On March 9, President Biden signed into law the Consolidated Appropriations Act, 2024 (HR 4366) to avert a partial government shutdown. The $460 billion spending package includes a 1.68% reduction to the 3.4% cut to the Medicare Physician Fee Schedule conversion factor that took effect on January 1. (The conversion factor is an element in the equation that determines physician reimbursement for every payment code.)
The new payment rate went into effect on March 9; it is not retroactive to January 1. APA continues to work for full repeal of the physician pay cut, which was automatically enacted to offset overall increases in Medicare payment.
The impact of the remaining overall payment reduction on individual psychiatrists depends on what kinds of services they provide. The fee schedule, released last November, did include some good news for psychiatrists; positive provisions included an increase in reimbursement for providing psychotherapy as an add-on to evaluation and management (E/M) services and the extension of some telepsychiatry provisions into 2024.
The appropriations act also reauthorizes some substance use disorder treatment programs that were created under the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act.
Other provisions in the appropriations act include the following:
For related information see the Psychiatric News article “Psychiatrists Win Important Gains in 2024 Fee Schedule.”
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People with attention-deficit/hyperactivity disorder (ADHD) who begin taking medications for the condition within three months of their diagnosis may have a lower risk of dying within two years compared with their peers who do not take ADHD medications, a study in JAMA has found.
Zheng Chang, Ph.D., of the Karolinska Institutet in Stockholm and colleagues examined data from 148,578 Swedish individuals aged 6 to 64 years who had an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation for at least 18 months prior to their diagnosis. They followed the patients from ADHD diagnosis for two years or until death, emigration, or December 31, 2020, whichever came first. The researchers categorized mortality into natural causes (that is, physical conditions) and unnatural causes (that is, suicide, accidental injuries, accidental poisoning, and other external injuries).
Overall, 56.7% of the patients initiated ADHD medication. This was defined as receiving any of the six licensed ADHD medications (methylphenidate, amphetamine, dexamphetamine, lisdexamfetamine, atomoxetine, and guanfacine) within three months of diagnosis.
The researchers found that patients who initiated ADHD medication had a 21% lower risk of dying of any cause and a 25% lower risk of dying from unnatural causes compared with patients who did not initiate ADHD medication.
“ADHD medication may reduce the risk of unnatural-cause mortality by alleviating the core symptoms of ADHD and its psychiatric comorbidities, leading to improved impulse control and decision-making, ultimately reducing the occurrence of fatal events,” Chang and colleagues wrote. “There is also evidence showing that ADHD medications were associated with lower risk of accidents, substance use, and criminality, which in turn could lead to lower rates of unnatural deaths.”
There was no statistically significant difference in death by natural causes between the two groups. The researchers said that this was reassuring given concerns about the cardiovascular safety of stimulants.
The researchers added that their results cannot conclusively establish a cause-and-effect relationship between initiating ADHD medications and lower risk of dying because they did not measure certain confounders, such as lifestyle factors, that could affect risk.
For related information, see the Psychiatric News article “ADHD Meds Linked to Cardiovascular Risk.”
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Symptoms of callousness and emotional coldness in children—which can be risk factors for conduct disorder and antisocial personality disorder—are more likely influenced by genetics rather than harsh or poor parenting, according to a report in AJP in Advance.
The findings suggest that one-time interventions aimed at teaching better parenting skills alone may be insufficient, wrote Patrizia Pezzoli, Ph.D., of University College London and colleagues. “Rather than discouraging parenting interventions, these findings suggest that combining parent support with child-focused strategies targeting behaviors that may elicit negative responses represents a promising approach,” the researchers wrote.
Pezzoli and colleagues analyzed data on 9,260 twin pairs (12,029 fraternal twins and 6,491 identical twins) from the Twin Early Development Study, a longitudinal study of twins born in England and Wales between 1994 and 1996 that included assessments when the children were 7, 9, and 12. Twin studies are useful because they can help distinguish genetic and environmental influences on behavior.
The researchers measured callous and unemotional (CU) traits in children using the Strengths and Difficulties Questionnaire and the Antisocial Process Screening Device. They assessed negative parental discipline to deal with child misbehavior, such as hitting and shouting, using a semi-structured interview and negative parental feelings with the Parental Feelings Questionnaire. They explored what may contribute to these outcomes based on the genetic similarity of identical vs. fraternal twins and the shared vs. different experiences of these twins at home, school, or elsewhere.
At age 7, genetic factors accounted for 67% of the difference in CU traits among these children, whereas environmental differences between twins accounted for the remaining 33%. By age 12, the influence of genetic factors on CU traits was still strong but dropped to 55%. Environmental differences accounted for 25% while shared environment that promotes twin similarity accounted for 20% of CU traits at age12.
Similarly, the children’s genetic factors accounted for 58% of the differences in negative parental discipline when children were 7; shared environment accounted for just 15%. However, at age 12 shared environment accounted for 84% of the differences in negative parental discipline among the families.
“An increase in shared environmental influences on negative parenting indicates that parents rated their own parenting as distinct for each of their twins in mid childhood, but less so in late childhood,” Pezzoli and colleagues wrote. “These results suggest that parental discipline may become less tailored to children’s characteristics as they grow older.”
The researchers note that environmental risk factors outside the home—such as exposure to violence at school or in the community—should be addressed in family interventions. “More clinical research is needed to determine the adequate intensity and duration of support for parents of children with varying levels of CU traits,” they conclude. “…[I]nterventions addressing multiple environmental risk factors, rather than parenting alone, are better suited to influence the development of CU traits.”
For related information see the Psychiatric News article, “Early Childhood Behavior Predicts Adult Temperament, 26-Year Study Finds.”
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A neuromelanin-sensitive MRI (NM-MRI) may successfully predict which patients with first-episode psychosis will eventually develop treatment-resistant schizophrenia, according to a study published today in AJP in Advance. Neuromelanin is a brain pigment that is a by-product of dopamine metabolism and therefore can be a visual indicator of healthy dopamine functioning.
“[T]here is an urgent need for markers to identify treatment nonresponders in schizophrenia at an early stage and facilitate timely initiation of clozapine, the only antipsychotic with proven efficacy in nonresponders,” wrote Marieke van der Pluijm, Ph.D., of the University of Amsterdam and colleagues. Patients with treatment-resistant schizophrenia do not show increased dopamine function, unlike patients who respond to treatment, van der Pluijm and colleagues continued. This suggests that neuromelanin levels—a proxy of dopamine function—may be an early marker for treatment resistance.
