Friday, September 6, 2024

Researchers Propose Olanzapine and Perphenazine as First-Line Schizophrenia Treatments

Along with aripiprazole and risperidone, olanzapine and perphenazine should be considered first-line antipsychotics for patients with schizophrenia, according to a clinical perspective published in Schizophrenia.

“Clinicians face challenges in balancing efficacy and side effects when prescribing antipsychotics to treatment-naive patients,” wrote Matej Markota, M.D., and colleagues at Mayo Clinic in Rochester, Minnesota. “Existing algorithms approach this issue by assigning high significance to a few side effects, such as weight gain and/or tardive dyskinesia, commonly leading to exclusion of agents such as olanzapine and first-generation antipsychotics (FGAs), respectively, as first-line treatments.”

In the article, Markota and colleagues suggested physicians should focus instead on three overlapping factors:

  • Overall efficacy, particularly long-term efficacy since schizophrenia is a disorder requiring long-duration treatment.
  • All-cause discontinuation as a surrogate for side-effect burden rather than weighing one or two side effects.
  • Mortality risk, which factors in medication effectiveness, discontinuation rate, and long-term burden of reported side effects, such as the cardiovascular implications of excess weight gain.

When considering those factors, the researchers noted that clinical trials have shown olanzapine demonstrates superior efficacy as well as low discontinuation rates compared with risperidone or aripiprazole. Olanzapine does have a high risk of weight gain, but available data does not suggest it increases mortality relative to other medications. Given its demonstrated effects on hostility, the researchers believe olanzapine is a preferred first-line choice for patients for whom aggression may be a concern, with clozapine as a second-line medication.

Meanwhile, perphenazine has typically been overlooked due to the risks of extrapyramidal symptoms like tardive dyskinesia (TD) among first-generation antipsychotics. “However, there is considerable variability in TD risk within FGA and second-generation antipsychotic classes, a nuance frequently ignored by other algorithms,” Markota and colleagues wrote. “Perphenazine has one of the lowest known risks of TD among FGAs.” This medication also has a favorable metabolic and weight gain profile, they noted.

Markota and colleagues stressed that their medication rationale was for a “general” patient: “[W]hen idiographic factors of individuals dictate a different approach, the considerations discussed here should defer to individualized plans, and patients and practitioners should engage in shared decision-making at every step.”

For related information, see the Psychiatric News article “Clozapine Found Most Effective in Patients With Schizophrenia and Conduct Disorder.”

(Image: Getty Images/iStock/filo)



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




at

Thursday, September 5, 2024

Researchers Find Lack of Systemic Adverse Event Reporting in Psychedelics Research

About 4% of individuals with a neuropsychiatric disorder had a serious adverse event—including worsening depression, suicidal behavior, psychosis, or convulsions—after being given a “classic” psychedelic as part of a research study, according to a meta-analysis that spanned some 75 years issued by JAMA Psychiatry. The meta-analysis identified no such adverse events among healthy participants; at the same time, tracking of such events should be improved, the study researchers wrote.

“Recording aversive experiences as adverse events is pragmatic and necessary. In particular, the presence and absence of any [adverse events] … such as precipitation of an affective or psychotic illness, persisting perceptual disturbances, and cardiac toxicity, should be clearly reported,” wrote Jared T. Hinkle, M.D., Ph.D., of Johns Hopkins University School of Medicine, and colleagues. “…Our results broadly indicate that while medically or psychiatrically significant adverse events, for example, psychosis [or] suicidality, are relatively rare, these events are often serious when they occur."

Hinkle and colleagues examined 214 clinical or research studies going back to 1951, for which 53% (114 studies) reported analyzable adverse event data. These studies included 1,726 healthy participants, 934 participants receiving outpatient psychiatric care, and 844 participants receiving inpatient psychiatric care; all participants received high doses of one of the four most actively studied psychedelics: LSD (lysergic acid diethylamide), psilocybin, DMT (dimethyltryptamine), or 5-MeO-DMT (5-methoxy-N,N-dimethyltryptamine). All studies involving inpatients were done prior to 1970, researchers noted.

Results were as follows:

  • In contemporary research studies (since 2005), there were no reports of deaths by suicide, persistent psychotic disorders, or hallucinogen persisting perception disorders.
  • Of 584 outpatient participants administered high-dose psilocybin, three exhibited delayed suicidal behaviors; all three individuals had treatment-resistant depression.
  • Reports of other adverse events requiring medical intervention, such as paranoia or headache, were rare.
  • Just two serious acute events (within 48 hours of psychedelic effect) were identified in outpatient participants: One person given LSD in a study of anxiety experienced “acute transient anxiety and delusions” refractory to lorazepam, which required olanzapine and overnight observation, and one participant with depression and a history suggestive of orthostasis given DMT experienced a substantial blood pressure drop.

The researchers cautioned that only 29% of contemporary studies with adverse event data reported all adverse events, as opposed to only listing adverse drug reactions. This could explain the lower-than-expected reported rate of certain adverse events—for example, visual hallucinations—among participants. The researchers also noted that individuals with psychotic or manic disorders are typically excluded from contemporary research studies.

“Although psychedelic treatments were initially very well tolerated in participants with psychiatric conditions, the rate of potentially life-threatening delayed adverse events was higher in participants with psychiatric conditions than those without. The reasons for this remain undetermined,” Hinkle, a PGY-2 psychiatry resident at Johns Hopkins Hospital, told Psychiatric News Alert via e-mail. “Also, these data do not generalize to psychedelic use outside of a clinical or research context, so psychiatrists should advise their patients accordingly.”

For more information, see the Psychiatric News article “Psychedelic Use in Psychiatry Demands New Informed Consent Process, Bioethicists Say.”

(Image: Getty Images/iStock/microgen)



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




at

Wednesday, September 4, 2024

Patients Without Psychiatric Illness Likely Not at Risk for Depression, Suicidal Behavior With Semaglutide

People without known major psychiatric illness who are treated with semaglutide for obesity do not appear to be at increased risk for depression or suicidal thinking or behavior compared to patients receiving a placebo, according to a report yesterday in JAMA Internal Medicine.

Semaglutide is a glucagon-like peptide 1 (GLP-1) receptor agonist that has been shown to produce clinically significant weight loss in patients with obesity or Type 2 diabetes. However, both the Food and Drug Administration and the European Medicines Agency have been monitoring the safety of GLP-1 receptor agonists following postmarketing surveillance reports of depression and suicidal ideation in people prescribed these medications, noted Thomas Wadden, Ph.D., of the University of Pennsylvania Perelman School of Medicine, and colleagues.

