Tuesday, December 24, 2024

‘Positive’ and ‘Negative’ Don’t Capture the Emotions Many People Feel During the Holidays

In his “Editor’s Desk” column in the December issue of Psychiatric News, Editor in Chief Adrian Preda, M.D., offers a meditation on the complicated mix of emotions that many people experience during the holiday season. It’s not that they aren’t happy. It’s that they’re also a little sad. And joyful. And nostalgic. And lonely. Learn more in this excerpt from Dr. Preda’s column:

On the surface, this is a time for joy and celebration, but as often happens, reality is more complex. Many of us find that the holidays’ cheer is tinged with a sense of sadness and regret. Loneliness, which is hard enough to bear the rest of the year, grows sharp edges during this season. Then, there are the memories: times past, often seeming better than times present; grief for the loved ones who are no longer with us; and, in the final weeks of the year, each day seems to etch itself in time, moving inexorably forward, one after the next, toward an unavoidable end—another year gone, and a cold reminder that time is slipping away.

As if that weren’t enough, the New Year is looming. When facing an unknown future, should we feel excitement or dread?

Against this emotional landscape, the pressure to conform to the omnipresent holiday cheer can feel like salt in the wound for those already grappling with loss and facing the chasm of times past eroding times present. Is there a better way to understand and navigate this time of the year?

Part of the challenge lies in how we categorize emotions. Most public discourse on mental health tends to split feelings into just two groups: negative and positive. The negative emotions are well known and easily named: sadness, fear, anger, disgust, and anxiety. But when it comes to positive emotions, many people struggle. After happiness and joy, there’s often a long pause.

Read Dr. Preda’s entire column here.

For related information, see the Psychiatric News Alert “Holidays Bring Anxiety for Some but Continue to Be a Source of Merriment for Many.”

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Happy Holidays from Psych News! Alerts will resume on Friday, December 27.

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Monday, December 23, 2024

Fear of Addressing People by Name May Be Signal of Social Anxiety Disorder

Alexinomia, the fear of saying other people’s names and using names actively in conversation, may be an overlooked symptom of social anxiety disorder, according to a study in the Journal of Anxiety Disorders.

Thomas Ditye, Ph.D., M.Sc., M.Res., of Sigmund Freud Private University in Vienna, and colleagues analyzed data from 190 adults (143 female, 40 male, 7 nonbinary) with a mean age of 30.3 years. First, the researchers assessed the participants for symptoms of social anxiety disorder using the Social Interaction Anxiety Scale (SIAS), which measures the degree of psychological distress when interacting with other people, and the Liebowitz Social Anxiety Scale (LSAS-SR), which measures anxiety and avoidance in relation to social interactions and performance situations. After that, participants completed the 24-item Alexinomia Questionnaire, an unpublished self-report questionnaire to measure symptoms related to anxious behavior with respect to saying names.

According to the SIAS, 67.9% of the participants had a high likelihood of social anxiety. The mean score for alexinomia in this group was 31.43, compared with 14.26 in the group with a low likelihood of social anxiety.

According to the LSAS-SR, 48.9% of participants fulfilled the criteria for social anxiety. For the LSAS, the researchers divided participants into groups according to the severity of their symptoms (low, mild, moderate, severe, highly severe). Those in the low symptom group had a mean alexinomia score of 16.20, compared with 36.81 in the mild symptom group, 32.33 in the moderate symptom group, 39.13 in the severe symptom group, and 38.29 in the highly severe symptom group.

“[O]ur findings could be the start of a discussion around adding alexinomia symptoms to assessments of social anxiety,” Ditye and colleagues wrote. “To support this discussion, it is necessary to reliably measure the prevalence of alexinomia in socially anxious individuals as well as in samples with other psychological disorders. Therefore, a standardized, clinical tool is urgently needed for its diagnosis.”

For related information, see the Psychiatric News article “Attention Training Program May Improve Social Anxiety Symptoms.”

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Friday, December 20, 2024

Sertraline Plus Brexpiprazole May Be Effective Combo for PTSD

Individuals with posttraumatic stress disorder (PTSD) who took a combination of sertraline and the antipsychotic brexpiprazole showed significantly greater symptom improvement than those who took sertraline plus placebo, according to a study in JAMA Psychiatry.

“The selective serotonin reuptake inhibitors (SSRIs), sertraline and paroxetine, are the only US Food and Drug Administration–approved pharmacotherapies for PTSD,” wrote Lori L. Davis, M.D., of the University of Alabama at Birmingham Heersink School of Medicine, and colleagues. Yet SSRIs aren’t particularly effective for some PTSD symptoms such as hyperarousal, and about 40% of patients do not respond at all, the authors added. “Taken together, this evidence indicates an unmet need for new PTSD treatment options.”