The researchers recruited 62 patients aged 18 to 35 years with first-episode psychosis whose primary diagnosis was on the schizophrenia spectrum. They also recruited 20 healthy controls. All participants were assessed at baseline with an NM-MRI scan, a clinical interview, and an IQ test. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS). Patients received antipsychotic treatment from their psychiatrists throughout the study.
Treatment response was assessed with a clinical interview at six months. Participants were considered nonresponsive if they continued to show moderate or higher symptoms on at least one of five PANSS domains (delusions, conceptual disorganization, hallucinatory behavior, mannerisms and posturing, and unusual thought content) following two trials of antipsychotics; if they showed a complete absence of response or experienced severe side effects following one antipsychotic trial; or if they were switched to clozapine during the follow-up period.
Fifteen patients were classified as nonresponders, while the remaining 47 were considered responders. In the baseline NM-MRI, nonresponders showed significantly lower NM-MRI signal compared with responders, predominantly in a brain region called the substantia nigra. This region is rich in dopamine neurons and regulates movement as well as emotions and reward behaviors. Based on the neuromelanin composition, the researchers could predict whether a patient would respond to treatment with up to 68% accuracy.
Among 28 responders and 9 nonresponders who participated in a follow-up scan, the NM-MRI signal did not change over six months in either group. This indicates that neuromelanin accumulation might reflect a stable trait, rather than a variable that is dependent on an individual’s state.
“[T]his study demonstrates the potential of NM-MRI as a noninvasive marker for treatment resistance in schizophrenia at an early stage,” the authors concluded. “Eventually, an adequate prediction model could lead to early identification of treatment resistance in schizophrenia and thereby substantially reduce delays in effective treatment and improve outcomes.”
For related information, see the Psychiatric News Alert “Speed of Response to Visual Stimuli May Be Biomarker for Psychosis.”
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A study published today in JAMA reports that many high school seniors are using products containing Δ8-tetrahydrocannabinol (THC), a variant of the main psychoactive compound of marijuana, Δ9-THC. The analysis also showed that Δ8-THC use was elevated in states where recreational marijuana was illegal.
“Gummies and other edibles, electronic vaping devices, and combustible flower containing Δ8-THC are marketed as providing a user experience comparable to marijuana in a product that is federally legal,” wrote Alyssa F. Harlow, Ph.D., of the University of Southern California and colleagues. “Δ8-THC exposure may pose risks to adolescents, including addiction, neurodevelopmental changes, acute psychiatric reactions from accidental overdosing, and exposure to toxic byproducts generated during Δ8-THC synthesis.”
Harlow and colleagues examined data from the 2023 Monitoring the Future study, a nationally representative classroom-based survey of 8th, 10th, and 12th grade students. The 2023 survey included a question for a subset of 12th graders on whether they used Δ8-THC in the past year, and, if yes, how many times. The students also answered a similar question on past-year marijuana use. The final sample included 2,186 responses.
Overall, 11.4% of seniors in the U.S. reported past-year Δ8-THC use and 30.4% reported past year marijuana use. Of seniors who reported using Δ8-THC, 35.4% used it at least 10 times in the past year, while 16.8% used it at least 40 times.
Other findings from the survey included the following:
“The unregulated proliferation of Δ8-THC represents a potential threat to the public’s health,” wrote Jennifer M. Whitehill, Ph.D., of the University of Massachusetts, Amherst, and colleagues in an accompanying editorial. “As health professionals, we need to improve our capacity for addressing the evolving cannabinoid marketplace by instituting centralized and coordinated systems for monitoring cannabis products.”
To read more on this topic, see the Psychiatric News article “Nicotine Gummies, Tablets Popular Among Adolescents.”
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About one in six intentional firearm-related deaths in women of childbearing age occur during or shortly after pregnancy, a study in the American Journal of Preventive Medicine has found.
Naima T. Joseph, M.D., M.P.H., of Boston Medical Center and colleagues analyzed data from the Centers for Disease Control and Prevention’s National Violent Death Reporting System from 2008 to 2019. Women aged 15 to 44 years who died by suicide or homicide involving a firearm were included. The researchers defined pregnancy-associated deaths as deaths that occurred during pregnancy or within one year of childbirth.
Over the study period, there were 4,204 firearm-related homicides and deaths by suicide: 2,098 were homicides, of which 22% were associated with pregnancy; and 2,106 were deaths by suicide, of which 11% were associated with pregnancy. Women and girls who died by pregnancy-associated homicide had an average age of 22.2 years, and 54.8% were Black; the average age of those who died by pregnancy-associated suicide was 28.5 years, and 80.5% were White.
The researchers also found the following notable differences where relevant circumstances were known:
“The findings are concerning and indicate that enhanced strategies supporting mental health treatment, effective interventions addressing interpersonal violence, and strategic public health interventions addressing firearm safety are urgently needed to prevent needless pregnancy-associated violent deaths,” Joseph and colleagues wrote. “There is concern that the current national political landscape will serve to worsen the risks of intimate partner violence for pregnant individuals both through restriction of access to abortions and limiting states’ abilities to restrict firearms.”
For related information, see the Psychiatric News article “Gun Violence Is an Underrecognized Social Determinant of Health.”
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APA’s Good Faith Estimates Survey: Please Respond Today
The No Surprises Act requires clinicians to provide patients who are uninsured or are insured but choose not to submit claims through their health plan with a Good Faith Estimate of the cost of care. The Centers for Medicare and Medicaid Services has asked APA for your feedback on efforts to comply with these requirements and any educational support you may need from CMS. The deadline is today, March 8.
TAKE SURVEY
Akathisia—a feeling of restlessness that is often accompanied by movements like rocking or pacing—is a common side effect of antipsychotic medications. A meta-analysis published in JAMA Network Open suggests that biperiden, mirtazapine, and vitamin B6 are the three most effective treatment options for antipsychotic-induced akathisia.
Cyril Gerolymos, M.D., of Aix-Marseille Université in Marseille, France, and colleagues compiled data from 15 randomized clinical trials testing potential pharmacotherapies for akathisia in people taking antipsychotics. The combined data included 492 patients, 324 of whom received an active drug and 168 received placebo. Ten medications were evaluated: biperiden, clonazepam, cyproheptadine, mianserin, mirtazapine, propranolol, trazodone, valproate, vitamin B6, and zolmitriptan.
