article: JAMA editor resigns over controversial podcast
https://www.mdedge.com

AGENDA: 2021 Psychiatry Update CME/CE Virtual Event (June 15-19): Solving Clinical Challenges -- Improving Patient Care:
https://na.eventscloud.com/website/21668/agenda/

Current Psychiatry Article: The lasting effects of childhood trauma
https://www.mdedge.com

JAMA Psychiatry Article: Association of Antihypertensive Drug Target Genes With Psychiatric Disorders
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2777005

APA Learning Center Free Members Course of the Month: Buprenorphine Update and Evolving Standards of Care
https://www.psychiatry.org

Current Psychiatry Article: The ABCs of successful vaccinations: A role for psychiatry
https://www.mdedge.com

 

 

February 2021

We are back in your inbox this month with a candid interview with Dr. Craig Chepke, who is in private practice in North Carolina and serves as Adjunct Associate Professor of Psychiatry for Atrium Health and Adjunct Assistant Professor of Psychiatry at the University of North Carolina School of Medicine. Dr. Chepke and I dove right into several hot topics, including the role and use of pharmacogenomics, trends in people newly seeking care during COVID who have undiagnosed ADHD, how COVID has changed the way we practice, and telemedicine as the new paradigm shift in patient treatment and communication.
Last issue we gave you key insights from Donald W. Black, MD, and Jeffrey R. Strawn, MD, FAACAP—faculty from Medscape’s upcoming virtual conference, CP/AACP Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care. Drs. Black and Strawn shared thoughts on the far-reaching psychological effects of the COVID-19 quarantine on patients—including adolescents, and current treatments of the negative symptoms of schizophrenia, and more. If you missed it, you can find that interview here. 
Make sure to check out the Suggested Readings from Dr. Chepke in the areas of personalized medicine, bioethics, and obesity, inflammation and cognition in this issue. 
This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Annals of Clinical Psychiatry, NEJM, and JAMA Psychiatry. Also, don’t miss the link to the APA Child & Adolescent Telepsychiatry Toolkit. This section is designed to have best practices information in one place at your fingertips to stay informed—enjoy!
Don’t forget to check out details for the Innovations in Psychiatry: Virtual Spring Conference 2021 here. 
Thank you to Dr. Chepke for his critical contribution and candor. Please contact me at [email protected] with any comments and/or suggestions.

–Colleen Hutchinson

 

Interview

Hot Topics in Psychiatry: A Candid Chat with Craig Chepke, MD, FAPA
Craig Chepke, MD, FAPA is in private practice at Excel Psychiatric Associates in Huntersville, NC and is an Adjunct Associate Professor of Psychiatry for Atrium Health and an Adjunct Assistant Professor of Psychiatry for the University of North Carolina School of Medicine. He has special interests in treatment-resistant and severe mental illness, movement disorders, ADHD, and sleep medicine. 

Colleen: The use of pharmacogenomics in psychiatric treatment is a divisive issue, but I’ve heard you use the phrase, “You can’t let perfect be the enemy of the good” when discussing this topic. Do you think it’s underused? Is it misused?
Dr. Chepke: The best word to describe pharmacogenomics (PGX) in psychiatry might be misunderstood. I readily concede that there is not conclusive evidence that PGX improves outcomes, and that if used without properly educating the patient about its strengths and limitations, it could be detrimental to outcomes. However, PGX is like any other tool we use in medicine—it can be used well, or it can be used badly. It’s still in a nascent state and is nowhere near perfect, but that doesn’t mean that it shouldn’t be used at all. Imagine if physicians in 1895 looked at the plain film X-ray and said “Eh, come back to me when it can scan in 3 dimensions.” There’d have been a lot of preventable morbidity and mortality the following 75 years until the CT came along! 

I wouldn’t advocate for everyone to start ordering PGX on every patient, but I don’t think that anyone can ignore it altogether. People are suffering and dying from psychiatric illness every day, and we can’t throw away any opportunity to try to do better than we’re able to now. No intervention in medicine works 100% of the time. With medications, we’re very comfortable with the statistical concept of Number Needed to Treat, but I’ve heard many colleagues say that they ordered PGX 2-3 times and “It wasn’t helpful,” so they abandoned it. 

