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Psychiatric subspecialty is changing its name
Constantine G. Lyketsos, MD, remembers when the Academy of Psychosomatic Medicine held annual meetings that attracted 200. Now, the subspecialty organization’s meeting attracts about 1,000 people, and is getting a new name to reflect that growth.
“The field has grown substantially, and I think it will grow further with this name change,” said Dr. Lyketsos, who along with James L. Levenson, MD, spearheaded the effort to have the subspecialty recognized almost 20 years ago. “The field is the same. [But the] name change is going to change the way we are perceived by our primary customers – the patients. It will probably be a positive development for our trainees.”
The organization will be rebranded as the Academy of Consultation-Liaison Psychiatry. The name change, aimed in part at shedding the ambiguity around the word “psychosomatic” and better capturing the mission of consultation-liaison psychiatry, will be reflected across the group’s platforms. The tagline on the group’s journal, Psychosomatics, will become “The Journal of Consultation-Liaison Psychiatry,” and the theme of the group’s November 2018 annual meeting in Orlando will focus on the rebranding.
“I’m a consultation-liaison psychiatrist, and I think that clears the air from the very beginning,” said Dr. Lyketsos, professor and chair of psychiatry at Johns Hopkins Bayview in Baltimore.
Consultation-liaison psychiatrists work collaboratively with four groups of “complex medically ill” patients, Dr. Lyketsos, Dr. Levenson, and associates wrote a few years ago while advocating on behalf of the subspecialty. They treat patients with comorbid psychiatric and general medical illness; those with psychiatric illness directly tied to a primary medical condition, such as dementia or delirium; those with “complex illness behavior such as ‘somatoform’ disorders”; and those admitted to medical-surgical units after incidents such as attempted suicide. Consultation-liaison psychiatrists, who typically work in teaching hospitals, tend to provide services that are reactive – emergent or urgent (Eur J Psychiatry. 2006;20[3]:165-71).
Some think the field is limited to inpatient consultations, but it encompasses a “spectrum of physicians working at the interface between psychiatry and the other medical specialties, including many outpatient settings,” wrote Robert J. Boland, MD, academy President James R. Rundell, MD, and their associates (Psychosomatics. 2017. doi: 10.1016/j.psym.2017.11.006).
“Clinicians in consultation-liaison psychiatry face a wide breadth of conundrums and controversies in all areas of practice,” Dr. Rundell wrote in a recent newsletter. In addition to raising awareness among patients and medical-surgical colleagues, Dr. Rundell said, the academy hopes to educate other psychiatrists about the scope of consultation-liaison psychiatry.
The change will go into effect April 15.
Constantine G. Lyketsos, MD, remembers when the Academy of Psychosomatic Medicine held annual meetings that attracted 200. Now, the subspecialty organization’s meeting attracts about 1,000 people, and is getting a new name to reflect that growth.
“The field has grown substantially, and I think it will grow further with this name change,” said Dr. Lyketsos, who along with James L. Levenson, MD, spearheaded the effort to have the subspecialty recognized almost 20 years ago. “The field is the same. [But the] name change is going to change the way we are perceived by our primary customers – the patients. It will probably be a positive development for our trainees.”
The organization will be rebranded as the Academy of Consultation-Liaison Psychiatry. The name change, aimed in part at shedding the ambiguity around the word “psychosomatic” and better capturing the mission of consultation-liaison psychiatry, will be reflected across the group’s platforms. The tagline on the group’s journal, Psychosomatics, will become “The Journal of Consultation-Liaison Psychiatry,” and the theme of the group’s November 2018 annual meeting in Orlando will focus on the rebranding.
“I’m a consultation-liaison psychiatrist, and I think that clears the air from the very beginning,” said Dr. Lyketsos, professor and chair of psychiatry at Johns Hopkins Bayview in Baltimore.
Consultation-liaison psychiatrists work collaboratively with four groups of “complex medically ill” patients, Dr. Lyketsos, Dr. Levenson, and associates wrote a few years ago while advocating on behalf of the subspecialty. They treat patients with comorbid psychiatric and general medical illness; those with psychiatric illness directly tied to a primary medical condition, such as dementia or delirium; those with “complex illness behavior such as ‘somatoform’ disorders”; and those admitted to medical-surgical units after incidents such as attempted suicide. Consultation-liaison psychiatrists, who typically work in teaching hospitals, tend to provide services that are reactive – emergent or urgent (Eur J Psychiatry. 2006;20[3]:165-71).
Some think the field is limited to inpatient consultations, but it encompasses a “spectrum of physicians working at the interface between psychiatry and the other medical specialties, including many outpatient settings,” wrote Robert J. Boland, MD, academy President James R. Rundell, MD, and their associates (Psychosomatics. 2017. doi: 10.1016/j.psym.2017.11.006).
“Clinicians in consultation-liaison psychiatry face a wide breadth of conundrums and controversies in all areas of practice,” Dr. Rundell wrote in a recent newsletter. In addition to raising awareness among patients and medical-surgical colleagues, Dr. Rundell said, the academy hopes to educate other psychiatrists about the scope of consultation-liaison psychiatry.
The change will go into effect April 15.
Constantine G. Lyketsos, MD, remembers when the Academy of Psychosomatic Medicine held annual meetings that attracted 200. Now, the subspecialty organization’s meeting attracts about 1,000 people, and is getting a new name to reflect that growth.
“The field has grown substantially, and I think it will grow further with this name change,” said Dr. Lyketsos, who along with James L. Levenson, MD, spearheaded the effort to have the subspecialty recognized almost 20 years ago. “The field is the same. [But the] name change is going to change the way we are perceived by our primary customers – the patients. It will probably be a positive development for our trainees.”
The organization will be rebranded as the Academy of Consultation-Liaison Psychiatry. The name change, aimed in part at shedding the ambiguity around the word “psychosomatic” and better capturing the mission of consultation-liaison psychiatry, will be reflected across the group’s platforms. The tagline on the group’s journal, Psychosomatics, will become “The Journal of Consultation-Liaison Psychiatry,” and the theme of the group’s November 2018 annual meeting in Orlando will focus on the rebranding.
“I’m a consultation-liaison psychiatrist, and I think that clears the air from the very beginning,” said Dr. Lyketsos, professor and chair of psychiatry at Johns Hopkins Bayview in Baltimore.