The researchers noted that clinicians should be prudent about interpreting their results due to the small sample size, but offered the following findings:
“[M]irtazapine consistently ranked first in both the main analysis and all subgroup analyses. However, mirtazapine may be poorly tolerated due to its sedative effects and the potential for weight gain,” Gerolymos and colleagues wrote. Rather, they suggested that vitamin B6 may be the best option in terms of risk-benefit ratio, as it is very well tolerated. However, for patients with akathisia who also have depressive symptoms and insomnia, mirtazapine may be preferred.
Gerolymos and colleagues also cautioned that “trazodone should be avoided in men who have specific hematologic or neurologic diseases (such as sickle cell anemia, multiple myeloma, leukemia, hypercoagulable states, or autonomic nervous system disorders) or in men with anatomical deformations of the penis.”
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Transcranial direct current stimulation (tDCS) may augment virtual reality–guided exposure therapy for veterans with posttraumatic stress disorder (PTSD), according to findings published yesterday in JAMA Psychiatry. In the study, veterans with war zone–related trauma had significantly greater improvements in PTSD symptoms when receiving virtual reality combined with tDCS compared with veterans who received virtual reality and sham stimulation.
Mascha van ’t Wout-Frank, Ph.D., of the VA Providence (R.I.) Healthcare System and colleagues recruited 54 participants (94% male; mean age 46 years) from the system who had PTSD related to war zone experiences. Participants were randomized to receive up to six 25-minute sessions of active tDCS plus virtual reality or sham tDCS plus virtual reality over 10 business days, with at least one day between sessions. The stimulation started simultaneously with the virtual reality program, which provided the participants with visual, auditory, haptic, and olfactory immersion into Iraq or Afghanistan war scenes. Participants were presented with 12 virtual reality scenarios, beginning with a low-intensity experience of riding in a mine-resistant ambush-protected vehicle. From there, the exposures became more intense by the addition of a distant gun battle, a Black Hawk flyover, or an improvised explosive device that caused the leading vehicle to flip.
The primary outcomes were self-reported PTSD symptoms as assessed through the PTSD Checklist for DSM-5 (PCL-5) at baseline, after three sessions, after the last session, and at one- and three-month follow-up. A decrease of 10 or more points was defined as clinically meaningful. To measure changes in psychophysiological arousal, the authors measured skin conductance with electrodes on the participants’ nondominant hands.
Average PCL-5 scores did not meaningfully differ between the two groups at baseline (48.6 among the active tDCS group compared with 45 in the sham group). After completing the six virtual reality sessions, participants in the tDCS group had an average PCL-5 score of 36, representing a clinically meaningful reduction in symptoms, compared with an average score of 38.9 in the sham group. At the one-month follow-up, PCL-5 scores fell to 31.4 in the tDCS group compared with 37.9 in the sham group, representing a statistically significant difference.
Further, there were greater reductions in skin conductance across the six sessions in the tDCS group compared with the sham group, suggesting that those in the tDCS group were getting more accustomed to the virtual exposures, the authors wrote.
“This intervention imposed low participant burden, had modest technical cost, and yielded clinically meaningful improvements in an otherwise difficult-to-treat patient population,” the authors concluded. “This reflects an important step forward in the use of combined brain stimulation and contextual control and underscores the innovative capability of these technologies.”
For related information, see the Psychiatric News article “Virtual Exposure Therapy Found Effective for PTSD.”
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APA’s Good Faith Estimates Survey: Please Respond Today
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APA’s Good Faith Estimates Survey: Please Respond Today
The No Surprises Act requires clinicians to provide patients who are uninsured or are insured but choose not to submit claims through their health plan with a Good Faith Estimate of the cost of care. The Centers for Medicare and Medicaid Services has asked APA for your feedback on efforts to comply with these requirements and any educational support you may need from CMS. The deadline is Friday, March 8.
TAKE SURVEY
The transition into menopause by itself does not appear to raise the risk of depression in women, according to a review in The Lancet. However, a subset of women with a history of depression and/or certain menopause-related risk factors may be vulnerable to depressive symptoms during this period.
“Clinicians should not assume that psychological symptoms during the menopause transition are always attributable to hormonal changes,” wrote Lydia Brown, Ph.D., M.Psych., of the University of Melbourne and colleagues. “Potential misattribution of psychological distress and psychiatric disorders to menopause could harm women by delaying accurate diagnosis and the initiation of effective psychotropic treatments, and by creating negative expectations for people approaching menopause.”
Brown and colleagues analyzed 12 prospective studies reporting depressive symptoms, major depressive disorder, or both for more than 25,000 women during the menopause transition. Only two of the studies, totaling around 600 women, used structured clinical interviews to diagnose major depressive disorder.
They found that the risk of first lifetime major depressive disorder is not increased during menopause, but individuals with previous major depressive disorder might be at increased risk of recurrence. Additionally, women are not universally at risk of depressive symptoms during menopause.
Vulnerability to depressive symptoms during menopause may be due to menopause-related risk factors including severe vasomotor symptoms such as hot flashes and night sweats, sleep disturbance, a long transition, or significant hormone fluctuations. Psychosocial risk factors such as a depression history, stressful life events, or lack of social support can also increase the risk for depressive symptoms.
Brown and colleagues offered the following recommendations:
In an editorial accompanying the review, Lancet editors wrote: “We need to send a realistic, balanced message to women and to society: menopause does not herald the start of a period of decay and decline but is a developmental life stage that can be negotiated successfully with access to evidence-based information as well as appropriate social and medical support.”
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]]>Frequent cannabis use may raise the risk of heart attack and stroke, a study in the Journal of the American Heart Association has found.
Abra Jeffers, Ph.D., M.S., M.Phil., of Massachusetts General Hospital and colleagues examined data from the Behavioral Risk Factor Surveillance Survey (BRFSS) between 2016 and 2020. The BRFSS is an annual telephone survey of adults in which participants report on their health behaviors and whether health care professionals had ever diagnosed them with a health condition. Jeffers and colleagues drew data from 434,104 adults aged 18 to 74 years across 27 states and two territories to assess the association of cannabis use with self-reported cardiovascular outcomes.
In the BRFSS, participants were asked how often they had used cannabis in the previous 30 days and whether they had any diagnoses of coronary heart disease or angina, myocardial infarction (heart attack), or stroke. Jeffers and colleagues adjusted for tobacco use and other characteristics, including the participants’ age, sex, race, body mass index, diabetes, physical activity levels, and socioeconomic status.
Among all participants, 4% reported using cannabis daily, and 7.1% reported using cannabis nondaily. Among participants who reported any cannabis use, nearly 75% reported that they mainly used cannabis by smoking it, and approximately 25% reported using cannabis by some method other than smoking, such as vaping, drinking, or eating it.