Those who are adamant that PGX has no value in psychiatry might look at other fields of medicine like oncology, where the use of genetic data has completely transformed the field. I’m sure we could find quotes from oncologists decades ago belittling the use of pharmacogenomics in cancer treatment that haven’t aged well. Our patients need help too desperately to keep our heads stuck in the sand. I think we need to study pharmacogenomics, order it where appropriate, and use our experiences to generate hypotheses to contribute back to research that can improve and potentially validate them. A variation of the quote you used in the question that we say frequently in psychiatry is “It’s about progress, not perfection.” That’s where I think we’re at with PGX, but the future is exciting.

Colleen: Difficulties stemming from the pandemic have driven many people to seek psychiatric treatment for the first time. Have you noticed any interesting trends in people newly seeking care during COVID?
Dr. Chepke: Most of the patients I’ve seen recently who are new to psychiatric treatment say that their symptoms are coming from issues caused by the pandemic. However, I’ve found that most of them have actually been struggling for much longer than that, and probably should have come in for care years before. The pandemic just gives them a convenient and socially acceptable reason to make the leap in overcoming the stigma that still accompanies mental health treatment. But I’m okay with scapegoating the pandemic if it gets people the help they need!

Another interesting pattern is that a lot of the adults who have been coming in are reporting depression and anxiety and lack of response to antidepressants. However, they don’t really fit the presentation of someone with treatment-resistant depression— which is an area I have a lot of experience in diagnosing and treating. They’re often reasonably high-functioning people who tell me things like they’re anxious because they feel so overwhelmed with their responsibilities that they just shut down, so they always feel behind. They say they’re depressed because they never fulfilled the potential in life that they (or others) thought they should. Their self-esteem is terribly low and their support network is often very small because they either let their relationships lapse or have burned bridges because they have no filter.

Everything about these people screams ADHD, but they were able to avoid an ADHD diagnosis in childhood because they had few or no behavioral problems that would prompt a closer look by teachers or guidance counselors, and they were able to "brute force" their way into decent or even good grades with a combination of intelligence, willpower, and creative study hacks. 

Working from home can be great for some people, but for those with ADHD, the loss or change in structure and routine can cause them to decompensate, especially if the degree of difficulty has increased by having to facilitate remote learning for their children. I think we need to be on the lookout for these types of presentations, not just now during the pandemic, but at all times. Making the right diagnosis and effectively treating ADHD can be lifechanging, and it’s better late than never.

Colleen: Dr. Chepke, many say COVID has changed the way medicine is practiced. How do you see this in practicing psychiatry? Will these be short-term or lasting changes?
Dr. Chepke: I think being forced outside of our comfort zones is the best thing that could happen to the field of medicine. As the philosopher Jiddu Krishnamurti wrote, “Tradition becomes our security, and when the mind is secure, it is in decay.” The pandemic has forced me to adopt or create different skillsets in many cases to get the job done. Here’s a sample of things the pandemic has helped me learn how to:

Screen for movement disorders such as tardive dyskinesia over video.
Decide if someone glancing away is watching their pet dart by or is responding to internal stimuli. 
Sit in silence while someone types a long passage that she doesn’t want her abusive spouse to hear. 
Help someone grieve the loss of a parent they couldn’t see because of a nursing home lockdown.
Keep someone out of the hospital because they’d rather end their life than risk getting COVID on an inpatient unit. 
Fake an unstable connection when I don’t know what to say.
Another notable change I’ve seen (which is old hat to my social worker wife) is that when a patient conducts a session on their own home turf rather than making a pilgrimage to our offices with our rules, there’s a subtle yet powerful shift in the dynamics of shared decision making. 
I fully anticipate that many of the changes we've seen with telemedicine will be persistent— there's no putting this genie back in the bottle. A lot depends on what government and private insurers do, but patients have become accustomed to easy access to telemedicine in the past year, so I doubt that politicians could justify not making the changes to Medicare and Medicaid permanent to their constituents. After that, private insurers will fall in line. While it's not perfect, and some aspects are worse, there are too many advantages for the field not to adopt at least a hybrid model of in-person and virtual visits, which is what I anticipate doing with my clinical practice in the future. I certainly plan to keep the new skills the pandemic made me learn out of necessity!

