Wednesday, June 30, 2021

Paid Family Leave May Reduce Psychological Distress of New Parents

Paid family leave policies enacted by states for new parents appear to improve mental health and decrease psychological distress of new parents, according to a report in the American Journal of Preventive Medicine.

“This evidence comes at a critical time of ongoing policy debates at the state and federal levels in the U.S. when public and policymaker support for a national [paid family leave] policy is growing,” wrote Rita Hamad, M.D., Ph.D., of the University of California, San Francisco, and colleagues.

In the United States, the federal Family and Medical Leave Act provides 12 weeks of unpaid leave to eligible workers, the authors wrote. In recent years, nine states (including California and New Jersey) and Washington, D.C., have enacted paid family leave policies that provide salary support for new parents while they are on leave. (APA provides eligible employees up to 12 weeks of paid leave from work after the birth or adoption or foster care placement of a child.)

To examine the effects of the paid family leave policies on parent and child mental health, Hamad and colleagues analyzed data collected between 1997 and 2016 as part of the annual National Health Interview Survey. The authors compared changes in parental psychological distress (as determined by the Kessler 6 score) and child behavioral problems (as determined by the Mental Health Indicator score) among families in California and New Jersey before and after implementation of paid family leave policies.

Exposure to paid family leave policies was associated with decreased psychological distress among parents (a 25% decrease from the baseline Kessler 6 score), the authors reported. However, Black and Hispanic parents experienced smaller improvements in psychological distress compared with White parents. In addition, the effects of exposure to paid family leave was mixed for children of different backgrounds.

Hamad and colleagues noted that the specific way that states implement and fund paid family leave policies may be critical, especially for vulnerable groups. “Future work should examine whether variations in the implementation of state policies have differential impacts on vulnerable families,” they concluded.

For related information see the Psychiatric News article “Paid Family Leave Improves Health, Mental Health for Both Mothers and Infants.”

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Tuesday, June 29, 2021

People With Substance-Induced Psychosis Found to Be at Greater Risk of Death Than General Population

People with substance-induced psychosis appear to be at a greater risk of dying earlier than those who do not experience psychosis, according to a study in Addiction. The analysis revealed that the risk of death was elevated in people with substance-induced psychosis regardless of whether they later developed schizophrenia.

“Although not necessarily a causal finding, this provides a strong rationale for monitoring people with [a] previous diagnosis of substance-induced psychosis and developing and implementing interventions to reduce this excess mortality,” wrote Carsten Hjorthøj, Ph.D., M.Sc., of the University of Copenhagen and colleagues.

Hjorthøj and colleagues examined data from the nationwide Danish registers, specifically focusing on individuals who were born in Denmark, lived in Denmark at age 15, and were 15 or older between the study period of January 1, 1994, and August 10, 2017. The population was followed until death, emigration, or August 10, 2017, whichever came first.

Of the more than 5.6 million people included in the study, 9,303 were diagnosed with substance-induced psychosis only, 2,197 were diagnosed with schizophrenia following substance-induced psychosis, and 39,738 were diagnosed with schizophrenia without preceding substance-induced psychosis.

A total of 1,240,860 people died during the follow-up period. After adjusting for such variables as age, sex, and parental history of schizophrenia and substance use disorder, the researchers found that people with substance-induced psychosis were more than six times as likely to die during the follow-up period as those who had never been diagnosed with substance-induced psychosis or schizophrenia. The risk of death in people with substance-induced psychosis who later developed schizophrenia was even greater; they were nearly 10 times as likely to die as those who had never been diagnosed with either substance-induced psychosis or schizophrenia. For comparison, people who had been diagnosed with schizophrenia without preceding substance-induced psychosis were three times as likely to die during the follow-up period. Those with substance-induced psychosis (including those who did and did not develop schizophrenia) appeared to be at a particularly high risk of suicide and accidental deaths compared with those without substance-induced psychosis.

“[O]ur results make it abundantly clear that people with substance-induced psychosis have a highly increased risk of both all-cause and cause-specific mortality, even if they do not progress to being diagnosed with schizophrenia,” the authors concluded.

For related information, see the American Journal of Psychiatry article “Prediction of Onset of Substance-Induced Psychotic Disorder and Its Progression to Schizophrenia in a Swedish National Sample.”

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Monday, June 28, 2021

Research to Prevent Suicide of Black Youth Must Take Ground Zero Approach, Say Experts

More research on the prevention of suicide among Black youth is urgently needed, yet clinicians can and should address suicidality within this population in their practices now, according to two viewpoints published today in JAMA Pediatrics.

Over the past several decades, data have clearly illustrated the rising trend of suicide among Black youth, wrote Arielle H. Sheftall, Ph.D., a principal investigator in the Center for Suicide Prevention and Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital in Ohio, and Adam Bryant Miller, Ph.D., a research assistant professor in the Department of Psychology and Neurosciences at the University of North Carolina at Chapel Hill. “[T]he rate of suicide in Black youth younger than 13 years is approximately 2 times higher compared with their White counterparts,” Sheftall and Miller wrote.

Following a report released by the Congressional Black Caucus in December 2019, the National Institute of Mental Health (NIMH) requested information on key points related to the prevention of suicide among Black youth. Sheftall, Miller, and colleagues responded to the request by outlining areas that require more research to address suicide prevention among this population, including culturally relevant risk factors and the developmental trajectory of suicidal ideation and behavior among Black youth.

Research on suicide in this population cannot be conducted through a “White-centric lens,” Sheftall and Miller wrote. Risk factors for suicide that commonly apply to other groups, like depression, may not be linked to suicide in Black youth. “Because of the lack of culturally sensitive theories, we have little information about how unique, race-related stressors may contribute to disparities in suicide rates among Black youth,” the authors wrote. They suggest a mixture of quantitative and qualitative methodology, such as interviews and focus groups with youth, families, and clinicians, to better understand culturally relevant risk and protective factors.

Further, to inform and identify effective prevention efforts, researchers must identify the factors relevant to suicidal ideation among Black youth, barriers for Black youth in sharing suicidal ideation, and unique features of ideation among this population.

Despite NIMH’s call for research, the urgency to address suicide among Black youth requires clinicians to act now through assessments, interventions, and advocacy, wrote Tennisha Riley, Ph.D., an assistant professor in the Department of Counseling and Educational Psychology at Indiana University, and colleagues in another viewpoint.

Riley and colleagues emphasized the importance of universal screenings for suicidality across health care settings, but they noted that clinicians should be aware that suicidality and risk factors may differ for Black youth compared with other groups. “Black youth are more likely to endorse symptoms of somatic complaints or relationship difficulties compared with White youth,” they wrote.

