Brief social contact-based video interventions are effective in decreasing self-stigma and increasing treatment-seeking intentions. The present study is the first to target essential workers with self-reported anxiety, d...Brief social contact-based video interventions are effective in decreasing self-stigma and increasing treatment-seeking intentions. The present study is the first to target essential workers with self-reported anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms during the COVID-19 pandemic. We hypothesized that viewers of the intervention would show greater increases in treatment-seeking intentions than nonviewers and that those without prior mental health diagnoses or care would have larger increases than those with past mental health care engagement. Additionally, participants who were more emotionally engaged with the intervention would experience greater treatment-seeking intention increases. This randomized controlled trial recruited 1,309 essential workers via crowdsourcing who self-reported threshold levels of anxiety, depression, or PTSD symptoms to view either a brief social contact-based video intervention or a control video. Participants' treatment-seeking intentions were assessed using 3 items from the Attitudes Toward Seeking Professional Psychological Help-Short Form at baseline, immediately postintervention, and 30 days afterward. Generalized estimating equation (GEE) analyses revealed an immediate group-by-time effect of increased treatment-seeking intentions in the intervention group ( = .006, Cohen = 0.22). Further GEE analyses revealed significant effects among individuals in the intervention group without prior psychiatric diagnoses ( < .001, Cohen = 0.41), as compared to those with psychiatric diagnoses, and among those without prior treatment experience ( < .001, Cohen = 0.40) compared to those who had. Participants who were more emotionally engaged experienced significantly greater increases in treatment-seeking intentions ( < .001). All hypotheses were supported, indicating the efficacy of a brief video intervention in increasing treatment-seeking intentions among essential workers with clinical needs. These results highlight the ability of brief, easily disseminated interventions to reach those most in need of care and effectively increase treatment-seeking intentions. Trial identifier: NCT05826132.
Veteran status and bipolar disorder (BD) are two substantial risk factors for suicide. Models of suicide implicate neurocognition and impulsivity in suicidal behavior. We aim to examine neurocognitive dysfunction and imp...Veteran status and bipolar disorder (BD) are two substantial risk factors for suicide. Models of suicide implicate neurocognition and impulsivity in suicidal behavior. We aim to examine neurocognitive dysfunction and impulsivity correlates of suicide in veterans with BD. We included 29 veterans with a bipolar spectrum disorder with a suicide attempt history (BD/SA+), 33 veterans with bipolar spectrum disorder without a suicide attempt history (BD/SA-), and 22 healthy control veterans (HC) recruited between January 2021 and July 2023. Participants were administered the MATRICS Consensus Cognitive Battery; Barratt Impulsivity Scale; Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale; and Impulsive/Premeditated Aggression Scale. BD/SA+ performed worse on working memory than BD/SA-; mean difference (MD [95% CI], -5.74 [-10.65 to -0.82], =.034) and HC (-10.31 [-15.77 to -4.85], < .001). BD/SA+ also performed worse on verbal learning than BD/SA- (MD [95% CI], -4.49 [-8.41 to -0.57], = .038) and HC (-5.52 [-9.87 to -1.16], = .038). Differences between BD/SA+ and BD/SA- in working memory remained significant when adjusting for depressive ( = .037) and manic ( = .024) symptoms, but verbal learning was no longer significantly different when adjusted for depression. BD/SA+ also had higher scores than BD/SA- on impulsive (MD [95% CI], 3.68 [0.64 to 6.73], = .018) and premeditated (5.80 [1.51 to 10.10], = .013) aggression. Across the BD groups, poorer working memory was associated with greater premeditated aggression ( = -0.321, = .013) while poorer verbal learning was associated with greater impulsive ( = -0.297, = .021) and premeditated ( = -0.372, = .003) aggression. Results suggest that in veterans with BD, poorer working memory is associated with suicide attempt independent of depression, while verbal learning impairments associated with suicide attempt may be influenced by depression. Neurocognitive dysfunction may underlie aggression to drive suicidal behavior. Findings support the role of neurocognition in models of suicide in BD and can inform risk detection and intervention.