Wadden and colleagues analyzed pooled data from four phases of the Semaglutide Treatment Effect in People with Obesity (STEP) trial that tested 2.4 mg of semaglutide in patients with obesity. (One phase of the trial also included patients with Type 2 diabetes.). The STEP trial excluded participants who had a history of severe psychiatric illness—such as major depression or schizophrenia—or suicide attempt, as well as individuals who screened for elevated depressive symptoms or suicidal ideation within the past 30 days. The original STEP trial and this secondary analysis were funded by Novo Nordisk A/S, and researchers from the company were involved in this analysis.

The analysis included 3,681 patients (73% female). Across the four trials, only 2.8% of patients treated with semaglutide had a postbaseline Patient Health Questionnaire score of 15 or greater—suggestive of moderately severe or greater symptoms of depression requiring evaluation by a mental health professional—compared with 4.1% of those receiving placebo. Suicidal ideation as assessed by the Columbia–Suicide Severity Rating Scale was less than 1% in all trials, with no differences between treatment groups.

Wadden and colleagues noted that a small number of patients taking semaglutide may experience depression or suicidal thoughts “which may be related to psychosocial complications of obesity or other factors, including life stressors.”

They concluded: “We encourage clinicians to monitor mental health in people with overweight or obesity, including those prescribed semaglutide, 2.4mg, or similar medications. This is essential for ensuring that these individuals obtain the psychiatric care they require to manage anxiety, depression, and related psychiatric complications, which may occur in the presence or absence of weight management interventions.”

In another study published in JAMA Internal Medicine yesterday, Peter Ueda, M.D., Ph.D. at Sweden’s Karolinska Institutet and colleagues analyzed nearly a decade of patient data from Swedish and Danish health registries and found no evidence that GLP-1 RAs increased the risk of suicide death in adults relative to those who took another class of diabetes medications (sodium-glucose cotransporter-2 inhibitors).

For more information, see the Psychiatric News article “Blockbuster Weight Loss Drugs Not Tied to Suicidality, Studies Show.”

(Image: Getty Images/iStock/aprott)



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




at

Tuesday, September 3, 2024

Cannabis Use Linked to Absenteeism at Work

Cannabis use disorder (CUD) and frequent cannabis use are linked to greater absenteeism at work, a study in the American Journal of Preventive Medicine has found.

Kevin H. Yang, M.D., of the University of California, San Diego, and colleagues analyzed data from 46,499 adults who were employed full-time and participated in the National Survey on Drug Use and Health from 2021 to 2022. Participants were asked if they had ever used cannabis and, if yes, how recently. Those who used cannabis in the past month were asked how often. Proxy diagnosis of CUD and CUD severity were determined using standardized items corresponding to DSM-5 criteria. Participants were then asked how many days of work they had missed in the past month because they were sick or injured and how many days of work they had missed because they “just didn’t want to be there.”

Overall, an estimated 15.9% of participants used cannabis in the past month. In addition, 4.0%, 1.6%, and 0.9% met criteria for mild, moderate, and severe CUD, respectively. Participants who used cannabis in the past month had a mean 1.47 days of missed work because of illness or injury, compared with 0.95 days for those who never used cannabis. Participants who used cannabis in the past month had a mean 0.63 days of skipping work compared with 0.28 days for those who had never used cannabis. Individuals who met the criteria for any CUD were more likely than those without CUD to miss or skip work, with the latter showing a stepwise increase as CUD severity increased.

Yang and colleagues wrote that cannabis use has been linked to anxiety, panic attacks, depression, sleep disturbances, respiratory issues, and vehicle accidents, all of which could contribute to increased absenteeism due to illness or injury. They added that individuals who are injured or ill may turn to cannabis for self-medication, potentially exacerbating the cycle of absenteeism.

The researchers noted that cannabis consumption may lead to reduced motivation and cognitive changes, which may partially explain why individuals who use cannabis are more likely to skip work. They added that such associations may be bidirectional, where individuals wanting to skip work may be more inclined to use cannabis because of factors such as boredom.

“These findings underscore the need for targeted interventions, workplace prevention policies, and further research to mitigate the negative consequences of cannabis use on work productivity and overall public health,” Yang and colleagues concluded.

For related information, see the Psychiatric News article “SUDs Cost Employer Health Insurance $35 Billion Per Year.”

(Image: Getty Images/iStock/EduLeite)



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




at

Friday, August 30, 2024

Study Uncovers No Strong Evidence That Autism Is Linked With Poor Amygdala Connectivity

A systematic analysis of brain imaging data from nearly 500 individuals suggests that a prevailing neurological hypothesis of autism spectrum disorder (ASD)—theorizing that people with ASD have poorer neural connections in certain brain regions relative to those without ASD—may not be accurate. These findings were published in American Journal of Psychiatry.

“Despite enormous effort and interest, the neural basis of autism spectrum disorder … remains poorly understood,” wrote Dorit Kliemann, Ph.D., of the University of Iowa, and colleagues. They noted that the neurobiology of ASD has generally been tested piecemeal, and results have been limited by small sample sizes, the use of imaging data from multiple sites, and unclear data quality.

In their more comprehensive study, Kliemann and colleagues analyzed high-quality functional MRI data from 488 individuals aged 16 to 50 (212 with ASD and the remaining with no psychiatric illness) available via the Autism Brain Imaging Data Exchange. They examined the relative strength of the neural connections emanating from the amygdala among these individuals when they were not actively engaged in any tasks (resting-state connectivity). The amygdala processes emotions and social cues and therefore is a region of interest in ASD research.

The researchers identified no reliable evidence of atypical amygdala connectivity among the ASD group as a whole relative to those without ASD; they also observed that average variation in connectivity among individuals with ASD was about the same as the variation in those without. Kliemann and colleagues found similar results whether they examined connectivity in the amygdala as a whole or just in specific amygdala subregions.

“It is important to note that we do not conclude that amygdala [connectivity] is generally typical in autism. Instead, we conclude that the evidence for atypical [connectivity] of the amygdala in autism is weak at best, and unreliable,” the researchers concluded. They urged continued acquisition and analysis of high-quality data—“an investment worth prioritizing if we are to better understand and delineate the neurobiological substrates of autism.”

For related information, see the Psychiatric News article “Children With Autism, Fragile X Show Distinct Early Brain Changes.”

(Image: Getty Images/iStock/libre de droit)



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




at

Thursday, August 29, 2024

Researchers Identify Neurons That Regulate Opioid Analgesia Independent of Euphoria

Researchers have identified and characterized a set of neurons that specifically regulate the pain-relieving effects of opioids and not their euphoric effects, according to a study published today in Science.