In terms of developing prevention interventions, Riley and colleagues emphasized the importance of culturally informed approaches; listening to Black youth’s views of the world; and collaborating with parents, teachers, and mentors. “Given the importance of connectedness, interventions implemented within community locations (eg, Black churches) might be useful in increasing access to evidence-based, culturally relevant approaches,” they wrote.

Finally, Riley and colleagues highlighted the unique role that clinicians play in advocating for Black youth. “Advocacy involvement is paramount in challenging current social, justice, and health care systems that are steeped in the systemic oppression of Black and African American individuals in the U.S.,” they wrote. “We encourage clinicians and researchers to continue learning about systems of oppression in the U.S. and other societies, engage in active discussions of racism with colleagues, and model these collective efforts for early career professionals.”

For related information, see the Psychiatric News articles “Alarming Black Youth Suicide Trend Must Be Addressed, Experts Say” and “Congress Considering Bills to Curb Black Youth Suicide.”

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Friday, June 25, 2021

Support Minority Youth by Participating in APA’s Inaugural Moore Equity in Mental Health 5K

On Saturday, July 10, APA will host the first annual Moore Equity in Mental Health 5K to raise funds for the APA Foundation’s Moore Equity in Mental Health Community Grants Initiative. The initiative provides education about the mental health needs of minority youth and supports individuals and organizations that develop and provide culturally sensitive mental health services. July is the Bebe Moore Campbell Minority Mental Health Awareness Month.

“There has been progress in mental health research, policy, and programs, but children, adolescents, and young adults continue to experience poor mental health outcomes, particularly minority and immigrant youth,” said Regina James, M.D., chief of APA’s Division of Diversity and Health Equity and APA deputy medical director. “Youth of color experience additional hurdles, such as lower rates of service utilization and fewer linguistically and culturally appropriate services, and their mental health needs are not adequately met.”

In an APA blog post released earlier this month, James and APA CEO and Medical Director Saul Levin, M.D., M.P.A., pointed out that nearly half of youth aged 13 to 18 will experience a mental disorder. “Joining the 5K is a good way to remind or educate your friends and neighbors about these facts and to help address these problems,” they wrote.

The Moore Equity in Mental Health Community Grants Initiative was established in 2021 by APA’s Division of Diversity and Health Equity in partnership with the APA Foundation. The initiative and the 5K event are named after Bebe Moore Campbell (1950-2006), a best-selling author, journalist, teacher, and mental health advocate whose daughter had mental illness. Moore Campbell worked to raise awareness of the mental health needs of the Black community and other underrepresented communities after navigating a health system that prevented her daughter from getting help and support.

On the day of the event, APA will host a virtual program starting at noon ET. The program will feature guest speakers, including NFL veteran and broadcaster Brandon Marshall, who will discuss the disparities in mental health care and substance use treatment experienced by minority youth. After the virtual program, participants are encouraged to show their support by completing a 5K in their communities.

This year’s inaugural 5K event is supported by donations from Janssen, Eisai, Menninger, Neurocrine Biosciences, Otsuka, Truist, and Austen Riggs Center.

For more information, including instructions on how to register and create an individual or team fundraising page, visit the Moore Equity in Mental Health 5K web page.

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Thursday, June 24, 2021

Discharge Planning Improves Engagement With Psychiatric Care, Study Finds

Regardless of a patient’s level of engagement in psychiatric care prior to being hospitalized, having an appointment scheduled when discharged from the hospital may increase the likelihood that the patient receives follow-up care, according to a study published yesterday in Psychiatric Services.

“In the United States, 42%−51% of adults and 31%−45% of youths do not attend mental health visits within 30 days after discharge,” which can increase the risk of relapse, rehospitalization, and death, wrote Thomas Smith, M.D., of the New York State Psychiatric Institute and colleagues. “Patients who were not engaged in psychiatric care before admission are much more likely to fail to transition to outpatient care after inpatient psychiatric discharge.”

Smith and colleagues used data from four sources, including the New York state Medicaid claims records and the 2012-2013 New York state Managed Behavioral Healthcare Organization Discharge File, which was created to review discharge planning practices related to inpatient psychiatric admissions. The 18,793 participants were Medicaid enrollees under 65 years old who were admitted to an inpatient psychiatric unit from 2012 to 2013 with a principal diagnosis of a mental disorder and had an inpatient stay of no more than 60 days before being discharged. The study’s primary outcome was whether the patient attended an outpatient psychiatric visit within either seven or 30 days after discharge.

The researchers compared the outcomes of the patients according to their levels of engagement in psychiatric care during the six months before hospitalization: high engagement (four or more visits with a psychiatric provider, with visits in at least four of the six months), partial engagement (four or more visits but with all visits occurring in three of the six months), low engagement (one to three visits in the six-month period), and no engagement (no visits in the six-month period).

The less patients were engaged in care prior to their admission, the less likely they were to have a follow-up appointment scheduled as part of their discharge plan. Only 15% of highly engaged patients did not have an appointment scheduled, compared with 18%, 22%, and 28% of partial, low, or no engagement patients, respectively. However, regardless of the patients’ level of engagement, scheduling an outpatient appointment as part of the discharge plan was significantly associated with attending an initial outpatient psychiatric appointment within seven or 30 days after discharge. Among patients who had not received any outpatient care in the six months before hospitalization, those whose discharge plans included a scheduled outpatient appointment were about three times more likely than those who did not receive an appointment to follow up within seven days and more than twice as likely to follow up within 30 days.

“This finding has important implications; hospital providers who do not offer discharge planning to patients who are leaving against medical advice or otherwise refusing to collaborate on discharge planning should consider revising their policies to ensure that all patients receive a follow-up appointment regardless of the circumstances of their discharge,” the authors wrote.

For related information, see the Psychiatric News article “Most Patients Do Not Obtain Follow-up Care After Nonfatal Opioid Overdose.”

(Image: iStock/Chinnapong)

Wednesday, June 23, 2021

Cannabis Use May Increase Risk of Suicidality in Young Adults, Study Suggests

Cannabis use appears to be associated with an increased risk of suicidal thoughts and actions in young adults, according to a study published Tuesday in JAMA Network Open. These risks were similar regardless of whether the young adults had major depression and were more pronounced in women than men.

“Suicide is a leading cause of death among young adults in the United States, and the findings of this study offer important information that may help us reduce this risk,” said lead study author Beth Han, M.D., Ph.D., M.P.H., of the National Institute on Drug Abuse (NIDA) in a news release.