Consultation-liaison psychiatrists work collaboratively with four groups of “complex medically ill” patients, Dr. Lyketsos, Dr. Levenson, and associates wrote a few years ago while advocating on behalf of the subspecialty. They treat patients with comorbid psychiatric and general medical illness; those with psychiatric illness directly tied to a primary medical condition, such as dementia or delirium; those with “complex illness behavior such as ‘somatoform’ disorders”; and those admitted to medical-surgical units after incidents such as attempted suicide. Consultation-liaison psychiatrists, who typically work in teaching hospitals, tend to provide services that are reactive – emergent or urgent (Eur J Psychiatry. 2006;20[3]:165-71).
Some think the field is limited to inpatient consultations, but it encompasses a “spectrum of physicians working at the interface between psychiatry and the other medical specialties, including many outpatient settings,” wrote Robert J. Boland, MD, academy President James R. Rundell, MD, and their associates (Psychosomatics. 2017. doi: 10.1016/j.psym.2017.11.006).
“Clinicians in consultation-liaison psychiatry face a wide breadth of conundrums and controversies in all areas of practice,” Dr. Rundell wrote in a recent newsletter. In addition to raising awareness among patients and medical-surgical colleagues, Dr. Rundell said, the academy hopes to educate other psychiatrists about the scope of consultation-liaison psychiatry.
The change will go into effect April 15.
Disrupted sleep tied to alexithymia
a pair of studies shows.
Alexithymia is a condition characterized by difficulty identifying and expressing one’s emotions. “The mechanism by which alexithymia confers risk of disrupted sleep remains unclear, [but] suggestions include increased nocturnal arousal as a result of poor verbalization of emotions and increased light sleep,” wrote Jennifer Murphy, citing previous research.
The researchers found associations between total alexithymia scores and reduced sleep quality (P less than .001). They also found a significant association between the TAS-20 subscales and reduced sleep quality (all P less than .006).
In the second study, in which 73 men and women participated, Ms. Murphy and her associates sought to determine whether the association found in the first study was tied to depression or anxiety. Participants went online and completed three questionnaires: the TAS-20; the PSQI; and the Depression, Anxiety, & Stress Scale, or DASS-21, in a randomized order. Higher scores on the DASS-21 correlate with greater levels of depression, anxiety, and stress. None of the questionnaires asked about any aspects of sleep.
Ms. Murphy said in an interview that although it might be too early to make a clear clinical recommendation, the results suggest that “clinicians should be aware of the possibility of sleep problems characterized by heightened alexithymia and more generally in those with alexithymia.”
Whilst further research is needed to confirm the direction of causality between disrupted sleep and alexithymia and how these subjective sleep reports in alexithymia map onto objectively measured sleep problems, these data suggest a link that is independent of depression and anxiety, she said.
Meanwhile, other researchers report that alexithymia is becoming more clinically relevant. Rising rates of alexithymia are being reported in psychiatric conditions such as autism, eating disorders, schizophrenia, and alcohol and substance abuse. The condition is also seen in neurologic conditions such as multiple sclerosis and traumatic brain injury (Neuropsychologica. 2018;11:229-40).
Ms. Murphy and her associates cited several limitations of their research. One is that they did not control for factors that affect sleep quality and alexithymia such as body composition. They also cited reports of discrepancies between objective and subjective measures – such as those made by self-report – and the relatively small sample sizes.
The research was supported by the Economic and Social Research Council and the Baily Thomas Charitable Trust. No conflicts of interest were reported.
SOURCE: Murphy J et al. Pers Individ Dif. 2018 Mar 27;129:175-8.
a pair of studies shows.
Alexithymia is a condition characterized by difficulty identifying and expressing one’s emotions. “The mechanism by which alexithymia confers risk of disrupted sleep remains unclear, [but] suggestions include increased nocturnal arousal as a result of poor verbalization of emotions and increased light sleep,” wrote Jennifer Murphy, citing previous research.
The researchers found associations between total alexithymia scores and reduced sleep quality (P less than .001). They also found a significant association between the TAS-20 subscales and reduced sleep quality (all P less than .006).
In the second study, in which 73 men and women participated, Ms. Murphy and her associates sought to determine whether the association found in the first study was tied to depression or anxiety. Participants went online and completed three questionnaires: the TAS-20; the PSQI; and the Depression, Anxiety, & Stress Scale, or DASS-21, in a randomized order. Higher scores on the DASS-21 correlate with greater levels of depression, anxiety, and stress. None of the questionnaires asked about any aspects of sleep.
Ms. Murphy said in an interview that although it might be too early to make a clear clinical recommendation, the results suggest that “clinicians should be aware of the possibility of sleep problems characterized by heightened alexithymia and more generally in those with alexithymia.”
Whilst further research is needed to confirm the direction of causality between disrupted sleep and alexithymia and how these subjective sleep reports in alexithymia map onto objectively measured sleep problems, these data suggest a link that is independent of depression and anxiety, she said.
Meanwhile, other researchers report that alexithymia is becoming more clinically relevant. Rising rates of alexithymia are being reported in psychiatric conditions such as autism, eating disorders, schizophrenia, and alcohol and substance abuse. The condition is also seen in neurologic conditions such as multiple sclerosis and traumatic brain injury (Neuropsychologica. 2018;11:229-40).
Ms. Murphy and her associates cited several limitations of their research. One is that they did not control for factors that affect sleep quality and alexithymia such as body composition. They also cited reports of discrepancies between objective and subjective measures – such as those made by self-report – and the relatively small sample sizes.
The research was supported by the Economic and Social Research Council and the Baily Thomas Charitable Trust. No conflicts of interest were reported.
SOURCE: Murphy J et al. Pers Individ Dif. 2018 Mar 27;129:175-8.
a pair of studies shows.
Alexithymia is a condition characterized by difficulty identifying and expressing one’s emotions. “The mechanism by which alexithymia confers risk of disrupted sleep remains unclear, [but] suggestions include increased nocturnal arousal as a result of poor verbalization of emotions and increased light sleep,” wrote Jennifer Murphy, citing previous research.
The researchers found associations between total alexithymia scores and reduced sleep quality (P less than .001). They also found a significant association between the TAS-20 subscales and reduced sleep quality (all P less than .006).