“[C]linical management of chronic pain remains a staggering challenge, and opioids remain essential analgesic options,” wrote Michael P. Fatt, Ph.D., of Sweden’s Karolinska Institutet, and colleagues. “However, the reliance on opioid analgesics has contributed to the opioid epidemic. Alternative therapeutic strategies that provide pain relief across different pain conditions are urgently needed.”

Fatt and colleagues employed multiple neuroscience and computational techniques to track and manipulate neuronal activity in mice that had received shots of morphine. The researchers found that pain relief could be controlled by an ensemble of neurons located in a region of the brainstem called the rostral ventromedial medulla (RVM). After being activated by morphine, these RVM neurons communicate with other neurons in the spinal cord and tell them to inhibit incoming pain signals.

The pain inhibition was mediated by a molecule known as brain-derived neurotrophic factor (BDNF). When researchers blocked BDNF activity in the RVM neurons, morphine produced no analgesic effects in mice; however, when they boosted BDNF expression, morphine could relieve pain at low doses that normally have no effect.

“Has the neural substrate for morphine analgesia now been identified? It may be more accurate to say that one neuronal population that can contribute to opioid analgesia has been molecularly characterized,” Caitlynn De Preter, B.S., and Mary M. Heinricher, Ph.D., of Oregon Health and Sciences University, wrote in an accompanying perspective article. They noted that research studies have identified other sites in the brain associated with opioid analgesia.

“However, acknowledging that other circuit elements likely contribute to opioid analgesia does not detract from the findings of Fatt et al.,” De Preter and Heinricher continued. These results and follow-up research will “provide the tools for targeting specific neural circuits to achieve effective pain relief with fewer side effects, potentially identifying targets for nonopioid pain management and the treatment of chronic pain conditions.”

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

(Image: Getty Images/iStock/BlackJack3D)



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




at

Wednesday, August 28, 2024

School-Based Mindfulness Interventions Show Positive Mental Health Benefits for Students

Mindfulness-based interventions at schools can help students improve their thinking, resilience, emotional regulation and awareness, and overall mental health, according to a literature review in Psychiatric Services.

“As mindfulness interventions become more widely used and extensively studied, they hold promise for fostering student well-being and mitigating the development of mental health conditions over time,” wrote Tina Marshall, Ph.D., of research consulting firm Westat, and colleagues.

The authors conducted a review of research studies on school-based mindfulness interventions published between 2008 and 2022. To be included in the analysis, the intervention had to have mindfulness as its primary focus and include at least two components (for instance, a combination of breathing awareness and awareness of bodily sensations).

Marshall and colleagues rated the interventions according to the level of evidence supporting them. Of the 24 interventions that the researchers identified across 41 studies, three interventions were rated as having a high level of evidence supporting their effectiveness:

All three of these interventions incorporated components such as breathing awareness, awareness of bodily sensations, awareness of mental states, emotional self-regulation skills, and adopting a nonjudgmental attitude toward one’s present state. MiSP and MBSR also included seated or slow-walking meditation activities. The studies supporting these interventions were almost entirely conducted with middle or high school students.

Three other interventions—Gaia Program, MindUP, and a program that blended MBSR and mindfulness-based cognitive therapy—had a moderate level of supporting evidence. These interventions had more research with elementary school children and generally had activities to promote kindness, empathy, compassion, or gratitude.

Positive outcomes included significant improvements in executive functioning, resilience, emotion-regulation skills, emotional awareness, and emotional clarity, as well as decreases in internalizing, externalizing, and attention problems; stress; depressive symptoms; self-hostility; expressive suppression; avoidance and fusion; and rumination.

The researchers found that few studies examined outcomes for underserved populations. They noted that, given the positive outcomes, school administrators may choose to integrate these interventions into standard programming for health promotion. “Further research is needed to support decision makers in selecting cost-effective interventions and addressing the needs of students from underserved populations,” the researchers wrote.

For related information, see the Psychiatric News article “Mindfulness Has Parallels to Indigenous Cultural Practices.”

(Image: Getty Images/iStock/xavierarnau)



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




at

Tuesday, August 27, 2024

Cholinesterase Inhibitors May Slow Patients’ Cognitive Decline in Lewy Body Dementia

Patients with dementia with Lewy bodies (DLB) who took cholinesterase inhibitors had significantly slower cognitive decline over five years compared with patients who took memantine or no medication, according to a study published by Alzheimer’s and Dementia.

Hong Xu, Ph.D., of the Karolinska Institutet in Stockholm, Sweden, and colleagues tapped into a Swedish registry on cognitive/dementia disorders to assess 1,095 individuals who were diagnosed with DLB between May 2007 and December 2018. All individuals had taken the Mini-Mental State Examination (MMSE) at the time of diagnosis and were treated within 90 days with a cholinesterase inhibitor (814), memantine (133), or neither (148). Among those treated with a cholinesterase inhibitor, 69% received rivastigmine, 21% received donepezil, and 10% received galantamine.

Researchers analyzed the individuals’ MMSE scores for up to five years, as well as the incidence of major cardiovascular events (hospitalizations for myocardial infarction, congestive heart failure, or stroke) and all-cause mortality for up to 10 years.

Researchers reported the following results:

  • The average MMSE score among individuals at baseline was 21.9; after five years, the average MMSE score among those taking cholinesterase inhibitors was 19.81, compared with 9.62 among those taking memantine and 9.61 among those taking neither. A dose-response relationship suggested higher cholinesterase inhibitor doses provided greater cognitive benefits.
  • Among individual cholinesterase inhibitors, donepezil and galantamine significantly slowed cognitive decline, but rivastigmine did not. One possible explanation is that rivastigmine users in the study, unlike those taking donepezil or galantamine, did not achieve the recommended dose, researchers said.
  • Patients treated with cholinesterase inhibitors had a 34% lower mortality risk during the first year of follow-up compared with those taking no medications; however, these drugs did not reduce long-term risk of major adverse cardiovascular events or death.

Potential limitations of the study include the inherent challenge of accurately diagnosing DLB and a lack of information on patients’ lifestyle habits, frailty, severity of comorbidities, blood pressure, or presence of co-occurring Alzheimer’s disease, all of which could have influenced the findings.

“Our findings shed light on the potential cognitive benefits of [cholinesterase inhibitor] treatment in DLB patients,” the researchers wrote. “Further research is necessary to elucidate the underlying mechanisms and explore potential pleiotropic effects of [cholinesterase inhibitors] on long-term outcomes.”