Han and colleagues analyzed data collected from 281,650 adults aged 18 to 34 years who participated in the National Survey on Drug Use and Health between 2008 and 2019. As part of the survey, participants were asked about past-year major depressive episode and suicidal ideation, plan, and attempt. They were also asked about lifetime and past-year use of tobacco, alcohol, cannabis, and cocaine, as well as sociodemographic information (including age, sex, race/ethnicity, educational attainment, college/school enrollment, employment status, family income, marital status, and health insurance). The authors used DSM-IV criteria to estimate the prevalence of past-year alcohol, cannabis, and cocaine use disorders and major depressive episode.

Past-year suicidal ideation and plan along with daily cannabis use increased among all of the sociodemographic subgroups, with the exception of daily cannabis use among current high school students, the authors reported. Past-year suicide attempts also increased among most subgroups.

“Past-year [cannabis use disorder], daily cannabis use, and nondaily cannabis use were associated with a higher prevalence of past-year suicidal ideation, plan, and attempt in both sexes,” the authors wrote. For instance, among people without a major depressive episode, about 3% of those who did not use cannabis had suicidal ideation, compared with about 7% of those with nondaily cannabis use, about 9% of those with daily cannabis use, and 14% of those with a cannabis use disorder. Similarly, among people with depression, 35% of people who did not use cannabis had suicidal ideation, compared to 44% of those with nondaily cannabis use, 53% of those with daily cannabis use, and 50% of those with a cannabis use disorder. Women who used cannabis at any frequency were more likely to have suicidal ideation or report a suicide plan or attempt than men with the same frequency of cannabis use.

“While we cannot establish that cannabis use caused the increased suicidality we observed in this study, these associations warrant further research, especially given the great burden of suicide on young adults,” said NIDA Director Nora Volkow, M.D., who is a senior author on the study. “As we better understand the relationship between cannabis use, depression, and suicidality, clinicians will be able to provide better guidance and care to patients.”

For related information, see the Psychiatric News article “Cannabis Withdrawal Syndrome Affects Nearly Half of Those Who Quit” and the American Journal of Psychiatry article “U.S. Adults With Pain, a Group Increasingly Vulnerable to Nonmedical Cannabis Use and Cannabis Use Disorder: 2001–2002 and 2012–2013.”

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Tuesday, June 22, 2021

Depression Risk After NICU Discharge Decreases in Moms, but Not Dads

Mothers and fathers of premature infants are known to be at higher risk of postpartum depression compared with parents of full-term infants. A study in Pediatrics has found that while mothers’ risk of depression decreased after an infant’s discharge from the neonatal intensive care unit (NICU) at the hospital, fathers’ depression risk stayed relatively constant during and after the NICU stay.

“Clinicians must understand how different populations are at risk for [postpartum depression] to ensure optimal child outcomes,” wrote Craig Garfield, M.D., of Northwestern University Feinberg School of Medicine and colleagues. “Screening parents for [postpartum depression] while their infant is in the NICU may be a key first step toward assisting both parents and, in the case of fathers in particular, becoming aware of potential post-discharge needs.”

Garfield and colleagues enrolled 230 mothers and 201 fathers who had premature infants (<37 weeks gestational age) recently admitted to the NICU for a prospective study. All the parents were screened with the Edinburgh Postpartum Depression Scale (EPDS) at four time points: one week after the infant was admitted to the NICU, at NICU discharge, 14 days post discharge, and 30 days post discharge. An EPDS score of 10 or higher (out of 21 max) was considered the cutoff for depression.

At the initial assessment, 33% of the mothers and 17% of fathers had a positive EPDS screen. By the final assessment 30 days after NICU discharge, average EPDS scores had dropped by about three points in mothers but only one point in fathers—which the authors noted was a significant difference. The researchers calculated that the mothers were about 11 times as likely to screen positive on the EPDS following NICU admission compared with 30 days post discharge, whereas fathers had the same odds of screening positive at NICU admission and 30 days post discharge.

“Mothers and fathers experience different depressive symptom trajectories from NICU to home,” Garfield and colleagues concluded. “Screening parents for [postpartum depression] during the NICU stay is likely to result in improved identification of parents at-risk for [postpartum depression] after discharge.”

To read more about this topic, see the Psychiatric News article “Text Messages May Help Educate, Screen New Mothers for PPD.”

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Monday, June 21, 2021

Supreme Court Rejects Texas-Led Claim to Invalidate Affordable Care Act

The U.S. Supreme Court last week upheld the Affordable Care Act (ACA) and ruled against the state of Texas and other plaintiffs in its challenge to the ACA, saying the plaintiffs had no legal standing to bring the case.

The ruling puts to rest the latest legal challenge to the ACA brought by Republican activists and lawmakers seeking to weaken or invalidate altogether the landmark health care reform signed by President Barack Obama in 2010.

The suit, California et al. v. Texas et al., was brought by the state of Texas and 19 other states. It revolved around the “severability” of one component of the ACA—the individual mandate, which had required uninsured individuals who did not sign up for health insurance to pay a penalty—from the rest of the law. Texas and the other plaintiffs argued that since Congress amended the law in 2017 to eliminate the penalty associated with the mandate, the entire ACA was therefore unconstitutional.

In 2019, APA signed a friend-of-the-court brief rebutting the Texas argument and stating that wholesale invalidation of the ACA would “have a devastating impact on patients and the American health care system.”

In its 7-2 decision, the Supreme Court ruled that the plaintiffs did not have legal “standing” to bring the case because they did not prove that they had been injured by the law. Writing for the majority, Justice Stephen Breyer wrote, “[W]e conclude that the plaintiffs in this suit failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional. They have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”

Marvin Swartz, M.D., a member and past chair of the APA Committee on Judicial Action, said APA joined the 2019 amicus brief “out of grave concern that yet another legal assault on the ACA would do irreparable harm to our patients.”

Swartz told Psychiatric News that numerous studies have documented improved insurance coverage for people with mental illness and substance use disorders under the ACA. “We are heartened that the court held 7-2 that the plaintiffs in the case had no standing to bring the suit,” he said. “While decided on fairly narrow and technical grounds, we are hopeful that the decision will put challenges to the ACA behind us and instill further confidence in this cornerstone of equitable and affordable health care.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., welcomed the court’s ruling. “With more Americans seeking mental health and substance use services, the elimination of coverage would impact millions of Americans,” Levin said. “The court made the right decision. APA will continue to be vigilant about protecting the rights of our patients guaranteed by the ACA.”

For more information, see the Psychiatric News article “APA Joins Amicus Brief in Argument Against Texas Ruling Invalidating ACA.”