The researchers found that participants who used cannabis daily by any means had a 25% increased likelihood of heart attack and a 42% increased likelihood of stroke compared with participants who did not use cannabis.
The researchers wrote that although the mechanisms linking cannabis to heart disease are unclear and were not explored in the current study, multiple factors could play a role. In addition to toxins, endocannabinoid receptors—the part of cells responsible for recognizing tetrahydrocannabinol (THC), the main psychoactive ingredient in cannabis—are widespread in the body’s cardiovascular tissues and might increase heart risks. They also noted that smoking, the predominant method of cannabis use, may pose additional cardiovascular risks via inhalation of particulate matter.
“Cannabis has strong, statistically significant associations with adverse cardiovascular outcomes independent of tobacco use and controlling for a range of demographic factors and outcomes,” the researchers wrote. “Patients and policymakers need to be informed of these potential risks, especially given the declining perception of risk associated with cannabis use.”
For additional information, see the American Journal of Psychiatry article “Risks and Benefits of Cannabis and Cannabinoids in Psychiatry.”
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The No Surprises Act requires clinicians to provide patients who are uninsured or are insured but choose not to submit claims through their health plan with a Good Faith Estimate of the cost of care. The Centers for Medicare and Medicaid Services has asked APA for your feedback on efforts to comply with these requirements and any educational support you may need from CMS. The deadline is Friday, March 8.
]]>Low-frequency transcranial magnetic stimulation (TMS) can improve symptoms of psychomotor slowing in individuals with schizophrenia, reports a study in JAMA Psychiatry. Psychomotor slowing involves impairment of both fine and gross motor movements, making tasks like walking or talking difficult.
“Psychomotor slowing often comes with multiple disadvantages, such as cognitive impairment, sedentary behavior, cardiometabolic risks, poor quality of life, lower subjective well-being, and impaired functioning,” wrote Sebastian Walther, M.D., and colleagues at the University of Bern, Switzerland. The researchers noted that there are no specific treatments for psychomotor slowing but hypothesized that targeting the supplementary motor area of the brain with TMS might be a promising approach.
Walther and colleagues enrolled 88 adults (aged 18 to 60) with schizophrenia spectrum disorder and severe psychomotor slowing, defined as a score of 15 or more on the Salpêtrière Retardation Rating Scale. The participants were evenly divided to receive low-frequency repetitive TMS (rTMS at 1 hertz), high-frequency intermittent theta burst stimulation (iTBS at 50 hertz), or sham stimulation or to be placed on a waiting list. All stimulation protocols involved 15 sessions across three weeks; after three weeks, the wait list group received rTMS. Participants were allowed to continue taking their existing medications.
After three weeks, 68% of adults who received rTMS responded to treatment, defined as at least a 30% improvement in Salpêtrière Retardation Rating Scale scores. By comparison, 36% of iTBS recipients, 32% of sham participants, and 18% of adults on the waitlist responded. After adjusting for demographic variables and medication use, the researchers estimated someone receiving rTMS had more than 80% greater odds of responding than someone receiving iTBS or sham.
Walther and colleagues also noted that 63% of the waitlist group responded to rTMS once they got the treatment. Additionally, no participants reported experiencing severe adverse events, with the most common side effects being fatigue and head/neck pain.
To read more about psychomotor problems, see the Psychiatric News article “Comprehensive Catatonia Guideline Released.”
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A large majority of U.S. adults who have pets feel that their pets have a positive impact on their mental health, according to the latest findings from APA’s Healthy Minds Poll released today.
“It’s easy to overlook the role of pets when we’re talking about mental health,” said APA President Petros Levounis, M.D., M.A., in a news release. “But for people who do enjoy the company of animals, they can be a source of companionship, comfort, love, and friendship. I routinely encourage adoption of a pet to my patients who struggle with addiction to alcohol, drugs, or technology. We’re also starting to see more and more research around the role that animals can play in recovery from depression and other psychiatric disorders.”
The poll was conducted online by Morning Consult from February 6 to 9 with a sample of 2,200 adults. The results were released jointly with the American Veterinary Medical Association.
Among all survey respondents, 72% reported having pets at home—52% had dogs; 37% had cats; 7% had fish; 4% had birds; and less than 3% had turtles, chickens, horses, snakes, lizards, rabbits, guinea pigs, or hamsters. Eighteen percent of pet owners said one or more of their pets were certified as an emotional support animal.
Among pet owners, 84% said their pets have a mostly positive impact on their mental health, compared with only 1% of pet owners who reported a mostly negative impact. Those who said their pets positively affect their mental health offered the following reasons:
When asked how much they worried about various stressors related to pets, 76% of respondents said they worried about their pets aging or passing away, 67% worried about their pet’s health conditions, and 67% worried about their pet’s care when traveling.
For related information, see the Psychiatric News special report “How Companion Animals Can Participate in Treatment of Mental Illness.”
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Individuals at high risk of psychosis who later develop a full-blown psychotic illness respond more slowly on a test of response time than high-risk individuals who do not, according to a report published today in AJP in Advance. The differences in response time correlated to noticeable differences in the brain’s electrical activity.
Yongqing Hou, Ph.D., of Southwest University in Chongqing, China, and colleagues used electroencephalography (EEG) to measure brain activity of 223 participants during a computerized test in which they were shown square targets with different colors. The task required participants to press the space bar quickly and accurately only when they saw a red square, which appeared 15% of the time. During the rest of the time, they were shown an “interference” square, which was usually blue, but occasionally other colors.
The participants (who were all freshmen at Chinese universities) included 122 individuals with psychosis risk syndrome, 50 individuals with an emotional disorder (depression and/or generalized anxiety) but no psychosis risk syndrome, and 51 control subjects with no psychiatric illness. Individuals meeting criteria for psychosis risk were followed for 12 months and reclassified into three subgroups: those who converted to full-blown psychosis, those who did not convert but remained symptomatic, and those who experienced remission from symptoms.
Average response time on the test was highest for individuals in the psychosis risk group at 407.38 milliseconds; for participants with emotional disorders, it was 406.97 milliseconds, and for controls it was 389.88 milliseconds. There were also notable EEG differences in a brainwave signal called N2, which changed immediately after the red square appeared on screen. The degree of change, or the N2 amplitude, reflects how well an individual can pay attention and process new information. Individuals in the psychosis risk group had significantly smaller N2 amplitudes than control subjects and similar amplitudes to those of individuals with emotional disorders.
