Wednesday, September 28, 2022

Feeling Strong Sense of Purpose May Protect Older Veterans From Mental Illness

Older veterans who say they have a strong sense of purpose in life may be less likely to experience a range of mental disorders compared with those with those lacking such a sense of purpose, according to a report in The American Journal of Geriatric Psychiatry.

Perceived purpose in life refers to the extent to which a person believes that his or her life is motivated by goals and aims that they care about, Ian C. Fischer, Ph.D., of Indiana University-Purdue University at Indianapolis and colleagues wrote. The “[r]esults of this study suggest that existing interventions that have been shown to increase [purpose in life] may have the potential to help mitigate risk for, and alleviate symptoms of, various mental disorders,” they added.

Data were drawn from the National Health and Resilience in Veterans Study (NHRVS), a survey of 4,069 U.S. veterans, the majority of whom were 60 years and older, White, and male. The NHRVS was administered between November 18, 2019, and March 8, 2020, and all participants completed an anonymous, 50-minute, web-based survey. As part of this survey, veterans completed the four-item Purpose in Life Test Short Form and were screened for mental disorders and suicidality.

The researchers broke the participants into three groups: those who endorsed a high purpose in life, average purpose in life, or low purpose in life.

Most participants (71.7%) endorsed average levels of perceived purpose in life; 16% endorsed low purpose in life and 12.4% endorsed high purpose in life. High purpose in life was associated with 42% to 94% reduced odds of screening positive for major depressive, generalized anxiety, posttraumatic stress, and substance use disorders, as well as suicidality, Fischer and colleagues wrote.

“Given the ‘dose-response’ relationship found between purpose in life and a broad range of mental health outcomes, purpose in life may be an important transdiagnostic prevention and treatment target,” they concluded.

For related information, see the Psychiatric News article “Interventions That Promote Wisdom May Help Patients With Psychiatric Conditions.”

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Tuesday, September 27, 2022

Black Children Less Likely to Report Suicidal Thoughts in Emergency Room, Study Suggests

Black children brought to an emergency department for behavioral issues appear less likely to report suicidal thoughts than children of other races, suggests a report published today in Psychiatric Services. Additionally, Black children were more likely to be brought to the emergency department by police and to be discharged rather than hospitalized for psychiatric care.

Carol Vidal, M.D., Ph.D., of the Department of Psychiatry and Behavioral Sciences at Johns Hopkins and colleagues analyzed electronic medical record data from 504 patients aged 8 to 12 years visiting a pediatric emergency department (ED) with a psychiatric issue in 2019. This “urban pediatric ED, … located in the Mid-Atlantic region, has an estimated annual census of 35,000 patient visits (60% Black, 21% White, 10% Latino/Latina or Hispanic; approximately 60% had public insurance),” Vidal and colleagues wrote.

The researchers examined youth’s responses to the Ask Suicide-Screening Questions tool (ASQ)—a four-item suicide risk screening instrument completed in the ED. They also compared the youth’s demographic data, mode of arrival to the ED, primary ED clinical impression (for instance, suicidal ideations, oppositional defiant disorder or related problems, or depression and anxiety), and more. A total of 398 youth completed the ASQ; of these, 42% reported wishing they were dead, 32% reported feeling they would be better off dead, and 37% reported thinking of killing themselves in the past week. A previous suicide attempt was reported by 28% of the youth.

When the researchers examined the responses by the race of the youth, they found that there was little difference in the percentage of youth who reported a previous suicide attempt (27% of White youth, 28% of Black youth, and 29% of other/multiracial youth). However, Black youth were less likely to report wishing they were dead (35% vs. 57% in White youth and 50% of other/multiracial youth), feeling that they would be better off dead (27% vs. 38% and 50%), and thinking about killing themselves in the past week (33% vs. 47% and 43%) in the past couple weeks. Further analysis revealed that 35% of Black youth were transported to the ED by police compared with 12% of White youth and 15% of other/multiracial youth.

“[N]on-Black preadolescents were three times as likely as Black children to be admitted to inpatient psychiatric care,” Vidal and colleagues continued. “Although racial differences in admission to inpatient psychiatric care could be related to the lower frequency of self-reported suicidal thoughts among Black preadolescents, other patient, parent, and provider factors likely contribute to this disparity, given that Black preadolescents in our sample who reported thoughts of suicide were still less likely to be hospitalized than were non-Black peers with thoughts of suicide.”

While the authors noted several limitations of the study—including its small sample and focus on a single ED—they wrote that the findings point to the need for more research: “Research to better understand racial disparities in suicide risk among preadolescents can inform prevention efforts.”

