Friday, February 21, 2020

Tendency Toward Negative Moods in Preadolescence Linked to Eating Disorders in Young Adulthood

Negative affectivity, a tendency toward feeling negative emotions such as anger or sadness, may increase the risk of developing eating disorders in young adulthood, a study in the International Journal of Eating Disorders has found.

Annelies E. van Eeden, M.D., of Parnassia Psychiatric Institute in the Netherlands and colleagues used data from the Tracking Adolescents’ Individual Lives Survey (TRAILS), a Dutch community cohort study tracking youth from preadolescence to adulthood. Over the course of TRAILS, participants had assessments at ages 11, 13, 16, 19, 22, and 26 years. Their temperaments were assessed at age 11 using the Early Adolescent Temperament Questionnaire–Revised, and their BMIs were measured at every visit. At ages 19, 22, and 26 years they were screened for eating disorders.

Participants with negative affectivity at age 11 generally weighed more than those who did not have negative affectivity, and they were roughly 30% more likely to have been diagnosed with an eating disorder by the time they were 19 years old. Those with greater negative affectivity also gained more weight in adolescence and young adulthood than their peers.

“This could induce unhealthy … strategies in order to manage the weight and consequently lead to the development of disordered eating and eating disorders,” the researchers wrote.

For related information, see the Psychiatric News articles “Binge-Eating Risk Factors in Adolescents Vary by Socioeconomic Status” and “Researchers Estimate Prevalence of Eating Disorders Among Children.”

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Thursday, February 20, 2020

Cognitive Benefits of Exercise in Patients With Schizophrenia Sustained Over One Year, Study Shows

Several studies have found that patients with schizophrenia experience cognitive benefits from exercise. A study in Psychiatric Research suggests schizophrenia patients who participate in a 12-week aerobic exercise program may continue to experience cognitive benefits months after the program ends.

“These findings encourage the incorporation of [aerobic exercise] in psychosocial treatment regimens [for schizophrenia],” wrote Takeshi Shimada, Ph.D., of the Medical Corporation Seitaikai Mental Support Soyokaze Hospital in Japan and colleagues.

Shimada and colleagues conducted a randomized trial in which patients were recruited from a psychiatric hospital in Nagano, Japan. Forty participants with schizophrenia and other schizoaffective disorders aged 20 to 65 were randomly assigned to one of two groups: one group received treatment as usual, which consisted of meetings with a psychiatrist, medication, case management, and rehabilitation programs over a 12-week period; the other group participated in a 12-week aerobic exercise program in addition to receiving treatment as usual. Participants in the exercise program attended one group class (involving exercise videos) and one individual session (involving treadmill or stationary bike) a week, each lasting an hour.

Shimada and colleagues used the Brief Assessment of Cognition in Schizophrenia (BACS) to evaluate the participants’ verbal memory, working memory, motor speed, verbal fluency, attention, and executive function. The researchers also measured participants’ intrinsic motivation (defined as sense of purpose, motivation, and curiosity), psychiatric symptoms, social functioning, and functional outcome. Assessments took place at baseline, after the 12-week aerobic exercise intervention, then at six months and a year later.

Immediately after the aerobic exercise intervention, participants showed significant improvements in cognition, intrinsic motivation, psychiatric symptoms, and relationships with others. A year later, compared with the group that received treatment as usual only, those who also participated in aerobic exercise classes “showed significant, sustained improvements in several cognitive domains [including working memory, verbal fluency, attention, and executive function] as assessed by the BACS,” Shimada and colleagues wrote.

The aerobic exercise group also showed improved intrinsic motivation in the one-year follow-up, with a mean score on the Quality of Life Scale of 9.95 versus 6.75 in the treatment as usual group.

“Such sustained improvement in intrinsic motivation might further promote improvement and maintenance of cognition,” the authors wrote. The study, they added, “provides encouragement to the theory that [aerobic exercise] training is a feasible and well accepted intervention.”

For related information, see the American Journal of Psychiatry article “Therapeutic Potential of Physical Exercise in Early Psychosis.”

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Wednesday, February 19, 2020

Youth Who Stay in ED Overnight for Mental Health Problems Often Discharged Without Psychiatric Evaluation

Two-thirds of children and adolescents who had to stay in an emergency department (ED) for at least 24 hours with a mental health complaint had suicidal thoughts or behaviors, yet many did not receive a formal psychiatric evaluation by a psychiatrist with treatment recommendations, according to a report in JAMA Pediatrics.