Next, the researchers compared the data for the three subgroups. They found that individuals who converted to full-blown psychosis had significantly smaller N2 amplitudes than individuals who remitted or remained symptomatic but did not convert, even though response times were not significantly different among the subgroups.
“[I]t is necessary to be cautious when using N2 as a single indicator for psychiatric risk assessment in clinical practice,” Hou and colleagues wrote. “However, the findings of this study indicate that N2 amplitude can still be used as a neuroelectrophysiological biomarker for individualized psychiatric risk assessment in psychosis risk syndrome; by increasing objective clinical information, the accuracy and reliability of psychiatric risk assessment can be improved.”
For related information, see the Psychiatric News article “Predicting Schizophrenia: Field Moves From Clinical Assessment of Risk to Search for Biomarkers.”
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Hospitalized patients with opioid use disorder who were referred to an on-site clinic that provides wraparound services during the transition to outpatient care (a bridge clinic) reported fewer overdoses and more refills of medications like buprenorphine in the weeks following discharge, a study in JAMA Network Open found. However, the use of the bridge clinic was not associated with a faster discharge compared with usual opioid use disorder (OUD) care, nor did it reduce hospital readmissions or health care costs.
“Bridge clinics offer presumed care advantages, including timely provision of [medications] while a long-term clinician is identified, and notwithstanding other barriers, including stigma, they may offer the ability to discharge patients early,” wrote David Marcovitz, M.D., of the Vanderbilt University School of Medicine and colleagues.
Marcovitz and colleagues recruited 335 hospitalized adults with OUD (median age of 38) who were being seen in an addiction consultation service. Patients were randomized to receive usual care or care in the bridge clinic, which was co-located with the addiction consultation service. Patients assigned to the bridge clinic received enhanced case management during and after their hospitalizations, as well as a buprenorphine-naloxone prescription at discharge. They were asked to present weekly to the bridge clinic for the first eight weeks, then twice monthly based on their clinical presentations. Patients in the usual care group were referred to a community clinic and received a buprenorphine-naloxone prescription at discharge.
At 16 weeks, patients reported their recurrent opioid use, overdoses, and the number of buprenorphine-naloxone prescriptions they filled; they also reported whether they had been successfully linked to health care professionals who provided medications for OUD. Information on health care utilization was collected from the patients’ electronic medical records.
The median lengths of stay in the hospital did not differ between patients in the bridge clinic or in usual care (5.7 days compared with 5.9 days, respectively). After discharge, patients in the bridge clinic group had fewer hospital-free days, experienced more hospital readmissions, and had higher care costs. The total median cost of care was $9,482 in the bridge clinic group compared with $1,705 in the usual care group.
Eighty-eight patients completed the 16-week follow-up calls. Compared with the usual care group, those in the bridge clinic group were less likely to report having experienced an overdose and more likely to report linkage to health care professionals who provided medications for OUD. They also reported refilling more buprenorphine prescriptions.
The finding that the bridge clinic group incurred greater costs and more may be a result of patients utilizing care that they previously had not, wrote Marlene Martin, M.D., of the University of California, San Francisco, and Noa Krawczyk, Ph.D., of the NYU Grossman School of Medicine, in an accompanying commentary. “This finding may also reflect increased trust in the health care system associated with the bridge clinic group, as stigma often prevents patients with OUD from seeking and accessing care.”
For related information, see the Psychiatric News article “Bridge Clinic Cuts Emergency Department Use in Patients With OUD.”
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Children whose parents experience parenting stress and other parenting issues may have a higher risk of nonsuicidal self-injury in adolescence, a study in the Journal of the American Academy of Child & Adolescent Psychiatry has found.
Tove Wichstrøm, M.A., and Lars Wichstrøm, Ph.D., of the Norwegian University of Science and Technology in Trondheim, Norway, examined data from 759 Norwegian adolescents at age 12, 14, or 16 years to determine the adolescents' rate of nonsuicidal self-injury as measured by the Child and Adolescent Psychiatric Assessment. The researchers also examined data provided by the adolescents' parents, teachers, and the youth themselves collected when the adolescents were 6 years old. Childhood data included parental characteristics (parental stress, parental depression, perceived parental hostility, and perceived emotional availability), childhood characteristics (negative affectivity, emotion regulation, symptoms of emotional disorders, and symptoms of behavioral disorders), and negative childhood life events such as victimization by bullying.
Overall, 10% of the adolescents reported nonsuicidal self-injury during the preceding 12 months at 12, 14, or 16 years of age. Females had 11.6 times the odds of nonsuicidal self-injury compared with males. Adolescents whose parents reported parental stress when the adolescents were 6 years old had 4.8 times the odds of reporting nonsuicidal self-injury compared with adolescents whose parents did not report parental stress. Adolescents who perceived parental hostility and negativity at 6 years old had 1.8 times the odds of nonsuicidal self-injury compared with adolescents who did not. However, child characteristics and negative events did not appear to increase the odds of adolescents reporting nonsuicidal self-injury.
"Stress in parents is hypothesized to have widespread negative impacts on child development, including the development of behavioral problems and reduced social competence. It is therefore possible that increased stress contributes to the emergence of risk factors in children, which have implications for [nonsuicidal self-injury]-related vulnerabilities in adolescence," Wichstrøm and Wichstrøm wrote.
"[U]niversal or indicated interventions to reduce parenting stress and to improve parent‒child interactions during childhood may reduce the risk of [nonsuicidal self-injury] in adolescence," they concluded.
For related information, see the Psychiatric Services article, "Testing the Impact of a Peer-Delivered Family Support Program: A Randomized Clinical Effectiveness Trial."
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Since 2019, calls to U.S. poison centers involving youth or young adults who took the psychedelic psilocybin have risen sharply, according to a study published today in the Journal of Adolescent Health. The timing is notable as 2019 was the start of a psilocybin decriminalization movement across numerous states and cities.
Rita Farah, Ph.D., and colleagues at the University of Virginia School of Medicine analyzed data from the National Poison Data System, which collects de-identified poison exposure data from centers across the country. The researchers examined all cases of psilocybin exposure between 2013 and 2022 involving young people aged 13 to 25.
Over the 10-year period, the researchers identified 4,055 calls for psilocybin exposure, of which about 66% involved psilocybin alone. The poison calls generally included a visit to a health care facility due to hallucinations or delusions, agitation, elevated heart rate, or confusion. The calls included two reported deaths, but both involved a secondary substance (fentanyl and amphetamine).