For this clinical trial—supported by Otsuka Pharmaceutical and H. Lundbeck A/S—Davis and colleagues enrolled 450 adults with PTSD of at least six months duration and no comorbid depression. All participants received placebo pills for one week, and those who did not show a strong placebo response were randomly assigned sertraline (150 mg/day) plus brexpiprazole (2-3 mg/day) or sertraline plus placebo for 11 more weeks.

Among the 416 participants (74.5% female) who entered the active-treatment period of the study, those who received sertraline plus brexpiprazole showed a 19.2-point reduction in their PTSD symptoms (assessed with the Clinician-Administered PTSD Scale for DSM-5, or CAPS-5) after nine weeks, compared with a 13.6-point reduction in the sertraline-plus-placebo group. Sertraline plus brexpiprazole was superior to sertraline plus placebo for all four CAPS-5 symptom clusters: intrusive thoughts, avoidance behaviors, arousal, and negative mood.

Participants who took sertraline plus brexpiprazole also showed strong improvements in their depressive symptoms, anxiety symptoms, and psychosocial functioning.

The combination therapy was also well-tolerated, Davis and colleagues noted; the most common treatment-related side effects were nausea and fatigue, and only 4% of participants discontinued due to side effects.

For related information, see the Psychiatric News article, “Guided Anesthetic Injection May Help Patients With PTSD.”

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Thursday, December 19, 2024

Some Systemic Factors May Cause Inequities in Risk Assessments

Psychiatric patients with severe mental illness and those who were admitted to the emergency department (ED) accompanied by police were more likely than their counterparts to be considered a high risk for violence or aggression, according to a study issued today in Psychiatric Services.

In emergency and acute psychiatry, routinely assessing each patient’s risk of violence or aggression may prevent the need for coercive or potentially traumatizing interventions, wrote Christoffer Dharma, M.Sc., of the University of Toronto, and colleagues. “Despite this well-intentioned goal, psychiatric assessments may be influenced by social determinants of health.”

Dharma and colleagues used electronic health record (EHR) data for 7,424 patients (58% male) who had 12,650 acute care stays at the Centre for Addiction and Mental Health in Toronto between May 2016 and May 2022. All patients were admitted through the ED and assessed for their risk of becoming violent or aggressive within the next 24 hours. Risk assessments were conducted by acute care nurses and based on the Dynamic Appraisal of Situational Aggression, which measures factors such as the patient’s impulsivity, irritability, unwillingness to follow directions, and negative attitude. The EHR data also included information on violent or aggressive incidents that occurred while the patient was in care.

In 76% of cases, the risk assessments were aligned with the incidents, most often when low-risk assessments were followed by no violent incidents during the patient’s stay. Risk assessment accuracy was much lower than the overall average for Black patients, patients brought to the ED by police, and patients in supported or unstable housing.

In the researchers’ adjusted analysis, however, patient race and/or housing status was not the strongest predictor of wrongly assessing high violence risk. Rather, it was psychiatric diagnosis, as patients with bipolar disorder, a neurodevelopmental disorder, or a neurocognitive disorder were approximately three times as likely to be assessed as high risk without a subsequent violent incident compared with their counterparts with a depressive or anxiety disorder. Patients who were accompanied by police were also twice as likely as their counterparts who admitted themselves to receive a high-risk assessment without a subsequent violent incident.

“The practice of clinicians using police apprehension as a cue for determining and potentially managing patient risk raises concern,” the authors wrote. “Our findings also indicate the roles of other [social determinants of health], such as housing status and psychiatric diagnosis type, that should be considered in future research on violence risk assessment and management.”

For related information, see the Psychiatric Services article “Race-Based Disparities in the Frequency and Duration of Restraint Use in a Psychiatric Inpatient Setting.”

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Wednesday, December 18, 2024

Downward Trend in Substance Use Among Teens Continues, Study Shows

Substance use among teenagers continues to be stable or decline across all categories of drugs, continuing a downward trend that began during the COVID-19 pandemic, according to data compiled by the Monitoring the Future (MTF) study, funded by the National Institute on Drug Abuse (NIDA).

“This trend in the reduction of substance use among teenagers is unprecedented,” said Nora D. Volkow, M.D., director of NIDA, in a statement. “We must continue to investigate factors that have contributed to this lowered risk of substance use to tailor interventions to support the continuation of this trend.”

