Lack of Social Contacts on a Suicide Prevention Plan Linked to Higher Risk of Suicide

Veterans at risk of suicide who do not list a contact for emergencies when creating a safety plan may be more likely to attempt or die by suicide within a year than those who list a contact, according to a report in Psychiatric Services. The study found that these veterans are also more likely to be hospitalized.

“Although it was unclear why these contacts were missing, the lack of social contacts on safety plans may be a potential indicator for future suicide risk and may serve as a marker of other suicide risk factors (such as lack of belonging and isolation),” wrote Samantha Chalker, Ph.D., of the University of California, San Diego, and colleagues.

Safety planning is a suicide prevention intervention that relies partly on an individual’s social relationships, including a “distraction contact” for when the at-risk individual needs to be distracted from isolation or from suicidal thoughts and a “help contact” to turn to in a suicidal crisis.

Chalker and colleagues examined data on 1,602 veterans who completed a safety plan between October 1, 2018, and July 8, 2020, using the U.S. Department of Veterans Affairs San Diego Healthcare System’s electronic medical record system. The researchers specifically focused on whether the safety plans listed distraction and/or help contacts, as well as recorded suicide attempts, suicide deaths, and use of crisis services (including inpatient psychiatric hospitalization admissions and emergency department visits) within one year of creating a safety plan.

They found that 20% of veterans who completed a safety plan (n=320) did not have a distraction contact and 10% (n=161) did not have a help contact; of this group, 105 veterans did not have a person listed in either category.

Within the 12 months following completion of a suicide safety plan, 6% of the veterans in the sample made at least one suicide attempt or died by suicide, 8% had at least one psychiatric inpatient hospitalization, and 15% had at least one emergency department visit. Veterans without a help contact in their safety plan were 2.11 times more likely to attempt suicide or die by suicide within a year than were veterans with a help contact. Similarly, veterans who did not list either a distraction or a help contact were 2.45 times more likely to make a suicide attempt or die by suicide in the next year than were veterans with both distraction and help contacts.

Veterans without a help contact were also 1.9 times more likely to have a psychiatric inpatient hospitalization than were veterans with a help contact and 1.88 times more likely to be admitted to the emergency department. Veterans who did not report a distraction contact did not show any increased use of crisis services, however.

“This study reaffirms the importance of quality and completeness when creating effective safety plans,” the researchers wrote. “Its findings also suggest that the lack of social contacts on safety plans may be an important target for future suicide prevention interventions.”

For related information, see the Psychiatric News article “Upping Our Game to Prevent Suicide.”

Black and Hispanic Patients Disproportionately Referred for Decisional Capacity Consultations

Medical teams may be more likely to seek an evaluation of a patient’s decision-making capacity if the patient is Black or Hispanic than if the patient is White or Asian, suggests a report in Psychiatric Services.

The findings—based on the review of 181 decisional capacity consultations for patients hospitalized at a tertiary care medical center from 2018 to 2019—revealed “capacity assessments appear subject to bias from the beginning of the process,” wrote William S. Garrett, M.D., M.P.H., of Icahn School of Medicine at Mount Sinai and colleagues.

The analysis by Garrett and colleagues involved a retrospective chart review of patient medical records, which contained demographic information, medical and surgical notes, and consultation-liaison psychiatry notes.

They found that capacity consultation requests were placed disproportionately for Black patients, who represented 43% of capacity consultations but only 18% of total inpatient admissions. Hispanic patients represented 26% of capacity consultations and 21% of admissions. Although White patients represented 53% of inpatient admissions, they represented only 28% of capacity consultations and Asian patients represented 9% of admissions and 3% of capacity consultations.

“When challenges to autonomy occur at such a disproportionate rate, a consulting provider’s introduction of a capacity assessment into a patient’s clinical picture has the potential for harm,” Garrett and colleagues wrote. “It raises questions regarding the patient’s decision-making autonomy and capabilities, with significant implications for the perpetuation and worsening of the patient’s vulnerability in the health care system.”

Of the 181 patients included in this study, 130 received an evaluation from a consultation-liaison psychiatrist, and of these, 95 were determined to have no capacity; the authors found that patient race did not affect the likelihood of a no capacity decision. However, Hispanic patients who received a no capacity decision were about three times as likely as Blacks to not experience a change in hospital treatment.

“These findings reveal the potential biases introduced with both the initial challenge to a patient’s capacity and the subsequent outcomes of the consultation. As such, the balance of risk versus benefit or utility of these consultations in certain populations must be carefully considered,” Garrett and colleagues wrote. “Psychiatrists should acknowledge disparate frequencies and impacts of decisional capacity assessments, which can negatively affect therapeutic relationships among patients, families, and care teams.”

For related information, see the Psychiatric News Alert “Patients of Color Disproportionately Subjected to Involuntary Admission to Psychiatric Hospitals.”

(Image: iStock/FG Trade)

---

APA Responds to CareDash Complaints

APA has learned from members that CareDash, a health care provider review and referral website, is engaging in deceptive and misleading business practices. APA sent a letter to CareDash demanding that they remove from the platform all profiles of psychiatrists who have not provided consent to display their profile. APA members listed on CareDash without their consent are encouraged to consider taking action by filing individual complaints with 1) the Federal Trade Commission; 2) their State’s consumer protection office (state contact information can be found in the dropdown menu); and/or 3) the Better Business Bureau by selecting “File a Complaint.”

Risk of Death From COVID-19 Remains Higher Among People With Serious Mental Illness

Numerous studies have found that people with serious mental illness (SMI) are disproportionately impacted by COVID-19. A report in Schizophrenia Bulletin now suggests that people with schizophrenia and/or bipolar disorder may remain at elevated risk of death from the virus compared with people without mental illness regardless of the availability of COVID-19 vaccines.

“[D]espite population vaccination efforts that have prioritized people with SMI—and significantly higher vaccination uptake in some SMI groups—disparities still remain in COVID-19 mortality for people with SMI compared [with] the general population,” wrote Lamiece Hassan, Ph.D., of the University of Manchester and colleagues.

For the study, Hassan and colleagues relied on data from the Greater Manchester Care Record—an electronic health record that includes details of primary care visits, hospital stays, and deaths of more than 3 million residents of Manchester, United Kingdom. The researchers compared COVID-19 mortality in three overlapping samples of patients with SMI aged 18 years and older—those with schizophrenia, bipolar disorder, and/or major depressive disorder—from February 1, 2020, through September 30, 2021. (In England, the NHS started administering COVID-19 vaccinations to patients with SMI on December 8, 2020, according to Hassan and colleagues.) Participants were followed up for up to 20 months and their outcomes were compared with people of similar age and sex who did not have a history of mental illness.