Colleen: Dr. Chepke, the psychological effects of the COVID-19 quarantine are far-reaching. What is your advice to the community psychiatrist who is grappling with the challenges this pandemic has presented?
Dr. Chepke: I'd boil it down to the idea that telemedicine is about preparation, preparation, preparation. Time management is always difficult in psychiatry, but I think it's more challenging during the pandemic. Many people are starving for human contact, so I’ve found that sessions have tended to run longer with many patients. I've been trying to adapt by setting clearer boundaries, such as starting the session by reminding patients how much time we have allotted for the session and asking them to come to the appointment with an agenda for what they want to discuss so we can hit the ground running at the start of the session. 
I've also noticed that I’ve been spending a greater percentage of sessions talking as opposed to listening compared to before the pandemic started, and that patients have been much more interested in knowing how I am doing than before. I think that the high degree of uncertainty in everyone's lives is making some people crave reassurance a little more than usual. There's a wide variety of viewpoints on how much self-disclosure mental health clinicians should engage in, but I've found that spending a few seconds giving them a glimpse of something that's been a challenge for me has really helped normalize my patients' struggles to adapt. In turn, it seems to really loosen them up and help engage them in the work of the session.
Also, make sure you are actually doing okay! I won't use the dreaded "B-word" (burnout), but I think we should take advantage of the increased access and convenience afforded by telemedicine to enter into therapy ourselves? Many of us were in personal psychotherapy as a part of our training, and I’ve used the excuse of COVID to get back in to therapy to brush up on my coping skills.
Another trend I’ve noticed is that patients are looking to me for advice on accurate information on COVID-19 topics like the efficacy of masks, distancing, and now vaccines. We may not have been trained in infectious diseases, but we have the relationship to be able to combat rapid expansion in the spread of misinformation that’s occurred in society recently. I think we should be well-suited to this, as evidence-based medicine was designed to combat misinformation from anecdotes and confirmation bias in the practice of medicine!

Colleen: What do you think will help solve the conundrum of frontline practitioners regularly having to address mental health conditions that they do not know how to treat or even in many cases diagnose?
Dr. Chepke: This is a tough situation for frontline practitioner, and I feel for them because they didn’t train or sign up for managing psychiatric conditions, but there’s simply not enough mental health professionals to see everyone who needs it. Making a good diagnosis is always important in medicine, and the lack of biomarkers in psychiatry makes it hard for clinicians who lack the training and clinical experience. One of the most difficult diagnoses to make in psychiatry is unfortunately a commonly encountered one, which is differentiating between major depressive disorder (MDD) and bipolar depression. I think bipolar disorder is both overdiagnosed and underdiagnosed—it’s just misdiagnosed a lot. Some studies estimate 1 out of 4 patients who are treated for MDD in primary care settings actually have bipolar disorder. I’d recommend using screening tools such as the Mood Disorder Questionnaire, which is the historical gold standard, or possibly the Rapid Mood Screener, which was developed very recently by a group of colleagues I know and respect highly, with industry funding, and shows promise. Another tip for psychiatric diagnosis is to never underestimate the power of collateral information!
In terms of treatment, I’d recommend focusing initially on three high-yield items that can help put out some fires regardless of diagnosis.
First, assess the patients’ sleep. Finding and treating insomnia or obstructive sleep apnea in your patients will not only improve their daytime wakefulness, it will also pay dividends in a wide variety of psychopathology. I tell my patients, "Sleep is the foundation of mental health, and without a good foundation, your whole house will crumble."
Next, check on how much news and social media the person is consuming on a daily basis. Almost every time I ask this question, I get back a sheepish grin and the response “too much.” This is not a new problem by any means, but it seems to have spiked to new heights with the pandemic, and social and political unrest, and has been driving a lot of anxiety, as well as insomnia. I’ve given “prescriptions” to patients to limit their intake of these from any source to a set amount— usually either 30 or 60 minutes, either all at once or in divided doses as they choose. Modern smartphones can be set to enforce limits on an app-by-app basis, and that’s helped patients to stick with the limits.
Finally, if they’ve already been prescribed psychotropics, actively and directly assess their adherence to treatment. Don’t assume that they’re taking their meds exactly as prescribed, if at all. This is true across any chronic illness, not just psychiatric conditions. One study showed that concordance between clinician estimates of antipsychotic adherence and claims data was about 50%— no better than a coin flip. One technique that helps make conversation easier and more likely to get an honest answer is to normalize it. I say something along the lines of, “I take a medication for stomach acid, and I forget it about once a week and don’t realize it until I get the worst heartburn. How often do you tend to miss doses of your medication?” Rather than lecturing them about needing to take it perfectly, explore their reasons. Is it that they think it doesn’t work, that it causes side effects, or do they have trouble affording it? This information is critical to guide your next steps. After all, the efficacy of any medication is 0% if the person doesn’t actually take it.