Conducted annually by researchers at the University of Michigan, the MTF study is given to students in eighth, tenth, and twelfth grades and asks about their use and perceptions of various substances. From February through June 2024, MTF investigators collected 24,257 surveys from students enrolled across 272 public and private schools in the United States.

Adolescents most commonly reported use of alcohol, nicotine vaping, and cannabis in the 12 months prior to the survey, but these rates all declined between 2023 and 2024 for all three grades surveyed, according to the survey data tables.

For instance, 12.9% of eighth graders reported using alcohol in 2024, compared with 15.1% in 2023; 26.1% of tenth graders reported using alcohol in 2024, compared with 30.6% in 2023; and 41.7% of twelfth graders reported using alcohol in 2024, compared with 45.7% in 2023.

Similarly, cannabis use declined for eighth graders from 8.3% in 2023 to 7.2% this year, for tenth graders from 17.8% to 15.9%, and for twelfth graders from 29% to 25.8%. And nicotine vaping decreased by 1.8% for eighth graders and by 2.2% for both tenth and twelfth graders.

“Kids who were in eighth grade at the start of the pandemic will be graduating from high school this year, and this unique cohort has ushered in the lowest rates of substance use we’ve seen in decades,” said Richard A. Miech, Ph.D., research professor at the University of Michigan Institute for Social Research and team lead for the MTF study.

For related information, see the Psychiatric News article “Survey Finds Illicit Drug Use Among Youth Declining While Overdose Deaths Rise.”

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Tuesday, December 17, 2024

Higher Daily Step Counts Associated With Fewer Depression Symptoms Among Adults

Another reason to lace up your sneakers: higher daily step counts are associated with fewer depressive symptoms in cross-sectional and longitudinal studies of the general adult population, according to a meta-analysis issued yesterday by JAMA Network Open.

“The results of meta-analytic studies have consistently indicated that higher levels of [physical activity] provide protection against the emergence of depression,” wrote Bruno Bizzozero-Peroni, Ph.D., M.P.H., at the Universidad de Castilla-La Mancha in Cuenca, Spain, and colleagues. “Light-intensity activities, such as walking, may constitute an adequate form of [physical activity] for reducing the risk of depression.”

The researchers compiled data on all published observational studies that objectively measured daily step counts and also examined depression outcomes. They found 27 cross-sectional studies and six longitudinal studies involving 96,173 adults across five continents.

Compared with a more sedentary lifestyle, walking 5,000 or more steps a day was associated with fewer depressive symptoms among the cross-sectional studies, with slightly higher benefits seen at 7,500 and 10,000 daily steps.

Further, among cross-sectional studies that measured depression as a categorical outcome, achieving 7,500 or more steps a day was associated with a 42% lower prevalence of depression compared with walking less than 7,500 steps a day. These findings were corroborated by the cohort studies, which found that adults who increased their activity by 1,000 steps a day had a 9% lower risk of developing depression, while those who accumulated 7,000 or more steps a day had a 31% lower risk.

The researchers noted that it cannot yet be established whether there is a ceiling above which there would be no additional benefit from increasing steps. Furthermore, the study did not discriminate between various types of physical activity or examine the role of other potential physical activity–related benefits, such as social well-being. The researchers noted that the optimal number of steps to prevent depression may vary according to sex, age, and individual risk of mental disorders.

“Our results showed significant associations between higher numbers of daily steps and fewer depressive symptoms as well as lower prevalence and risk of depression in the general adult population,” the researchers wrote. “The objective measurement of daily steps may represent an inclusive and comprehensive approach to public health that has the potential to prevent depression.”

For related information, see the Psychiatric News article “Exercise Is Neuroplastic Medicine.”

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Monday, December 16, 2024

Majority of Patients Want to Know if AI Is Used in Their Health Care

Are you using artificial intelligence (AI) in the care you offer patients? Chances are they want to know that. A study in JAMA Network Open suggests that more than half of patients wish to be notified when AI is used in their health care.

Jodyn Platt, Ph.D., M.P.H., of the University of Michigan Medical School, and colleagues conducted a survey of 2,021 adults from June 27 to July 17, 2023. The survey included a video that described how AI is used in health care and scenario-based questions that provided examples. Participants were asked how true it was that “It is important that I am notified about the use of AI in my health care.” Options were “not at all true,” “somewhat true,” “fairly true,” and “very true.”

More than half—62.7%—of participants stated it was “very true” that they want to be notified, whereas only 4.8% of participants did not find notification important. Females expressed greater desire for notification than males, and White respondents expressed greater desire for notification than Black or Hispanic respondents.