Staying overnight in the emergency department without receiving care, known as boarding, is a significant problem related to the shortage of inpatient psychiatric beds. Erin O’Donnell, M.D., of the Division of Pediatric Emergency Medicine at Johns Hopkins University School of Medicine and colleagues analyzed data on 573 children and adolescents (average age of 14) who stayed at least 24 hours with a mental health complaint at one urban pediatric ED. Most of the patients were African American, resided within city limits, and had no long-term physical conditions.

On average, patients stayed in the ED for 54 hours. The most common chief complaints included suicidal ideation or suicidal attempt and behavior disorder. Many patients had a history of psychiatric problems, with only 74 (12.9%) having no previous psychiatric diagnosis. Nearly half of the patients also had a history of being seen in the ED for mental health concerns.

A total of 378 (66%) of the youth answered positively to suicide-screening questions. Yet only 295 (51.5%) received a formal psychiatric evaluation by a psychiatrist with treatment recommendations. A total of 97 patients (16.9%) for whom hospitalization was initially recommended were discharged home.

“Identifying that almost half of patients had prior mental health–related ED visits together with previous studies revealing that patients fail to receive care from mental health clinicians prior to ED presentation underscores the importance of improving access to outpatient services,” O’Donnell and colleagues wrote. “Given that a sizable portion of boarding patients were discharged home, further efforts are needed to optimize the therapeutic care delivered in the ED and to identify interventions aimed at preventing repeated crises.”

For more information, see the Psychiatric News article “Resource Document on ED Boarding Spells Out Best Practices.”

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Tuesday, February 18, 2020

Severe Infection Associated With Increased Risk of Substance-Induced Psychosis

People with a history of severe infection such as hepatitis or sepsis may be more likely to develop substance-induced psychosis than people without such history, suggests a report in AJP in Advance.

Previous research by Carsten Hjorthøj, Ph.D., M.Sc., of Copenhagen University Hospital and colleagues revealed that people with substance-induced psychosis—psychosis that occurs during intoxication and resolves after use of the substance is terminated—are more likely to develop schizophrenia compared with the general population. “However, relatively little is known about the etiology and exact pathophysiological mechanisms of substance-induced psychoses, apart from the obviously necessary component cause of having used the substance in question,” they wrote.

For the current study, Hjorthøj and colleagues analyzed data from nationwide Danish registers that included all people born in Denmark since 1981. The authors were able to obtain information about individuals who experienced substance-induced psychosis, infections, and/or schizophrenia, as well as information about parental substance use disorders and psychosis. The final sample included 2,256,779 individuals, for whom 3,618 cases of substance-induced psychosis were recorded.

Any infection increased the risk of substance-induced psychosis (hazard ratio=1.30), the authors reported. “The risk of substance-induced psychosis was doubled the first two years after a severe infection and remained increased for more than 20 years,” they wrote. “Hepatitis in particular appeared to have such an association, with a more than threefold increase in substance-induced psychosis after adjustment for substance use disorder and other potential confounders.” Additional analysis revealed that hepatitis following substance-induced psychosis is associated with an increase in the risk of conversion to schizophrenia.

The findings support “the hypothesis of an immune-related component not just for schizophrenia but for psychosis in general,” the authors continued. “If the exact mechanisms underlying the psychotogenic properties of infections or the immune response can be identified, this is likely to lead to improvements in treatment for psychotic disorders. … Our findings may also hold direct relevance in terms of secondary and tertiary prevention of both substance-induced psychosis and later conversion to schizophrenia.”

For related information, see the American Journal of Psychiatry study “Rates and Predictors of Conversion to Schizophrenia or Bipolar Disorder Following Substance-Induced Psychosis.”

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Friday, February 14, 2020

Secondhand Smoke May Raise Risk of Depressive Symptoms in Adolescents

Adolescents who are exposed to secondhand smoke may be more likely to develop symptoms of depression, a study in the American Journal of Preventive Medicine has found. The risk is also dose-dependent, meaning that the more secondhand smoke to which an adolescent is exposed, the higher the risk.

“Smoking has been linked with depressive symptoms in adolescents, but data on secondhand smoking and depressive symptoms in low- and middle-income countries are scarce,” wrote Louis Jacob, Ph.D., of the University of Versailles Saint-Quentin-en-Yvelines in France and colleagues. “This is an important omission as enforcement of tobacco control policy legislation is weaker in [low- and middle-income countries] compared with high-income countries.”