This proof-of-concept study examined the effects of brexpiprazole treatment on substance use, psychiatric symptoms, and quality of life in patients with co-occurring schizophrenia and substance use disorder. In this 12-...This proof-of-concept study examined the effects of brexpiprazole treatment on substance use, psychiatric symptoms, and quality of life in patients with co-occurring schizophrenia and substance use disorder. In this 12-week study, patients diagnosed with schizophrenia and substance use disorder using criteria were randomly assigned to switch from their current antipsychotic medication to brexpiprazole (up to 4 mg/day) or remain on their current antipsychotic treatment (treatment as usual [TAU]). Substance use was assessed by the number of days of substance use and the dollars spent on substance in the past week, and substance craving was assessed using the Visual Analog Scale (VAS). Quality of life was assessed using the Heinrichs-Carpenter Quality of Life Scale (QOL). In addition, psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale-Severity of Illness. Thirty-nine patients were randomized (21 in the brexpiprazole group, 18 in the TAU group). Mixed models for repeated measures showed that, despite the lack of statistical significance, a consistent pattern of decrease in the brexpiprazole group was observed for the number of days of substance use and the dollars spent, as well as substance craving; the brexpiprazole group had a 15.5 points greater decrease in VAS (=.157) and a $33.3 greater decrease in the dollars spent (=.108) from baseline to week 12 compared with the TAU group. The brexpiprazole group did show a statistically significant 8.9 points greater increase in QOL compared with the TAU group ( =.020). Even though it was not statistically significant, the brexpiprazole group had a 2.4-point greater decrease in the PANSS General Psychopathology subscale score (=.150) and a 1.9-point greater decrease in the PANSS Negative Symptom subscale score (=.126) compared with the TAU group. This study suggests that brexpiprazole might be beneficial in reducing substance craving and use in patients with schizophrenia and co-occurring substance use disorder; this potential benefit may help improve quality of life and overall psychiatric symptoms in a difficult-to-treat patient population. ClinicalTrials.gov identifier: NCT03526354.
To assess determinants of immediate postpartum anxiety (IPPA) and its association with postpartum depression (PPD). We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is...To assess determinants of immediate postpartum anxiety (IPPA) and its association with postpartum depression (PPD). We conducted an analysis of the Interaction Gene Environment in Postpartum Depression cohort, which is a prospective, multicenter, French cohort including 3,310 women enrolled between November 2011 and June 2016. Women completed the Hospital Anxiety and Depression Scale-Anxiety (HAD-A) at the maternity department between the second and fifth days following childbirth. IPPA was defined by HAD-A score >7, while HAD-A score >10 defined moderate to severe IPPA. Risk factors were collected. PPD was assessed prospectively at 2 months and 1 year postpartum. The prevalence of IPPA in this population was 24%, and 7.4% for severe anxiety. Factors independently associated with IPPA were found. Among women with IPPA, 31.2% developed PPD, compared to 16.9% of those without anxiety (adjusted odds ratio [aOR]=2.0; [95% CI, 1.6-2.5]). The association was stronger for early-onset PPD (aOR=2.2 [1.7-3.0]) than for late-onset PPD (aOR=1.8 [1.3-2.4]), even after adjusting on sociodemographic characteristics and history of major depressive episode before or during pregnancy. The higher the intensity of IPPA was, the higher the prevalence of PPD was. IPPA has specific determinants and is associated, according to its intensity, with early-and late-onset PPD. Identifying (1) women at risk of anxiety, and thus eligible for dedicated support during pregnancy, and (2) women exhibiting anxiety during their maternity stay represent two targets to prevent the onset of PPD.