In the second study, in which 73 men and women participated, Ms. Murphy and her associates sought to determine whether the association found in the first study was tied to depression or anxiety. Participants went online and completed three questionnaires: the TAS-20; the PSQI; and the Depression, Anxiety, & Stress Scale, or DASS-21, in a randomized order. Higher scores on the DASS-21 correlate with greater levels of depression, anxiety, and stress. None of the questionnaires asked about any aspects of sleep.
Ms. Murphy said in an interview that although it might be too early to make a clear clinical recommendation, the results suggest that “clinicians should be aware of the possibility of sleep problems characterized by heightened alexithymia and more generally in those with alexithymia.”
Whilst further research is needed to confirm the direction of causality between disrupted sleep and alexithymia and how these subjective sleep reports in alexithymia map onto objectively measured sleep problems, these data suggest a link that is independent of depression and anxiety, she said.
Meanwhile, other researchers report that alexithymia is becoming more clinically relevant. Rising rates of alexithymia are being reported in psychiatric conditions such as autism, eating disorders, schizophrenia, and alcohol and substance abuse. The condition is also seen in neurologic conditions such as multiple sclerosis and traumatic brain injury (Neuropsychologica. 2018;11:229-40).
Ms. Murphy and her associates cited several limitations of their research. One is that they did not control for factors that affect sleep quality and alexithymia such as body composition. They also cited reports of discrepancies between objective and subjective measures – such as those made by self-report – and the relatively small sample sizes.
The research was supported by the Economic and Social Research Council and the Baily Thomas Charitable Trust. No conflicts of interest were reported.
SOURCE: Murphy J et al. Pers Individ Dif. 2018 Mar 27;129:175-8.
FROM PERSONALITY AND INDIVIDUAL DIFFERENCES
Early trauma exposure tied to telomere shortening in men with schizophrenia
Men with schizophrenia and healthy women who were exposed to childhood trauma have shorter leukocyte telomere length (LTL) than do their counterparts in both groups, a small study shows.
“This converse sex-association in schizophrenia compared to the healthy controls is yet another measure suggesting that the pathobiology of schizophrenia may lie, in part, in the mechanisms related to sexual differentiation,” wrote Gabriella Riley, MD, of the department of psychiatry at New York University, and her associates.
To conduct the study, Dr. Riley and her associates recruited 48 inpatients and outpatients with schizophrenia and schizoaffective disorders, as defined by the DSM-5, who were stabilized on medication. Eighteen controls were recruited from postings in the area and Internet recruitment efforts, the researchers reported (Schizophr Res. 2018. doi: 10.1016/j.schres.2018.02.059).
After analyzing the data, Dr. Riley and her associates found that the They also found larger correlations between LTL reductions among men with schizophrenia who had been exposed to early trauma but not in women with schizophrenia (–0.320 vs. 0.447) with such exposure. Conversely, larger correlations in LTL reductions were found among healthy women who had been exposed to early trauma, compared with the male controls (–0.275 vs. 0.688).
To read the full study, click here.
Men with schizophrenia and healthy women who were exposed to childhood trauma have shorter leukocyte telomere length (LTL) than do their counterparts in both groups, a small study shows.
“This converse sex-association in schizophrenia compared to the healthy controls is yet another measure suggesting that the pathobiology of schizophrenia may lie, in part, in the mechanisms related to sexual differentiation,” wrote Gabriella Riley, MD, of the department of psychiatry at New York University, and her associates.
To conduct the study, Dr. Riley and her associates recruited 48 inpatients and outpatients with schizophrenia and schizoaffective disorders, as defined by the DSM-5, who were stabilized on medication. Eighteen controls were recruited from postings in the area and Internet recruitment efforts, the researchers reported (Schizophr Res. 2018. doi: 10.1016/j.schres.2018.02.059).
After analyzing the data, Dr. Riley and her associates found that the They also found larger correlations between LTL reductions among men with schizophrenia who had been exposed to early trauma but not in women with schizophrenia (–0.320 vs. 0.447) with such exposure. Conversely, larger correlations in LTL reductions were found among healthy women who had been exposed to early trauma, compared with the male controls (–0.275 vs. 0.688).
To read the full study, click here.
Men with schizophrenia and healthy women who were exposed to childhood trauma have shorter leukocyte telomere length (LTL) than do their counterparts in both groups, a small study shows.
“This converse sex-association in schizophrenia compared to the healthy controls is yet another measure suggesting that the pathobiology of schizophrenia may lie, in part, in the mechanisms related to sexual differentiation,” wrote Gabriella Riley, MD, of the department of psychiatry at New York University, and her associates.
To conduct the study, Dr. Riley and her associates recruited 48 inpatients and outpatients with schizophrenia and schizoaffective disorders, as defined by the DSM-5, who were stabilized on medication. Eighteen controls were recruited from postings in the area and Internet recruitment efforts, the researchers reported (Schizophr Res. 2018. doi: 10.1016/j.schres.2018.02.059).
After analyzing the data, Dr. Riley and her associates found that the They also found larger correlations between LTL reductions among men with schizophrenia who had been exposed to early trauma but not in women with schizophrenia (–0.320 vs. 0.447) with such exposure. Conversely, larger correlations in LTL reductions were found among healthy women who had been exposed to early trauma, compared with the male controls (–0.275 vs. 0.688).
To read the full study, click here.
FROM SCHIZOPHRENIA RESEARCH
Lurasidone approved for bipolar I depression for children aged 10-17
The Food and Drug Administration has approved lurasidone HCI (Latuda) for treating bipolar I depression in children and adolescents, according to a March 6 statement from the drug’s manufacturer.
“We know that children who have been diagnosed with bipolar depression can be at risk for poor school performance and impairments in social functioning,” said Robert L. Findling, MD, professor of psychiatry and behavioral sciences at Johns Hopkins University, Baltimore, in the statement.
Approval of the atypical antipsychotic is based on results of a 6-week, randomized placebo-controlled phase 3 study of 347 children and adolescents diagnosed with bipolar I depression. Patients received either 20-80 mg/day of lurasidone or placebo.
Patients who received lurasidone reportedly experienced improved bipolar depression symptoms, compared with placebo, based on “the primary efficacy endpoint of change from baseline to week 6 on the Children’s Depression Rating Scale–Revised total score (–21.0 vs. –15.3; effect size = 0.45; P less than .0001),” the statement said. Clinically relevant changes also were found among patients who took the medication on other measures, including the Clinical Global Impressions-Bipolar Scale.