For related information, see the Psychiatric News article, “New Medication, Staging Criteria Signal a Potential Shift in Alzheimer’s Care.”

(Image: Getty Images/iStock/Chinnapong)



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




at

Monday, August 26, 2024

First-Line Antidepressants Linked to Lower Fall Risk in Older Patients With Depression

First-line antidepressants may help lower the risk of falls and fall-related injuries in older patients with depression, according to a study published today in JAMA Network Open.

Grace Hsin-Min Wang, Pharm.D., M.S., of the University of Florida, Gainesville, and colleagues examined claims data amassed from 101,953 Medicare beneficiaries age 65 or older who received a diagnosis of depression in 2017 or 2018.

Overall, 45.2% of the individuals did not receive any treatment for their depression (the control group), while 14.6% received psychotherapy. Among those who were prescribed first-line antidepressants, 9.2% took sertraline, 9% took escitalopram, 4.7% took citalopram, 3.8% took mirtazapine, 3.1% took duloxetine, 2.9% took trazodone, 2.8% took fluoxetine, 2.3% took bupropion, 1.4% took paroxetine, and 1.0% took venlafaxine. To recognize that real-world clinical practice may not involve immediate treatment, the researchers allowed for a 90-day grace period for treatment initiation following depression diagnosis.

The individuals were then followed for one year from the date of diagnosis or until the earliest fall and related injury after diagnosis, death, entry into hospice or a skilled nursing facility, changing to Medicare Advantage, switching or combining their treatments with other treatments, or discontinuing treatment—whichever came first. Falls and related injuries included outcomes such as bone fractures, sprains, strains, dislocations, and superficial skin injuries.

Compared with adults receiving no treatment, those receiving psychotherapy did not demonstrate any increased or decreased risk of falls or related injuries. However, compared with no treatment, taking first-line antidepressants was associated with a lower risk of falls as follows:

  • Bupropion and paroxetine: 26% lower risk
  • Venlafaxine: 25% lower risk
  • Duloxetine, fluoxetine, mirtazapine, and trazodone: 22% lower risk
  • Citalopram and sertraline: 19% lower risk
  • Escitalopram: 17% lower risk

The researchers noted that their results contradict those of previous studies that suggested antidepressants may increase the risk of falls and related injuries because of anticholinergic side effects such as orthostatic hypotension, sedation, and syncope. They said some potential reasons for these different findings may be that other studies included adults without depression in the control group and did not allow for a grace period for treatment initiation.

“Although there have been concerns about [falls and related injury] risk associated with these treatments in older adults, our findings suggest that standard first-line depression treatments do not exacerbate FRI risk, indicating their safety for initiation in older adults newly diagnosed with depression,” Wang and colleagues wrote. “However, it remains crucial for clinicians to consider the full spectrum of potential adverse effects and customize treatment plans to ensure a balance between effectiveness and risks.”

For related information, see the American Journal of Psychiatry article “Real-World Evidence on Clinical Outcomes of Commonly Used Antidepressants in Older Adults Initiating Antidepressants for Depression: A Nationwide Cohort Study in Denmark.”

(Image: Getty Images/iStock/Toru Kimura)



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




at

Friday, August 23, 2024

Majority of Americans Believe Schools Play a Vital Role in Youth Mental Health

More than three-quarters of Americans (84%) believe school staff play a crucial role in identifying signs of mental health problems in students, but less than half (45%) believe most school staff have been trained in identifying these concerns, according to the latest Healthy Minds Monthly Poll, commissioned by APA and fielded by Morning Consult.

As children begin to return to school this month, the poll found that Americans are widely supportive of education about mental health in school, with 89% saying that students should be educated about mental health and the same number saying that school staff should participate in mental health trainings. The poll was conducted on July 22, 2024, among a sample of 2,223 adults.

In a statement, APA President Ramaswamy Viswanathan, M.D., Dr.Med.Sc., affirmed the importance of mental health training for school staff. “When school staff and students have access to good quality mental health education, they are more prepared if they or someone they know is struggling,” Viswanathan said. “One of the best things we can do in light of the youth mental health crisis is to give children and teenagers, and the people that are around them most days, the tools to understand what to do if someone isn’t feeling right.”

Respondents to the Healthy Minds poll said they believe cyberbullying/bullying (42%), mental health (32%), and social media (30%) are the most concerning issues negatively affecting K-12 students today. While more than a quarter of parents (29%) are not confident that their school staff has the training to help students with mental health concerns, 82% believe that school staff would initiate a conversation with them about their child’s mental health concerns and 73% believe that staff would refer their child to mental health services if needed.

Almost half (45%) of parents think they should discuss mental health more with their children. Three-fourths of parents (77%) would be comfortable referring their child to mental health services if they noticed a concerning behavior change.

Recently, the APA Foundation implemented a free training program for K-12 school staff called Notice. Talk. Act.® at School. The curriculum, currently funded by the Substance Abuse and Mental Health Services Administration, educates school staff on the signals of a potential mental health concern and equips them with the confidence to discuss mental health with children and connect them to appropriate resources.

For more information, see the Psychiatric News article “Popular APA Foundation Program Becomes Notice. Talk. Act. at School.”

(Image: Getty Images/iStock/skynesher)



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




at

Thursday, August 22, 2024

Involuntary Commitment for Individuals With SUD Must Balance Benefits, Harm

Civil commitment of individuals with SUD—with or without co-occurring mental illness—must be implemented in a way that maximizes benefits to them while minimizing harm, according to an essay published as part of a “Controversies in Psychiatric Services” column exploring the ethics of involuntary behavioral health treatment in the journal Psychiatric Services.

“Implementation of civil commitment for people with substance use disorder in the United States has historically been characterized by considerable ambivalence and inconsistency, both in legislation and in clinical practice,” wrote Kenneth Minkoff, M.D., at ZiaPartners Inc. in Tucson. Despite this, a growing number of states—37 in all, along with the District of Columbia—have now passed legislation to allow the practice.

Minkoff acknowledged that “the moral argument for such legislation is powerful,” citing the example of an individual with severe opioid use disorder who overdoses, is revived with naloxone by first responders, and immediately wants to use opioids again; or another individual with SUD whose brain has been “so affected by the disease of addiction that they clearly are unable to protect themselves from harm.”

Balanced again those dangers, Minkoff noted, is the fact that “the limited available data on the effectiveness of civil commitment of people with substance use disorder often do not show favorable results.” To combat this, he calls for leaders and experts in the field to craft data-informed guidelines for the involuntary commitment of individuals with SUD.