The study included 48,912 people with a diagnosis of schizophrenia, 13,932 with bipolar disorder, 152,489 with major depressive disorder, and 773,734 without a history of mental illness. A total of 5,442 participants died due to COVID-19 during the study observation period: 1,083 had schizophrenia, 136 had bipolar disorder, 926 had major depressive disorder, and 3,570 had none of these.

When compared against their respective matched control groups without mental illness, COVID-19 mortality rates were significantly higher among people with schizophrenia (Risk Ratio [RR]: 3.18), bipolar disorder (RR: 2.69), and major depressive disorder (RR: 1.59). After adjusting for vaccination status, demographics, and comorbidities, the researchers found that the risk ratios for COVID-19 related mortality were reduced but remained significantly associated with schizophrenia (RR: 1.61) and bipolar disorder (RR: 1.92), but not major depressive disorder. Compared with being unvaccinated, having received two COVID-19 vaccines was significantly associated with lower risk for COVID-19 mortality among people with schizophrenia and major depressive disorder, but not bipolar disorder, the authors noted.

“These findings strengthen the case for addressing the life-shortening, physical health needs of people with mental illnesses and continued research into the source of vulnerability to COVID-19 to protect these groups from further health disparities,” the authors wrote.

For related information, see the Psychiatric News articles “COVID-19 Greatly Increases Mortality Risk for Schizophrenia Patients, Research Shows” and “Patients With MH Disorders Found More Susceptible to COVID-19, Death.”

(Image: iStock/BlackJack3D)

Higher Neuropeptide Y Linked to Less Cognitive Impairment After Stroke

People who have high levels of the neurotransmitter neuropeptide Y may have a lower risk of cognitive impairment after ischemic stroke than those with low levels of neuropeptide Y, a study in the Journal of Affective Disorders has found. Ischemic stroke occurs when a blood clot blocks or narrows an artery leading to the brain. Neuropeptide Y is thought to regulate mood, appetite, circadian rhythms, and other functions.

Chongke Zhong, M.D., Ph.D., of the Medical College of Soochow University, Suzhou, China, and colleagues collected data from the blood samples of 593 adult patients who were admitted to a hospital for ischemic stroke between August 2009 to May 2013. Blood samples were drawn from the patients within 24 hours of being admitted to the hospital. The researchers then followed up with participants three months after hospitalization to assess the patients’ cognitive impairment using the Montreal Cognitive Assessment Score.

After three months of follow-up, 71.2% of the patients had experienced cognitive impairment. The researchers then divided the patients into three groups according to the levels of neuropeptide Y in the blood samples taken when the patients were admitted to the hospital. The researchers found that those in the group with the highest levels of neuropeptide Y were about 40% less likely to experience cognitive impairment after ischemic stroke compared with patients in the group who had the lowest amounts of neuropeptide Y.

“Plasma [neuropeptide Y] may have the potential to be a predictive factor and a therapeutic target for cognitive impairment after ischemic stroke,” Zhong and colleagues wrote. “It is of great clinical interest to test whether exogenous administration of [neuropeptide Y] in the acute phase of stroke would decrease the risk of [post-stroke cognitive impairment].”

For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Effective Tools to Predict Depression in Acute and Subacute Phase of Ischemic Stroke.”

(Image: iStock/peterschreiber.media)

---

Was Your Profile Used on CareDash Without Your Permission?

APA has heard from members regarding deceptive and misleading business practices by CareDash, a health care provider review and referral website. APA sent a letter to CareDash demanding that it remove from the platform all profiles of psychiatrists who have not provided consent to display their profile. APA members listed on CareDash without their consent are encouraged to consider taking action by filing individual complaints with (1) the Federal Trade Commission; (2) their state's consumer protection office (state contact information can be found in the dropdown menu); and/or (3) the Better Business Bureau by selecting “File a Complaint.”

Antidepressants Found to Reduce Risk of Hospital Visits for COVID-19

Among patients who are infected with COVID-19, those taking certain antidepressants may be less likely to visit the emergency department (ED) or be hospitalized than those who are not taking antidepressants, according to a study published this week in Translational Psychiatry.

“Certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have shown promise as early treatments for COVID-19,” wrote Bradley Fritz, M.D., M.S.C.I., of the Washington University School of Medicine and colleagues. “Because many individuals around the world have not been fully vaccinated and breakthrough infections can sometimes cause severe COVID-19 in vaccinated individuals, effective treatments with favorable tolerability profiles are urgently needed.”

Fritz and colleagues used data from the BJC Healthcare network of hospitals in Missouri and Illinois. Participants included in the study were aged 18 and older, had a positive COVID-19 test between March 2020 and May 2021, and were not admitted to the hospital on the day they tested positive. The authors used electronic health record data to determine whether the participants had an ED or hospital visit within 30 days of testing positive and to determine what medications and dosages they were taking. Antidepressant exposure was defined as inclusion of an antidepressant on patients’ medication list at any health care visit prior to the positive COVID-19 test.

A total of 25,034 participants were included in the study, 4,557 (18.3%) of whom were taking at least one antidepressant when they tested positive. The incidence of an ED or hospital visit was significantly greater among patients taking antidepressants (21.2%) compared with those who were not (9.3%). However, after adjusting for confounding variables such as sex, age, race and ethnicity, obesity, number of diagnoses, and concurrent exposure to other medications, antidepressant exposure was associated with decreased odds of an ED or hospital visit. The patients who benefited were those taking SSRIs, bupropion, and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. A daily dose equivalent to 40 mg of fluoxetine a day was associated with the strongest benefit; bupropion was associated with decreased odds of an ED or hospital encounter when taken at any dose.

“When designing future prospective studies, researchers should consider SSRIs and other antidepressants with FIASMA activity as candidate interventions for outpatient therapy of COVID-19, prescribed at a dose of at least 40 mg/day of fluoxetine-equivalents,” the authors concluded.

For related information, see the Psychiatric News article “Antidepressants May Reduce Severity of COVID-19.”

(Image: iStock/AzmanL)

Children With ADHD at Higher Risk of Infectious Diseases, Study Finds

Children with attention-deficit/hyperactivity disorder (ADHD) appear to be at higher risk of infectious diseases, according to a large population-based case control study published in the Journal of the American Academy of Child and Adolescent Psychiatry.

