Highlights From APA Annual Meeting: Day Three

Day three of APA’s Annual Meeting included a call to psychiatrists to lead in efforts to improve the lives of children, the release of APA poll results showing mental health stigma remains a major challenge in the workplace, and conversation around the ways psychiatrists can help people of differing political backgrounds find common ground.

Through May 22, Psychiatric News will deliver an evening digest of important highlights from the meeting.

Kellogg CEO Urges Psychiatrists to Advocate for Trauma-Informed Care for Children

During the William C. Menninger Memorial Lecture on Monday, La June Montgomery Tabron called on psychiatrists to promote racial healing and to integrate social determinants of health into medical care so all people have an equal opportunity to living a healthy life.
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Poll Draws Attention to Mental Health Stigma in Workplace, Concerns Over Social Media

Although most respondents to a national poll by APA said they know how to access mental health services through work, more than one-third worry that seeking mental health care might impact their job. Those surveyed also agreed that social media may be contributing to feelings of loneliness and social isolation. Read More >

Simpler Blood Monitoring, Sharing Clinical Experiences Critical to Expanding Clozapine Use

Speaking to a packed house, schizophrenia experts share their experiences with clozapine to increase psychiatrists’ comfort in using the highly effective but underutilized treatment.
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Black Psychiatrists Persevered Despite Discrimination in Education, Organized Medicine

Speakers at a 175th Anniversary History Track session described how black psychiatrists sought equal treatment and the need to continue working to eliminate racial discrimination.
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Women Making Strides in Academic Psychiatry but Gender Bias, Discrimination Still Too Common

The number of women entering psychiatry continues to increase, but a gender gap persists in compensation, advancement, and research funding. Session attendees offer up several practical solutions. Read More >

Factors to Keep in Mind When Prescribing to Pregnant Patients

Most psychiatric medications can be safely continued in pregnancy, but changes that occur during pregnancy may affect absorption, distribution, and metabolism of these medications. Read More >

Psychiatrists Have Role to Play in Building Bridges Between Today’s Polarized Society

A sociologist explores the psychological reasonings that fuel the divergent views of those on the right and the left. Read More >

Stay Tuned for Coverage of 175th Anniversary Gala

APA’s 175th Anniversary Gala at the magnificent San Francisco City Hall got under way as this issue of the APA Daily went to press. More than 700 people were expected to attend. Proceeds will support the work of the APA Foundation. Coverage of the gala will appear in a future issue.

Highlights From APA Annual Meeting: Day Two

Day two of APA’s Annual Meeting included an address by psychiatrist and incoming AMA President Patrice Harris, M.D., to APA’s Board of Trustees; a discussion of the challenges that international medical graduate students face; and a recommendation that psychiatrists consider ways their own mindfulness could benefit their patients.

Through May 22, Psychiatric News will deliver an evening digest of important highlights from the meeting.

Incoming AMA President and Former APA Board Member Lays Out Plans for Presidential Year

Psychiatrist Patrice Harris, M.D., told trustees that the integration of mental health and general medical care and promoting diversity across organized medicine would be among her priorities for the year.
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Valerie Jarrett Shares Insights From Her Years in the White House

In a wide-ranging “fireside chat” with APA President Altha Stewart, M.D., Valerie Jarrett talked about the experience of serving as President Obama’s longest-serving senior adviser. Read More >

Childhood Trauma Changes Biology of Brain

Advances in neurobiology and genetics explain the links between early life adversity and increased risk for psychiatric and medical conditions later in life, but how and when does psychiatry intervene?
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Why Psychiatrists Must 'Mindfully' Embrace Nutritional Wellness for Themselves and Their Patients

As the obesity epidemic expands, psychiatrists must go beyond telling patients how to lose weight to helping them live a healthy and fit life. Applying mindfulness to eating is one technique both physicians and their patients can benefit from.
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History Track Session Focuses on Challenges Faced by IMGs

A panel discussion of IMGs described the insensitivity and isolation—ranging from cultural misunderstandings to frank discrimination—that these trainees face in the workplace. Read More >

Overlap Between PTSD, TBI Symptoms Creates Challenges for Diagnosing Patients

Experts on Saturday discussed similarities in the causes and symptoms of PTSD and TBI, which can be critical for the determination of disability. Read More >

Winners of Resident/Medical Student Poster Competition Announced

Winners were recognized for their research focused on building resilience and addressing burnout in medical students and residents, reducing agitation, and more. Read More >

Highlights From APA’s 2019 Annual Meeting Day One

Welcome to San Francisco!