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APA to Hold Virtual Town Hall With NIH Leaders

APA is sponsoring a free webinar on Tuesday, June 22, at noon ET with the directors of NIMH, NIDA, and NIAAA—Joshua Gordon, M.D., Ph.D., George Koob, Ph.D., and Nora Volkow, M.D., respectively. As the COVID-19 pandemic slowly recedes in the U.S., what do they see next on the horizon for mental health/substance use research? Join these leaders as they answer questions raised during their sessions at APA’s 2021 Annual Meeting and bring your own questions for the open discussion.


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Thursday, June 17, 2021

Many Substance Use Treatment Facilities Fail to Offer HIV Testing, Study Finds

Only about 3 in 10 substance use treatment facilities in the United States offered HIV testing in 2018, and fewer than half of facilities treating people with medication for opioid use disorder (OUD) offered HIV testing, according to a study published in Psychiatric Services in Advance.

“Substance use treatment facilities are uniquely positioned to improve early identification, treatment, and prevention of HIV,” wrote Nicholas Riano, M.A.S., of the Weill Institute for Neurosciences; Mark Olfson, M.D., M.P.H., of the New York State Psychiatric Institute; and colleagues. “These facilities could play an important role in diagnosing HIV among the 25% of people with serious mental illness who have comorbid substance use disorders.”

Riano and colleagues examined data from the 2018 National Survey of Substance Abuse Treatment Services, an annual survey of drug and alcohol treatment facilities conducted by the Substance Abuse and Mental Health Services Administration. In addition to determining the types of substance use treatment offered (such as medication for OUD) and other mental health services, the surveys requested information about the availability of HIV testing and/or counseling at each facility.

Among 14,691 treatment facilities, 41% offered medication treatment for OUD and 68% offered other mental health services. Other findings among the facilities include the following:

  • 29% offered HIV testing, 53% offered HIV counseling, 23% offered both, and 41% offered neither.
  • Rates of HIV testing availability were significantly higher in facilities offering medication for OUD compared with those not offering such treatment (48% vs. 16%).
  • Rates of HIV testing availability were higher among facilities offering mental health services compared with those not offering such services (31% vs. 24%).
  • There was significant state-to-state variation in the proportion of facilities offering HIV testing, ranging from 9% to nearly 63% of facilities.

The finding that only 29% of substance use treatment facilities offered HIV testing in 2018 was consistent with prior reports, the authors wrote. “This low rate of HIV testing is a missed opportunity for early HIV diagnosis, treatment, and prevention, particularly at a time when the nation is grappling with the impact of the opioid epidemic and investing in the ‘Ending the HIV Epidemic’ initiative, which features testing as a key strategy,” they continued.

They concluded: “State- and federal-level policymakers have opportunities to use evidence-based approaches to increase HIV testing in these facilities, monitor adoption rates, and use financial incentives and their regulatory and licensing authority to increase testing and improve HIV-related health outcomes.”

For related information, see the Psychiatric Services report “Three Decades and Counting: HIV Service Provision in Outpatient Mental Health Settings.”

(Image: iStock/Alex Levine)

APA to Hold Virtual Town Hall With NIH Leaders

APA is sponsoring a free webinar on Tuesday, June 22, at noon ET with the directors of NIMH, NIDA, and NIAAA—Joshua Gordon, M.D., Ph.D., George Koob, Ph.D., and Nora Volkow, M.D., respectively. As the COVID-19 pandemic slowly recedes in the U.S., what do they see next on the horizon for mental health/substance use research? Join these leaders as they answer questions raised during their sessions at APA’s 2021 Annual Meeting and bring your own questions for the open discussion.


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Wednesday, June 16, 2021

Pharmacogenetic-Guided Treatment Shows No Benefit Over Standard Treatment for Adolescents With MDD

Adolescents with major depressive disorder (MDD) who receive treatment guided by pharmacogenetic testing appear to show similar improvements over time as those who did not receive guided treatment, according to a report in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Despite great initial enthusiasm and a surge of companies offering pharmacogenetics testing for psychiatric medications, controversy within the psychiatric field regarding the utility of pharmacogenetics testing is widespread,” wrote Jennifer L. Vande Voort, M.D., of the Mayo Clinic and colleagues. Few studies have examined whether treatment guided by such tests is associated with better outcomes in youth with depression compared with those receiving standard care.

Vande Voort and colleagues randomly assigned 176 adolescents aged 13 to 18 with moderate to severe MDD (score ≥40 on the Children’s Depression Rating Scale-Revised [CDRS-R]) to one of two groups:

  • GENE: Physicians treating participants in the GENE group received the participants’ pharmacogenetic testing results at the baseline visit.
  • TAU: Physicians treating participants in the treatment as usual (TAU) group did not receive the participants’ pharmacogenetic testing results until after the eight-week visit.

The participants were seen by a psychiatrist and completed assessments at baseline, weeks 4 and 8, and 6 months. These assessments included the CDRS-R, Quick Inventory of Depressive Symptomatology (QIDS), Children’s Global Assessment Scale (CGAS), and Young Mania Rating Scale (YMRS). Throughout the trial, psychiatrists were asked to record the reasons for medication decisions, such as whether the decision was based on pharmacogenetics testing or clinical judgment.

“This study found that participants in both the GENE and TAU arms improved throughout the duration of the study, and there was no statistical difference in improvement between the two arms on the CDRS-R, QIDS, and CGAS,” the authors reported. “In addition, there was no statistical difference in YMRS scores or the number of adverse events/side effects between the GENE and TAU arms throughout the duration of the study.”

The authors noted that although selective serotonin reuptake inhibitors (SSRIs) were the most frequently prescribed medications for participants in both treatment arms, the TAU arm had nearly 15% more SSRIs prescribed than the GENE arm.

“Pharmacogenetics testing held a great deal of promise as the gateway to personalized medicine. … [U]nfortunately, the field is not there yet, and clear clinical utility for commercial combinatorial platforms in adolescents with depression remains elusive,” Vande Voort and colleagues wrote. Future studies should explore “whether concordance (defined as when the clinician’s treatment recommendation matches the pharmacogenetics testing report of ‘use as directed’) is associated with greater response/remission rates or lower side effect burden when compared to nonconcordant treatment,” they advised.

For related information, see the Psychiatric News articles “Pharmacogenomic Tests in Psychiatry: Not Ready for Prime Time” and “Task Force on Gene Testing for Antidepressant Efficacy Concludes Tests Not Yet Ready for Widespread Use.”

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Tuesday, June 15, 2021

AMA Opposes Administration of Ketamine, Use of ‘Excited Delirium’ for Law Enforcement Purposes

The AMA opposes the use of ketamine and other sedative/hypnotic agents as a pharmacological intervention for agitated individuals in out-of-hospital settings to chemically restrain an individual solely for law enforcement purposes and not for legitimate medical reasons.