The study, involving more than 50,000 children and adolescents in a large HMO in Israel, found that ADHD was associated with significantly higher rates of all types of pediatric infectious diseases, use of all kinds of anti-infective agents, and high rates of visits to primary care physicians and specialists.

“Since ADHD is a highly prevalent disorder worldwide and represents the most common behavioral problem in clinical practice, a vulnerability to infectious diseases represents a significant public health concern,” wrote lead author Eugene Merzon, M.D., of Leumit Health Services, Tel Aviv, and colleagues. “Such vulnerability is critical in situations of a pandemic such as that posed by COVID-19.”

The researchers analyzed data on 18,756 youth aged 5 to 18 with ADHD and 37,512 age-matched controls enrolled in Leumit Health Services between January 1, 2006, and June 30, 2021. Children with underlying cancer or a primary or secondary immune deficiency were excluded from the study because of the high rate of infections associated with these disorders. ADHD diagnosis was based on DSM-IV or DSM-5 criteria, depending on the year of the diagnosis. The main outcomes were infectious diseases of all types, use of anti-infectious agents, and physician visits.

Children with ADHD were 1.4 times more likely to have respiratory infections, 1.3 times more likely to have acute gastroenteritis, and 1.2 times more likely to have bronchopneumonia than children without ADHD. They were also more likely to have specific bacterial, viral, parasitic, and fungal infections—in particular, salmonella infections.

Children with ADHD were more likely than those without to be prescribed all anti-infectious agents, including anti-bacterial, anti-viral, anti-fungal, anti-parasitic, and combination agents. They were 1.5 times more likely to be prescribed ciprofloxacin.

Finally, children with ADHD had significantly higher rates of visits with primary care physicians and specialists than children without ADHD. They were 1.4 times more likely to visit a pediatrician, 1.6 times more likely to see an ear nose and throat physician, and 1.3 times more likely to see a dermatologist.

“We suggest that subjects with ADHD suffer from an aberrant immunological response, resulting in a higher vulnerability to being infected by microorganisms,” the researchers wrote. “We did not examine the effect of stimulant treatment on the rates of infections in children with ADHD. This necessitates a distinct study design and might be planned in future research.”

For related information, see the Psychiatric News article “Symptoms, Impaired Function of ADHD Often Persist Beyond Childhood.”

(Image: iStock/FatCamera)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Television Watching, Computer Use Found to Have Opposite Impact on Dementia Risk

A study published in PNAS has found that older adults who spend many hours a day watching television are at increased risk of developing dementia, but those who spend more than an hour daily on a computer have a slightly reduced risk of dementia. These findings remained strong regardless of how much or little the adults engaged in physical activity.

“Our results help clarify associations of [sedentary behavior] with brain health and suggest that it is not time spent sitting per se but the type or context of leisure-time [sedentary behavior] that is associated with dementia risk,” wrote David A. Raichlen, Ph.D., of the University of Southern California and colleagues.

Raichlen and colleagues used data from the UK Biobank, a database that contains both baseline and follow-up health, lifestyle, and genetic information from about half a million adults in the UK. For their analysis, Raichlen and colleagues examined data on 146,651 participants who were at least 60 years old and dementia-free at the baseline assessment. During the follow-up period (average of 12 years), 3,507 of these adults developed dementia.

The researchers found that adults who spent 4 hours a day or more watching TV had about 20% greater risk of developing dementia than those who spent less than 2 hours a day watching TV. In contrast, adults who spent 1 hour or more on a computer daily had a 24% reduced risk of dementia compared with those who spent less than 30 minutes on a computer. The amount of physical activity in which subjects engaged did not significantly impact these estimated risks.

“While [physical activity] is associated with a beneficial reduction in dementia risk, this relationship does not strongly impact associations between leisure-time [sedentary behaviors] and dementia risk, suggesting two key and potentially separate behavioral pathways for altering risk of incident dementia,” Raichlen and colleagues wrote.

“[O]ur results highlight a key behavioral characteristic for public health messaging and modification,” the authors concluded. “Reducing cognitively passive [sedentary behaviors] like TV watching and increasing cognitively active [sedentary behaviors] like computer use, by even a small amount, may have an important impact on dementia risk in individuals regardless of their engagement in [physical activity].”

To read more on this topic, see the Psychiatric News Alert “Study Pinpoints Activities Associated With Reduced Risk of Cognitive Decline.”

(Image: iStock/Charday Penn)

---

APA Wants to Know More About You!

APA is committed to anti-racism and ensuring diversity, equity, and inclusion across the Association. Sharing demographic data helps APA meet these goals. In addition to that information, let APA know about your interests and practice profile to help us better serve you with resources and benefits relevant to you. Please update your member profile now!

FDA Approves Novel Rapid-Acting Oral Antidepressant

The Food and Drug Administration (FDA) has approved Auvelity, an extended-release tablet that combines dextromethorphan and bupropion for the treatment of major depressive disorder in adults. The FDA granted Breakthrough Therapy designation to Auvelity in March 2019.

Dextromethorphan, commonly used as a cough suppressant, inhibits the NMDA receptor, which is the same receptor targeted by the rapid-acting antidepressant esketamine. The antidepressant bupropion inhibits the metabolic enzyme CYP2D6, which prolongs the time that dextromethorphan remains active.

“The approval of Auvelity represents a milestone in depression treatment based on its novel oral NMDA antagonist mechanism, its rapid antidepressant efficacy demonstrated in controlled trials, and a relatively favorable safety profile,” said Maurizio Fava, M.D., psychiatrist-in-chief at Massachusetts General Hospital and the Slater Family Professor of Psychiatry at Harvard Medical School, in a press release from Axsome Therapeutics, manufacturer of Auvelity.

The approval of Auvelity was based on two large clinical trials. The first was a placebo-controlled trial known as GEMINI, which included 327 adults with major depression. After six weeks, Montgomery-Åsberg Depression Rating Scale (MADRS) scores dropped by 16 points among adults randomized to twice-daily Auvelity (45 mg dextromethorphan and 105 mg bupropion) compared with 12 points of those randomized to placebo. In addition, 40% of adults taking Auvelity achieved remission (defined as MADRS score of ≤ 10) compared with 17% of those taking placebo.

The second trial, called ASCEND, involved 97 adults with major depression and compared the 45 mg dextromethorphan/105 mg bupropion combo with 105 mg bupropion alone. Like the GEMINI trial, adults taking Auvelity showed greater reductions in MADRS scores after six weeks than those taking bupropion (13.7 points vs. 8.8 points, respectively) and greater remission rates (47% vs 16%). The most common side effects included dizziness, headache, diarrhea, sleepiness, dry mouth, sexual dysfunction, and excessive sweating.