The most common adverse effects were nausea (16% vs. 5.8%), weight gain (6.9% vs. 1.7%), and insomnia (5.1% vs. 2.3%).
Lurasidone also has been approved for treating schizophrenia and bipolar I depression in adults. Last year, the drug was approved for treating schizophrenia in adolescents.
The Food and Drug Administration has approved lurasidone HCI (Latuda) for treating bipolar I depression in children and adolescents, according to a March 6 statement from the drug’s manufacturer.
“We know that children who have been diagnosed with bipolar depression can be at risk for poor school performance and impairments in social functioning,” said Robert L. Findling, MD, professor of psychiatry and behavioral sciences at Johns Hopkins University, Baltimore, in the statement.
Approval of the atypical antipsychotic is based on results of a 6-week, randomized placebo-controlled phase 3 study of 347 children and adolescents diagnosed with bipolar I depression. Patients received either 20-80 mg/day of lurasidone or placebo.
Patients who received lurasidone reportedly experienced improved bipolar depression symptoms, compared with placebo, based on “the primary efficacy endpoint of change from baseline to week 6 on the Children’s Depression Rating Scale–Revised total score (–21.0 vs. –15.3; effect size = 0.45; P less than .0001),” the statement said. Clinically relevant changes also were found among patients who took the medication on other measures, including the Clinical Global Impressions-Bipolar Scale.
The most common adverse effects were nausea (16% vs. 5.8%), weight gain (6.9% vs. 1.7%), and insomnia (5.1% vs. 2.3%).
Lurasidone also has been approved for treating schizophrenia and bipolar I depression in adults. Last year, the drug was approved for treating schizophrenia in adolescents.
The Food and Drug Administration has approved lurasidone HCI (Latuda) for treating bipolar I depression in children and adolescents, according to a March 6 statement from the drug’s manufacturer.
“We know that children who have been diagnosed with bipolar depression can be at risk for poor school performance and impairments in social functioning,” said Robert L. Findling, MD, professor of psychiatry and behavioral sciences at Johns Hopkins University, Baltimore, in the statement.
Approval of the atypical antipsychotic is based on results of a 6-week, randomized placebo-controlled phase 3 study of 347 children and adolescents diagnosed with bipolar I depression. Patients received either 20-80 mg/day of lurasidone or placebo.
Patients who received lurasidone reportedly experienced improved bipolar depression symptoms, compared with placebo, based on “the primary efficacy endpoint of change from baseline to week 6 on the Children’s Depression Rating Scale–Revised total score (–21.0 vs. –15.3; effect size = 0.45; P less than .0001),” the statement said. Clinically relevant changes also were found among patients who took the medication on other measures, including the Clinical Global Impressions-Bipolar Scale.
The most common adverse effects were nausea (16% vs. 5.8%), weight gain (6.9% vs. 1.7%), and insomnia (5.1% vs. 2.3%).
Lurasidone also has been approved for treating schizophrenia and bipolar I depression in adults. Last year, the drug was approved for treating schizophrenia in adolescents.
Schizophrenia and gender: Do neurosteroids account for differences?
Neurosteroids may be tied to the gender differences found in the susceptibility to schizophrenia, a cross-sectional, case control study showed.
“These findings suggest that neurosteroids are involved in the pathophysiology of schizophrenia in male patients but not so much in female patients,” reported Yu-Chi Huang, MD, of the department of psychiatry at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, and associates.
To conduct the study, the researchers recruited 65 patients with schizophrenia from an outpatient department and psychiatry ward of the hospital. Eligible patients were aged 18-65 years, diagnosed with schizophrenia as defined by the DSM-IV-TR, and taking a stable dose of antipsychotics for at least 1 month before the start of the study. In addition, the participants could have no history of major physical illnesses and had to be of ethnic Han Chinese origin. Thirty-six of the patients were men.
The control group was made up of 103 healthy hospital staff and community members who were within the same age range as the patients. The controls could have no history of illicit drug use, physical illnesses, or psychiatric disorders and had to be ethnic Han Chinese. Forty-seven members of the control group were males (Psychoneuroendocrinology. 2017 Oct;84:87-93).
Participants fasted and blood samples were obtained. Dehydroepiandrosterone (DHEA) levels were measured using the DHEA ELISA [enyme-linked immunosorbent assay] – ADKI-900-093, dehydroepiandrosterone sulfate (DHEAS) levels were measured with the Architect DHEA-S reagent kit, and pregnenolone levels were measured using the pregnenolone ELISA kit. Psychiatric diagnoses were assessed for both groups using a psychiatric interview based on the Mini-International Neuropsychiatric Interview, the Positive and Negative Syndrome Scale (PANSS), and the 17-item Hamilton Depression Rating Scale. Several factors tied to schizophrenia were evaluated, including the age of onset, illness duration, and use of antipsychotics. The numbers were placed into a database and analyzed.
After controlling for age and body mass index, the researchers found that in male patients with schizophrenia, DHEA and DHEAS serum levels were positively associated with the age of onset of schizophrenia (P less than .05) and negatively associated with the duration of illness (P less than .05). (P less than .05 ). Furthermore, the levels of DHEA, DHEAS, and pregnenolone were lower among the male schizophrenia patients, compared with the serum levels of the healthy male controls. No differences were found in serum levels among the female patients with schizophrenia and the healthy controls.
The findings suggest that DHEA, DHEAS, and pregnenolone could be markers of the duration of illness and the severity of general symptoms among male patients with schizophrenia. To read the entire study, click here.
Neurosteroids may be tied to the gender differences found in the susceptibility to schizophrenia, a cross-sectional, case control study showed.
“These findings suggest that neurosteroids are involved in the pathophysiology of schizophrenia in male patients but not so much in female patients,” reported Yu-Chi Huang, MD, of the department of psychiatry at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, and associates.
To conduct the study, the researchers recruited 65 patients with schizophrenia from an outpatient department and psychiatry ward of the hospital. Eligible patients were aged 18-65 years, diagnosed with schizophrenia as defined by the DSM-IV-TR, and taking a stable dose of antipsychotics for at least 1 month before the start of the study. In addition, the participants could have no history of major physical illnesses and had to be of ethnic Han Chinese origin. Thirty-six of the patients were men.