In addition, the AMA opposes the use of the term “excited delirium” as a medical diagnosis until a clear set of diagnostic criteria for the term is validated.

With strong support from APA and the Section Council on Psychiatry, the AMA House of Delegates yesterday approved a report by the AMA’s Council on Science and Public Health (CSAPH) addressing concerns about recent deaths of people—predominantly young Black men labeled as experiencing “excited delirium”—after ketamine was administered to restrain them. In December 2020, the APA Board of Trustees approved a position statement asserting that “excited delirium” lacks any clear diagnostic criteria and calling for evidence-based protocols for administration of ketamine in emergency medical situations outside the hospital.

At the AMA meeting, Ken Certa, M.D., senior delegate for APA, told the House that too many people have died after being administered ketamine by police or emergency medical technicians. Disproportionately, they have been people of color, he said.

“As psychiatrists, we take care of people in emergency situations; we have experience dealing with people brought in by the police in agitated states,” Certa told the AMA delegates. “That doesn’t mean they have ‘excited delirium’—we don’t know what that is. We have tried to find a coherent body of literature to support that diagnosis, and it is simply not there. … We need a strong statement from the AMA that it can’t be used. Out-of-hospital ketamine has the potential to kill people, especially people who have been marginalized.”

The new policy urges law enforcement and frontline emergency medical service (EMS) personnel to participate in training overseen by EMS medical directors that minimally includes de-escalation techniques and the appropriate use of pharmacological intervention for agitated individuals outside the hospital. The policy also urges medical and behavioral health specialists—instead of law enforcement—to serve as first responders and decision-makers in medical and mental health emergencies.

Laura Halpin, M.D., Ph.D., a member of the CSAPH and a child and adolescent psychiatry fellow at UCLA, said the recommendations are critical. “We have denounced the use of ‘excited delirium’ as a justification for use of force by law enforcement officers and recognize that this has devastatingly led to disproportionally high mortality among communities of color, and especially Black men,” she told Psychiatric News. “Our recommendation that physicians and mental health specialists, and not law enforcement, should serve as the first responders and decision-makers on crisis intervention teams will help protect our vulnerable patients.”

APA CEO and Medical Director Saul Levin, M.D., M.P.A., added, “We welcome the AMA’s strong statement and important recommendations on this matter, and we will continue to work with the AMA and other physician specialties to monitor this issue.”

For related information, see the Psychiatric News article “Board Adopts Position Against Diagnosis of ‘Excited Delirium,’ Police Use of Ketamine.”

Monday, June 14, 2021

Anti-inflammatory Drug May Reduce Heavy Drinking in People With Alcohol Use Disorder

Ibudilast—a drug that suppresses the production of inflammatory molecules in the brain—can significantly reduce heavy drinking in adults with alcohol use disorder (AUD), suggests a small study in Translational Psychiatry.

“A growing body of literature indicates that the neuroimmune system may play a critical role in the development and maintenance of AUD, termed the neuroimmune hypothesis of alcohol addiction,” wrote Erica Grodin, Ph.D., of the University of California, Los Angeles, and colleagues. Both the blood samples and postmortem brain samples of people with AUD have shown elevated biomarkers of inflammation. Other studies have found an association between inflammation and depressed mood, which is also common in people with AUD. “Therefore, a neuroimmune modulator may treat AUD and related negative mood symptoms through similar pathways,” the authors wrote.

The researchers randomly assigned 52 adults aged 21 to 50 with mild to severe AUD (according to the DSM-5 criteria) to receive 50 mg of ibudilast or placebo twice daily over two weeks. The participants were asked to complete daily diary assessments, indicating their past-day alcohol use, alcohol cravings, and mood throughout the trial. The participants also had three in-person visits that included toxicology, blood pressure, and heart rate screenings. At the end of the first week, they also completed an assessment of their reactions to alcohol cues while receiving an MRI scan. The participants in the study were compensated up to $350 for completing the trial.

After two weeks, the researchers found no statistical differences in the number of drinking days or negative mood between the adults taking ibudilast and those taking placebo. However, adults taking ibudilast were 45% less likely to engage in heavy drinking (≥5 drinks/day for men and ≥4 drinks/day for women) during the study compared with adults taking placebo.

The MRI data revealed a potential mechanism of ibudilast’s effects. The participants who took ibudilast had less activity in their ventral striatum in response to alcohol cues compared with those who took placebo.

“[E]xploratory analyses indicated that ventral striatal activation to alcohol cues was predictive of drinking in the week following the neuroimaging scan,” Grodin and colleagues wrote. “These results suggest a biobehavioral mechanism through which ibudilast acts, namely, by reducing the rewarding response to alcohol cues in the brain leading to a reduction in heavy drinking...”

There were no significant differences in the occurrence of gastrointestinal problems or other adverse side effects between the two groups of participants. Grodin and colleagues noted that in addition to showing ibudilast is well tolerated, the side effect data support that the reduction in drinking was not due to the medication making people sick.

To read more on this topic, see the Psychiatric News article “Underage Drinking Declines, But Extreme Binge Drinking Rises.”

(Image: iStock/pedrosala)

Friday, June 11, 2021

Lybalvi Approved for Schizophrenia, Bipolar I Disorder in Adults

The Food and Drug Administration (FDA) has approved Lybalvi (olanzapine and samidorphan) for the treatment of schizophrenia in adults, Alkermes announced. The agency also approved Lybalvi for the treatment of bipolar I disorder in adults, as a monotherapy for maintenance, and as a monotherapy or an adjunct to lithium or valproate for the acute treatment of manic or mixed episodes.

Olanzapine is an antipsychotic, and samidorphan is a new chemical agent and an opioid antagonist. Lybalvi is taken once a day and may be taken with or without food. It will be available in fixed dosage strengths composed of 10 mg of samidorphan and 5 mg, 10 mg, 15 mg, or 20 mg of olanzapine.

The approval is based on data from the ENLIGHTEN clinical development program. In ENLIGHTEN-1, 403 patients who were experiencing an acute exacerbation of schizophrenia took either Lybalvi or placebo for four weeks. At the end of the study, those who had taken Lybalvi had statistically significant reductions from baseline in Positive and Negative Syndrome Scale scores compared with those who took placebo.