 

Suggested Readings

Personalized Medicine

Article: Escitalopram in Adolescents with Generalized Anxiety Disorder: A Double-Blind, Randomized, Placebo-Controlled Study. Strawn, J. R., Mills, J. A., Schroeder, H., et al. The Journal of Clinical Psychiatry81.5 (2020): 0-0.
https://pubmed.ncbi.nlm.nih.gov/32857933/
Dr. Craig Chepke: The unassuming title of this article buries the lede of the trial’s noteworthy use of one of the most divisive topics in contemporary psychiatry— pharmacogenomics. Much work remains to be done to make pharmacogenomics ready to deploy for all patients, and this study offers a valuable blueprint on how studies can generate hypotheses. While controversial, I believe that discounting the necessity to figure out how to use pharmacogenomics to personalize treatment is tantamount to discarding the importance of knowing the effect of renal or hepatic function on medication efficacy and tolerability.

Bioethics

Article: A historical review of placebo-controlled, relapse prevention trials in schizophrenia: The loss of clinical equipoise. Lawrence, Ryan E., Paul S. Appelbaum, and Jeffrey A. Lieberman. "A historical review of placebo-controlled, relapse prevention trials in schizophrenia: The loss of clinical equipoise." Schizophrenia Research (2020).
https://pubmed.ncbi.nlm.nih.gov/33234427/
Dr. Craig Chepke: As a field, we always want long-term data for the medications we prescribe, and randomized withdrawal studies are the most common way that the efficacy of psychotropics is studied beyond the acute phase. This paper explores the vital question of whether these studies are still ethical in a chronic and degenerative brain disease like schizophrenia where evidence has shown cumulative duration of untreated psychosis leads to worse longterm functional outcomes.

Obesity, Inflammation, and Cognition

Article: Liraglutide improves memory in obese patients with prediabetes or early type 2 diabetes: a randomized, controlled study. Vadini, F., Simeone, P. G., Boccatonda, A., et al. International Journal of Obesity44.6 (2020): 1254-1263.
https://pubmed.ncbi.nlm.nih.gov/31965072/
Dr. Craig Chepke: People with severe mental illness are at greater risk of obesity and metabolic disease, and psychotropic medications add fuel to that fire. Beyond the mortality risk of these conditions, there’s significant evidence that the inflammatory state associated with obesity and insulin resistance contributes to cognitive abnormalities. Phase 3 trials are about to begin for another GLP-1 receptor agonist, semaglutide, in Alzheimer’s Disease, so even if you haven’t added these to your armamentarium as I have, you should at least keep your eyes on this class of medications.

 
Psychiatry Resource Section

Clinical Psychiatry News Article: Reproductive psychiatry in 2021: Old questions and new challenges
https://www.mdedge.com/psychiatry/article/234890/obstetrics/reproductive-psychiatry-2021-old-questions-and-new-challenges

NEJM Audio Interview: An International Look at Covid-19:
https://www.nejm.org/contact-nejm?query=footer

Annals of Clinical Psychiatry Article: Obsessive Compulsive Personality Disorder and Obsessive-Compulsive Disorder: Clinical Characteristics, Diagnostic Difficulties, and Treatment
https://www.tandfonline.com/doi/abs/10.3109/10401230500295305

Current Psychiatry Article: COVID-19 drives physician burnout for some specialties
https://www.mdedge.com/psychiatry/article/234969/coronavirus-updates/covid-19-drives-physician-burnout-some-specialties

JAMA Psychiatry Article: Suicide Prevention in the COVID-19 Era—Transforming Threat Into Opportunity
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2772135

APA Child & Adolescent Telepsychiatry Toolkit:
https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/child-adolescent

 

 

January 2021

Inaugural Issue

Hot Topics in Psychiatry: Our Thought Leaders Weigh In

E-News Inaugural Issue

Welcome to Psychiatry in Practice E-Newsletter. I am excited to take on the management of this new Medscape publication with this inaugural issue! As you will see in this and future issues, we have some e-news features in store for you that will benefit all practicing psychiatrists. Designed to keep you up to date on the latest research, meetings coverage, and best practices, Innovations in Psychiatry will improve your patient care and save you time by keeping you up to speed with the latest critical content from multiple channels.