The authors noted that the average level of desire to be notified about AI was higher than found in a previous survey using the same scale that asked about notification when using patients’ health information or biospecimens.

“[O]ur findings suggest that notification about AI will be necessary for ethical AI and should be a priority for organizations and policymakers,” Platt and colleagues wrote. “With this signal about the public’s preference for notification, the question for health systems and policymakers is not whether to notify patients but when and how. As health systems begin to establish governance for AI tools, multiple approaches to notification will be needed.”

For related information, see the Psychiatric News article “AI in Psychiatry: What APA Members Need to Know.”

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Friday, December 13, 2024

Community Stabilization Programs May Reduce Psychiatric Boarding Among Youth

Youth who experience a mental health crisis and participate in a community stabilization program are significantly less likely to return to an emergency department (ED) or inpatient psychiatric unit, according to a study issued yesterday in Psychiatric Services.

Rebecca Marshall, M.D., M.P.H., of the Oregon Health & Science University, and colleagues used data from the Oregon Health Authority’s Crisis and Transition Services (CATS) program. Youth qualified for CATS if they were at risk for boarding in the ED due to safety concerns, severe depression or anxiety, or other mental health concerns that impaired their functioning. CATS provided 24/7 crisis response, crisis safety planning, short-term clinical interventions, and connections to longer-term services. Services lasted for 45 days after enrollment.

The researchers included 533 youth ages 11 to 17 years (69% female) who participated in CATS from 2018 to 2020. Using All Payer All Claims data, each participant was matched with two controls (n=1,066) of the same sex and similar age who had the same reason for an ED or inpatient care visit. One control group included those discharged from an inpatient hospital or psychiatric unit, while the other included those discharged from the ED. Youth in the control groups received either behavioral health treatment that did not include CATS or no treatment at all.

CATS participants were significantly less likely than those who did not participate to return to the ED or require inpatient hospitalization in the year after their initial mental health crisis. While the risk of returning to the ED for a suicide attempt was similar for CATS participants and nonparticipants, the risk of receiving hospitalization for a suicide attempt was significantly lower for those enrolled in CATS.

“This finding suggests that, although CATS may not reduce suicide attempts overall, youths in this program were able to return home rather than be hospitalized in an [inpatient] unit, thereby decreasing the burden placed on EDs to board youths and allowing youths to stay in the community,” the researchers wrote.

“This study suggests that community-based crisis intervention programs with an array of services and that focus on bridging youths to longer-term services may represent a safe and effective alternative to ED boarding for some youths with high-acuity behavioral health needs,” the researchers concluded.

For related information, see the Psychiatric News article “Oregon Pilot Program Would Expand MH Crisis Services for Youth.”

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Thursday, December 12, 2024

CBT Plus Lisdexamfetamine Dramatically Reduces Binge-Eating Episodes, AJP Study Finds

Combining cognitive behavioral therapy (CBT) with lisdexamfetamine (LDX) reduced binge-eating frequency in adults with binge-eating disorder by more than 95%—significantly greater than either treatment alone, according to a clinical study published yesterday in the American Journal of Psychiatry. However, CBT or LDX alone still resulted in robust binge-eating reduction.

“The superiority of the combined … approach might reflect, in part, complementary and synergistic effect of the two treatments,” wrote Carlos M. Grilo, Ph.D., of Yale University School of Medicine, and colleagues. “CBT and LDX likely operate via distinct mechanisms (the former via reducing unhealthy restraint and unstructured eating and addressing the core body-image disturbance and the later via eating regulation and reward effects and reduced impulsivity) and one can speculate that some of the LDX effects on improving executive functioning might enhance ability to derive greater benefit from CBT.”

Grilo and colleagues enrolled 141 adults ages 18 to 64 (83.7% women) with binge-eating disorder and comorbid obesity. The participants were equally divided into one of three treatment arms for 12 weeks: CBT only, LDX only (target dose of 50 to 70 mg/day), or CBT+LDX. The CBT involved 12 weekly 60-minute sessions and focused on helping individuals identify maladaptive eating thoughts and behaviors and work toward normalized eating patterns.

After 12 weeks, participants who received CBT+LDX reported a 96.1% decrease in the frequency of binge-eating episodes in the past 28 days; further, 70.2% of participants achieved remission (zero binge-eating episodes in the past 28 days). Patients in the CBT and LDX groups also reported significant binge-eating declines, although only 44.7% and 40.4%, respectively, achieved remission.