Between 2013 and 2018, the number of psilocybin calls per year remained steady among both adolescents (aged 13 to 19) and young adults (aged 20 to 25). Starting in 2019, however, the rates increased each year. In 2022, psilocybin-related poison calls by young adults had more than doubled compared with 2018 (to nearly 300 calls), while calls by adolescents had more than tripled (over 450 calls). The researchers noted that overall call volume to poison centers did not fluctuate significantly between 2013 and 2022.
Farah and colleagues noted that their analysis could not assess how psilocybin-related poison calls changed in specific regions where this drug has been decriminalized. “As psilocybin might become more available, continued surveillance is critical to inform lawmakers and help guide public policy,” they wrote.
To read more on this topic, see the Psychiatric News article “Marijuana, Hallucinogen Use Reach Historic Levels Among Young Adults.”
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Nearly one in five people who attempt suicide either have no history of prior mental illness or do not meet the criteria for a diagnosis of mental illness at the time of the attempt, a study in JAMA Psychiatry suggests.
“This finding challenges clinical notions of who is at risk for suicidal behavior and raises questions about the safety of limiting suicide risk screening to psychiatric populations,” wrote Past APA President Maria A. Oquendo, M.D., Ph.D., of the University of Pennsylvania and colleagues.
The researchers analyzed data from 1,948 adults (66.8% female) aged 20 to 65 years with a history of suicide attempts who were surveyed between April 2012 and June 2013 in the U.S. National Epidemiologic Study of Addictions and Related Conditions III.
The researchers found that 6.2% of the respondents did not have a diagnosis of mental illness at any time prior to attempting suicide or afterwards up to the point they completed the survey. They also found that an additional 13.4% made a first suicide attempt before the onset of mental illness, and some did not meet the criteria for a mental illness until several years after their suicide attempt. All told, an estimated 19.6% of adults reported a lifetime suicide attempt with no evidence of a mental illness prior to their first attempt; this prevalence was approximately the same in males and females.
“From a clinical standpoint, these findings suggest that a history of suicide attempts should be obtained regardless of whether the person has a psychiatric disorder, given that suicide attempts are associated with future attempts and future suicide,” Oquendo and colleagues wrote.
“[P]olicy makers, clinicians, and health systems should weigh the costs and benefits of expanding suicide risk screening beyond the current targets and consider universal screening to prevent suicide attempts, which have significant morbidity as well as medical and other costs,” they added.
For related information, see the Psychiatric News article “Half of Patients With Suicidal Thoughts Deny It.”
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Children who show greater food responsiveness in early childhood have a higher risk of experiencing eating disorder symptoms in early adolescence, while those who eat more slowly have a lower risk of such symptoms, according to a study published this week in The Lancet Child & Adolescent Health.
“Eating disorders frequently coexist with other psychiatric disorders and have high mortality rates,” wrote Ivonne Derks, Ph.D., of Erasmus Medical Center in Rotterdam, Netherlands, and colleagues. “Because these disorders are difficult to treat, focus is shifting towards prevention and early intervention when symptoms or episodes first arise, often in adolescence.”
Derks and colleagues used data from two population-based cohort studies: Generation R, which is based in Rotterdam, and Gemini, which is based in England and Wales. Parents reported their children’s appetitive traits by completing the Child Eating Behaviour Questionnaire (CEBQ) when children were aged four (Generation R) or five (Gemini). Youth self-reported eating disorder symptoms when they were aged 12 to 13 (Gemini) or 14 (Generation R). Eating disorder symptoms included restrained (restricted) eating, uncontrolled eating, emotional eating, binge eating, and compensatory behaviors (such as purging, extended fasting, or hiding or throwing away foods). A total of 3,670 participants from both studies were included in the final analysis.
The authors looked at seven appetitive traits measured by the CEBQ. Higher scores in three traits reflected a more avid appetite: food responsiveness (how responsive children are toward external food cues), food enjoyment, and emotional overeating. Higher scores in four traits reflected a poorer appetite: food fussiness, satiety responsiveness (how quickly children feel full), eating slowly, and emotional undereating.
Derks and colleagues found that greater food responsiveness in early childhood was associated with increased odds of all five eating disorder symptoms in adolescence, especially binge eating. A 1-unit increase in the food responsiveness scale in early childhood corresponded with a 47% increased risk of binge eating symptoms in early adolescence, the authors wrote.
“This finding is important because overeating and restrictive eating disorder symptoms often co-occur within eating disorders (e.g., in bulimia nervosa or anorexia nervosa binge/purge type) or might trigger one another (e.g., binge eating episodes are often preceded by restrained eating, which can drive binge eating episodes),” the authors wrote.
Additional findings include the following:
“Our findings could provide new opportunities for treatment and prevention of eating disorders,” the authors wrote. “[T]eaching parents and children how to recognize and respond to internal feelings of hunger and satiety, encourage slower eating at mealtimes, and not to offer or eat food for reasons other than homoeostatic hunger… are practices that support the development of healthy eating habits.”
For related information, see the Psychiatric News article “APA Releases Updated Guideline for Treating Eating Disorders.”
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More than a third of individuals at “ultra-high risk” (UHR) of psychosis who did not convert to psychosis over a 6- to 12- year period did develop a new, non-psychotic mental disorder, according to a report in Schizophrenia Bulletin. Further, more than a quarter of these individuals still met criteria for UHR. Ultra-high risk refers to youth or young adults who experience a range of brief intermittent psychotic symptoms and/or subthreshold psychotic experiences, putting them at greatly increased odds of developing a full-threshold psychotic disorder.
“Because this UHR sample never developed a full threshold psychosis, they would not have been targeted for prolonged intervention,” wrote lead author Anneliese E. Spiteri-Staines, Ph.D., of the University of Melbourne, Australia, and colleagues. “However, given their long-term impairment, this group would benefit from longer-term treatment both for their non-psychotic disorders and continuing [attenuated psychosis symptoms].”
The researchers evaluated 102 young people (62% female) enrolled in the Personal Assessment and Evaluation Clinic, a specialized clinic for high-risk youth at the Orygen Mental Health Center in Melbourne. All participants were between 15 and 30 years of age at baseline and met the criteria for UHR but had not converted to full-threshold psychosis at a follow-up assessment 6 to 12 years after their baseline assessment.
UHR status was determined using the Comprehensive Assessment of At-Risk Mental States (CAARMS). Mental disorder diagnosis was assessed using the Structured Clinical Interview for DSM-IV. Transition to psychosis was determined using both the CAARMS and DSM-IV.