“These guidelines could begin with targeting specific populations and carefully delineating commitment criteria, length of commitment, types of settings, and appropriate interventions and outcomes,” Minkoff wrote. He suggested that such guidelines “target harm reduction and overdose prevention as goals rather than necessarily serving as the formal commencement of long-term recovery from opioid use disorder.”

Minkoff concluded: “Beginning with small steps with an eye toward maximizing benefits, minimizing avoidable harms, and continually gathering data that can be used to improve involuntary interventions may be better than either doing nothing or implementing involuntary interventions that do not work.”

For more information, see the Psychiatric News article “Harm Reduction Approach to Substance Use Provides Realistic Support for Patients.”

(Image: Getty Images/iStock/FG Trade Latin)



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




at

Wednesday, August 21, 2024

Resilience and Gratitude Linked to Successful Aging Among Vets With Mental Disorders

Resilience and a strong sense of gratitude were significantly associated with self-reported successful aging among U.S. veterans with depression, anxiety, and/or posttraumatic stress disorder (PTSD), according to a report in the American Journal of Geriatric Psychiatry.

Somatic symptoms, such as pain, were negatively associated with successful aging, but veterans with more somatic symptoms who also had higher degrees of gratitude were significantly more likely to report successful aging, according to the study.

“Given that there are effective positive psychiatry interventions designed to enhance positive psychosocial characteristics such as resilience and gratitude, such interventions may also help promote successful aging in U.S. veterans” with mental disorders, wrote lead author Robert H. Pietrzak, Ph.D., M.P.H., of the National Center for PTSD, VA Connecticut Healthcare System, and colleagues. (Past APA President Dilip Jeste, M.D., is a co-author on the paper.)

The researchers examined the association between self-reported successful aging and a range of psychosocial variables—including resilience, gratitude, somatic complaints, and exercise—among 475 veterans (average age 58.3; 83.1% male) who screened positive for major depressive disorder, generalized anxiety disorder, and/or PTSD as part of the 2019-2020 National Health and Resilience in Veterans Study (NHRVS). Veterans were asked to rate how successfully they were aging on a 10-point scale, from 1 for least successful to 10 for most successful—with successful aging defined as a self-rating of 8.

The researchers assessed resilience using a 10-item version of the Connor-Davidson Resilience Scale and gratitude using the Gratitude Questionnaire – Six Item Form. The latter asks respondents to rate on a 7-point scale how much they agree (1 = strongly disagree, 7 = strongly agree) with such statements as “I have so much in life to be thankful for,” “If I had to list everything that I felt grateful for, it would be a very long list,” and “I am grateful to a wide variety of people.”

One in five (20.6%) veterans rated themselves as aging successfully. Resilience and gratitude were the strongest positive correlates of successful aging, accounting for 38.1% and 32.4% of the variance, respectively. Greater somatic symptoms were most negatively associated with successful aging, accounting for 11.2% of the variance. Respondents who reported that they engaged in strenuous exercise were also more likely to say they were aging successfully.

“Further research is needed to investigate causal relationships between psychosocial factors and successful aging, and to evaluate the efficacy of psychosocial interventions to promote successful aging in U.S. veterans and other populations with common mental disorders,” the authors concluded.

For related information, see the Psychiatric News Special Report “Positive Psychiatry Shines Light on Patients’ Strengths, Wisdom.”

(Image: Getty Images/iStock/flySnow)



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




at

Tuesday, August 20, 2024

Florida’s Red Flag Gun Law Results in Decrease in Expected Homicide Rate

Since Florida implemented a red flag gun law, the state’s rate of firearm homicides rose from 4.51 per 100,000 people in 2017 to 5.28 in 2021—while states with similarly conservative gun policies and no red flag laws saw a larger increase, from 4.50 to 6.85 firearm homicides per 100,000 people, according to a study issued in JAMA.

“In response to the 2018 Parkland high school shooting that killed 17 people, Florida’s legislature enacted a red flag law permitting the temporary removal of firearms by law enforcement officers from individuals posing a danger to themselves or others,” wrote Catherine Gimbrone, M.P.H., and Kara E. Rudolph, Ph.D., both at Columbia University Mailman School of Public Health. “Florida is one of the few politically conservative and largely pro-firearm states to pass a law restricting gun ownership.”

Gimbrone and Rudolph mined data from the Centers for Disease Control and Prevention on state-level homicide and suicide mortality rates from 2009 to 2021. They combined data from 2009 to 2021 from 19 states with similarly conservative gun laws that did not have a red flag gun law to create a comparison group, then adjusted for state sociodemographic and economic variables and determined average annual mortality rates.

The researchers reported the following:

  • In Florida, the firearm homicide rate rose from 4.51 deaths per 100,000 people in 2017 to 5.28 in 2021; in the comparison group, firearm homicides increased from 4.50 to 6.85.
  • Since 2018, 10,965 petitions have been filed under Florida’s red flag gun law, increasing from 1,192 in 2018 to 2,907 in 2022, exceeding those of states with comparable laws.
  • From 2019 to 2021, Florida’s red flag law was associated with an 11% reduction in firearm homicide rates, equivalent to 0.73 fewer deaths per 100 000 population per year than comparison states.
  • There were no differences from expected mortality rates in Florida’s firearm suicide or non-firearm homicide or suicide.

One limitation of the study is that it cannot definitively attribute the reduction in expected firearm homicide rates to Florida’s red flag law versus other societal changes after the Parkland high school mass shooting. “The magnitude of the estimated association is plausible, given estimates from studies on other gun control legislation,” researchers wrote. “Findings suggest that red flag laws may reduce the growing burden of firearm homicides.”

For more information, see the Psychiatric News article “Better Resident Training About State Gun Laws and Mental Health Needed.”

(Image: Getty Images/iStock/gerenme)



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




at

Monday, August 19, 2024

Study Finds Increased Suicide Risk in Spouses of People With Cancer

Spouses of people who have cancer have a higher risk of suicide attempt or death by suicide, especially in the first year after the spouse’s diagnosis, a study in JAMA Oncology has found.

Qianwei Liu, M.D., Ph.D., of Southern Medical University in Guangzhou, China, and colleagues compared data from 409,338 spouses of Danish patients diagnosed with cancer with that of 2,046,682 matched individuals whose spouses did not have a cancer diagnosis (the control group). The researchers drew the data from Danish national health registers and the Danish Causes of Death Register from 1986 through 2016. The individuals were followed until they had a first suicide attempt, died by suicide, died by other causes, emigrated, or December 31, 2016—whichever came first. If the spouse of an individual originally in the control group was diagnosed with cancer during follow-up, the individual was shifted to the group whose spouses had cancer.