The researchers analyzed data from the 2003-2008 Global School-Based Student Health Survey of more than 37,000 adolescents aged 12 to 15 years who had never smoked and who lived in 22 low- or middle-income countries. To determine participants’ exposure to secondhand smoke, they were asked, “During the past seven days, on how many days have people smoked in your presence?” To determine whether participants had experienced symptoms of depression, they were asked, “During the past 12 months, did you ever feel so sad or hopeless every day for two weeks or more in a row that you stopped doing your usual activities?”

Overall, 53.6% of the participants had been exposed to secondhand smoke on at least one day in the past week, and 24.5% had experienced depressive symptoms in the past year. Nearly 29% of participants who were exposed to secondhand smoke every day over the past week had experienced depressive symptoms compared with 23% of those who were not exposed to secondhand smoke. Compared with those who were not exposed to secondhand smoke over the previous week, those who were exposed on at least three days were 48% more likely to have experienced depressive symptoms, while those who were exposed on all seven days were 63% more likely to have experienced depressive symptoms.

The researchers wrote that the increased risk of depressive symptoms in adolescents exposed to secondhand smoke may stem from increased levels of perceived stress because of physical discomfort, the association between secondhand smoke and chronic physical conditions in childhood and adolescence such as asthma, and/or the effects of nicotine on neurotransmitters and inflammation.

“If corroborated by further longitudinal studies, these findings suggest that reducing [secondhand smoke] exposure may be important not only for the prevention of physical diseases such as ischemic heart disease, lung cancer, and asthma, but also for adolescent depressive symptoms in [low- and middle-income countries],” the researchers wrote.

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Thursday, February 13, 2020

Psychiatric Medications Not Associated With Poorer Weight Loss Following Bariatric Surgery

Psychiatric medications do not appear to interfere with weight loss in obese patients who have had bariatric surgery, according to a report in Psychosomatics, the journal of the Academy of Consultation-Liaison Psychiatry.

Moreover, serotonin-norepinephrine reuptake inhibitors (SNRIs) may be associated with greater weight loss than other types of antidepressants one year after bariatric surgery, according to Michael Hawkins, M.D., of the Scarborough Health Network-Centenary Site in Ontario and colleagues.

Comorbid psychiatric illness is common among obese patients who have bariatric surgery, and some antidepressants are known to cause weight gain. Hawkins and colleagues sought to determine whether psychiatric medications affected the amount of weight lost following surgery.

They analyzed data on 190 patients who had bariatric surgery. Of these, 61 were taking psychiatric medications before surgery, and 50 continued taking psychiatric medications one year after surgery. Antidepressants and benzodiazepines/hypnotics were the most common medications taken by patients before and after surgery.

They found no significant difference in total weight loss between patients taking a psychiatric medication before surgery compared with those who were not; nor was there a difference in weight loss among those taking a psychiatric medication one year after surgery compared with those who were not. Among patients taking antidepressants, those taking SNRIs lost significantly more weight than patients taking serotonin selective reuptake inhibitors (36.4% vs. 27.8%).

“This longitudinal study suggests that psychiatric medication use was not associated with poorer [percent total weight loss] at one year after bariatric surgery, wrote the researchers. “Within class, antidepressant use may have differential effects on weight loss after bariatric surgery and warrants further investigation.”

For related information, see the Psychiatric News article “SGAs Increase Teen Abdominal Fat, Decrease Insulin Sensitivity.”

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Wednesday, February 12, 2020

APA Announces Results of 2020 Election

APA’s Committee of Tellers has approved the following results of APA’s 2020 national election. Please note that these results are considered public but not official until approved by the Board of Trustees at its meeting on March 14 and 15 in Washington, D.C.

Vivian B. Pender, M.D.

Richard F. Summers, M.D.

Michele Reid, M.D.

Area 2 Trustee
Glenn A. Martin, M.D.

Area 5 Trustee
Jenny Boyer, M.D., Ph.D., J.D.

Resident-Fellow Member Trustee-elect
Sanya Virani, M.D., M.P.H.

“I congratulate Dr. Pender and all of today’s successful candidates on their election,” said APA President Bruce Schwartz, M.D. “I look forward to collaborating with them as APA works to improve access to and quality of mental health care for all.”

Pender’s term as APA president-elect will begin this April at the conclusion of the APA Annual Meeting in Philadelphia, when current President-elect Jeffrey Geller, M.D., M.P.H., begins his one-year term as president.

“APA members and the profession of psychiatry will be well served by the leadership of Dr. Pender,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “I have known her for years, and her dedication and passion for psychiatry will greatly benefit APA during her tenure.”

Complete results of the election will be reported in the March 6 issue of Psychiatric News.

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The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.