ENLIGHTEN-2 evaluated the weight-gain profile of Lybalvi compared with olanzapine over six months in 561 patients with stable schizophrenia. Patients who took Lybalvi had a lower mean percent weight gain at six months compared with those in the olanzapine group and a lower proportion of patients who gained 10%or more of their baseline body weight at six months. The difference in weight gain between the two groups became apparent after the fourth week of the trial, and their rates of weight gain continued to diverge for the remainder of the study. At the sixth week, weight stabilized in the Lybalvi group and remained flat for the rest of the study period.

Lybalvi has a boxed warning about increased mortality in older patients who have dementia-related psychosis. The warning also states that the medication is not approved for the treatment of patients with dementia-related psychosis.

Lybalvi should not be taken by patients who are taking opioids or who are experiencing acute opioid withdrawal. Prior to initiating Lybalvi, there should be at least a seven-day opioid-free interval from the last use of short-acting opioids and at least a 14-day opioid-free interval from the last use of long-acting opioids.

Potential side effects of Lybalvi include dry mouth, sleepiness, dizziness, increased appetite, and constipation.

For related information, see the American Journal of Psychiatry article “How Much of an Advance is the Addition of Samidorphan to Olanzapine?

Thursday, June 10, 2021

N.Y. State Program for First-Episode Psychosis Reduces Hospitalization, ER Use

Medicaid patients in New York state with a first episode of psychosis visited the emergency room and hospital significantly less after enrollment in the coordinated specialty care program OnTrackNY than prior to enrollment, according to a report in Psychiatric Services in Advance.

OnTrackNY is New York state’s early intervention program for individuals aged 16 to 30 who have experienced nonaffective psychosis for less than two years. With 23 sites throughout the state, OnTrackNY offers psychotherapy, medication management, family education and support, case management, and work and education support, depending on each individual’s needs and preferences. The Center for Practice Innovations at Columbia University, New York State Psychiatric Institute, and the New York State Office of Mental Health are partners in OnTrackNY.

“Notably, hospitalization rates have been shown to decrease during the first three months after OnTrackNY enrollment and remain relatively steady thereafter; the present study showed that these rates did not significantly increase during the first six months after discharge,” wrote Jennifer Humensky, Ph.D., of Columbia University Department of Psychiatry and New York State Psychiatric Institute and colleagues.

They compared rates of hospitalization and emergency room (ER) visits for 138 patients who were enrolled in OnTrackNY for at least six months and covered by Medicaid in the six months prior to program entry, the six months prior to OnTrackNY discharge, and the six months after OnTrackNY discharge.

In the pre-enrollment period, participants had an average of 1.45 ER visits, 0.80 inpatient visits, and 12.88 inpatient days. This use decreased to an average of 0.88 ER visits, 0.26 inpatient visits, and 3.7 inpatient days in the six months before discharge from OnTrackNY. Six months after discharge from ONTrackNY, the rates had not significantly changed: Patients had an average of 0.83 ER visits, 0.3 inpatient visits, and 4.9 inpatient days.

“Although more research is needed, particularly of larger populations and over a longer time frame, this study provides an initial indication that decreases in hospitalization and ER usage are maintained and do not significantly increase in the first six months after discharge from OnTrackNY,” the researchers concluded.

For related information, see the Psychiatric News article “Evidence Supporting Early Psychosis Treatment Grows as Programs Gain Ground in Communities.”

(Image: iStock/SDI Productions)

Wednesday, June 9, 2021

Matching Patients to Therapists’ Strengths Found to Improve Mental Health Outcomes

Patients who were matched to therapists with proven effectiveness in addressing the patients’ top areas of concern experienced greater improvements following treatment than those paired with therapists randomly, according to a study published today in JAMA Psychiatry.

“Mental illness is a major public health problem, and even among people who engage mental health care, more than 60% do not benefit meaningfully from care received,” wrote Michael Constantino, Ph.D., of the University of Massachusetts, Amherst, and colleagues. “These results suggest that measurement-based therapist report cards can help redirect [mental health care] toward therapists’ strengths.”

Constantino and colleagues conducted a trial across six clinics in Cleveland, Ohio, that included 48 therapists and 218 patients. To be included, the therapists had to provide outcome data from at least 15 cases, which were used to establish their performance profiles. Using 12 symptomatic or functional domains determined by the Treatment Outcome Package (TOP), the therapists were classified as effective (on average, their patients’ symptoms reliably improved), neutral (on average, their patients’ symptoms neither improved nor deteriorated), or ineffective (on average, their patients’ symptoms reliably deteriorated) within each of the domains. The TOP measures how much a patient has experienced 12 specific concerns in the past two weeks, including depression, quality of life, social conflict, substance misuse, suicidality, violence, and work functioning, among others. The TOP also measured patients’ impairment.

The patients in the 16-week trial completed the TOP to determine what interventions they needed. They were then randomly assigned to the matched group or the care-as-usual group. Those in the matched group were assigned to therapists who had proven effective in addressing the patients’ top three elevated domains as determined by their TOP results. Patients in the care-as-usual group were assigned to therapists through typical procedures, such as the therapist’s availability. The patients completed the TOP and the Symptom Checklist-10 (to measure psychological distress) at baseline and bi-weekly throughout the trial or the end of their treatment.

Patients in the matched group experienced greater reductions in their overall impairment compared with patients in the care-as-usual group. Though the matched group started treatment with higher impairment scores, on average, than the care-as-usual group, they ended the trial in the nonclinical range with an average score of about zero, which is the mean score for the general population. Impairment scores for patients in the care-as-usual group improved, but they still ended treatment in the clinically impaired range. Similarly, patients in the matched group experienced greater weekly reductions in psychological distress compared with patients in the care-as-usual group.

“Notably, the good fit in this study came not from changing what the therapists did in their treatment, but rather who they treated,” the authors wrote. “Capitalizing on whatever it is that a therapist historically does well when treating patients with certain mental health problems, the current data indicate that our match system can improve the effectiveness of that care, even with neither therapist nor patient being aware of their match status.”

For related information, see the American Journal of Psychotherapy article “Patient Choice in Depression Psychotherapy: Outcomes of Patient-Preferred Therapy Versus Randomly Allocated Therapy.”

(Image: iStock/KatarzynaBialasiewicz)

Tuesday, June 8, 2021

Alzheimer’s Antibody Therapy Receives Accelerated Approval Amid Controversy

The Food and Drug Administration (FDA) yesterday granted accelerated approval to the monoclonal antibody aducanumab for the treatment of Alzheimer’s disease.

Alzheimer’s disease is characterized by changes in the brain—which include beta-amyloid plaques and neurofibrillary, or tau, tangles—that result in the loss of neurons and their connections.

“Currently available therapies only treat symptoms of the disease; this treatment option is the first therapy to target and affect the underlying disease process of Alzheimer’s,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research.