In terms of weight loss, those receiving CBT+LDX or LDX lost an average of 4.8% and 5.5% of their baseline body weight, respectively, while those receiving only CBT lost 0.5% of their baseline weight.

For related information, see the American Journal of Psychiatry study “Naltrexone-Bupropion and Behavior Therapy, Alone and Combined, for Binge-Eating Disorder: Randomized Double-Blind Placebo-Controlled Trial.”

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Wednesday, December 11, 2024

New Schizophrenia Drug Shows Marked Effect on Cognitive Deficits

Individuals with schizophrenia and cognitive deficits who were treated with the combination of xanomeline and trospium chloride showed clinically significant improvements in cognition compared with those receiving placebo, according to a report today in the American Journal of Psychiatry. The results, pooled from two Phase 3 clinical trials, replicate cognitive benefits seen in smaller studies.

Xanomeline/trospium chloride was approved for use by the U.S. Food and Drug Administration (with the brand name Cobenfy) in September 2024 for the treatment of schizophrenia in adults. Cognitive deficits are a stubborn feature in many cases of schizophrenia that significantly affect long-term trajectory and daily functioning.

“Collectively, the xanomeline/trospium clinical studies reflect the first time a monotherapy for the treatment of schizophrenia has shown a replicable cognitive benefit,” wrote lead author William Horan, Ph.D., executive director of clinical development at Bristol Myers, and colleagues. This study was sponsored by Karuna Therapeutics, a Bristol Myers Squibb company.

Across the two trials, 357 patients with acute schizophrenia were randomly assigned to receive oral xanomeline/trospium or placebo twice daily for five weeks. Most participants assigned to xanomeline/trospium were taking the maximum dosage of 125 mg/30 mg twice daily at week 5, with the remainder taking an intermediate dosage of 100 mg/20 mg.

Participants completed a computerized assessment of four key cognitive domains (executive function, visual memory, sustained attention, and verbal recall and recognition) at baseline, week 3, and week 5. Overall, 137 participants had significant cognitive deficits at baseline.

Among patients with cognitive impairment, those receiving xanomeline/trospium showed a significantly larger improvement in their cognitive scores from baseline to week 5 than the placebo group, with a calculated effect size of 0.54 (indicating a moderate level of improvement). The largest difference in performance between the xanomeline/trospium and placebo groups observed at week 5 was for verbal recall and recognition.

The effect remained significant after accounting for changes in positive and negative symptoms—suggesting that the effect on cognition is independent of improvement in psychotic symptoms. As with previous studies, there was no evidence of cognitive benefit for xanomeline/trospium when analyzing the full sample of 357 participants.

Cobenfy is the first drug approved for schizophrenia that does not act on dopamine (D2) receptors in the brain; rather it targets muscarinic acetylcholine receptors in areas of the brain more central to the cognitive and behavioral symptoms of schizophrenia.

For related information, see the Psychiatric News article “Questions and Excitement About New Schizophrenia Drug.”

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Tuesday, December 10, 2024

New Guideline Advises Metformin to Prevent Antipsychotic-Induced Weight Gain

Clinicians should prescribe metformin when initiating an antipsychotic in order to prevent weight gain in many cases, according to a new evidence-based guideline issued by Schizophrenia Bulletin yesterday.

“A 2022 Cochrane review of pharmacological interventions for the prevention of AIWG (antipsychotic-induced weight gain) found that metformin was the only pharmacological agent that may be effective for preventing weight gain when started with an antipsychotic,” wrote Aoife Carolan, M.Pharm., at Saint John of God Hospital and the Royal College of Surgeons in Dublin, and colleagues. “Despite this, metformin for the prevention of AIWG is not routinely offered in psychiatric practice.”

Carolan and colleagues developed the guideline utilizing the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument to ensure a high standard was followed. This included undertaking a comprehensive review of the literature and having the guideline findings reviewed by an independent panel of experts.

The guideline offered three core recommendations:

  • Initiate metformin when prescribing a high-risk weight-inducing antipsychotic, such as olanzapine or clozapine.
  • Initiate metformin with a medium-risk antipsychotic (quetiapine, paliperidone or risperidone) in patients with one or more cardiometabolic risk factors; in people ages 10 to 25 years; or for those with a BMI between 25 and 30.
  • Initiate metformin with any antipsychotic if >3% increase in baseline body weight is observed during the first year of treatment.

In terms of dose, the new guideline recommends escalating from 500 mg daily to 500 mg twice daily over two weeks, followed by biweekly increases of 500 mg as tolerated up to 1 g twice daily at week 6. Metformin should be discontinued if risks for lactic acidosis are present, or the condition is suspected; if body mass index falls below 20; or if the antipsychotic medicine is discontinued. Metformin should be avoided where there is harmful use of alcohol.