In its release, Axsome said that Auvelity is expected to be commercially available by the end of this year.

For related information, see “Effect of AXS-05 (Dextromethorphan-Bupropion) in Major Depressive Disorder: A Randomized Double-Blind Controlled Trial.”

Patients of Color Disproportionately Subjected to Involuntary Admission to Psychiatric Hospitals

Patients of color—particularly patients who identify as Black, multiracial, or another race—are significantly more likely than White patients to be subjected to involuntary psychiatric hospitalization, a study in Psychiatric Services in Advance has found.

Timothy Shea, M.D., of Massachusetts General Hospital and Harvard Medical School and colleagues examined data from 4,393 patients whose initial admission to a psychiatric unit at a large hospital in Boston occurred between 2012 and 2018. Among the patients, 73% identified as White, 11% as Black, 10% as primarily Hispanic or Latinx, 4% as Asian, and 3% as another race or multiracial.

“In Massachusetts, patients can be involuntarily admitted to a psychiatric unit by a licensed clinician,” Shea and colleagues wrote. “At admission, the patient must be offered the opportunity to sign in to the hospital on a conditional voluntary legal status … . If the patient declines or lacks the capacity to sign in, then the physician must determine whether the patient meets commitment criteria on the basis of imminent danger to self or others or grave inability to care for self. The admitting physician can admit such patients for an involuntary hold for an observation period of 3 business days (equivalent to a 72-hour emergency hold in most states).”

Overall, 28% of the patients were involuntarily admitted. Compared with White patients, Black patients had 1.57 times the odds of being admitted involuntarily, and patients who identified as other race or multiracial had 2.12 times the odds of being admitted involuntarily. Furthermore, patients of color were more likely to be diagnosed with a psychotic disorder: 25% of White patients were diagnosed with a psychotic disorder compared with 58% of Black patients, 49% of Asian patients, 41% of Latinx patients, and 41% of patients who identified as other race or multiracial.

Shea and colleagues noted that other studies suggest reasons for these disparities, including interpersonal racism, implicit bias, and differences between racial groups with respect to illness severity, access to and engagement with mental health care, and social determinants of health.

“Future work should interrogate the role of patient-provider–level interpersonal racism, differences in symptom severity, and prehospitalization treatment history in mediating inequities,” the researchers wrote. “Such work may inform interventions designed to ensure that coercive measures are used in an equitable fashion.”

For related information, see the Psychiatric Services article “Ethnoracial Differences in Coercive Referral and Intervention Among Patients With First-Episode Psychosis” and the Psychiatric News article “Psychiatrists Must Get Off Sidelines to Fight Racism.”

(Image: iStock/LightFieldStudios)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

COVID-19 Can Increase Risk of Psychiatric Disorders for Up to Two Years

The increased risk of depression and anxiety that patients experience after developing COVID-19 typically subsides within two months, according to a study published yesterday in The Lancet Psychiatry. However, patients may have an elevated risk for developing other psychiatric and neurological conditions, such as psychosis, brain fog, and seizures, for up to two years after their infections.

“The results have important implications for patients and health services as it suggests new cases of neurological conditions linked to COVID-19 infection are likely to occur for a considerable time after the pandemic has subsided,” study co-author Paul Harrison, B.M. B.Ch., of the University of Oxford said in a statement. “Our work also highlights the need for more research to understand why this happens after COVID-19, and what can be done to prevent or treat these conditions.”

Harrison and colleagues used data from the TriNetX electronic health record network, an international network of de-identified health care records from approximately 89 million patients (mostly from the United States, but also from Australia, Bulgaria, India, Malaysia, Spain, Taiwan, and the United Kingdom). The authors identified patients of any age who were diagnosed with COVID-19 between January 20, 2020, and April 13, 2022. These patients were matched with a cohort of patients diagnosed with any other respiratory infection.

The authors compared the risk of 14 neurological and psychiatric diagnoses for up to two years after infection among patients in the COVID-19 group with those in the other respiratory infection group. These diagnoses included anxiety disorder, mood disorder, psychotic disorder, insomnia, cognitive deficit (or brain fog), dementia, epilepsy or seizures, and ischemic stroke. To investigate the impact of different variants of COVID-19, the authors also compared patients diagnosed directly before and after the emergence of the alpha, delta, and omicron variants. The data were analyzed according to the patients’ ages: children (under 18 years), adults (18 to 64), and older adults (65 years and older).

Nearly 1.3 million patients with confirmed COVID-19 diagnoses were included in the study. Compared with adults diagnosed with any other respiratory disease, those who had had COVID-19 had a higher risk of brain fog (550 cases per 10,000 people in the control group vs. 640 cases per 10,000 people in the COVID-19 group) and muscle disease (32 cases per 10,000 people in the control group vs. 44 cases per 10,000 people in the COVID-19 group). In older adults who had had COVID-19, there was a higher occurrence of brain fog (1,540 cases per 10,000 people in the COVID-19 group vs. 1,230 cases per 10,000 people in the control group), dementia (450 cases per 10,000 people in the COVID-19 group vs. 330 cases per 10,000 people for dementia in the control group), and psychotic disorder (85 cases per 10,000 people in the COVID-19 group vs. 60 cases per 10,000 for psychotic disorder in the control group).

Among adults, the risk of mood or anxiety disorder diagnoses initially increased immediately after the COVID-19 infection but returned to the same risk level as other respiratory infections after 43 days for mood disorders and 58 days for anxiety disorders. After two years, there was no difference in the incidence of mood and anxiety disorders between the COVID-19 group and the group of patients diagnosed with any other respiratory infection.

Children were not at greater risk for mood or anxiety disorders following a COVID-19 diagnosis compared with children diagnosed with other respiratory infections. In the two years following COVID-19, however, children were more likely to be diagnosed with seizures (260 cases per 10,000 children for the COVID-19 group vs. 130 cases per 10,000 for the control group) and psychotic disorders (18 cases per 10,000 children for the COVID-19 group vs. 6 cases per 10,000 for the control group).

The delta variant was associated with significantly higher six-month risks of numerous disorders compared with individuals diagnosed with COVID-19 in the period just before delta emerged. Delta increased the risk of anxiety by 10%, insomnia by 19%, brain fog by 38%, epilepsy or seizures by 26%, and ischemic strokes by 27%. Delta was associated with a 40% lower risk of dementia, however. The risks during the omicron wave were similar to those when delta was the dominant variant.