The FDA’s accelerated approval pathway is designed to speed up the approval of medications for a serious or life-threatening illness that provides a meaningful therapeutic advantage over existing treatments. The pathway enables drug companies to provide a surrogate biomarker that they believe can reasonably suggest future clinical benefit. In the case of aducanumab, accelerated approval was granted based on data from three clinical studies (including two phase 3 studies) demonstrating a significantly greater reduction of beta-amyloid plaques in patients with early stage Alzheimer’s disease who took aducanumab compared with those who took placebo.

The phase 3 data on the effects of aducanumab on cognition were inconclusive. Though one of the phase 3 trials found that patients who received aducanumab had a slightly slower cognitive decline than those who received placebo, the other phase 3 trial did not. In fact, an FDA advisory panel voted nearly unanimously in November 2020 that the clinical data supporting aducanumab were not sufficient to warrant approval.

“Under the accelerated approval provisions, … the FDA is requiring the company, Biogen, to conduct a new randomized, controlled clinical trial to verify the drug’s clinical benefit. If the trial fails to verify clinical benefit, the FDA may initiate proceedings to withdraw approval of the drug,” the FDA release stated.

The approval of aducanumab quickly sparked debate among clinicians, researchers, and advocacy groups. Many scientists believe that the approval—even conditional—is premature.

“The most compelling argument for approval was the unmet need, but that cannot, or should not, trump regulatory standards,” said Caleb Alexander, M.D., a professor of epidemiology at Johns Hopkins University and member of the FDA advisory panel, in a news article. “It’s hard to find any scientist who thinks the data are persuasive.”

Malaz Boustani, M.D., M.P.H., the Richard M. Fairbanks Chair of Aging Research at Indiana University School of Medicine and a research scientist at the Regenstrief Institute, gave a more optimistic view in an interview with Psychiatric News. Though the data are not yet conclusive, he noted that the safety profile of aducanumab was favorable relative to other antibody-based medications such as those used in chemotherapy. Given the tremendous health care burden of Alzheimer’s, he said that he believes the benefit-harm ratio supported a conditional approval.

“I think this approval could also have a ripple effect in improving Alzheimer’s recognition,” Boustani said. “Currently, we miss anywhere from 50% to 80% of patients with Alzheimer’s because brain scans are not routinely provided as a standard of care.” Now that an early stage Alzheimer’s treatment exists, physicians may be more willing to recommend scans for patients, which can help confirm the type of neurodegeneration a patient is experiencing, he said.

For related information, see the Psychiatric News article “New Report Suggests Alzheimer’s Prevalence May Triple by 2050.”

(Image: iStock/wenht)

Monday, June 7, 2021

APA Honors Rep. Bonnie Watson Coleman for Her Work to Improve Mental Health Care

APA has selected Rep. Bonnie Watson Coleman (D-N.J.) as this year’s winner of its Jacob K. Javits Award for Public Service for her commitment and dedication to increase patient access to mental health and substance use disorder services.

The Javits Award recognizes a federal and/or state public servant who has made outstanding contributions to the mental health community. It honors the legacy of Sen. Jacob K. Javits of New York, who achieved many successes on behalf of those with mental illness. The award was presented this past weekend during APA’s online federal advocacy conference.

“Rep. Watson Coleman’s leadership is critical to our nation’s mental health,” said APA President Vivian Pender, M.D., in an APA news release. “Her focus on health equities goes beyond simply funding the services that are needed, but to a wider lens of understanding how social determinants are impacting the mental health of diverse communities around the nation.”

In 2018, Watson Coleman convened a congressional hearing to discuss suicides among Black youth after data revealed that their suicide death rate was increasing faster than in other racial/ethnic groups. The following year, Watson Coleman helped to establish the Congressional Black Caucus (CBC) Emergency Taskforce on Black Youth Suicide and Mental Health. The task force created a work group of Black mental health experts and advocates to identify the causes driving this crisis and possible solutions (past APA President Altha Stewart, M.D., was a member of this work group). In December 2019, the task force released a comprehensive report titled “Ring the Alarm: The Crisis of Black Youth Suicide in America.” In conjunction with the release of the report, Watson Coleman introduced the Pursuing Equity in Mental Health Act of 2019 (HR 5469), a bill aimed at addressing disparities in access, care, and study of mental health issues among people of color. The bill passed the House but did not get a vote in the Senate. This past March, Watson Coleman and Rep. John Katko (R-N.Y.) reintroduced the Pursuing Equity in Mental Health Act (HR 1475). This bill is strongly supported by APA.

Watson Coleman, who is serving her fourth term in the U.S. House of Representatives, is the first Black woman to represent New Jersey in Congress. Before her election to the House, Watson Coleman served eight consecutive terms in the New Jersey General Assembly, where she became the first Black woman to serve as majority leader and chair of the New Jersey Democratic State Committee. She is also the first Black woman to win the Javits Award.

“I’m deeply honored to receive the Javits Award. I am also grateful to the APA for their efforts in fighting youth suicide,” Watson Coleman said. “When I formed the Congressional Black Caucus’s Emergency Taskforce on Black Youth Suicide and Mental Health, I immediately recognized the seriousness of the work we were doing. … I was also humbled by the outpouring of support and resources by the mental health community including organizations like the American Psychiatric Association and recognize that the work we’ve accomplished so far would not have been possible without their efforts.”

“I’m so pleased APA is presenting Rep. Watson Coleman with this award,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “She is such an important ally in Congress for us and for all people with mental illness and substance use disorders, and her leadership is bringing real, positive change to communities.”

For related information, see the Psychiatric News articles “Congress Considering Bills to Curb Black Youth Suicide” and “Alarming Black Youth Suicide Trend Must Be Addressed, Experts Say.”

Looking to Learn More About Apps?

Join members of App Advisor’s Expert Panel tomorrow, Tuesday, June 8, at 3 p.m. ET, for a webinar on HIPAA Privacy and Security Rules and how they relate to the use of apps for patient care. Experts will discuss the use of Business Associate Agreements between clinicians and app developers and more. For the second part of this event, registrants are asked to pre-submit questions about the App Evaluation Model. Presenters will respond to these questions and, if there is time, address other questions using the Q&A feature of Zoom.


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Friday, June 4, 2021

Medical Students Often Perceive Lack of Respect for Diversity Among Faculty

Nearly 18% of graduating medical students who responded to a survey in 2016 and 2017 perceived that medical school faculty show a lack of respect for diversity, a study published today in JAMA Network Open has found.