Overall, 35% of participants were diagnosed with a new non-psychotic disorder during the follow-up period, while 44% participants had a non-psychotic disorder at baseline that remitted. A further 54% had a non-psychotic disorder that persisted from baseline to follow-up. Altogether, only 6% of participants had not received a diagnosis of any non-psychotic DSM-IV disorder at either baseline or the follow-up assessment. The disorder that was the most persistent over time was mood disorder.
Spiteri-Staines and colleagues also found that of the 84 patients for whom data was available on UHR status at follow-up, 29% continued to meet UHR criteria, and these individuals were more likely to have a co-occurring mental disorder.
“There is a need to better understand the risk factors for the persistence and incidence of non-psychotic disorders in the UHR population, in addition to those associated with risk for developing psychotic disorder,” the researchers wrote. “Sustained clinical attention to monitor and avert these outcomes is warranted.”
For related information, see the Psychiatric News article, “Predicting Psychosis: Field Moves From Assessment of Clinical Risk to Search for Biomarkers.”
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People who speak more than one language may have a lower prevalence of dementia or mild cognitive impairment compared with those who speak only one language, according to a study published today in Alzheimer’s & Dementia.
“A large body of literature has focused on studying the protective effects of bilingualism against cognitive decline and dementia in clinical settings,” wrote Aparna Venugopal, M.Sc., and Avanthi Paplikar, Ph.D., of the National Institute of Mental Health and Neurosciences in Bengaluru, India, and colleagues. However, the authors noted that only a few community-based studies have investigated the protective role of bilingualism. “India offers a unique opportunity to study bilingualism, cognition, and dementia since the population is non-immigrant and linguistically diverse,” they wrote.
Venugopal, Paplikar, and colleagues conducted a door-to-door community survey in Jayanagar, South Bengaluru, India, from January to December 2021 among individuals aged 60 years or older. Each participant received a clinical examination by a general physician, after which a clinical psychologist and speech-language pathologist administered neuropsychological tests to assess dementia status. Participants completed the language use questionnaire to determine the number of languages in which they were proficient.
A total of 1,234 participants with a mean age of 71 years were included in the study. Among all participants, 1.9% were diagnosed with dementia and 6.5% were diagnosed with mild cognitive impairment. Further, 65% of participants were considered bilingual. Additional findings include the following:
“Overall findings indicate that bilingualism promotes healthy aging and protects against cognitive decline and dementia,” the authors wrote. “Our study has implications for public health interventions, highlighting the importance of promoting bilingualism and multilingualism as potential cognitive reserve factors that may delay or slow down cognitive decline.”
For related information, see the Psychiatric News article “COVID-19 Takes Cognitive Toll on Older Patients.”
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Patients with depression who have been discharged from psychiatric hospitals have the highest risk of dying by suicide in the first three days after discharge, with some risk factors increasing that risk further, according to a study published this week in JAMA Psychiatry.
Of all people dying by suicide, more than half had depression, and approximately 40% had been recently hospitalized, wrote Kari Aaltonen, M.D., Ph.D., of the University of Helsinki and colleagues. Therefore, people hospitalized for depression are at significant risk of suicide following their discharge. “Such a population with a distinct high-risk period in contact with psychiatric care forms a prioritizable target for selective suicide prevention,” they wrote.
Aaltonen and colleagues used data from Finnish registers such as the Care Register for Health Care and Statistics Finland, which included information on hospital admissions, discharges, diagnoses, and causes of death. They identified all psychiatric hospitalizations for depression among participants aged 18 years and older from 1996 to 2017; patients with comorbid major psychotic disorder or bipolar disorder were excluded. Each patient was followed for up to two years after discharge. For those with multiple hospitalizations, each discharge marked the beginning of a new follow-up period.
A total of 193,197 hospitalizations occurred during the study period among 91,161 participants (56.2% female; mean age 44 years). A total of 1,219 men and 757 women died by suicide during the study period. Additional findings included the following:
“Although we found a decreasing trend over time, the high-risk post-discharge period still requires intensified attention,” the authors wrote. “Continuity of care and access to enhanced psychiatric outpatient care within days of discharge should be imperative.”
For related information, see the Psychiatric News article “Army STARRS Study Finds Risks to Progression From Suicidal Ideation to Attempts.”
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Nearly 9 in 10 Mexican-origin youth living in Northern Indiana reported experiencing discrimination, according to a study published in the Journal of the American Academy of Child & Adolescent Psychiatry. These findings reflect the first wave of a three-wave longitudinal study, Seguimos Avanzando, which is examining the effects of discrimination as well as family support on the mental health of Mexican-origin youth in regions experiencing new migration.
“In new migration areas, Latinx individuals are often portrayed as having criminal tendencies, perpetuating negative stereotypes and increasing marginalization,” wrote Margarita Alegria, Ph.D., of Massachusetts General Hospital and colleagues. “Previous research has not studied risk and protective factors among Latinx individuals living in a predominantly White population state, and few studies used longitudinal designs barring rare exceptions.”
For wave 1, Alegria and colleagues surveyed an ethnically homogeneous sample of 344 Mexican-origin adolescents (aged 12 to 15) and their primary caregivers. Measures on the youth-reported surveys included past two-week depressive symptoms (Child Depression Inventory-2 Short Form), past three-month anxiety symptoms (Generalized Anxiety Disorder Scale of the Screen for Child Anxiety Related Emotional Disorders), past-month sleep quality (Pittsburgh Sleep Quality Index global scores), and lifetime perceived racial discrimination (Perceptions of Racism in Children and Youth).
After completing the wave 1 survey, 317 youth also completed a one-time 21-day diary in which they reported items including their daily stress, daily perceived racial discrimination, and previous night’s sleep quality.
The researchers found that 88.1% of youth reported at least one incident of lifetime discrimination. Furthermore, 29.7% had elevated depressive symptoms, 44.5% had probable generalized anxiety disorder, and 50.9% had poor sleep quality. Across both the survey and diary reports, Alegria and colleagues found a consistent correlation between increased perceived racial discrimination and worse mental health and sleep quality.
“Contributing factors [for these outcomes] for Mexican American youth could be acculturative stress, associated with worse mental health outcomes, the recent COVID-19 pandemic, exposure to food insecurity, and housing instability,” the researchers wrote. “Discrimination and uneasiness in social situations responding to racism could also cause elevated risk.”