This study aimed to assess the risk of dementia associated with specific autoimmune diseases and the impact of related pharmacologic treatments. Patients 55 years or older diagnosed with dementia by neurologists or psyc...This study aimed to assess the risk of dementia associated with specific autoimmune diseases and the impact of related pharmacologic treatments. Patients 55 years or older diagnosed with dementia by neurologists or psychiatrists between 2010 and 2021 were identified using claims data from Taiwan's National Health Insurance program. We examined 22 autoimmune diseases for their associations with dementia, controlling for age, gender, urbanization level, and comorbidities. Dementia prevalence was higher among individuals with autoimmune diseases (10.5% in cases vs. 8.7% in comparisons). Thirteen autoimmune diseases were linked with an elevated dementia risk, particularly Behçet disease, multiple sclerosis, and systemic lupus erythematosus. Associations with vascular dementia were stronger than with Alzheimer disease. Although overall dementia risk was higher in women, no significant sex differences were observed for specific autoimmune diseases. Nonsteroidal anti-inflammatory drugs and corticosteroids did not significantly alter dementia risk among individuals with autoimmune diseases; however, immunosuppressants were associated with a reduced risk when used for more than 180 days. Certain autoimmune diseases are significantly associated with an increased risk of dementia, particularly vascular dementia, highlighting the distinct role of inflammation. Effective prevention or treatment of autoimmune diseases may reduce dementia incidence by 0.8%. While immunosuppressants show potential for risk reduction, further prospective studies are needed to confirm this effect.
Lurasidone, a second-generation atypical antipsychotic, lacks significant published data on its transfer into human milk during lactation. The objective of this study was to (1) quantify the transfer of lurasidone into h...Lurasidone, a second-generation atypical antipsychotic, lacks significant published data on its transfer into human milk during lactation. The objective of this study was to (1) quantify the transfer of lurasidone into human milk, allowing for an estimation of maternal drug exposure to the breastfed infant and (2) report observations of infants exposed to lurasidone via breast milk. Milk samples and health histories were collected from 9 lactating mothers who donated milk samples to the InfantRisk Human Milk Biorepository while taking lurasidone (20-80 mg/day) from 2022 to 2024. The drug concentration-time profile of lurasidone in milk was determined using liquid chromatography-mass spectrometry, and maternal lurasidone doses were standardized to 40 mg/day. Lurasidone had an average milk concentration of 39.5 ng/mL at the 40 mg/day standardized dose. The relative infant dose (RID) was 1.16%, which is below the standard 10% threshold for infant safety. Even using the highest observed individual concentration of 174 ng/mL, the calculated RID was 3.03%. There were no maternal reports of adverse effects in the infants exposed to varying degrees of lurasidone in milk. The levels of lurasidone observed in all participants' milk samples were exceedingly low. The subsequently low RID is below the 10% threshold for infant safety, suggesting that the transfer of maternal lurasidone into human milk is clinically insignificant and poses minimal risk to a breastfed infant.