For related information, see the Psychiatric News article “Study Investigates Link Between Discrimination, ADHD, Suicide.”

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Monday, September 26, 2022

Adults With Child Trauma History Respond to Depression Treatment Similar to Other Adults

Adults with depression and a history of childhood trauma respond as well to medications and psychotherapy as those without childhood trauma, according to a meta-analysis published in Lancet Psychiatry.

“Several individual and meta-analytic studies indicate that a history of childhood trauma is associated with poorer response to first-line depression treatments, suggesting the need for new personalised treatments for patients with major depressive disorder and childhood trauma,” wrote Erika Kuzminskaite, M.S., of Vrije University in the Netherlands and colleagues with the Childhood Trauma Meta-Analysis Study Group. “However, the evidence on poorer treatment outcomes in adults with depression and childhood trauma has not been definitive.”

Kuzminskaite and colleagues collected data from 29 randomized clinical trials testing a medication, psychotherapy, or combination treatment for adults with major depression; all trials included assessments for childhood trauma. The combined samples included 6,830 adults, of whom 62% had reported a history of childhood trauma. Although adults with a history of childhood trauma on average had more severe depressive symptoms at baseline, they had similar symptom improvement following treatment as adults with no trauma history. The findings were consistent regardless of depression type (depression or treatment-resistant depression), treatment type (medication or psychotherapy), or trauma type (emotional, physical, or sexual abuse or neglect).

Kuzminskaite and colleagues noted that previous studies in this area typically looked at treatment response or depression remission as the outcomes. “Subsequently, greater improvement could be required for patients with childhood trauma to meet the definition of remission,” they wrote. “By contrast, we examined depression severity change from baseline to after treatment consistently taking baseline symptoms into account and using depression severity correlations from before and after treatment.”

“This meta-analysis delivers a hopeful message to patients with childhood trauma that evidence-based psychotherapy and pharmacotherapy could improve depressive symptoms,” wrote Antoine Yrondi, M.D., Ph.D., of the University of Toulouse, France, in an accompanying editorial. “However, physicians should keep in mind that childhood trauma could be associated with clinical features which might make it more difficult to reach complete symptomatic remission of major depressive disorder and, therefore, have an effect on daily functioning.”

For related information, see Prospective Study Delves Deeper Into Mental Health Effects of Childhood Trauma.

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Friday, September 23, 2022

High Rates of Depression, PTSD Persist Five Years After Water Crisis in Flint, Mich.

Five years after the water crisis in Flint, Mich., residents of the community had higher rates of past-year depression and posttraumatic stress disorder (PTSD) compared with the rest of the nation, a study in JAMA Network Open has found. During the crisis, which occurred from 2014 to 2017, many residents were exposed to drinking water with unsafe levels of bacteria, disinfection byproducts, and lead after the city switched its drinking water supply from Detroit’s system to the Flint River.

Aaron Reuben, Ph.D., of Duke University and colleagues analyzed data from a survey of 1,970 adults who lived in Flint during the crisis. The survey was conducted from August 13, 2019, through April 20, 2020. It asked participants about their crisis experiences, their mental health symptoms five years later, and their access to and use of mental health services in the intervening years. Among respondents, 53.5% identified as Black or African American, 42.5% identified as White, and 97.4% identified as non-Hispanic; 56.8% reported earning less than $25,000 a year.

Overall, 22.1% of participants had symptoms of past-year depression, 24.4% had symptoms of past-year PTSD, and 14.0% had symptoms of both conditions. Participants who believed that their or their family’s health was moderately or greatly harmed by the water crisis were 123% more likely than their peers to have symptoms of depression, 66% more likely to have symptoms of PTSD, and 106% more likely to have symptoms of both conditions. Participants who had a history of potentially traumatic events such as a life-threatening illness, serious accident, or previous disaster were 173% more likely than their peers to have symptoms of depression and 355% more likely to have symptoms of PTSD.

“These findings suggest that the water crisis could have exacerbated existing mental health disparities in Flint—a possibility that should be investigated in future studies,” Reuben and colleagues wrote.

Only 34.8% of participants reported ever being offered mental health services to help address their concerns or problems associated with the crisis. About 79% of those who were offered mental health services used them.

The researchers concluded “that (1) there is a large, unmet mental health need in the Flint community 5 years after the onset of the water crisis and (2) this need for mental health services is unlikely to remit without a comprehensive, systematic, and coordinated response from the local, state, and federal governments and public health communities,” the researchers wrote. “These findings suggest that community-level public works environmental disasters have large-scale and lasting psychological sequelae.”