The control group was made up of 103 healthy hospital staff and community members who were within the same age range as the patients. The controls could have no history of illicit drug use, physical illnesses, or psychiatric disorders and had to be ethnic Han Chinese. Forty-seven members of the control group were males (Psychoneuroendocrinology. 2017 Oct;84:87-93).
Participants fasted and blood samples were obtained. Dehydroepiandrosterone (DHEA) levels were measured using the DHEA ELISA [enyme-linked immunosorbent assay] – ADKI-900-093, dehydroepiandrosterone sulfate (DHEAS) levels were measured with the Architect DHEA-S reagent kit, and pregnenolone levels were measured using the pregnenolone ELISA kit. Psychiatric diagnoses were assessed for both groups using a psychiatric interview based on the Mini-International Neuropsychiatric Interview, the Positive and Negative Syndrome Scale (PANSS), and the 17-item Hamilton Depression Rating Scale. Several factors tied to schizophrenia were evaluated, including the age of onset, illness duration, and use of antipsychotics. The numbers were placed into a database and analyzed.
After controlling for age and body mass index, the researchers found that in male patients with schizophrenia, DHEA and DHEAS serum levels were positively associated with the age of onset of schizophrenia (P less than .05) and negatively associated with the duration of illness (P less than .05). (P less than .05 ). Furthermore, the levels of DHEA, DHEAS, and pregnenolone were lower among the male schizophrenia patients, compared with the serum levels of the healthy male controls. No differences were found in serum levels among the female patients with schizophrenia and the healthy controls.
The findings suggest that DHEA, DHEAS, and pregnenolone could be markers of the duration of illness and the severity of general symptoms among male patients with schizophrenia. To read the entire study, click here.
Neurosteroids may be tied to the gender differences found in the susceptibility to schizophrenia, a cross-sectional, case control study showed.
“These findings suggest that neurosteroids are involved in the pathophysiology of schizophrenia in male patients but not so much in female patients,” reported Yu-Chi Huang, MD, of the department of psychiatry at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan, and associates.
To conduct the study, the researchers recruited 65 patients with schizophrenia from an outpatient department and psychiatry ward of the hospital. Eligible patients were aged 18-65 years, diagnosed with schizophrenia as defined by the DSM-IV-TR, and taking a stable dose of antipsychotics for at least 1 month before the start of the study. In addition, the participants could have no history of major physical illnesses and had to be of ethnic Han Chinese origin. Thirty-six of the patients were men.
The control group was made up of 103 healthy hospital staff and community members who were within the same age range as the patients. The controls could have no history of illicit drug use, physical illnesses, or psychiatric disorders and had to be ethnic Han Chinese. Forty-seven members of the control group were males (Psychoneuroendocrinology. 2017 Oct;84:87-93).
Participants fasted and blood samples were obtained. Dehydroepiandrosterone (DHEA) levels were measured using the DHEA ELISA [enyme-linked immunosorbent assay] – ADKI-900-093, dehydroepiandrosterone sulfate (DHEAS) levels were measured with the Architect DHEA-S reagent kit, and pregnenolone levels were measured using the pregnenolone ELISA kit. Psychiatric diagnoses were assessed for both groups using a psychiatric interview based on the Mini-International Neuropsychiatric Interview, the Positive and Negative Syndrome Scale (PANSS), and the 17-item Hamilton Depression Rating Scale. Several factors tied to schizophrenia were evaluated, including the age of onset, illness duration, and use of antipsychotics. The numbers were placed into a database and analyzed.
After controlling for age and body mass index, the researchers found that in male patients with schizophrenia, DHEA and DHEAS serum levels were positively associated with the age of onset of schizophrenia (P less than .05) and negatively associated with the duration of illness (P less than .05). (P less than .05 ). Furthermore, the levels of DHEA, DHEAS, and pregnenolone were lower among the male schizophrenia patients, compared with the serum levels of the healthy male controls. No differences were found in serum levels among the female patients with schizophrenia and the healthy controls.
The findings suggest that DHEA, DHEAS, and pregnenolone could be markers of the duration of illness and the severity of general symptoms among male patients with schizophrenia. To read the entire study, click here.
FROM PSYCHONEUROENDOCRINOLOGY
More evidence backs adjunctive intranasal esketamine for refractory depression
Esketamine – the S-enantiomer of the anesthetic ketamine – continues to look promising as an adjunctive treatment for refractory depression, phase 2 results of a four-phase multicenter trial suggested.
“We observed a significant and clinically meaningful treatment effect (vs. placebo) with 28-mg, 56-mg, and 84-mg doses of esketamine,” reported Ella J. Daly, MD, of Janssen, and her associates. The results were apparent 1 week after treatment, and they persisted over the follow-up phase, which lasted 8 weeks.
“,” Dr. Daly and her associates wrote in JAMA Psychiatry (2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3739).
In the study, patients aged 20-64 years with a diagnosis of major depressive disorder were recruited from several outpatient referral centers. All of the participants had treatment-resistant depression, defined by the study as an inadequate response despite the use of two or more antidepressants. Overall, 67 patients were randomized to receive one of the three doses of intranasal esketamine or a placebo nasal spray. In addition, participants continued to take oral antidepressants during the study period. People with a history of psychotic symptoms, use of substances such as alcohol and cannabis, or significant medical comorbidities were excluded.
Among participants in the treatment groups, the mean total score changes on the Montgomery-Åsberg Depression Rating Scale (MADRS) surpassed the MADRS score changes among those on placebo. Specifically, the mean MADRS score change for those on the 28-mg dose was –4.2 (P = 0.2), on the 56-mg dose was –6.3 (P = .001), and on the 84-mg dose was –9 (P less than .001).
The most common side effects among participants treated with esketamine were dizziness, headache, and dissociative symptoms. However, most adverse events were transient and “either mild or moderate in severity,” the investigators reported.
Dr. Daly and her associates cited several limitations, including the small sample size and the study’s exclusion criteria. Despite those limitations, Dr. Daly and her associates said, the results support further investigation of intranasal esketamine for treatment-resistant depression. They said a phase 3 study aimed at evaluating the frequency needed for dosing and duration of effect is underway.
Janssen funded the study. Dr. Daly and several of the other investigators are Janssen employees.