Compared with individuals in the control group, individuals whose spouses had a cancer diagnosis had a 1.47-fold increased risk of dying by suicide and a 1.28-fold increased risk of having a suicide attempt during follow-up. During the first year after diagnosis, individuals whose spouses had cancer had a 2.56-fold increased risk of dying by suicide and a 1.45-fold increased risk of having a suicide attempt, and their risk of dying by suicide remained elevated throughout follow-up.

“The finding of the highest risk increase of suicide attempt and suicide death during the first year after cancer diagnosis corroborates our study group’s previous findings of the greatest risk increase of psychiatric disorders during the first year after cancer diagnosis among both patients with cancer and their spouses,” Liu and colleagues wrote.

The risk of having a suicide attempt or dying by suicide was higher in individuals with spouses whose cancer was diagnosed at an advanced or unknown stage compared with those whose spouses were diagnosed at an early stage. The researchers noted that this may be attributable to individuals experiencing a greater burden of the disease or a greater fear of the spouse dying.

“A greater burden of the disease may contribute to a higher level of psychological distress of the patient with cancer and a greater need of support and caregiving from their loved ones, particularly the spouse,” the researchers wrote.

For related information, see the APA blog post “‘Nowhere to Turn’: COVID-19 and Caregiver Stress.”

(Image: Getty Images/iStock/Yuto photographer)



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




at

Friday, August 16, 2024

Early Childhood Tablet Use Linked to Angry Outbursts

Tablet use in early childhood may promote angry outbursts and emotional dysregulation as the child grows, a study in JAMA Pediatrics has found.

Caroline Fitzpatrick, Ph.D., of the Université de Sherbrooke in Québec, and colleagues examined data from 315 children whose parents completed the Children’s Behavior Questionnaire each year from 2020 to 2022, when their children were 3.5, 4.5, and 5.5 years old. The parents also reported on their children’s tablet use.

The children spent an average of 6.5 hours per week (0.92 hours per day) using tablets when they were 3.5 years old, 6.7 hours per week (0.95 hours per day) when they were 4.5 years old, and 7.0 hours per week (1 hour per day) when they were 5.5 years old.

The researchers found that each 69-minute increase in tablet use when the children were 3.5 years old was associated with a 22% increase in expressions of anger and frustration when they were 4.5 years old. In turn, each standard deviation increase in anger and frustration at 4.5 years was associated with an increase of roughly 17 minutes in tablet use at 5.5 years.

“These findings indicate that tablet use can undermine child ability to effectively manage emotions during daily routines,” the researchers wrote. “Furthermore, children who express more anger may come to elicit more digital strategies to temper outbursts.”

The researchers noted prior studies that suggest children learn emotional regulation by watching parental emotional regulation and when parents engage in emotion-focused parenting such as providing emotional coaching. “More frequent child use of tablets could reduce learning opportunities afforded by these mechanisms and undermine the development of emotional regulation strategies,” they wrote.

“Our study suggests that parents be sensitized that tablet use in early childhood can disrupt the ability to manage anger and frustration and lead to increased outbursts in young children,” the researchers concluded.

For related information, see the Psychiatric News article “Slower Development of Young Children May Be Linked to Excess Screen Time.”

(Image: Getty Images/iStock/andresr)



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




at

Thursday, August 15, 2024

Psychotropic Polypharmacy Rose in Youth With Medicaid Over Five-Year Study

The number of Medicaid-enrolled youth who were treated with three or more psychotropic drug classes at the same time increased from 4.2% to 4.6% between 2015 and 2020, according to a study of claims in one Mid-Atlantic state issued in Psychiatric Services.

“Concurrent use of multiple psychotropic medications, also referred to as polypharmacy, is a safety concern in pediatric psychiatry,” wrote Yueh-Yi Chiang, B.S., University of Maryland School of Pharmacy in Baltimore, and colleagues. “Most states’ Medicaid programs have implemented oversight of psychotropic regimens that involve the prescription of three or more therapeutic classes of medications for youths ages ≤18 years, which has resulted in some evidence of lower medication use.”

Chiang and colleagues put this to the test by examining Medicaid claims data for youths who were taking one or more of six psychotropic medication classes, including antipsychotics, mood stabilizers, antidepressants, anxiolytics, sedatives, and attention-deficit hyperactivity disorder (ADHD) medications, and who had at least 90 continuous days of Medicaid enrollment between 2015 and 2020 in an unnamed Mid-Atlantic state. Researchers looked at the average days per year of psychotropic polypharmacy—defined as concurrent claims for three or more therapeutic classes of psychotropics—as well as the prevalence of various class combinations. Researchers also assessed changes in the number of psychotropic polypharmacy days by year.

Researchers found 541,380 Medicaid-enrolled youths with at least one mental health encounter during the five-year study period. Of the 126,972 who were prescribed at least one psychotropic medication, one-third were Black and one-third were White. The total number of youths prescribed psychotropic polypharmacy increased from 2,259 of 53,569 (4.2%) in 2015 to 2,334 of 50,806 (4.6%) in 2020. In addition, during that same period, the average annual duration of psychotropic polypharmacy increased by more than one week.

Among youth treated with polypharmacy, the vast majority (97%) were prescribed combinations of three psychotropic drug classes; the most common combination was an ADHD medication plus an antipsychotic and an antidepressant. Youths in the sample were prescribed polypharmacy for an average of seven to eight months out of the year.

One limitation of the study was that it relied on Medicaid data from a single state, which may limit its generalizability to other states. “The lack of clinical information in claims data limits our ability to assess treatment decisions, illness severity, and clinical outcomes related to psychotropic polypharmacy,” the authors noted. “…Future studies, possibly incorporating a longitudinal cohort design, are needed to investigate the long-term safety and health outcomes associated with such polypharmacy regimens.”

For related information, see the Focus: The Journal of Lifelong Learning in Psychiatry article “Assessing and Responding to the Trauma of Child Maltreatment.”

(Image: Getty Images/iStock/simonkr)



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




at

Wednesday, August 14, 2024

High Rate of Remission, Persistence of Delusions Among Those Who Relapse in FEP Clinic Found

More than 90% of individuals experiencing a first-episode psychosis (FEP) achieved remission within two years, according to a report in JAMA Psychiatry. Among the minority who relapsed, the researchers found that they experienced delusions that were similar to those they had experienced during their initial psychotic episode.

Delusions were centered on fewer specific themes during relapse episodes, indicating that certain core delusional beliefs were consolidated. The findings suggest that “delusions may serve a critical function for individuals who experience them, and their persistence following clinical intervention further indicates how the phenomena are central to a person’s sense of meaning in daily life,” wrote Gil Grunfeld, M.Sc., and colleagues at McGill University.