“Our findings shed new light on the longer-term mental and brain health consequences for people following COVID-19 infection,” the study’s lead author Max Taquet, B.M. B.Ch., Ph.D., of the University of Oxford, said in the statement. “With omicron as the dominant variant, although we see much milder symptoms directly after infection, similar rates of neurological and psychiatric diagnoses are observed as with delta, suggesting that the burden on the healthcare system may continue even with variants that are less severe in other respects.”

For related information, see the Psychiatric News article “A Hazy Picture of Long-Haul COVID Begins to Emerge.”

(Image: iStock/BlackJack3D)

Postpartum Depression More Likely in New Moms With Family History of Psychiatric Disorders

New mothers who have a family history of psychiatric disorders appear to have almost double the risk of postpartum depression than new mothers without such a family history, suggests a meta-analysis published today in JAMA Psychiatry.

The findings point to “the potential for a quick and low-cost assessment of [postpartum depression] risk in clinical practice using only 2 self-reported questions: history of personal and family psychiatric disorders,” wrote Mette-Marie Zacher Kjeldsen, M.Sc., of Aarhus University, Alessio Bricca, Ph.D., of the University of Southern Denmark, and colleagues.

The researchers began by conducting a literature search of articles in PubMed, Embase, and PsychINFO. They specifically searched for case-control and cohort studies that examined the association between family history of any psychiatric disorder and postpartum depression.

A total of 26 studies were included in the analysis, containing information on 100,877 postpartum women from 18 countries in Asia, Australia, Europe, North America, and South America. Most of the studies (23 of 26) relied on self-reported questionnaires to assess family history of psychiatric disorders, the authors noted.

“The primary analysis showed increased odds of [postpartum depression] when having family history of psychiatric disorders (odds ratio = 2.08), corresponding to a relative risk of 1.79,” Zacher Kjeldsen, Bricca, and colleagues wrote.

“Family history of psychiatric disorders is a strong risk factor for postpartum depression, which ideally can be identified through self-report already during pregnancy and enable timely and targeted preventive initiatives,” they concluded.

For related information, see the Psychiatric News special report “Stress and Distress During Pregnancy—How to Protect Both Mother and Child.”

(Image: iStock/FatCamera)

---

Virtual Mental Health Innovation Exchange Starts Tomorrow

The Mental Health Innovation Exchange, to be held virtually on August 18 and 19, is APA’s showcase and catalyst for the advancement of mental health technologies, dedicated to answering the question “What’s next in mental health technology?” Session topics include mental health tech and innovation, the future of telepsychiatry, and next-generation neuroscience. This event is free for all APA members.

LEARN MORE AND REGISTER

APA Report Describes Model That Can Help U.S. Communities Determine Psychiatric Needs

An APA task force has produced a computer simulation model that it believes can help any community in the United States determine how many psychiatric beds it needs and where best to invest resources to meet the need for care in that community. A summary of the work is described in the report “The Psychiatric Bed Crisis in the United States: Understanding the Problem, Moving Toward Solutions,” published in the American Journal of Psychiatry. (The full report can be found here.)

APA leaders and members of the task force said the model can be a game changer. “What we wanted to do is build a model that can support learning, engagement, and discussion among leaders and policymakers in communities,” said Kristen Hassmiller Lich, Ph.D., an associate professor of health policy and management at the University of North Carolina School of Global Public Health. She chaired a subgroup of the task force with expertise in statistics and systems modeling.

“[The model] can allow community leaders to test different alternatives and ask ‘what if’ questions” and “can help us get a better idea of what it would look like if our system was functioning in its best form,” Hassmiller Lich explained.

The APA Presidential Task Force on the Assessment of Psychiatric Bed Needs in the U.S. was charged in 2020 by then-APA President Jeffrey Geller, M.D., M.P.H., with developing a model for determining how many psychiatric beds a community might need to meet its demand for psychiatric care. Chaired by past APA President Anita Everett, M.D., the task force comprised more than 30 APA leaders, mental health professionals who are experts in health services and population health, and members of the APA administration.

Leaders from the University of Michigan and several local partners in Washtenaw County, Mich., will be the first to test the new model. They are now gathering data that can be fed into the model.

“Right now, when you make a decision [about how to fund mental health services], you make that decision on your own largely parochial view of things, without knowing how that decision impacts other players in the system,” Gregory Dalack, M.D., chair of the Department of Psychiatry at the University of Michigan, told Psychiatric News. “The model will give us more information about where strategic investments can be made and what the impact will be.”

Everett explained the model draws on artificial intelligence and is similar to a “machine learning” algorithm: The machine gets better and “learns” as it gathers more data. The participation of the University of Michigan and its partners will significantly advance the ability of the model to accurately forecast for other communities where they should focus resources, she said.

“If we learn some things, the task force will be empowered to take this to other communities that might use the model and then go to their state legislatures and say, ‘Here is where we need help, and this is what the impact would be,’ ” Dalack said.

For more information, see the Psychiatric News articles “Task Force on Psychiatric Beds Produces Model for Determining Need in Any Community” and “University of Michigan First to Test APA Model for Assessing Psychiatric Bed Needs.”

(Image: iStock/SDI Productions)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Online Exposure Therapy Improves Tic Symptoms in Youth

Behavioral therapy is recommended as a first-line treatment for Tourette syndrome and chronic tic disorder, but access to treatment is limited. A study published today in JAMA Network Open points to two 10-week, therapist-supported online programs that may be able to help reduce tics in youth.

Per Andrén, Ph.D., of the Karolinska Institutet in Stockholm and colleagues recruited Swedish youth aged 9 to 17 who had been diagnosed with Tourette syndrome or chronic tic disorder for the study. A total of 221 youth and their parents were randomly assigned to online exposure and response prevention (ERP) or tic education for 10 weeks. Participants assigned to online ERP practiced tic suppression while being gradually exposed to more challenging urges (unpleasant sensations that typically precede tics). Participants assigned to online tic education were taught about Tourette syndrome, chronic tic disorder, and common comorbid disorders, as well as behavioral exercises (such as engaging in healthy habits like proper sleep and nutrition and sharing information about Tourette syndrome and chronic tic disorder with peers). Children and parents could write to the therapist at any time through the online system, and both interventions included therapist support via text messages or telephone calls, as needed.

Three months after the interventions ended, scores on the clinician-rated 50-point Total Tic Severity Score of the Yale Global Tic Severity Scale dropped 6.08 points in the ERP group and 5.29 points in the tic education group. When the youth were assessed using the Clinical Global Impression Severity and Improvement (CGI-S/I) scales, the researchers found that 47.2% of youth in the ERP group achieved treatment response (defined as a rating of “much improved” or “very much improved” on the CGI-S/I compared with 28.7% of the youth in the tic education group. Both parents and children reported higher satisfaction scores for the ERP program compared with the tic education program.