SOURCE: Daly et al. JAMA Psychiatry. 2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3739
The study by Daly et al. is of interest for two key reasons, wrote Daniel S. Quintana, PhD, and his associates in an accompanying editorial (JAMA Psychiatry. 2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3738). First, of interest is the drug’s impact on depressive symptoms as measured on the Montgomery-Åsberg Depression Rating Scale. Second, the delivery mechanism is of interest, particularly in light of the increased bioavailability made possible by intranasal delivery. However, esketamine should be used with caution for psychiatric patients, he said.
“One of the three most common adverse effects was perceptual changes or dissociative symptoms, which fits with the known effect of ketamine and should be further clarified before starting routine in clinical practice,” he wrote. “Moreover, several issues related to long-term use, including the potential for addiction and adverse effects (somatic and cognitive) need to be carefully assessed in forthcoming studies.”
Dr. Quintana is affiliated with Oslo University Hospital & Institute of Clinical Medicine at the University of Oslo.
The study by Daly et al. is of interest for two key reasons, wrote Daniel S. Quintana, PhD, and his associates in an accompanying editorial (JAMA Psychiatry. 2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3738). First, of interest is the drug’s impact on depressive symptoms as measured on the Montgomery-Åsberg Depression Rating Scale. Second, the delivery mechanism is of interest, particularly in light of the increased bioavailability made possible by intranasal delivery. However, esketamine should be used with caution for psychiatric patients, he said.
“One of the three most common adverse effects was perceptual changes or dissociative symptoms, which fits with the known effect of ketamine and should be further clarified before starting routine in clinical practice,” he wrote. “Moreover, several issues related to long-term use, including the potential for addiction and adverse effects (somatic and cognitive) need to be carefully assessed in forthcoming studies.”
Dr. Quintana is affiliated with Oslo University Hospital & Institute of Clinical Medicine at the University of Oslo.
The study by Daly et al. is of interest for two key reasons, wrote Daniel S. Quintana, PhD, and his associates in an accompanying editorial (JAMA Psychiatry. 2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3738). First, of interest is the drug’s impact on depressive symptoms as measured on the Montgomery-Åsberg Depression Rating Scale. Second, the delivery mechanism is of interest, particularly in light of the increased bioavailability made possible by intranasal delivery. However, esketamine should be used with caution for psychiatric patients, he said.
“One of the three most common adverse effects was perceptual changes or dissociative symptoms, which fits with the known effect of ketamine and should be further clarified before starting routine in clinical practice,” he wrote. “Moreover, several issues related to long-term use, including the potential for addiction and adverse effects (somatic and cognitive) need to be carefully assessed in forthcoming studies.”
Dr. Quintana is affiliated with Oslo University Hospital & Institute of Clinical Medicine at the University of Oslo.
Esketamine – the S-enantiomer of the anesthetic ketamine – continues to look promising as an adjunctive treatment for refractory depression, phase 2 results of a four-phase multicenter trial suggested.
“We observed a significant and clinically meaningful treatment effect (vs. placebo) with 28-mg, 56-mg, and 84-mg doses of esketamine,” reported Ella J. Daly, MD, of Janssen, and her associates. The results were apparent 1 week after treatment, and they persisted over the follow-up phase, which lasted 8 weeks.
“,” Dr. Daly and her associates wrote in JAMA Psychiatry (2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3739).
In the study, patients aged 20-64 years with a diagnosis of major depressive disorder were recruited from several outpatient referral centers. All of the participants had treatment-resistant depression, defined by the study as an inadequate response despite the use of two or more antidepressants. Overall, 67 patients were randomized to receive one of the three doses of intranasal esketamine or a placebo nasal spray. In addition, participants continued to take oral antidepressants during the study period. People with a history of psychotic symptoms, use of substances such as alcohol and cannabis, or significant medical comorbidities were excluded.
Among participants in the treatment groups, the mean total score changes on the Montgomery-Åsberg Depression Rating Scale (MADRS) surpassed the MADRS score changes among those on placebo. Specifically, the mean MADRS score change for those on the 28-mg dose was –4.2 (P = 0.2), on the 56-mg dose was –6.3 (P = .001), and on the 84-mg dose was –9 (P less than .001).
The most common side effects among participants treated with esketamine were dizziness, headache, and dissociative symptoms. However, most adverse events were transient and “either mild or moderate in severity,” the investigators reported.
Dr. Daly and her associates cited several limitations, including the small sample size and the study’s exclusion criteria. Despite those limitations, Dr. Daly and her associates said, the results support further investigation of intranasal esketamine for treatment-resistant depression. They said a phase 3 study aimed at evaluating the frequency needed for dosing and duration of effect is underway.
Janssen funded the study. Dr. Daly and several of the other investigators are Janssen employees.
SOURCE: Daly et al. JAMA Psychiatry. 2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3739
Esketamine – the S-enantiomer of the anesthetic ketamine – continues to look promising as an adjunctive treatment for refractory depression, phase 2 results of a four-phase multicenter trial suggested.
“We observed a significant and clinically meaningful treatment effect (vs. placebo) with 28-mg, 56-mg, and 84-mg doses of esketamine,” reported Ella J. Daly, MD, of Janssen, and her associates. The results were apparent 1 week after treatment, and they persisted over the follow-up phase, which lasted 8 weeks.
“,” Dr. Daly and her associates wrote in JAMA Psychiatry (2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3739).
In the study, patients aged 20-64 years with a diagnosis of major depressive disorder were recruited from several outpatient referral centers. All of the participants had treatment-resistant depression, defined by the study as an inadequate response despite the use of two or more antidepressants. Overall, 67 patients were randomized to receive one of the three doses of intranasal esketamine or a placebo nasal spray. In addition, participants continued to take oral antidepressants during the study period. People with a history of psychotic symptoms, use of substances such as alcohol and cannabis, or significant medical comorbidities were excluded.
Among participants in the treatment groups, the mean total score changes on the Montgomery-Åsberg Depression Rating Scale (MADRS) surpassed the MADRS score changes among those on placebo. Specifically, the mean MADRS score change for those on the 28-mg dose was –4.2 (P = 0.2), on the 56-mg dose was –6.3 (P = .001), and on the 84-mg dose was –9 (P less than .001).