Every issue will feature a candid interview with one or multiple thought leaders in psychiatry. In this inaugural issue, I interview Donald W. Black, MD, and Jeffrey R. Strawn, MD, FAACAP—faculty from Medscape’s upcoming virtual conference, CP/AACP Psychiatry Update 2021: Solving Clinical Challenges, Improving Patient Care. These faculty share their thoughts on how COVID has changed the way psychiatrists practice, the far-reaching psychological effects of the COVID-19 quarantine on patients—including adolescents, and current treatments of the negative symptoms of schizophrenia. These thought leaders bring a critical knowledge of current issues and challenges in psychiatry, as well as pulse on current best practices, to both this interview and to the conference at which they present. CP/AACP Psychiatry Update 2021 is a MedscapeLIVE! event.

In this e-news, we will also feature Suggested Readings in which experts will provide not only their own recommendations of current articles to read, but critical article takeaways as well. 
Given the ever-changing nature of psychiatry and the current healthcare environment, we are also including a Psych Resource section to keep you updated on critical research, resources, and new developments. Please look to us as a collective resource of all things psychiatry. This includes association guidelines and updates, COVID and other general topic publications, and other helpful psychiatry best practices information in one place at your fingertips to stay informed.
Get ready to be engaged and entertained, as well as educated, in the coming months. We have great things in store for you!
Don’t forget to check out details for the Innovations in Psychiatry: Virtual Spring Conference 2021 here. Thank you to this month’s interview participants and upcoming meeting faculty, Dr. Donald W. Black and Dr. Jeffrey R. Strawn for their critical contributions.
Here’s to a new Medscape tool designed to keep you plugged in and informed, to the new names and faces you will see in these issues, and to developing a lasting rapport with you, the readership! We want to be your go-to source of information in all things psychiatry. Please contact me at [email protected] with any comments and/or suggestions.

Colleen Hutchinson

 

Interview

Hot Topics in Psychiatry: Our Thought Leaders Weigh In
Donald W. Black, MD, Professor of Psychiatry at the University of Iowa Roy J. and Lucille A. Carver College of Medicine in Iowa City, Iowa.
Jeffrey R. Strawn, MD, FAACAP is Associate Professor of Psychiatry & Pediatrics, Associate Vice Chair of Research, Director, Anxiety Disorders Research Program, Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati, Cincinnati Children's Hospital Medical Center.

Colleen: Dr. Strawn, how has the shift to telepsychiatry affected your practice?
Dr. Strawn: While telepsychiatry can be very effective for pediatric patients, there are certainly limitations, particularly in assessing young children. Also, I’ve found myself limited in some of the work with younger children where the examination often involves here-and-now interactions and play. Subtleties of these interactions and the transactional quality of play are often lost with telemedicine. That being said, with adolescents there are some very helpful tips that can make a telepsychiatry appointment more successful. Many of these are available through the websites of the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. For telehealth, like most of what we do, preparation and training are of paramount importance. First, we have generally recommended that clinicians log in several minutes early to download and install software updates. Second, it is very important to have a back-up telephone number for the patient should technical difficulties or connectivity problems arise. Then, there are certain preparations for the office environment; we recommend more lighting than we would frequently have in the office. 
In some of my work with adolescents, I’ve found that they’re more comfortable with the telepsychiatry setting. 

Colleen: Dr. Black, how has COVID impacted your practice? What have you done to mitigate any negative effect (practice-wise or clinically)?
Dr. Black:
Covid has been a huge problem on the inpatient unit where I work. Staff and patients were initially very anxious about it, although that has lessened as we’ve learned more about transmission. We’ve had to develop protocols to keep safe. For example, COVID-positive patients are not admitted, but will go to a COVID unit first. The inpatient unit has a mixed population, and some patients won’t wear masks, such as dementia patients, while others do. We’ve had to adjust our own behavior in response to maintain safety. We have team meetings on Zoom, for example. Interestingly, COVID has become a focus of some patients’ delusions.