“Mean therapist support time (text messages [96%] and telephone [4%]) was 19.1 … minutes per participant and week in the ERP group and 16.6 … minutes per participant and week in the comparator group, a statistically significant difference,” the authors wrote.

“[O]ur findings suggest that both internet-delivered interventions could be implemented into regular health care to increase treatment access for children and adolescents with [Tourette syndrome] or [chronic tic disorder]. However, we would favor the implementation of ERP based on its higher treatment response rates, likely cost-effectiveness, superior working alliance, and satisfaction ratings,” they concluded.

“Most health regions experience major barriers to accessibility to behavioral [tic] therapies because of a lack of trained care professionals, long waiting times, cost, and travel distance required to see a qualified therapist,” wrote Tamara Pringsheim, M.D., of the University of Calgary and John Piacentini, Ph.D., of the University of California, Los Angeles, in an editorial accompanying the study. “The ability to use a remote delivery system with therapist support could greatly increase both acceptability and capacity for care and is a meaningful advance in the ability to provide therapeutic interventions in our field.”

They added, “This is not by any means to say that medication no longer plays a role in the treatment of [Tourette syndrome].”

To read more on this topic, see the Psychiatric News article “‘Outbreak’ of Sudden Tics Among Teen Girls Has Surprising Global Similarity.”

(Image: iStock/Alan Lerma)

Use of Psychedelic Substances May Raise Risk of Seizures

Taking psychedelics could increase the risk of seizures in certain people, particularly those with a personal or family history of epilepsy, a study in Drug and Alcohol Dependence has found.

Otto Simonsson, Ph.D., of the Karolinska Institutet in Sweden and colleagues examined data from 613 U.S. adults who reported having ever used a classic psychedelic such as psilocybin; N,N-dimethyltryptamine (DMT); ayahuasca; lysergic acid diethylamide (LSD); mescaline; peyote; and/or San Pedro. Participants also reported whether they currently had epilepsy or a history of epilepsy and whether they had any family history of epilepsy.

Nearly 75% of the people included in the study reported having ever used LSD, and just over 70% reported having ever used psilocybin. Among all participants, nine, or 1.5%, reported seizures while using a classic psychedelic. Among these nine, seven had a family history of epilepsy and five had a personal history of epilepsy. Only two participants who reported seizures had neither a family nor personal history of epilepsy.

“The significant association with family history of epilepsy remained when those who had a personal history of epilepsy were excluded from the analysis, which suggests that there could be a genetic component that predisposes people with a family history of epilepsy to have classic psychedelic-related seizures,” Simonsson and colleagues wrote.

While the incidence of classic psychedelic-related seizures in the general population may be low, the findings highlight factors associated with a higher likelihood of classic psychedelic-related seizures, the researchers noted.

“These findings could have real-world implications both for informing exclusion criteria in classic psychedelic trials and for educating individuals who use classic psychedelics outside of research settings,” the researchers concluded.

For related information, see the Psychiatric News article “Psychedelic Therapy Hits Another Milestone, But Caution Urged.”

(Image: iStock/wildpixel)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Majority of Adults Favor Mental Health Resources in Schools, Worry About Gun Violence

An overwhelming majority of American adults agree that schools should play a key role in students’ mental health, including educating students about mental health and referring children to the appropriate professional if they notice signs of a mental health issue. The findings are the latest from APA’s Healthy Minds Monthly Poll.

“The overwhelming support for mental health programming in schools is so important for our next generation, as we face an unprecedented mental health crisis for adolescents and youth,” APA President Rebecca Brendel, M.D., J.D., said in a news release. “We must continue to support evidence-based practices that help children when they need it most.”

The Healthy Minds Monthly Poll was conducted by Morning Consult on July 21 and 22 with a sample of 2,210 adults. The interviews were conducted online.

Eighty-three percent of respondents agreed that schools play a crucial role in identifying possible signs of mental health issues in students, 87% agreed that it is important for school staff to participate in mental health trainings, and 85% agreed that it is important for every child to have a positive role model who is not a parent or caregiver. Additionally, nearly 3 out of 4 parents said they would feel comfortable referring their child to a mental health professional if they noticed a concerning change in their child’s attitude or behavior. However, the survey found that Black parents are significantly less comfortable referring their child to a mental health professional (54%) compared with their White (76%) and Hispanic (72%) counterparts.

Further, 55% of respondents ranked gun violence as one of the top three issues that they are most concerned will negatively impact K-12 students. Fifty-three percent of parents said they are concerned about the effects of COVID-19 on their child’s mental health.

The poll also gauged respondents’ anxiety around current events, comparing the responses with those from July’s Healthy Minds Monthly Poll. The findings include the following:

• 85% are anxious about inflation, similar to the finding in last month’s poll.
• 55% are anxious about the COVID-19 pandemic, an increase of seven points, with significant increases among Black adults (22 points), moms (11 points), parents (10 points), and Hispanic adults (nine points).
• 60% are anxious about climate change, an increase of four points.
• 70% are anxious about gun violence, an increase of four points.
• 56% are anxious about the future of reproductive rights, an increase of six points.

“Many global issues are weighing on Americans’ minds as we move into the end of summer,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., said in the release. “While the news can be stressful, taking action on an issue can help us to feel empowered, and for many, ensuring we aren’t exposing ourselves to constant negative news can help.”

For related information, see the Psychiatric News Alerts “Americans Anxious Over Current Events, But Most Rate Their Overall Mental Health as Good” and “School MH Professionals Found to Be Biased Against Black, Latinx Students.”

(Image: iStock/Dusan Stankovic)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!

Residency Directors Should Encourage, Support Personal Psychotherapy as Part of Training

Physicians training to be psychiatrists should be encouraged to seek psychotherapy for themselves, not only for the sake of their own mental health, but because it will make them better, more empathic psychiatrists, according to a Viewpoint in the American Journal of Psychotherapy.

“Personal psychotherapy is both a personal and professional endeavor,” wrote Megan E. Pruette, M.D., a clinical assistant professor of psychiatry at the University of North Carolina School of Medicine. “Therapists who have engaged in personal psychotherapy report reduced psychological distress, greater self-acceptance, better self-care, greater authenticity, improved job performance, and enhanced self-awareness, and they hope for similar improvements in their patients.” Engaging in personal psychotherapy also allows trainees to gain a better understanding of what it’s like to be on “the other side of the couch.”