Though the guideline focused on metformin, it also recommended that, if available, GLP-1 agonists should be considered for patients with a BMI above 30, certain cardiometabolic diseases, or obstructive sleep apnea.

For related information, see the Psychiatric News article “Metformin May Reduce Weight Gain in Youth Taking Antipsychotics.”

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Monday, December 9, 2024

Study Calculates Huge Mental Health Cost of Leaded Gasoline

Exposure to lead via car exhaust in the first five years of life may be responsible for an estimated 151 million excess mental disorders in the United States, according to a study in the Journal of Child Psychology and Psychiatry.

Michael J. McFarland, Ph.D., and colleagues at the University of Florida used data from the National Health and Nutrition Examination Surveys (NHANES) and historic data on leaded-gasoline consumption to estimate early life blood-lead levels from 1940 to 2015. McFarland and colleagues then calculated general psychopathology points (or p-factor points), gained by the U.S. population based on the level of early-life exposure. P-factor points roughly equate mental illness risk in that every three points gained by an individual above a certain threshold will result in one new psychiatric diagnosis. In addition to general psychopathology, the researchers calculated points for three behavioral subdomains known to be adversely affected by lead exposure: internalizing symptoms, attention-deficit/hyperactivity disorder (ADHD) symptoms, and the personality traits of neuroticism and conscientiousness.

Assuming that published lead-psychopathology associations are causal and not purely correlational, the researchers found that by 2015 the U.S. population had gained 602 million general psychopathology points as a result of childhood lead exposure. This equates to around 1.9 points per person, and potentially 151 million excess mental disorders. By 2015, the U.S. population had also:

  • Gained 202 million internalizing symptom-points
  • Gained 135 million ADHD symptom-points
  • Gained 45 million neuroticism points
  • Lost 63 million conscientiousness points

The association between lead exposure and mental illness was most pronounced in individuals born between 1966 and 1986, most of whom belong to Generation X and were children during the peak use of leaded gasoline.

“Large swaths of the population likely experienced elevated lead-linked mental illness symptomatology and altered personality, with significant implications for national well-being, innovation, economic productivity, need for and use of psychiatric services, and the prevalence of physical comorbidities, all of which bear individual investigation and estimation,” the researchers wrote. “The contribution of legacy lead exposures to population health and disease may be much larger than previously assumed.”

For related information, see the Psychiatric News article “Mental Health Impact of Air Pollution in the Southeast Asian Subcontinent.”

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Friday, December 6, 2024

Having a Geographically Diverse Social Network May Boost Mental Health

Individuals who have a diverse social network that spans multiple communities are less likely to use antidepressants, according to a spatial analysis published today in Science Advances.

A rich amount of research has shown that “bonding” social capital—having strong social support within a community—can reduce stress, anxiety, and depression, noted Balázs Lengyel, Ph.D., of the Corvinus University of Budapest, and colleagues. “Fewer investigators have argued for or explored the importance of diverse networks that can mobilize ‘bridging’ social capital, despite their pivotal role in providing, say, economic opportunities that subsequently influence health outcomes,” they wrote.

Lengyel and colleagues used data from the Hungarian National Healthcare Service Centre to assess antidepressant purchases from 2011 to 2015 for all Hungarians living in small towns (5,000 to 20,000 population). They linked that data to individuals’ social networks in 2011 using the International Who Is Who social media site, where people could create an online phone and address book of their friends. A total of 277,344 individuals had both antidepressant and social network information available.

The analysis found that both higher local cohesion—having a strong, connected group of friends within a town—and higher spatial diversity—having friends in diverse communities across the country—were associated with fewer days of antidepressant use over five years. However, the association was significantly greater for spatial diversity than local cohesion. The benefits of spatial diversity were also greater for younger individuals than older ones.

“Bridging social capital is extremely important for members of geographically isolated communities, where the lack of outside connections can make bonding social capital and cohesive social networks possibly even harmful for mental health by placing too much control on the individual, or by isolating the individual in an unhealthy social environment,” Lengyel and colleagues wrote.

“Whether our findings hold in large cities where local networks can provide more diversity is a question to be answered,” the researchers continued. “Social media can also spoil mental health; thus, we need a better understanding how the role of online and offline communication networks changes over time.”

For related information, see the Psychiatric News article “Faith Communities Are Potent Resource for Creating Connection and ‘Mattering’.”