Colleen: Dr. Strawn, during quarantine, and we are seeing an uptick in mental health issues in adolescents. What have you found to be effective in treating this particular population in these circumstances?
Dr. Strawn:
Many of my patients—who are often children, adolescents, and young adults—have struggled with the frequent shifts in their schools and families in the transition to and from various forms of non-traditional instruction. In parallel, their parents have taken on the roles of educators and guidance counselors while struggling with their own adjustments at work. I have seen amazing examples of flexibility and resilience. Much of what I have done has been to encourage and support this flexibility and resilience and to help them to problem solve when they have gotten stuck. I have also tried to support creative and safe ways in which they can maintain closeness while being physically distanced from their peers. I find myself more frequently explaining that the loneliness or frustration that we're discussing is not something that I can 'fix' with titration of an SSRI or a change in medication. For me, as a psychiatrist, I have felt much more frequently that I am 'with' my patients as they often poignantly describe their struggles related to COVID-19.

Colleen: Dr. Black, in your recent study, what were your findings regarding the association between comorbid disorders and changes in gambling activity?
Dr. Black:
First, nearly all people with a gambling disorder have comorbid mental health or addictive disorders. But the relationship between the comorbid disorder and gambling is complicated. Typically, those with depression or PTSD gamble more when the disorder is worse, whereas with some disorders, such as agoraphobia and social phobia. At least among younger gamblers, if substance abuse is more sever, gambling behavior is less. This is an example of a “substitute addiction.” That is, as one addiction subsides, the other takes over.

Colleen: Dr. Black, what is your advice regarding treatment of the negative symptoms of schizophrenia?
Dr. Black:
 Negative symptoms are unfortunately very common in patients with schizophrenia, and are more disabling than are positive symptoms, such as hallucinations and delusions. Sadly, we don’t have good treatments for negative symptoms. For this reason, it is important to determine if the symptoms are due to the patient’s psychotic disorder, or perhaps due to an accompanying depression, which can be treated, or perhaps reflect extrapyramidal side effects, which also can be treated. Newer medications on the horizon may be more effective in treating these symptoms. 

 
Suggested Readings

Pediatric Psychiatry

Article: Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A, Linney C, McManus MN, Borwick C, Crawley E. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020 Nov;59(11):1218-1239.e3. doi: 10.1016/j.jaac.2020.05.009. Epub 2020 Jun 3. PMID: 32504808; PMCID: PMC7267797.
https://pubmed.ncbi.nlm.nih.gov/32504808
Dr. Jeffrey Strawn: This article is important in that it highlights the hardship of isolation for children and adolescents and sounds the alarm that we must, as clinicians, be prepared for post-pandemic, post-quarantine psychiatric sequelae. It reminds us that social isolation may leave a scar even after we have been vaccinated, returned to classes and after school activities and once again think about 'curves' as grade adjustments rather than new cases or hospitalizations.

Self-care

Article: Well-being, burnout, and depression among North American psychiatrists. Summers RF, et al. Am J Psychiatry 2020; 177: 955-964.
https://pubmed.ncbi.nlm.nih.gov/32660300/
Dr. Donald Black: Burnout is pervasive among physicians in general. Summers et al focus on psychiatrists and look at risk factors which has implications for intervention.

 

Psychiatry Resource Section

Current Psychiatry Article: The rebirth of psychedelic psychiatry
https://www.mdedge.com/psychiatry/article/233919/depression/rebirth-psyc...

Annals of Clinical Psychiatry Article: Validity of Pilot Adult ADHD Self- Report Scale (ASRS) to Rate Adult ADHD Symptoms
https://www.tandfonline.com/doi/abs/10.3109/10401230600801077

Clinical Psychiatry News Article: APA apologizes for past support of racism in psychiatry
https://jamanetwork.com/journals/jamadermatology/fullarticle/2768252

Managing Depression in Primary Care: A Collaborative Care Approach (CME/CE Certified Supplement)
https://globalacademycme.realcme.com/learner/course/2586

NEJM Perspective: Testing in a Pandemic — Improving Access, Coordination, and Prioritization:
https://www.nejm.org/doi/full/10.1056/NEJMp2025173?query=featured_home