The researchers analyzed data on 636 consenting subjects (average age 23.8 years; 191 female) with affective or nonaffective FEP, followed for up to two years in an early intervention service for psychosis in Montréal, Quebec, Canada. The primary outcome was positive symptom relapse and remission, including the content and severity of delusions as defined by the Scale for the Assessment of Positive Symptoms. They also sought to understand what proportion experiences delusions during their relapse episode, and the durability of delusional themes across relapses.

A total of 558 individuals (94.4%) achieved remission. Of those, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis; a majority of those who relapsed (63.2%) had delusions, with nearly all (90.2%) experiencing delusions that were similar in content to those they experienced during their first psychotic episode. However, most of these presented with only one or two delusion themes during relapse episodes after experiencing three or more themes during their first episode.

The researchers concluded that specialized early intervention services for psychosis can achieve high rates of sustained remission. “However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes,” they wrote. “These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.”

For related information, see the Psychiatric News article “LAI Antipsychotics Beat Oral Meds for Preventing Relapse, Hospitalization.”

(Image: Getty Images/iStock/blueshot)



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




at

Tuesday, August 13, 2024

Buprenoprhine-Naloxone Combo Appears Safe During Pregnancy

Buprenorphine combined with naloxone is just as safe as buprenorphine alone for pregnant individuals with opioid use disorder (OUD), according to a report published yesterday in JAMA. For some complications such as neonatal abstinence syndrome, buprenorphine plus naloxone even appeared as the safer option.

Adding naloxone to buprenorphine is intended to deter diversion, because naloxone prevents buprenorphine’s euphoric effects when people try to take it intranasally or intravenously. “In pregnancy, buprenorphine alone is generally recommended because of limited perinatal safety data on the combination product,” wrote Loreen Straub, M.D., M.S., of Harvard Medical School, and colleagues.

To gain more insight into the risks of the combination product, Straub and colleagues made use of a Medicaid-based dataset that included rich patient-level information on mothers and their infants. They examined a range of maternal and neonatal outcomes among 3,369 pregnant individuals exposed to buprenorphine plus naloxone during the first trimester and 5,326 exposed to buprenorphine alone or who switched from the combination to buprenorphine alone by the end of the first trimester.

Compared with pregnant individuals who took buprenorphine alone, those who took the combination formula had a lower risk of having infants born with neonatal abstinence syndrome (37.4% versus 55.8%), infants who required neonatal intensive care (30.6% versus 34.9%), or infants who were small for their gestational age (10.0% versus 12.4%). The risk of other adverse outcomes, including congenital birth defects, preterm birth, respiratory problems in the infant, or severe maternal health problems post-delivery (such as heart attack or delirium), was similar with either medication type.

“This [study] supports the view that both formulations are reasonable options for treatment of OUD in pregnancy, affirming flexibility in collaborative treatment decision-making,” Straub and colleagues concluded.

For related information, see the American Journal of Psychiatry article “Flexible Buprenorphine/Naloxone Model of Care for Reducing Opioid Use in Individuals With Prescription-Type Opioid Use Disorder: An Open-Label, Pragmatic, Noninferiority Randomized Controlled Trial” and the related editorial “Flexible Buprenorphine/Naloxone Treatment Models: Safe and Effective in Reducing Opioid Use Among Persons With Prescription Opioid Use Disorder.”

(Image: Getty Images/iStock/blueshot)



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




at

Monday, August 12, 2024

Lykos Therapeutics’ Psychedelic MDMA Not Approved by FDA

Lykos Therapeutics’ submission of midomafetamine (MDMA) capsules for the treatment of posttraumatic stress disorder was rejected Friday by the Food and Drug Administration (FDA), with officials requesting an additional phase 3 study, which will take several years to complete.

This was the FDA’s first decision involving a psychedelic drug used for a psychiatric indication. Lykos said it plans to request a meeting with the FDA to ask for reconsideration of its decision.

“The FDA request for another study is deeply disappointing, not just for all those who dedicated their lives to this pioneering effort, but principally for the millions of Americans with PTSD, along with their loved ones, who have not seen any new treatment options in over two decades," Amy Emerson, Lykos Therapeutics’ CEO, said in a media release.

MDMA, also known as ecstasy, is an entactogen that is believed to increase an individual’s self-awareness and introspection. Lykos’ clinical trials included a novel psychotherapeutic intervention alongside MDMA sessions that Lykos said helps people access and process painful memories, so they can undergo therapy without becoming overwhelmed.

The concerns raised by the FDA in its rejection letter echo those of the agency’s independent Psychopharmacologic Drugs Advisory Committee, which in early June voted overwhelmingly against the approval of MDMA. Advisory committees’ recommendations are nonbinding, but the FDA typically follows them.

Among issues raised by the advisory committee were:

  • Lack of evidence of durability of the treatment response.
  • Allegations of sponsor/researcher bias and undue influence.
  • Expectancy bias stemming from prior illicit use of MDMA by trial participants.
  • Insufficient data on cardiovascular and hepatotoxicity risks.
  • “Functional unblinding” arising from most researchers and participants correctly guessing who received the placebo versus active treatment.
  • The role the psychotherapy played in the trial outcome, and the fact that psychotherapy is not regulated by the FDA.

The committee also focused on a documented case of serious sexual misconduct that occurred during a 2015 phase 2 trial. Notably, the journal Psychopharmacology on Saturday retracted three papers related to these phase 2 studies, noting that the study authors were aware of unethical conduct at one of the study sites but did not disclose that information to the journal or remove data generated by that site from their analysis.

Lykos took issue with what it called the limited number of subject matter experts on the advisory committee and that the discussion at times “veered beyond the scientific content” presented in the briefing documents. Lykos asserted that the FDA’s concerns “can be addressed with existing data, post-approval requirements, or through reference to the scientific literature.”

For more information, see the Psychiatric News article “Psychedelics’ Use as Medicine Hits Significant Roadblock.”

(Image: Getty Images/iStock/boonstudio)



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




at

Friday, August 9, 2024

Community Health Workers Boost Smoking Cessation in Adults With SMI, Study Finds

Adults with serious mental illness (SMI) and tobacco use disorder who engage with community health workers at least once a month are more likely to quit smoking than those with less engagement, according to a report published today in Psychiatric Services.

Community health workers are non-medical staff who assist health care systems by providing a range of support services to patients, including home visits, health education, and first aid.