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Thursday, December 5, 2024

Meta-Analysis Finds Trauma-Focused CBT Most Effective Psychological Treatment for Pediatric PTSD

Compared with other psychological treatments, trauma-focused cognitive behavioral therapies (TF-CBTs) are associated with the greatest reduction in pediatric posttraumatic stress disorder (PTSD) symptoms, according to a study issued yesterday in JAMA Psychiatry.

Thole Hoppen, Ph.D., of the University of Munster, Germany, and colleagues conducted a systematic review and meta-analysis of how psychological interventions for pediatric PTSD performed compared with either a passive (e.g., wait-list) or active (e.g., psychoeducation) control. They looked at four interventions: TF-CBTs (any CBT-based intervention with a trauma focus, such as prolonged exposure or cognitive process therapy), eye-movement desensitization and reprocessing (EMDR, which uses eye movements or other external stimuli to speed up the trauma healing process), non-trauma-focused interventions, and multidisciplinary treatments (treatments that combine techniques).

The researchers identified 70 randomized clinical trials that had at least 10 participants in both the intervention and control groups. The trials’ 5,528 participants were 19 years old or younger (average age of 12) with full or subthreshold PTSD. Most (74%) of the trials examined TF-CBTs.

All the psychological interventions were associated with significantly larger reductions in pediatric PTSD than passive controls, but TF-CBTs had the highest reductions both immediately posttreatment and long term (six or more months after treatment). After TF-CBTs, the order of most effective interventions was EMDR, multidisciplinary treatments, and non-trauma-focused interventions. EMDR was associated with significant reductions in PTSD immediately posttreatment and up to five months later, but the authors noted that data on long-term improvements was lacking. TF-CBTs were also the most effective treatment when compared with active controls, when restricting analyses to high-quality trials, and when only including trials that involved parents.

“The findings suggest TF-CBTs should be the first-line treatment recommendation for pediatric PTSD,” the authors wrote. They added that “disseminating these results may help reduce common treatment barriers by counteracting common misconceptions, such as the notion that TF-CBTs are harmful rather than helpful.”

The authors continued: “[W]hile data for other treatment approaches are emerging with some promising findings, more data (including long-term data) are needed to draw firmer conclusions.”

For related information, see the Psychiatric News article “Trauma-Focused CBT, Racial Socialization Build Resilience in Black Youth.”

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Wednesday, December 4, 2024

Donepezil Found Effective for Improving Memory After Traumatic Brain Injury

Donepezil, an acetylcholinesterase inhibitor, appears to be an effective treatment for severe, persistent verbal memory impairment after traumatic brain injury, according to a report in the Journal of Neuropsychiatry and Clinical Neurosciences.

Although the sample size was small, improvements in other cognitive domains such as processing speed were also observed in patients who responded to donepezil.

“Verbal memory impairments are common and persistent problems among persons with moderate to severe traumatic brain injury, interfere with everyday function, and are among the most important barriers to functional independence and productivity,” wrote lead author David Arciniegas, M.D., of the University of Colorado School of Medicine, and colleagues.

Arciniegas and colleagues randomized 75 patients with mild, moderate, or severe traumatic brain injury to receive donepezil 5 mg daily for two weeks followed by donepezil 10 mg daily for eight weeks or placebo for 10 weeks. After the 10-week treatment period, treatment was discontinued, and patients were observed for an additional four weeks. All patients were at least six months out from their injury.

Verbal learning as assessed by the Hopkins Verbal Learning Test–Revised was the primary outcome measure in this study. Secondary outcomes included co-occurring cognitive and noncognitive neuropsychiatric problems, and functional status.

Donepezil significantly improved verbal learning when compared with placebo. Overall, 42% of patients taking donepezil responded to treatment (defined as at least a 0.5-standard-deviation improvement in the Hopkins test total score), compared with 18% of those taking placebo. Among patients who responded to donepezil, improvements were also observed in other aspects of memory recognition and retention, attention, and executive function. The researchers observed no differences in improvement of everyday memory function (such as conversational memory) between the donepezil and placebo groups.

“Studies evaluating augmentation of evidence-based cognitive rehabilitation with donepezil, or other acetylcholinesterase inhibitors, are needed to better define the potential usefulness of such medications in the rehabilitation and long-term care of persons with persistent verbal memory impairments after [traumatic brain injury],” the authors concluded.

For more information, see the Psychiatric News article “Understanding the Breadth and Depth of the Subspecialty: TBI and Neuropsychiatry.”