There are several steps that training directors can take to create a culture of acceptance for residents seeking their own psychotherapy, Pruette wrote.

A survey of psychiatry residents indicated that time and finances were the most common reasons for residents not to engage in personal psychotherapy. Pruette suggested that training directors can help residents by providing a list of local therapists who accept residents’ insurance or are willing to work with residents on a sliding scale. She noted that some residency programs have taken these steps and seen an increase in the number of residents who engage in personal psychotherapy.

“If the importance of personal psychotherapy is emphasized and discussed openly throughout the residency, it will take away the stigma and shame that are sometimes associated with personal psychotherapy,” Pruette wrote. “Seeking personal psychotherapy should be encouraged and praised as an important part of training, not viewed as something to do only when there is a problem. Residency directors should talk to residents about the importance of personal psychotherapy as a part of their training,” and be understanding of the time needed to engage in personal psychotherapy.

Engaging in personal psychotherapy will enable psychiatrists in training to better understand their patients and the struggles they encounter, Pruette wrote. “Therapy is inherently difficult and uncomfortable at times. … Experiencing this discomfort increases clinicians’ understanding of the pain and challenges their patients face and fosters their empathy, respect, and compassion.”

For related information, see the Psychiatric News article “Supporting Psychotherapy Training in Residency.”

(Image: iStock/SDI Productions)

Addressing Adolescent Use of Nontobacco Oral Nicotine Products Said to be Public Health Priority

Nontherapeutic nicotine gums, tablets, or gummies are popular among adolescents, suggests a survey of high school students in Southern California. The survey findings, published in Pediatrics, revealed that use of such oral nicotine products was second only to e-cigarettes among 9th and 10th graders.

“Nontherapeutic nontobacco nicotine gums, lozenges, tablets, and gummies have several attributes that might attract youth,” wrote Alyssa F. Harlow, Ph.D., of the University of Southern California and colleagues. In addition to being marketed in many fruit flavors, “the act of putting a piece of gum or gummy in the mouth might feel intuitive and less risky for an adolescent, in contrast to nicotine or tobacco products that are inhaled,” they continued. “Importantly, oral nicotine products are discreet and easily concealed; without packaging, and in some cases, even with packaging, many products are indistinguishable from regular gum or candy, making them easy to hide from parents, teachers, or other authority figures.”

Harlow and colleagues examined data from an ongoing behavioral health survey being conducted among adolescents across seven school districts in Southern California. The study focused on data collected from 3,516 students from September 30 to December 14, 2021, when students from the first recruitment wave were in 10th grade and those from the second recruitment wave were in ninth grade. The survey asked students if they had ever used nicotine pouches, other nontobacco oral nicotine products, combustible cigarettes, e-cigarettes, snus, cigars, little cigars or cigarillos, and hookahs or waterpipes. Students were also asked if they had used the products in the past six months.

E-cigarette use was the most prevalent among these students, with 9.6% reporting ever using and 5.5% using in the past six months. Oral nicotine products such as gums and tablets were second most prevalent, with 3.1% of students reporting ever use and 1.4% past six month use.

Harlow and colleagues found that the use of any oral nicotine product (chewables or pouches) was about 2.5 times more prevalent in Hispanic teens compared with other races and ethnicities, 1.9 times as prevalent in participants identifying as female compared with those identifying as male, 2.8 times as prevalent in participants identifying as transgender or nonbinary compared with those identifying as male, and 1.6 times as prevalent in participants identifying as a sexual minority compared with those identifying as heterosexual.

Harlow and colleagues noted that over 99% of the adolescents who reported using oral nicotine products also reported a history of using other nicotine products, but the survey did not identify which products were initiated first.

“Given that use of other noncombustible nicotine products such as e-cigarettes increases risk of subsequent initiation of combustible cigarette smoking and cannabis use, there is reason to be concerned about whether nontobacco oral nicotine product use increases risk of using other harmful substances,” they wrote. “Adolescent non-tobacco oral nicotine product use surveillance should be a public health priority.”

To read more about this topic, see the Psychiatric News article “Minimum Age Raised to 21 for Tobacco, Nicotine Purchase.”

(Image: iStock/fatido)

---

Update Your APA Profile

APA is committed to anti-racism and ensuring diversity, equity, and inclusion across the Association. Sharing accurate demographic data helps APA meet these goals. Let APA know about your interests, demographics, and practice profile to help the Association better serve you with resources and benefits relevant to you!

LEARN MORE

Artificial Intelligence May Help More Patients Access Cognitive-Behavioral Therapy for Chronic Pain

Patients with chronic pain who receive cognitive-behavioral therapy that uses artificial intelligence to adjust treatment (AI-CBT-CP) experience similar outcomes as those who receive cognitive-behavioral therapy for chronic pain (CBT-CP) delivered by a therapist over the telephone, suggests a study published today in JAMA Internal Medicine.

Although CBT-CP—which targets maladaptive thought processes—is known to be a safe alternative to pharmacotherapy for the treatment of pain, “many patients do not have easy access to CBT-CP or receive a lower dose than intended,” wrote John D. Piette, M.Sc., Ph.D., of the University of Michigan School of Public Health and colleagues. This “trial indicated that despite using less therapist time, AI-CBT-CP achieved outcomes that were noninferior to outcomes of patients offered an equal number of 45-minute telephone sessions with a CBT-CP therapist.”

Piette and colleagues used medical records from two health care systems in the Department of Veterans Affairs (VA) from June 2017 to September 2019 to identify patients with chronic back pain who met the following criteria: at least two documented reports of moderate or worse pain intensity (defined as a 4 or above on the Numerical Rating Scale) during the prior year; moderate or worse pain-related disability (defined as a score of 5 or above on the Roland Morris Disability Questionnaire, or RMDQ); and moderate or worse musculoskeletal pain during three or more of the prior six months. A total of 278 participants were randomized to either the AI-CBT-CP group or the therapist-delivered telephone CBT-CP group.

Participants in both groups received 10 weekly sessions of CBT-CP that addressed pain coping skills, patient-selected behavioral goals, and step counts. Participants receiving therapist-delivered CBT-CP were offered 45-minute telephone sessions weekly; these sessions included a review of the patient’s pedometer logs and skill practice, a presentation of new skill information, the selection of behavioral goals, and the use of problem-solving techniques to address goal completion barriers. Participants receiving AI-CBT-CP completed daily interactive voice response (IVR) calls during which they described their step counts, sleep, pain intensity, interference, mood, self-efficacy, CBT skill practice, and progress toward behavioral goals. This daily report was used by an AI engine to make weekly recommendations for either a 45-minute or 15-minute therapist-delivered telephone session or an individualized IVR-delivered therapist message for 10 weeks. All participants were evaluated using the RMDQ at three and six months.