Cheryl Y. S. Foo, Ph.D., of Massachusetts General Hospital, and colleagues examined data from 196 adults with SMI (such as schizophrenia or bipolar disorder) as well as tobacco use disorder who received community health worker support as part of a clinical trial on smoking cessation. The community health workers visited participants in their homes or neighborhoods, encouraged them to set smoking-cessation goals, educated them about approved therapies, and assisted them with visits to their physician or self-help group. The community health workers also co-led group counseling sessions on smoking cessation alongside a clinically trained professional.

Foo and colleagues found that the participants who had more contact with community health workers—whether via home visits or group counseling sessions—were much more likely to quit smoking after two years compared with adults who had less community health worker engagement.

The optimal “dosage” of community health worker support—factoring in odds of success versus time commitment—was for an adult to have 30 to 65 visits over two years that lasted about 29 to 34 minutes each, as well as attending 20 to 57 group sessions over two years. Further increasing community health worker engagement above these levels only marginally improved tobacco-cessation outcomes, the researchers noted.

“Ideally, implementation of an evidence-based … intervention should strike a balance between the maximally efficacious dose and the dose that is reasonably affordable and feasibly accepted by a large enough proportion of recipients to maximize benefits in real-world settings,” they wrote.

As part of their study, Foo and colleagues also conducted qualitative interviews with patients, primary care physicians, and community health workers. The interviews indicated that the community health workers helped people quit by building trust and holding patients accountable. In addition, they were instrumental in breaking down structural barriers to treatment by helping to schedule appointments, provide transport, and ensuring insurance was up to date.

For related information, see the American Journal of Psychiatry editorial, “Social Determinants of Health and Smoking Cessation: A Challenge.”

(Image: Getty Images/iStock/XtockImages)



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




at

Thursday, August 8, 2024

Feelings of Sadness Down, Fears of Violence Up Among High Schoolers

The percentage of high school students who have experienced school-based violence and absenteeism because of safety concerns has risen over the last two years, according to a report by the Centers for Disease Control and Prevention (CDC). However, the same report revealed decreases in the percentage of high school students who feel persistently sad or hopeless and the percentage of students who ever used certain illicit substances.

Researchers in CDC’s Division of Adolescent and School Health compared data from the 2021 and 2023 Youth Risk Behavior Survey. Conducted every two years among a nationally representative sample of U.S. high school students, the survey captures demographic data while also asking the students about their health behaviors and conditions, substance use, and experiences such as school connectedness, unstable housing, and exposure to community violence.

Worsening trends from 2021 to 2023 centered on violence and safety concerns and include:

  • Increases in the percentage of students who were bullied at school (from 15% to 19%).
  • Increases in the percentage of students who missed school because of safety concerns either at school or on the way to school (from 9% to 13%).
  • Increases in the percentage of students who were threatened or injured with a weapon at school (from 7% to 9%).

Female and LGBTQ+ high school students were more likely than their peers to report concerns of violence. Nearly 3 in 10 LGBTQ+ students were bullied at school, while nearly 2 in 10 missed school because of safety concerns.

Key improvements to youth mental health from 2021 to 2023 include:

  • Decreases in the percentage of students who experienced persistent feelings of sadness or hopelessness (from 42% to 40%).
  • Decreases in the percentage of female students who experienced persistent feelings of sadness or hopelessness (from 57% to 53%) and who seriously considered attempting suicide (from 30% to 27%).
  • Decreases in the percentage of Hispanic students who felt persistently sad or hopeless (from 46% to 42%) and who seriously considered attempting suicide (from 22% to 18%).
  • Decreases in the percentage of Black students who attempted suicide (from 14% to 10%).
  • Decreases in the percentage of students who used illicit substances such as cocaine, inhalants, heroin, methamphetamines, hallucinogens, or ecstasy (from 13% to 10%).
  • Decreases in the percentage of students who currently misused prescription opioids (from 6% to 4%).

“These data show that we’ve made some progress in tackling these issues in recent years, which proves that they are not insurmountable. However, there’s still much work ahead,” CDC Division of Adolescent and School Health Director Kathleen Ethier, Ph.D., said in a statement. “Considering the vital role schools play in promoting health and well-being, it is critical to address school-based violence and safety concerns.”

For related info, see the Psychiatric News article, “Stages Preceding School Violence Offer Critical Points of Intervention.”

(Image: Getty Images/iStock/Daniel de la Hoz)



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




at

Wednesday, August 7, 2024

TMS More Effective Than Next-Step Antidepressant Treatment, Study Shows

Patients with treatment-resistant depression who received repetitive transcranial magnetic stimulation (rTMS) experienced greater reduction and remission of symptoms than those who received another trial of an antidepressant, according to a report in AJP.

“rTMS should be considered as a viable treatment option at an early stage of the treatment algorithm and may be more effective than antidepressant medication switch or augmentation,” wrote Iris Dalhuisen, Ph.D., of Radboud University Medical Center, the Netherlands, and colleagues.

Eighty-nine patients with unipolar nonpsychotic depression who had not responded to at least two medication trials (including at least one antidepressant) were randomized to receive either rTMS or the usual next treatment as indicated in Dutch practice guidelines.

Patients in the rTMS group received 25 sessions of high-frequency (10 Hz) TMS delivered to the left dorsolateral prefrontal cortex over an eight-week period; rTMS patients could remain on their existing medication. Those receiving treatment as usual either switched their current medication to a tricyclic antidepressant or augmented their current medication with lithium or a second-generation antipsychotic.

All patients also received either group or individual psychotherapy, of a variety of types, at least once a week.

The primary outcome was a change in depression severity based on the Hamilton Depression Rating Scale (HAM-D) after eight weeks. Secondary outcomes included remission rates as well as changes in specific depression-associated symptoms (anhedonia, anxiety, sleep, rumination, and cognitive reactivity).

Patients in the rTMS group experienced an average decrease in HAM-D scores of 10.02 points compared with just 4.19 among those in the medication group. Patients receiving rTMS (27.1%) were also significantly more likely to achieve remission of symptoms compared to those receiving another antidepressant (4.9%). They also experienced a greater reduction in symptoms of anxiety and anhedonia (inability to enjoy normally enjoyable activities).

The authors said analysis of the follow-up results of this ongoing study will be crucial. “Analysis of these data needs to establish what the long-term effectiveness and cost-effectiveness of both treatments is and whether rTMS still outperforms medication after several months,” they wrote. “Our cost-effectiveness analysis will show whether this result can be replicated based on real-world data.”

For related info, see the Psychiatric News article, “TMS Should Be Considered as First-Line Treatment for Moderate to Severe Major Depressive Disorder,” now on Newswire.

(Image: Getty Images/iStock/Grafissimo)



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




at