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Tuesday, December 3, 2024

Contingency Management App Improved OUD Treatment Outcomes

Augmenting medications for opioid use disorder (MOUD) with smartphone app–based contingency management resulted in improved treatment outcomes in a group of underinsured patients, according to a study issued yesterday in JAMA Network Open.

Traditionally delivered in clinics, contingency management (CM) provides financial incentives for accomplishing treatment goals, typically an opioid-negative finding on urine drug screens, wrote Elise N. Marino, Ph.D., from the University of Texas Health Science Center at San Antonio, and colleagues. “Although many individuals benefit from adding CM to MOUD, a long-standing limitation of this treatment is the requirement to attend multiple in-person appointments per week.”

The researchers used data from 3,759 uninsured or underinsured adults with opioid use disorder who were receiving publicly funded opioid treatment—including MOUD—from physicians’ offices or specialized clinics in Texas from November 2020 through November 2023. Participants were also given the option to receive a smartphone app–delivered CM program for one year. The app provided online individual and group support facilitated by peers; daily goal setting related to both substance use and recovery/self-care; encouragement; progress-tracking; and the ability to earn up to $800 in retail gift cards as an incentive.

In all, 622 participants (16.5%) opted to take part in the app-based CM. The researchers compared treatment outcomes of 300 participants who used the CM app with 300 participants who were similar in terms of age, sex, race, and ethnicity and chose to receive only MOUD.

Participants who chose the CM app reported significantly fewer days of opioid use at the end of treatment (8 days) compared with those who chose to receive MOUD only (12 days). Overall, 62% of the CM app group remained in treatment for the full year, compared with just 39% of the MOUD-only group. App participants were also significantly more likely to stay in treatment longer (290 days), compared with 236 days among MOUD-only participants.

“As a virtual treatment, app-based CM has fewer infrastructure barriers to implementation and should provide opportunities for rapid dissemination to patients,” Marino and colleagues wrote. “[H]owever, less than one-fifth of our entire sample chose to use it. Obtaining, owning, and navigating app-enabled devices may be barriers for some patients, and these apps require consistent use, which may become burdensome or unappealing over time, leading to low use. It is also possible that clinicians themselves may benefit from additional education and training to support adoption.”

For related information, see the Psychiatric News article “Experts Discuss Options for Treating Stimulant Use Disorder.”

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Monday, December 2, 2024

Behavioral Activation Therapy May Improve MH in Older People Who Have Been Abused

Psychotherapy based on the principles of behavioral activation may help reduce depressive symptoms and thoughts of suicide in people who have experienced elder abuse, according to a study published today in the American Journal of Geriatric Psychiatry.

Isabel Rollandi, Ph.D., of the Weill Cornell Institute of Geriatric Psychiatry, and colleagues examined data from 158 participants ages 60 or older who had experienced elder abuse. All participants had depressive symptoms as shown by a score of at least 10 on the nine-item Patient Health Questionnaire (PHQ-9) but did not have significant cognitive impairment. The researchers also collected data on the participants’ demographics, abuse history, and thoughts of suicide (PHQ-9 item 9) at baseline. The most prevalent abuse was emotional/psychological abuse, reported by 78.5% of participants, followed by verbal abuse, reported by 67.1%.

All participants completed 10 weeks of PROTECT therapy either in person or on the phone. PROTECT therapy consists of 45-minute sessions as follows:

  • One to three sessions that include discussions and psychoeducation about stress and depression, and to formulate the participants’ treatment goals related to the abuse, such as taking steps to promote safety or improving self-care.
  • Four to eight sessions to develop action plans to increase engagement in specific pleasurable and socially rewarding activities and meet the goals set.
  • Two sessions to discuss how the participant was faring in accomplishing goals and to work on strategies to maintain gains after completing the therapy.

At the end of treatment, scores on the PHQ-9—which was administered at the start of each session—dropped a mean of 5.58 points among participants who reported thoughts of suicide at baseline and 5.25 points among those without thoughts of suicide at baseline. In addition, the percentage of participants who reported thoughts of suicide decreased from 19% at baseline to 5.7%.

“These findings suggest that a brief intervention for depression delivered in the community can significantly contribute to reducing depressive symptoms in elder abuse victims regardless of depression severity and presence of [thoughts of suicide],” Rollandi and colleagues wrote. “Furthermore, it shows that a depression intervention can reduce suicidal ideation frequency, contributing to decreasing mortality risk in this vulnerable population. These results highlight and reaffirm the imperative to address the mental health needs of elder abuse victims and to deliver effective and scalable psychotherapy treatments that can be integrated in the community.”

For related information, see the Psychiatric News article “Abuse of Older People Increases During Pandemic.”

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