APA’s 2019 Annual Meeting began in San Francisco Saturday. From now through May 22, Psychiatric News will deliver an evening digest of some of the day’s highlights. Whether you are here in San Francisco or at home, these reports will convey the excitement and outstanding scientific program being presented at this year’s meeting.

Stewart Brings a Robust and Eventful Presidential Year to a Close

During the Opening Session on Saturday, Altha Stewart, M.D., described how APA renewed its global reach while laying the groundwork for a more diverse and inclusive profession and responding to several national emergencies.
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Schwartz: APA Must Lead the Way to End Stigma, Improve Care

Incoming APA President Bruce Schwartz, M.D., vowed during his Opening Session address on Saturday to focus on three crucial areas: increasing access to care, improving quality of care, and continuing the fight against the stigma and discrimination attached to mental illness. Read More >

Levin Speaks to Future of a 'Noble' Profession

The 2019 APA Annual Meeting can offer a blueprint for the future, said APA CEO and Medical Director Saul Levin, M.D., M.P.A., during the Opening Session on Saturday. “For all the progress we’ve made, there are still some areas where we must improve as we work toward our next milestones—the 200th and 225th anniversaries,” he said.
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MindGames Playoffs Offer Double Treat to Meeting Attendees

MindGames has become one of the most popular Annual Meeting attractions, and this year, attendees got two versions—the traditional resident competition and a special history version in honor of APA's 175th Anniversary.
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The Lincolns: Retrospective Diagnosing Raises Questions Worth Pondering

Studying the putative psychiatric symptoms of historical figures raises important questions about the nature of psychiatric diagnosis, how those diagnoses are viewed through various cultural lenses, and how they may change over time. Read More >

Medications for Cannabis Use Disorder May Ease Withdrawal But Fail to Achieve Abstinence

Treatments to manage withdrawal or block the positive effects of cannabis offer limited benefit, but an over-the-counter supplement may reduce drug-seeking behavior in youth. Experts question whether treatment goals should focus on curbing consumption versus total cessation. Read More >

APA Raises $15,000 for Center Serving Disadvantaged Women

As part of the APA’s annual “APA Gives Back” program, APA President Altha Stewart, M.D., presented a donation today of $15,000 to this year’s recipient, the Young Women’s Freedom Center. For 25 years, this center has been providing support, advocacy, and opportunities for healing for women and girls of color who are impacted by poverty or who were formerly incarcerated. Read More >

Obstructive Sleep Apnea May Raise Post-Op Heart Risk

Obstructive sleep apnea (OSA), a condition in which the soft tissues of the throat relax and narrow the airways during sleep, may raise the risk of developing heart problems after surgery, according to research published this week in JAMA. In OSA, breathing stops and starts multiple times during sleep, resulting in snoring, gasping for air, poor sleep quality, morning headaches, daytime fatigue, irritability, and difficulty concentrating.

The study, led by Matthew T. V. Chan, Ph.D., M.B.B.S., of the Chinese University of Hong Kong included 1,218 patients aged 45 years or older who had abdominal, vascular, or major orthopedic surgeries and were at risk for post-surgery heart-related complications. The patients underwent sleep studies at home or in the hospital the night before their procedures.

Although none of the patients had been diagnosed with OSA previously, the sleep studies revealed that 67.6% of them had the condition. Among all patients, 11.2% had a severe form of OSA in which their breathing stopped and started at least 30 times during the night.