The most common side effects among participants treated with esketamine were dizziness, headache, and dissociative symptoms. However, most adverse events were transient and “either mild or moderate in severity,” the investigators reported.
Dr. Daly and her associates cited several limitations, including the small sample size and the study’s exclusion criteria. Despite those limitations, Dr. Daly and her associates said, the results support further investigation of intranasal esketamine for treatment-resistant depression. They said a phase 3 study aimed at evaluating the frequency needed for dosing and duration of effect is underway.
Janssen funded the study. Dr. Daly and several of the other investigators are Janssen employees.
SOURCE: Daly et al. JAMA Psychiatry. 2017 Dec 27. doi: 10.1001/jamapsychiatry.2017.3739
FROM JAMA PSYCHIATRY
Key clinical point: Adjunctive intranasal esketamine appears to lift treatment-resistant depression symptoms quickly, and the results last for more than 2 months “with a lower dosing frequency.”
Major finding: The MADRS mean score change for participants on the 28-mg dose was –4.2 (P = .2), –6.3 (P = .001) for those on the 56-mg dose, and –.9.0 (P greater than .001) for those on the 84-mg dose.
Study details: A phase 2 placebo-controlled study of 67 participants with treatment-resistant depression conducted in four phases at several outpatient treatment centers.
Disclosures: Janssen funded the study, and Dr. Daly and several of the other investigators are Janssen employees.
Source: Daly et al. JAMA Psychiatry. 2017 Dec. 27. doi: 10.1001/jamapsychiatry.2017.3739.
Fat shaming interferes with patients’ medical care, experts say
WASHINGTON – Stereotypical views held by physicians, psychologists, nurses, and other medical professionals about overweight and obese patients need to change, panelists said at the annual convention of the American Psychological Association.
“We have a lot of negative attitudes toward heavy-weight people. Judging patients as too big or too fat produces physical and mental health effects,” said Joan C. Chrisler, PhD, the Class of ’43 Professor of Psychology at Connecticut College, New London. “Shame and disrespectful treatment can lead to delay in seeking health care, reluctance to return visits, or lower trust in the providers and their recommendations.”
A study of more than 300 autopsy reports showed that obese patients were 1.65 times more likely than normal weight and underweight groups combined were to have medical conditions such as endocarditis, ischemic bowel disease, and lung cancer that were not diagnosed, Dr. Chrisler said in a press release (Am J Clin Pathol. 2006 Jan;125[1]:127-31).
In addition to preventing patients from seeking care, Dr. Chrisler said in the release, unfamiliarity with the dosing adjustments sometimes required on medications based on the body mass index of patients affects the quality of care. She cited a retrospective study showing that emergency physicians frequently underdose common antibiotics in the emergency department (Am J Emerg Med. 2012 Sep;30[7]:1212-4).
“People aren’t born repulsed by fat people,” said Dr. McHugh, professor of psychology at Indiana University of Pennsylvania. “Fat hate is learned within the family.”
They encouraged more sensitivity from medical professionals when it comes to treating overweight and obese patients, such as providing changing gowns of different sizes in examination rooms and weighing patients in private areas of the medical office.
Dr. Chrisler and Dr. McHugh said weight stigma should be addressed in medicine and psychology through training and research, and in working with patients who are obese. “Treatments should focus on mental and physical health as the desired outcomes for therapy rather than weight,” Dr. McHugh said.
Dr. Chrisler, coauthor of a recent article on sizeism (Fat Studies. 2017 Aug;6[1]:38-53), had no disclosures. Dr. McHugh also had no disclosures.
Obesity is a major modifiable cause of diseases of the digestive tract that routinely goes unaddressed. The AGA Obesity Practice Guide was created to support gastroenterologists leading a care team to help patients with obesity achieve a healthy weight. The AGA Obesity Practice Guide provides a comprehensive, multi-disciplinary process to personalize innovative obesity care for safe and effective weight management. Learn more at www.gastro.org/obesity.
[email protected]
On Twitter @ginalhenderson
WASHINGTON – Stereotypical views held by physicians, psychologists, nurses, and other medical professionals about overweight and obese patients need to change, panelists said at the annual convention of the American Psychological Association.
“We have a lot of negative attitudes toward heavy-weight people. Judging patients as too big or too fat produces physical and mental health effects,” said Joan C. Chrisler, PhD, the Class of ’43 Professor of Psychology at Connecticut College, New London. “Shame and disrespectful treatment can lead to delay in seeking health care, reluctance to return visits, or lower trust in the providers and their recommendations.”
A study of more than 300 autopsy reports showed that obese patients were 1.65 times more likely than normal weight and underweight groups combined were to have medical conditions such as endocarditis, ischemic bowel disease, and lung cancer that were not diagnosed, Dr. Chrisler said in a press release (Am J Clin Pathol. 2006 Jan;125[1]:127-31).
In addition to preventing patients from seeking care, Dr. Chrisler said in the release, unfamiliarity with the dosing adjustments sometimes required on medications based on the body mass index of patients affects the quality of care. She cited a retrospective study showing that emergency physicians frequently underdose common antibiotics in the emergency department (Am J Emerg Med. 2012 Sep;30[7]:1212-4).
“People aren’t born repulsed by fat people,” said Dr. McHugh, professor of psychology at Indiana University of Pennsylvania. “Fat hate is learned within the family.”
They encouraged more sensitivity from medical professionals when it comes to treating overweight and obese patients, such as providing changing gowns of different sizes in examination rooms and weighing patients in private areas of the medical office.
Dr. Chrisler and Dr. McHugh said weight stigma should be addressed in medicine and psychology through training and research, and in working with patients who are obese. “Treatments should focus on mental and physical health as the desired outcomes for therapy rather than weight,” Dr. McHugh said.
Dr. Chrisler, coauthor of a recent article on sizeism (Fat Studies. 2017 Aug;6[1]:38-53), had no disclosures. Dr. McHugh also had no disclosures.
Obesity is a major modifiable cause of diseases of the digestive tract that routinely goes unaddressed. The AGA Obesity Practice Guide was created to support gastroenterologists leading a care team to help patients with obesity achieve a healthy weight. The AGA Obesity Practice Guide provides a comprehensive, multi-disciplinary process to personalize innovative obesity care for safe and effective weight management. Learn more at www.gastro.org/obesity.