For related information, see the Psychiatric News article “Preparing for Disasters at the Community Level: Prevention and Social Cohesion.”

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APA Invites You to Partner on Perinatal Initiative Funded by CDC Foundation

To address training and knowledge gaps regarding untreated perinatal mental illness, it is important to understand providers’ perspectives about pregnant persons with mental health issues during and after pregnancy. APA has been awarded a grant from the CDC Foundation to conduct a needs assessment of these gaps. APA is seeking 400 providers to take a 30-minute survey and 16 providers to participate in two-hour focus groups. Survey respondents will receive a $30 Amazon gift card, and focus group participants will receive a $450 honorarium. Those interested in participating can register at redcap.link/panpbhp_register.

Thursday, September 22, 2022

Telephone Intervention May Reduce Risky Alcohol Consumption

Participating in at least two sessions of a telephone-delivered intervention may help reduce total alcohol consumption, alcohol problem severity, and risky drinking patterns among patients with alcohol use problems, according to a study published yesterday in JAMA Psychiatry.

“Alcohol use disorders are estimated to affect 5.1% of the adult population worldwide,” wrote Dan Lubman, Ph.D., of Monash Addiction Research Centre in Victoria, Australia, and colleagues. “Yet, the magnitude of alcohol consumption and attributable harms remains in sharp contrast to the low rates of treatment use.”

Lubman and colleagues recruited participants aged 18 and older with problem alcohol use from across Australia via social media and clinician referrals. Problem alcohol use was defined as a score of more than 6 for females and more than 7 for males on the Alcohol Use Disorders Identification Test (AUDIT). Possible scores on the AUDIT range from zero to 40. AUDIT also measures hazardous use, harmful use, and dependence symptoms. Participants’ AUDIT scores were assessed at baseline and again three months later.

Participants were randomly assigned to either the intervention group or the active control group. Those in the intervention group received four to six 30- to 50-minute sessions of a telephone-delivered cognitive and behavioral intervention called Ready2Change. After receiving a clinical assessment in the first session, trained counselors introduced the participants in the intervention group to the following practices in session two: keeping a daily alcohol diary; identifying participants’ triggers; assistance managing urges with SOBER breathing (a mindfulness-based practice that includes five steps: stop, observe, breathe, expand, and respond); and establishing a helpful routine. The counselors tailored the remainder of the sessions (offered weekly) to individual participants, based on their reasons for engaging in treatment and challenges they faced. The active control group received alcohol consumption guidelines, stress management pamphlets, and four telephone check-ins that were five minutes or less.

Among 344 participants, two-thirds had AUDIT scores corresponding to the highest category of probable dependence, and only one-third had previously sought treatment for their alcohol use. Sixty-five percent of participants randomized to the intervention group completed the program (defined as participating in at least four sessions), and 80% of participants in the control group completed the program.

The AUDIT scores decreased significantly from baseline to three months in both groups, falling from 21 to 12.8 in the intervention group, and from 22.1 to 14.9 in the active control group. The intervention group showed a significantly greater reduction in hazardous use. When adjusting for exposure to two or more sessions, the researchers found that the intervention group had a greater reduction in their total AUDIT scores compared with the control group.

“The results of this clinical trial support [the] benefits of a telephone-delivered intervention in a general population sample of individuals who do not typically seek treatment for alcohol use problems, despite experiencing high problem severity,” the authors concluded. The “[f]indings demonstrate the potential benefits of this highly scalable telehealth model of alcohol treatment, with potential to reduce the treatment gap for problem alcohol use.”

For related information, see the Psychiatric News article “Pandemic May Be Accelerating Problematic Trends in Alcohol Use.”

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APA Invites You to Partner on Perinatal Initiative Funded by CDC Foundation

To address training and knowledge gaps regarding untreated perinatal mental illness, it is important to understand providers’ perspectives about pregnant persons with mental health issues during and after pregnancy. APA has been awarded a grant from CDC Foundation to conduct a needs assessment of these gaps. APA is seeking 400 providers to take a 30-minute survey and 16 providers to participate in two-hour focus groups. Survey respondents will receive a $30 Amazon gift card, and focus group participants will receive a $450 honorarium. Those interested in participating can register at redcap.link/panpbhp_register.

Wednesday, September 21, 2022

Computer Program That Boosts Self-Esteem May Prolong Effects of Single Ketamine Infusion

Completing a brief computer program that encourages positive thoughts about oneself appears to maintain the antidepressant effects of ketamine for at least 30 days in people with treatment-resistant depression, according to a report published today in the American Journal of Psychiatry.