In the 30 days after their surgeries, 21.7% of the participants with OSA developed heart and blood vessel complications, such as injury to their heart muscles, congestive heart failure, atrial fibrillation (an irregular, fluttering heartbeat), and thromboembolism (clots that block blood vessels). Only 14.2% of those without OSA developed these complications. This represents a 50% greater risk in people with OSA, regardless of the condition’s severity. However, after the researchers accounted for other factors, they determined the increased risk to be statistically significant only in patients with severe OSA, not mild or moderate OSA. Those with severe OSA had more than double the risk of those without OSA. Severe OSA was also associated with a nearly 14-fold increase in cardiac death, a nearly 7-fold higher risk of heart failure, and an 80% higher risk of heart injury.

The researchers noted that episodes of apnea and higher sedation either during or after the surgeries may have prompted health care professionals to make adjustments to the patients’ care such as lowering doses of opioids or keeping the patients on supplemental oxygen longer than usual.

“It is unclear how these interventions may affect perioperative outcomes. Nevertheless, the event rates reported in this study would represent the expected perioperative outcomes associated with untreated OSA in contemporary anesthetic practice for major noncardiac surgery,” the researchers wrote.

For more information, see the Psychiatric News article “Sleep Apnea Linked With Hard-to-Treat High Blood Pressure in Blacks.”

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Hospitalization for Psychosis Tied to Substance Misuse, Treatment Delays, Medication Nonadherence

The hospitalization rate for patients with first-episode psychosis (FEP) may be reduced by avoiding delays in initial treatment, preventing substance misuse, and enhancing medication adherence, according to a study published Tuesday in Psychiatric Services in Advance.

Even with current, evidence-based treatment, at least one-third of individuals with FEP will be hospitalized within two years of diagnosis, increasing treatment costs, disrupting schooling, and often, resulting in stress and trauma, wrote Delbert G. Robinson, M.D., of the Center for Psychiatric Neuroscience at the Feinstein Institutes for Medical Research and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and colleagues.

To identify risk factors for hospitalization, researchers evaluated data from the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared outcomes in patients experiencing a first episode of psychosis who received early intervention services versus usual care. (Patients in the early intervention group received personalized medication management, family psychoeducation, resilience-focused individual therapy, and supported education and employment. Those in the usual-care group received psychosis treatment determined by individual and clinician choice and service availability. The study found that those in the early intervention program remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school, compared with those in the usual-care group.)

As part of the original study, researchers conducted a Structured Clinical Interview for DSM-IV at baseline and assessed various other clinical measures every six months thereafter. Every month during the trial, researchers asked participants about their use of inpatient and emergency mental health services and assessed drug and alcohol use. At multiple times throughout the trial, the participants also rated their mental and emotional health and took various other evaluations.

Based on these data, Robinson and colleagues found that patients with longer duration of untreated psychosis, more hospitalizations before study entry, positive psychosis symptoms such as hallucinations and delusions, illegal drug use, and doubts about the value of medication were more likely to be hospitalized during the two-year treatment period.

The study findings could assist clinicians in developing more effective early intervention services. “Individuals enter outpatient treatment with an already fixed number of prior hospitalizations and [duration of untreated psychosis]. Changing these factors will require public health initiatives and innovative outreach strategies to facilitate earlier entry into treatment,” the researchers wrote. “Current [early intervention services] models include interventions to help individuals decrease substance misuse, achieve symptom reduction, and understand medications and adherence. Some of these interventions have low participation … suggesting that more effort may be needed to motivate individuals to use available services.”

For more information, see the Psychiatric News article “Psychosocial Treatments Found Effective for Early Psychosis” and the American Journal of Psychiatry article “Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program.”

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Benzodiazepine Use in Early Pregnancy Increases Risk of Miscarriage, Study Suggests

The use of any benzodiazepines during early pregnancy may increase the risk of miscarriage, according to a study published today in JAMA Psychiatry.