Guidetti C, Papakostas GI, Pani L
… +11 more, De Martin S, Serra G, Apicella M, Kröger C, Champasa P, Comai S, Mattarei A, Folli F, Pappagallo M, Manfredi PL, Fava M
Antidepressant tolerance/ tachyphylaxis (AT) is defined as initial response (≥ 50% improvement) to antidepressant treatment followed by relapse while on the same adequate dose. The impact of AT as prognostic indicator fo...Antidepressant tolerance/ tachyphylaxis (AT) is defined as initial response (≥ 50% improvement) to antidepressant treatment followed by relapse while on the same adequate dose. The impact of AT as prognostic indicator for response to subsequent antidepressant treatment is unknown. To test the efficacy of esmethadone (REL-1017) in a subgroup of patients with major depressive disorder (MDD) and AT. A phase 3, double-blind, randomized, placebo-controlled trial of esmethadone was conducted in adult outpatients with MDD. Prior to randomization, AT was independently assessed by clinicians from the Massachusetts General Hospital Clinical Trials Network and Institute using the MGH Antidepressant Treatment Response Questionnaire. Data for the primary efficacy end point were analyzed using mean difference in Montgomery-Åsberg Depression Rating Scale (MADRS) total score from baseline to primary end point (Day 28) in the AT subgroup from the intent to treat (ITT) population, the per-protocol (PP) population, and in patients with severe depression (baseline MADRS ≥35). Among 227 ITT patients, 87 experienced AT. For this subgroup, there was a nominally statistically significant mean difference of 5.4 (=.023, Cohen effect size 0.53) for esmethadone vs placebo in MADRS total score change from baseline to primary end point (Day 28). Additionally, there was a nominally statistically significant difference in response rate (=.0004). Consistent results were seen in the PP population with AT and in the severely depressed subgroup of patients with AT. These post hoc analyses, based on data collected independently pre-randomization, suggest that esmethadone may be an effective adjunctive treatment for patients with AT. These results need to be confirmed in larger prospective clinical trials.
Iron is an essential trace element that is important for the development, structure, and functioning of the brain. Iron has been both favorably and unfavorably implicated in neuropsychiatric disorders. For example, iron...Iron is an essential trace element that is important for the development, structure, and functioning of the brain. Iron has been both favorably and unfavorably implicated in neuropsychiatric disorders. For example, iron adequacy in pregnancy and early childhood has been suggested to reduce the risk of neurodevelopmental disorders and schizophrenia, but iron mechanisms have been implicated in neurodegenerative disorders, multiple sclerosis, and stroke. Supplemental iron may be indicated to treat restless legs syndrome, akathisia, and pica, but more commonly to treat iron deficiency associated with poor nutrition in major mental illness. Supplemental iron is commonly orally administered but is poorly absorbed by this route. It is therefore necessary to know what improves and what impairs iron absorption. This article explains that, for best absorption, oral iron supplements are ideally dosed as ferrous salts. The dose should be administered in the morning, on a fasting stomach, along with about 100 mg of vitamin C in the form of a tablet, or with a glass of orange or other citrus juice. If neither vitamin C nor citrus juice is available, as a poorer option, iron should be dosed with plain water. Absorption is markedly reduced if iron is administered in the afternoon, or with food such as cereals and other grains, or with beverages such as milk, tea, and coffee. Calcium supplements, antacids, H2 inhibitors, and proton pump inhibitors also reduce the absorption of orally administered iron. Some data suggest that alternate day dosing improves fractional iron absorption as well as reduces adverse effects of treatment. Finally, to reduce the risk of pill esophagitis, iron should be dosed with a full glass of liquid, and the patient should not recline or lie down for at least the next 30-60 min.
Doncarli A, Demiguel V, Le Ray C
… +9 more, Deneux-Tharaux C, Lebreton E, Apter G, Boudet-Berquier J, Chantry AA, Crenn-Hebert C, Vacheron MN, Regnault N, Tebeka S
Estimate nationwide postpartum depression (PPD) at 2 months prevalence and its related risk factors. The representative study sample comprised 7,133 women who were included in a national perinatal population- based surv...Estimate nationwide postpartum depression (PPD) at 2 months prevalence and its related risk factors. The representative study sample comprised 7,133 women who were included in a national perinatal population- based survey of all women who gave birth in France in March 2021. Data on maternal characteristics, course of pregnancy/delivery, and child's health were collected from face-to-face interviews in maternity wards and/or medical records and a self-questionnaire (including the Edinburgh Postnatal Depression Scale [EPDS]) at 2 months postpartum. Women with an EPDS score ≥13 were considered to have PPD. Poisson regression models with robust variance were used to estimate adjusted prevalence ratios (aPRs) for PPD. PPD prevalence at 2 months was 16.7% (95% CI, [15.7-17.7]). Factors significantly associated with PPD were (1) age ≤29 or ≥40 years (maximum aPR=1.41 95% CI, [1.12-1.77] obtained for 15- to 24-year-olds vs 35- to 39-year-olds); (2) being born in North Africa (1.29 [1.02-1.64] vs France); (3) having a lower level of health literacy (1.23 [1.14-1.35]); (4) having a history of psychological (1.45 [1.24-1.69]) or psychiatric (1.52 [1.23-1.88]) care since adolescence (vs none); (5) receiving little/ no support or good support during pregnancy (1.80 [1.52-2.14] and 1.31 [1.15-1.48] vs receiving very good support); (6) reporting feelings of sadness (1.92 [1.65-2.25]), anhedonia (1.69 [1.36-2.11]), or both (2.61 [2.26-3.01]) during pregnancy (vs none of these feelings); and (7) having had an instrumental vaginal delivery (1.18 [1.01-1.38] vs spontaneous vaginal delivery). These findings on PPD (prevalence and profile of women at higher risk) could guide clinicians and policies on early identification and preventive support for women in the perinatal period.