“Our observation that a perceived lack of respect was prevalent among medical students may reflect students’ perceptions regarding faculty-patient interactions, their experiences within the overall learning environment, and the direct social interaction or lack thereof between students and faculty,” wrote Jasmine Weiss, M.D., of Yale School of Medicine and colleagues. “During each clinical encounter in a teaching context, faculty should exemplify respectful interpersonal communication and effective patient engagement despite differences in culture, beliefs, and background.”

Weiss and colleagues analyzed data from 28,778 graduating medical students who responded to the Association of American Medical Colleges’ 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 medical schools in the United States.

Overall, 17.7% of the respondents reported perceiving that faculty showed a lack of respect for diversity. Students who identified as Black/African American had 3.24 times the odds of perceiving a lack of respect for diversity among faculty compared with White students. Those who identified as American Indian/Alaska Native/Native Hawaiian/Pacific Islander, Asian, or Hispanic/Latinx also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds of perceiving a lack of faculty respect for diversity compared with male students; and students who identified as lesbian, gay, or bisexual or whose sexual orientation was unknown had greater odds of perceiving a lack of faculty respect for diversity compared with heterosexual students. Students aged 33 years or older had greater odds of reporting perceived lack of faculty respect for diversity compared with students aged 26 years or younger.

“This perceived lack of respect for diversity has important implications for patient care, the learning environment, and social interactions with trainees,” the researchers wrote. “Further studies are needed to assess the mediators of students’ perceptions of faculty respect for diversity and how these perceptions may more directly impact student well-being as well as to identify optimal interventions to improve role modeling of respect for diversity among faculty.”

For related information, see the American Journal of Psychiatry articles “Dismantling Structural Racism in Academic Psychiatry to Achieve Workforce Diversity” and “Psychiatry Diversity Leadership in Academic Medicine: Guidelines for Success.”

(Image: iStock/SDI Productions)

Thursday, June 3, 2021

FDA Authorizes Marketing of New Aid to Diagnose Autism

Yesterday, the Food and Drug Administration (FDA) authorized marketing of a new device meant to help in the diagnosis of autism spectrum disorder (ASD), according to a news release. The Cognoa ASD Diagnosis Aid uses a machine learning algorithm to aid physicians when evaluating patients from 18 months through 5 years of age who are at risk of ASD.

According to the Centers for Disease Control and Prevention, ASD is estimated to affect 1 in 54 children in the United States. The disorder can be difficult to diagnose as symptoms can vary, which can delay treatment and early interventions. The average age of diagnosis is 4.3 years, according to the FDA.

“Autism spectrum disorder can delay a child’s physical, cognitive, and social development, including motor skill development, learning, communication, and interacting with others,” Jeff Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health, said in the release. “The earlier ASD can be diagnosed, the more quickly intervention strategies and appropriate therapies can begin.”

The ASD Diagnosis Aid allows parents, caregivers, and health care professionals to input details about their children or patients, then the software processes the information to make a diagnosis. It consists of three components: a mobile app that allows parents and caregivers to upload videos of their children and answer questions about behaviors; a video analysis portal through which certified specialists view and analyze uploaded videos; and a portal for physicians and other health care professionals to answer questions about patients’ behavior problems, track information about them, and review the software’s diagnostic report. The device issues reports that the child is positive or negative for ASD to help determine a diagnosis or that there is insufficient information.

A study compared the device’s assessments of ASD diagnoses among 425 patients aged 18 months to 5 years against assessments made by a panel of clinical experts. The ASD Diagnosis Aid provided a positive or negative result for ASD for 32% of patients. The device matched assessments made by the panel of clinical experts for 81% of patients who tested positive and 98% of patients who tested negative.

According to the release, the device accurately made an ASD determination in 98.4% of patients with ASD and 78.9% of patients without the disorder. The device provided a false positive result in 15 out of 303 patients without ASD and a false negative in 1 out of 122 patients with ASD.

“The Cognoa ASD Diagnosis Aid is indicated as an aid in the diagnosis of ASD for patients 18 months through 5 years of age who are at risk of developmental delay based on concerns of a parent, caregiver, or health care provider. The device is not indicated for use as a stand-alone diagnostic device but as an adjunct to the diagnostic process,” the release concluded.

For related information, see the American Journal of Psychiatry article “Variable Emergence of Autism Spectrum Disorder Symptoms From Childhood to Early Adulthood.”

Wednesday, June 2, 2021

ECT, Medication Combo Found as Safe as Medication Alone to Maintain Remission From MDD

Older adults being treated for depression with a combination of electroconvulsive therapy (ECT) and medication appear to have similar cognitive improvements over time as those treated with medication only, according to a report in the American Journal of Geriatric Psychiatry.

Sarah Lisanby, M.D., director of the Noninvasive Neuromodulation Unit at the National Institute of Mental Health, and colleagues looked at neurocognitive outcomes in adults aged 60 and over enrolled in the multicenter Prolonging Remission in Depressed Elderly (PRIDE) study. A 2016 analysis of that study, which appeared in the American Journal of Psychiatry, found that patients receiving a combination ECT and medication for six months experienced greater improvements in mood compared with those who received pharmacotherapy alone.

For the current study, Lisanby and colleagues examined six-month neurocognitive outcomes for a total of 120 patients with remitted depression who received either a combination of ECT (right unilateral ultrabrief pulse ECT), venlafaxine, and lithium or venlafaxine and lithium only as part of the PRIDE study. The researchers used standard instruments to assess attention and processing speed, verbal fluency, verbal learning and memory, memory of personal events in one’s own life, and executive functions.

With the exception of processing speed, there was statistically significant improvement across most neurocognitive measures from baseline to six-month follow-up for both groups of patients—those who received ECT, venlafaxine, and lithium as well as those who received medication alone. There were no significant differences between the two treatment groups at six months on measures of psychomotor processing speed, autobiographical memory consistency, short-term and long-term verbal memory, phonemic fluency, inhibition, and complex visual scanning and cognitive flexibility.

“Our key finding is that neurocognitive function improved over the six-month follow-up period,” Lisanby and colleagues wrote. “Given that [the combination of ECT, venlafaxine, and lithium] was more effective in sustaining antidepressant remission than [medication alone] without increasing the risk of neurocognitive side effects, these results support the use of [the combination of ECT, venlafaxine, and lithium] to prolong remission from depression,” Lisanby and colleagues wrote.

Lisanby and colleagues acknowledged that some of the patients in the study could have cognitive difficulties following the six-month time point. “Future research is warranted to examine the longer term cognitive, and antidepressant, trajectory,” they wrote.

For related news, see the Psychiatric News article “Older Patients With Depression May Benefit From ECT, Medication Combo.”



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