“The findings suggest that health care clinicians should carefully evaluate the risk-benefit ratio of benzodiazepines for the treatment of insomnia and mood or anxiety disorders in early pregnancy,” wrote Odile Sheehy, M.Sc., of the Centre Hospitalier Universitaire Sainte-Justine in Montreal and colleagues. “[I]f benzodiazepines are needed, they should be prescribed for short durations.”

Sheehy and colleagues analyzed data from the Quebec Pregnancy Cohort, which included all pregnancies of women aged 15 to 45 who were covered by the Quebec Public Prescription Drug Insurance Plan from January 1, 1998, to December 31, 2015. The researchers excluded data on pregnancies among several groups of women from the analysis, including women exposed to known teratogens during the first trimester, as well as those with a history of epilepsy, previous use of benzodiazepines, and/or planned abortions.

Of the 442,066 pregnancies included in the cohort, 27,149 (6.1%) ended with miscarriage. A pregnant woman was considered to have been exposed to a benzodiazepine if she had filled at least one prescription for any type of benzodiazepine between the first day of the last menstrual period and the date of miscarriage.

Among pregnancies ending with miscarriage, 375 (1.4%) were among women exposed to benzodiazepines in early pregnancy compared with 788 (0.6%) of the 134,305 matched-control pregnancies. After adjusting for potential confounders, including diagnoses of mood and anxiety disorders and insomnia before pregnancy, the researchers found benzodiazepine exposure in early pregnancy was independently associated with an increased risk of miscarriage (adjusted odds ratio, 1.85).

“The risk of [miscarriage] increased with increasing daily dose of benzodiazepines, which may suggest a dose-response effect,” the authors wrote.

Additional analysis revealed that the risk of miscarriage was similar among pregnant women exposed to short-acting benzodiazepines (defined as a half-life less than or equal to 24 hours), such as lorazepam, and long-acting benzodiazepines (defined as a half-life greater than 24 hours), such as diazepam.

The authors noted several limitations of the study, including smaller sample sizes in subgroup analyses on specific benzodiazepine agents, which resulted in lower statistical power, and missing information about smoking and/or alcohol intake behaviors during pregnancy.

For related information, see the Psychiatric News article “Benzodiazepine Use and Misuse Among Adults in the United States.”

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Low Social Engagement May Point to Older Adults at Risk of Alzheimer’s Disease

Spending little time engaging with friends and family or participating in activities outside the home may be a marker for possible cognitive decline in older adults who are still cognitively normal but show evidence of brain changes indicative of possible Alzheimer’s disease (AD), according to a report in the American Journal of Geriatric Psychiatry.

“Understanding changes in social engagement in older adults may lead to earlier diagnosis of AD and advances in evidence-based prevention and treatment,” wrote senior author Nancy Donovan, M.D., chief of the Division of Geriatric Psychiatry at Brigham and Women’s Hospital, and colleagues.

A total of 217 men and women aged 63 to 89 underwent assessments for social engagement and cognitive performance at baseline and three years later. The participants were evaluated using the Community Healthy Activities Model Program for Seniors questionnaire, including questions about the amount of time participants spent with friends and family outside the home, involvement with church and clubs, and more; the less total time participants reported engaging in such activities, the lower their total social engagement score. The Preclinical Alzheimer Cognitive Composite (PACC) assessed the episodic memory, executive function, and global cognition of the participants. Amyloid-β (a protein associated with AD) was measured using Pittsburgh Compound B-PET.

The researchers found that cognitively normal older adults with low levels of social engagement and evidence of accumulation of amyloid-β in the brain at baseline had greater cognitive decline at three years than those with high levels of social engagement at baseline. In contrast, higher baseline social engagement was associated with relative preservation of PACC, the authors reported.

“These findings emphasize the importance of social engagement as a resilience or vulnerability marker in older adults at risk of cognitive impairment due to AD and support recommendations promoting social engagement in older adults,” they wrote.

For related information, see the Psychiatric News article “Purpose in Life Linked to Physical Function in Older Adults.”

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