Failure to benefit from treatments for posttraumatic stress disorder (PTSD) is common. We previously developed the Emory Treatment Resistance Interview for PTSD (E-TRIP), the first tool to evaluate treatment resistance i...Failure to benefit from treatments for posttraumatic stress disorder (PTSD) is common. We previously developed the Emory Treatment Resistance Interview for PTSD (E-TRIP), the first tool to evaluate treatment resistance in PTSD. Here, we provide a simplified version of the scale, the E-TRIP-Short version (E-TRIP-S), that assesses prior responses to first-line evidence-based psychotherapies and medications for PTSD. US military personnel and veterans (N=102) being evaluated for treatment through a specialized academic medical center PTSD clinical program from May 2019 to February 2020 were interviewed by trained assessors. Descriptive statistics of the E-TRIP-S psychotherapy and medication scores were evaluated to provide preliminary evidence regarding the utility of the measure. Among those seeking care in an intensive outpatient program for PTSD, the majority of those with prior exposure to evidence-based interventions showed elevated E-TRIP-S scores. Only 11/39 (28.2%) of psychotherapy-treated and 12/52 (23.2%) of medication-treated patients reported that a prior treatment "definitely helped" for their intrusion or avoidance symptoms, indicating limited benefit from previous treatments and providing proof of concept for the measure. One-quarter of those who failed to benefit from one modality (ie, an evidence-based psychotherapy or medication) reported being definitely helped when treated with the alternative modality. The E-TRIP-S offers a simplified method for assessing treatment resistance among PTSD patients. Preliminary results suggest that the E-TRIP-S may contribute to clinical care by informing treatment selection for individuals and may support research by identifying treatment-resistant patients for testing new interventions or for stratifying patients based on prior treatment outcomes in clinical trials.
The diagnosis of attention-deficit/hyperactivity disorder (ADHD) is based on a set of symptoms and 2 main dimensions (impulsive/hyperactive and attentional). While the relationships between ADHD symptoms and emotional dy...The diagnosis of attention-deficit/hyperactivity disorder (ADHD) is based on a set of symptoms and 2 main dimensions (impulsive/hyperactive and attentional). While the relationships between ADHD symptoms and emotional dysregulation (ED) have been widely studied, the interactions between individual symptoms have rarely been examined. The purpose of this study was to assess which symptoms are most influential (central) and which symptoms connect (bridge) the 2 main dimensions of ADHD and ED. Data from wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II) were utilized, which included a large, nationally representative sample of the US population (N=33,546). Eighteen ADHD symptoms were examined based on criteria, along with 4 variables related to ED. Symptom network analyses were conducted to explore the relationships between ADHD and ED symptoms. The prevalence of ADHD was found to be 10.12% (N=3,397). Among all ADHD and ED symptoms, ED symptoms had the lowest influence (centrality) values. In terms of bridging the 2 ADHD dimensions, 2 ED symptoms were among the 4 most influential. The low centrality of ED symptoms supports the traditional focus on the 2 main dimensions of ADHD. However, the significant role of ED symptoms in connecting the impulsive/ hyperactive and attentional dimensions highlights their importance within the ADHD framework. These findings have potential implications for the epidemiology, public health, research, and clinical understanding of ADHD.