While previous studies have shown that intravenous ketamine can rapidly reduce symptoms of depression within a couple of hours, these effects tend to wear off within weeks. The findings suggest that a low-cost, automated behavioral intervention might help to extend the effects of a single infusion of ketamine for patients who do not respond to other treatments.

“Training the brain to link perceptions of yourself with positive ideas during this ketamine-primed plasticity window exceeded my expectations,” said lead author Rebecca Price, Ph.D., an associate professor of psychiatry at the University of Pittsburgh School of Medicine, in a press release. “I was surprised and amazed to get such clear findings from an intervention that was so minimal.”

For the study, 154 adults (aged 18 to 60) with treatment-resistant depression were assigned to one of three groups: one received a ketamine infusion (0.5 mg/kg over 40 minutes) plus automated self-association training (ASAT); the second received a saline infusion plus ASAT; and the third received a ketamine infusion plus sham ASAT.

ASAT consisted of eight 15- to 20-minute sessions delivered twice daily for four consecutive days that were initiated one day after infusion. For the ASAT sessions, participants viewed words associated with positive feelings (such as “lovable” and “worthy”) and images of themselves and other people. Participants performed simple computer tasks, such as indicating whether targets were real words or random letter strings, to enhance engagement and reinforce the positive associations. Sham ASAT consisted of the same computer tasks, but with predominantly neutral rather than positive images and words, and no images of the participant.

The primary outcome was score on the Montgomery-Åsberg Depression Rating Scale (MADRS), and the participants were followed for 30 days.

Price and colleagues found that ketamine rapidly and significantly reduced MADRS total depression scores 24 hours after infusion.

Depression scores in the ketamine plus ASAT group remained significantly and stably low over the 30-day study period compared with those in the saline plus ASAT group. In contrast, depression scores in the ketamine plus sham ASAT group increased over the 30 days, approaching the levels observed in the saline plus ASAT group.

“If the present results can be replicated, this novel, integrative treatment may provide a method to urgently bring relief and to efficiently extend this relief via safe, low-cost, portable techniques,” the researchers wrote.

For related information, see the American Journal of Psychiatry article “Single, Repeated, and Maintenance Ketamine Infusions for Treatment-Resistant Depression: A Randomized Controlled Trial.”

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Tuesday, September 20, 2022

Neurological Effects of Monkeypox Largely Unknown, Review Finds

Much remains unknown about the long-term neurologic effects of monkeypox. In an article published today in JAMA Neurology, researchers from the National Institute of Neurological Disorders and Stroke (NINDS) and colleagues described how reports of complications from other orthopoxviruses, such as smallpox, may offer clues about the neurologic consequences of monkeypox.

“Although the COVID-19 pandemic is the worst pandemic in a century, the recent past has seen several major pandemics, including Zika, Ebola, dengue, West Nile, and AIDS,” wrote B. Jeanne Billioux, M.D., of NINDS and colleagues. “A common thread to these pandemics is the long-term neurologic complications such as post–COVID-19 conditions, congenital Zika syndrome, post-Ebola syndrome, West Nile encephalitis, and HIV-associated neurocognitive disorders. … Yet often these manifestations go unrecognized, initially masked by the acute systemic involvement by the infection and later attributed to end-organ damage or to pandemic-related psychosocial stresses.”

Billioux and colleagues provided an overview of orthopoxviruses known to infect humans before describing the clinical features of smallpox and monkeypox. They described reports of headaches, febrile seizures/encephalopathy, and transverse myelitis among patients with smallpox as well as other symptoms. They noted that while “very few neurologic complications of monkeypox have been described,” existing reports highlight headache; neuropathic pain; and mood disturbance, including depression and anxiety as the most common symptoms in patients with monkeypox. Additionally, there have been several reports of patients with monkeypox experiencing encephalitis with seizures.

The authors offered several considerations for diagnosis, treatment, and prevention of monkeypox before concluding, “[B]ased on known neurologic complications of orthopoxviruses, we must be prepared for the possibility of viral encephalitis, myelitis, ADEM [acute disseminated encephalomyelitis], Guillain-Barré syndrome, neuropathic pain, and others, and treat them accordingly. Particular attention should be paid to patients with immunocompromised conditions… .”

In addition, health care professionals should be on the lookout for neurological adverse reactions to vaccines that protect against orthopoxviruses, they noted.

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Neuropsychiatry’s Role in the Postacute Sequelae of COVID-19: Report From the American Neuropsychiatric Association Committee on Research.”

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