The researchers found that the participants’ three-month mean RMDQ score difference between AI-CBT-CP and standard CBT-CP was −0.72 points and the six-month difference was −1.24—findings that the authors noted suggest that participants receiving 10 weeks of AI-CBT-CP had noninferior outcomes for pain-related function compared with participants receiving 10 weeks of 45-minute telephone sessions with a CBT-CP therapist. “AI-CBT-CP achieved these outcomes with only 30% of the clinician time required for the comparison program of weekly 45-minute therapist sessions,” Piette and colleagues wrote.

They concluded, “Given that AI-CBT-CP required less clinician-patient contact time, patients may find the intervention more convenient, and health systems could use it to treat more patients without additional clinical resources.”

For related information, see the Psychiatric News article “Integrated Behavioral Approaches Show Promise in Treating Pain.”

(Image: iStock/Charday Penn)

Mental Illness Associated With Higher Levels of Oxidative Stress

People who have mental illness are more likely to have higher levels of oxidative stress in their bodies than those without mental illness, a meta-analysis in JAMA Psychiatry has found. Oxidative stress occurs when there is an imbalance of free radicals and antioxidants in the body. A certain amount of oxidative stress is normal and occurs when the body fights off illness or repairs injury. However, long-term oxidative stress can damage cells, DNA, and RNA, leading to chronic inflammation in the body that raises the risk of numerous conditions like Alzheimer’s disease, cardiovascular disease, diabetes, and Parkinson’s disease.

The study’s findings may help explain why people with mental illness tend to have a higher rate of physical illness, Anders Jorgensen, M.D., Ph.D., of the University of Copenhagen and colleagues wrote.

The researchers analyzed data from 82 studies that compared markers of DNA and RNA damage from oxidative stress in people with mental illness with those in people without mental illness. The studies in the analysis used samples from different cell types, such as cells in urine, cerebrospinal fluid, and plasma, to discover markers of DNA and RNA damage in the body and brain caused by oxidative stress. All told, there were 10,151 patients with mental illness and 10,532 people without mental illness in the meta-analysis.

The researchers found a general trend of higher oxidative stress levels in patients with dementias, followed by psychotic disorders and bipolar disorders compared with people without these conditions. Patients who had major depressive disorder tended to have greater blood cell and plasma or serum DNA markers of oxidative stress, but not urinary DNA or RNA markers, than those without major depressive disorder. The meta-analysis included few studies of people with substance use disorder or anxiety disorders, so the researchers considered their findings inconclusive. However, the studies did not show a specific trend toward increased markers of oxidative stress in the brains of people with mental illness compared with those without mental illness.

“Given that there was an association with [oxidative stress] across many different diagnoses and matrices, and given that [oxidative stress] was not specifically increased in the brain, we consider it more likely to be [a byproduct] of the psychiatric conditions rather than a pathophysiologic factor underlying specific psychopathology,” the researchers wrote. “This finding is consistent with growing evidence showing general, transdiagnostic signs of accelerated aging and age-related illness in psychiatric disorders.”

(Image: iStock/Gilnature)

Home-Based Transcranial Direct Current Stimulation May Improve Attention in Adults With ADHD

Adult patients with attention-deficit/hyperactivity disorder (ADHD) who received home-based treatments of transcranial direct current stimulation (tDCS) daily for four weeks showed improved attention compared with patients who received sham stimulation, according to a small study published yesterday in JAMA Psychiatry.

“[T]he need of daily visits to clinics or hospitals has been always a major challenge for the use of tDCS in clinical contexts,” wrote Douglas Teixeira Leffa, M.D., Ph.D., of the Hospital de Clínicas de Porto Alegre in Brazil and colleagues. “Thus, the home-based device opens a new window of opportunity, especially for participants who live in geographically remote areas or have physical or cognitive disabilities that may hinder access to clinical centers.”

Leffa and colleagues recruited patients from the Hospital de Clínicas de Porto Alegre who were aged 18 to 60, met DSM-5 criteria for ADHD (combined or inattentive subtypes), and were not being treated with stimulants. All participants had moderate to severe symptoms of inattention, defined as an inattention score of 21 or higher on the clinician-administered Adult ADHD Self-report Scale version 1.1 (CASRS-I). Sixty-four participants were randomized to receive active or sham tDCS.

All participants received a home-based tDCS device, which was preprogrammed with the number of sessions and stimulation dosage (or sham stimulation). They also received a neoprene cap they could wear to which electrodes were already attached to ensure the stimulation was provided accurately and consistently throughout the study period. At baseline, participants were instructed on using the device and received their first stimulation session while assisted by trained staff. Participants then underwent 30-minute daily sessions of tDCS with a 2-mA direct constant current for four weeks, for a total of 28 sessions. To mimic the sensations commonly reported with tDCS, the sham treatment devices delivered a 30-second ramp up stimulation (from 0-mA to 2-mA), followed by a 30-second ramp down (from 2-mA to 0-mA), at the beginning, middle, and end of the sessions. At baseline and weeks two and four, participants’ inattention was assessed using CASRS-I. The participants were also evaluated for symptoms of hyperactivity-impulsivity, depression, anxiety, and executive function over the course of the study.

Fifty-five participants completed all four weeks of treatment (25 in the tDCS group and 30 in the sham group). At week four, the mean inattention score on the CASR-I in the tDCS group was 18.88, compared with 23.63 in the sham group (higher scores on CASRS-I indicate greater symptoms of inattention). Eleven participants (34.3%) in the tDCS group achieved a 30% reduction in CASRS-I score compared with two participants (6.2%) in the sham group. There were no statistically significant differences in hyperactivity-impulsivity, depression, anxiety, or executive function between the two groups. Adverse events were mostly mild, with participants in the tDCS group reporting skin redness, headache, and scalp burn. Two participants in the tDCS group withdrew due to depressive symptoms and dizziness.

“Our findings support the use of tDCS as a safe and effective treatment for adults with ADHD with no concomitant treatment with stimulants,” the authors wrote. “This is particularly relevant since a vast body of literature describes low long-term adherence rates and persistence to pharmacological treatment in patients with ADHD.”

For related information, see the Psychiatric News article “Noninvasive Electrical Stimulation Shown Effective for ADHD.”

(Image: iStock/Henrik5000)

---

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.

Follow Psychiatric News on Twitter!