Individuals with bipolar II disorder (BD II) have among the highest rates of suicide ideation (SI), attempts, and deaths. No studies to date have examined psychosocial treatment of SI in adults with BD II. The purpose of...Individuals with bipolar II disorder (BD II) have among the highest rates of suicide ideation (SI), attempts, and deaths. No studies to date have examined psychosocial treatment of SI in adults with BD II. The purpose of this study was to investigate whether patients with BD II depression receiving interpersonal and social rhythm therapy (IPSRT), an evidence-based psychotherapy for BD, experienced a decrease in SI, and whether this varied by use of adjunctive medication compared to IPSRT monotherapy. In a post hoc analysis of Swartz et al (2018), adults meeting criteria for BD II, currently depressed (n=92), were randomly assigned to receive IPSRT+placebo (IPSRT+P) or IPSRT+quetiapine (IPSRT+Q) and treated for 20 weeks. SI was assessed at baseline and weekly using the 17-item Hamilton Depression Rating Scale item 3. Multilevel logistic regression was used to model SI categorically. The results demonstrate a decrease in odds of SI over time (OR=0.8719, 95% CI, 0.8166-0.9309, ≤.001), with a 13% decrease in the odds of having SI for each additional week of treatment. There was no significant difference between those receiving IPSRT+P vs IPSRT+Q. IPSRT has the potential to mitigate suicidal ideation in patients with BD II depression, regardless of whether they receive medication in addition to IPSRT. IPSRT alone may be a reasonable option to treat SI in an outpatient setting for some patients with BD II, especially those for whom medication is contraindicated or who prefer avoiding medication. ClinicalTrials.gov identifier: NCT01133821.
To determine the prevalence of burnout among psychiatry residents, fellows, and attendings ("psychiatry doctors") prior to and following the COVID-19 pandemic. A systematic search of MEDLINE, Embase, PsycINFO, and PubMe...To determine the prevalence of burnout among psychiatry residents, fellows, and attendings ("psychiatry doctors") prior to and following the COVID-19 pandemic. A systematic search of MEDLINE, Embase, PsycINFO, and PubMed databases was performed to identify studies reporting the prevalence of burnout pre-COVID-19 (pre-March 2020) and post-COVID-19 (post March 2020). The search was limited to articles written in English and published in peer-reviewed journals from January 1, 2010, until June 27, 2024. There were 1,825 studies screened by 2 independent reviewers, with 36 eligible for inclusion. Observational studies and randomized controlled trials reporting the prevalence of burnout using validated tools were eligible for inclusion. Prevalence data were independently extracted by 2 authors and pooled using a random effects model. A subgroup analysis was performed, stratifying burnout by country income status. The prevalence of burnout was 37.5% (95% confidence interval [CI], 28.2-47.3; 25 studies; 12,524 psychiatry doctors) prior to the COVID-19 pandemic and 32.0% (95% CI, 18.6-47.0; 12 studies; 7,458 psychiatry doctors) following the COVID-19 pandemic. Almost 1 in 2 psychiatry doctors from middle-income countries reported burnout pre-COVID-19 (49.8% [95% CI, 34.5-65.1]; 3 studies), with no studies reporting the prevalence of burnout in low-income countries. There was significant heterogeneity between studies. Burnout among psychiatry doctors is common, affecting 1 in 3 both prior to and following the COVID-19 pandemic. Additional studies are needed from psychiatrists in low- and middle-income countries to better characterize the prevalence of burnout in this cohort.