For related information, see the Psychiatric Services article “Leveraging Latinx and Spanish-Language Media to Achieve Mental Health Equity.”
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A machine learning program that analyzes patients’ brain imaging data along with many clinical variables of major depression—such as symptom severity—predicted whether patients with major depressive disorder would respond to the antidepressant sertraline, according to a report in AJP in Advance.
Machine learning is a type of artificial intelligence that combines a very large number of patient variables—more than a single physician could collect—to try to reliably predict an outcome of interest for individual patients. With each new piece of data, the computer “learns” to refine its prediction—hence the term “machine learning.
Maarten G. Poirot, M.S., and Henricus G. Ruhé, M.D., Ph.D., of the University of Amsterdam and colleagues used data from 229 patients with major depression who had enrolled in the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study, a randomized controlled trial designed to evaluate variables that predict antidepressant response. Brain MRI images and a wide variety of socioeconomic, behavioral, and neuropsychiatric variables were collected before and one week after treatment with sertraline.
The researchers first tested their machine learning program on 105 patients who received sertraline and found the program could predict treatment response after 8 weeks using both pretreatment data (patient baseline variables) or early treatment data (changes after one week) significantly better than random chance; accuracy ratings ranged from 62% to 68%. The machine learning program did not generally perform as well when assessing whether patients in the placebo group responded to treatment, indicating that the prediction tool was specific to sertraline.
Moreover, the analysis was able to pinpoint which variables were most important in the prediction. “The algorithm suggested that blood flow in the anterior cingulate cortex, the area of brain involved in emotion regulation, would be predictive of the efficacy of the drug. And at the second measurement, a week after the start, the severity of their symptoms turned out to be additionally predictive,” said Ruhé in a press release. In the article, the researchers noted that since their program would likely not need input from a second session of MRI scanning to be accurate, the cost and burden on patients would be lowered in clinical practice.
The researchers concluded, “With additional external validation, these findings will contribute toward the use of predictive modeling in individualizing clinical sertraline treatment of patients with MDD.”
For related information, see the Psychiatric News article “Research Using Machine Learning in Psychiatry Expands Rapidly.”
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At-risk youth whose parents were enrolled in a behavioral intervention as children use fewer inpatient and outpatient mental health services than their peers, according to a report in AJP in Advance. The intervention, known as Fast Track, combines cognitive and social skills training for children and child behavior management training for parents.
“Preventive interventions like Fast Track delivered in one generation may reduce use of some of the highest-demand and most expensive health services for children in the next generation,” wrote W. Andrew Rothenberg, Ph.D., of Duke University and colleagues. “Potential mechanisms that might explain these reductions include a decreased risk for internalizing psychopathology and decreased use of corporal punishment to create a more optimal family environment for the next generation.”
The initial Fast Track cohort included 891 children in grades 1 through 5 and families recruited from elementary schools in areas of high crime and poverty in the early 1990s. Half of the children were provided the Fast Track intervention, and the other half were in the control group. Participants in both groups were subsequently interviewed at age 25, which included assessments of internalizing and externalizing problems and whether the participants, if parents, spanked their children. The participants with children were contacted again at age 34 and asked to complete a survey about their children’s mental health and health service use.
In total, 398 parents filled out these surveys at age 34; 209 of the parents were in the Fast Track group and filled out measures for a combined 581 children. The remaining 189 parents were in the control group and filled out these measures for a combined 476 children.
Rothenberg and colleagues found that compared with the children whose parents were in the control group, those whose parents were in Fast Track were 3.29 times less likely to have used inpatient mental health services, 1.85 times less likely to have used outpatient mental health services, and 1.38 times less likely to have used general inpatient health services. However, there were no differences between the groups in the use of general outpatient services, school-based services, and overall mental health symptoms.
“[A]lthough there were no significant differences between the intervention and control groups on … mental health scores, both groups appear to be functioning as well as or better than children from a ‘normative’ population whose parents were not at high risk for conduct problems,” the authors wrote.
For related information, see the Psychiatric News article “Group School Intervention Helps Girls Cope With Internalized Trauma.”
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At its meeting on February 9, APA’s Committee of Tellers approved the following results for APA’s 2024 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 9 and 10.
President-elect
Theresa M. Miskimen Rivera, M.D.
Treasurer
Steve Koh, M.D., M.P.H., M.B.A.
Trustee at Large
Patricia Westmoreland, M.D.
Early Career Psychiatrist Trustee
Sudhakar K. Shenoy, M.D.
Area 1 Trustee
John C. Bradley, M.D.
Area 4 Trustee
Dionne Hart, M.D.
Area 7 Trustee
Mary Hasbah Roessel, M.D.
Resident-Fellow Member Trustee-Elect
Nicolas K. Fletcher, M.D., M.H.S.A.
“Our profession faces multiple challenges,” Miskimen Rivera said in a news release. “We need a cohesive, actionable, multi-year strategy to enact effective and permanent change. As president, I will focus on the workforce challenges facing psychiatry, with the ultimate goal being to reverse these challenges, enabling greater fulfillment in our practices and achieving better patient outcomes.”
Miskimen Rivera is chair and medical director of the Department of Psychiatry at Hunterdon Medical Center in Flemington, N.J. A speaker of English and Spanish, she has worked for 30 years to improve access and delivery of psychiatric care to bilingual and bicultural communities. She has held appointed positions under the three past governors of New Jersey to address mental health issues spanning the intersection of technology and the delivery of psychiatric care, mental health in university settings, and youth suicide prevention.
Miskimen Rivera is an APA delegate on the AMA’s Section Council on Psychiatry and is a member of the American College of Psychiatrists. She is also a clinical professor of psychiatry at Robert Wood Johnson Medical School.
“Congratulations to everyone who has been elected to APA’s Board of Trustees,” said APA President Petros Levounis, M.D., M.A. “I look forward to working with all of them to lead APA’s efforts as we continue to innovate, advocate, and research on behalf of the doctors who serve millions of patients and families with substance use and mental health disorders.”
Commented APA CEO and Medical Director Saul Levin, M.D., M.P.A., “I’m so pleased for Dr. Miskimen Rivera, a longtime colleague and friend of APA, to become our president,” said “With her long track record of leadership throughout the organization and in her home state, she is a proven leader and will bring much experience to her year as president.”
Miskimen Rivera’s term as APA president-elect will begin in May at the conclusion of APA’s 2024 Annual Meeting, when President-Elect Ramaswamy Viswanathan, M.D., begins his one-year term as president. The other newly elected trustees will also begin their terms of office then as well.
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