[email protected]
On Twitter @ginalhenderson
WASHINGTON – Stereotypical views held by physicians, psychologists, nurses, and other medical professionals about overweight and obese patients need to change, panelists said at the annual convention of the American Psychological Association.
“We have a lot of negative attitudes toward heavy-weight people. Judging patients as too big or too fat produces physical and mental health effects,” said Joan C. Chrisler, PhD, the Class of ’43 Professor of Psychology at Connecticut College, New London. “Shame and disrespectful treatment can lead to delay in seeking health care, reluctance to return visits, or lower trust in the providers and their recommendations.”
A study of more than 300 autopsy reports showed that obese patients were 1.65 times more likely than normal weight and underweight groups combined were to have medical conditions such as endocarditis, ischemic bowel disease, and lung cancer that were not diagnosed, Dr. Chrisler said in a press release (Am J Clin Pathol. 2006 Jan;125[1]:127-31).
In addition to preventing patients from seeking care, Dr. Chrisler said in the release, unfamiliarity with the dosing adjustments sometimes required on medications based on the body mass index of patients affects the quality of care. She cited a retrospective study showing that emergency physicians frequently underdose common antibiotics in the emergency department (Am J Emerg Med. 2012 Sep;30[7]:1212-4).
“People aren’t born repulsed by fat people,” said Dr. McHugh, professor of psychology at Indiana University of Pennsylvania. “Fat hate is learned within the family.”
They encouraged more sensitivity from medical professionals when it comes to treating overweight and obese patients, such as providing changing gowns of different sizes in examination rooms and weighing patients in private areas of the medical office.
Dr. Chrisler and Dr. McHugh said weight stigma should be addressed in medicine and psychology through training and research, and in working with patients who are obese. “Treatments should focus on mental and physical health as the desired outcomes for therapy rather than weight,” Dr. McHugh said.
Dr. Chrisler, coauthor of a recent article on sizeism (Fat Studies. 2017 Aug;6[1]:38-53), had no disclosures. Dr. McHugh also had no disclosures.
Obesity is a major modifiable cause of diseases of the digestive tract that routinely goes unaddressed. The AGA Obesity Practice Guide was created to support gastroenterologists leading a care team to help patients with obesity achieve a healthy weight. The AGA Obesity Practice Guide provides a comprehensive, multi-disciplinary process to personalize innovative obesity care for safe and effective weight management. Learn more at www.gastro.org/obesity.
[email protected]
On Twitter @ginalhenderson
EXPERT ANALYSIS FROM THE 2017 APA CONVENTION
Tips for avoiding potentially dangerous patients
WASHINGTON – Clinicians who treat patients with emotional and psychiatric problems must put risk management interventions in place for their safety, Jeffrey N. Younggren, PhD, said at the annual convention of the American Psychological Association.
“Many times, people lose sight of the nature of their therapeutic relationship,” said Dr. Younggren, professor of psychology at the University of Missouri in Columbia. To stay safe, clinicians must overreact, he said, just as they do with suicide risk assessments.
Dr. Younggren critiqued an American Psychological Association article on safety and offered his own recommendations. Among them:
- Think about evacuation strategies. “Don’t get between that individual and the door,” said Dr. Younggren, a clinical and forensic psychologist.
- Refuse to see patients who are inebriated or intoxicated. If such a patient shows up for an appointment in one of these conditions and refuses to leave, call the police.
- Remove yourself from physical danger. “I’m a very good ‘fall on the ground’ person,” said Dr. Younggren, who said he has been attacked by patients three times in his career. “That’s a risk management strategy.”
- Terminate patients appropriately in the absence of threats. However, “if someone threatens you, write them a letter, and you’re done,” he said.
Dr. Younggren suggested that other recommendations in the article were unrealistic, such as, don’t work alone at night, install security cameras, and learn self-defense techniques. “What does [learn self-defense techniques] mean,” he asked. “My best one is to fall down.”
Mismanagement of the therapeutic alliance can careen out of control, as it did in the case of Ensworth vs. Mullvain.
In that case, decided in 1990, Heather Ensworth, PhD, a psychologist who practiced in California, treated a patient named Cynthia Mullvain for just short of 2 years and then terminated the treatment. But Ms. Mullvain did not accept the termination and persuaded Dr. Ensworth to see her again “to resolve the termination issues to help [Mullvain] disengage from [Ensworth].”
After several harassing incidents, Dr. Ensworth terminated contact with Ms. Mullvain a second time. At this point, Dr. Ensworth sought and was granted a restraining order against the patient. Despite the restraining order, Ms. Mullvain’s harassing behavior continued. Among other things, she stalked Dr. Ensworth, sent her threatening letters, and started doing community service work at a library located about 150 feet away from Dr. Ensworth’s home, according to Dr. Ensworth’s petition seeking a second restraining order. Ultimately, the court ruled that Ms. Mullvain had “willfully engaged in a course of conduct that seriously alarmed, annoyed, or harassed Ensworth, and that Ensworth actually suffered substantial emotional distress.”
Ernest J. Bordini, PhD said that, beyond private offices, nurses and aides are at greatest risk when it comes to workplace violence. According to a report by the Occupational Health and Safety Administration (OSHA), in 2013, psychiatric aides had the highest rate among health care workers of violent injuries that led to days away from work: 590 per 10,000 full-time employees, compared with 55 such injuries per 10,000 for nursing assistants. The report said the highest risk areas were emergency departments, geriatrics, and behavioral health.
Psychiatric patients are more likely to be the victims of violence than perpetrators, but Dr. Bordini, a neuropsychologist with expertise in forensic assessment, said in an interview that he wanted to add a point.
“It is important to dismiss the notion that all psychiatric patients do not have elevated risks of assault,” he said. “Those who present with psychoses or bipolar disorder can have elevated risk, especially if they develop delusional thoughts or obsessions about the therapist or another individual. Paranoid individuals already feel threatened, and hence can strike out in anticipation.”
He said he and his colleagues are not advocating that all clinicians train in self defense or arm themselves. However, it is essential to be proactive. Falling down can work for some, Dr. Bordini said, but “experience teaches us that playing possum does not always cease an attack. I recommend de-escalation, escape, and/or self-defense plans that one has practiced, feels comfortable with, and feels confident that they can execute under stress.”
At the meeting, he said some patients are able to sense fear from the clinician. “If you’re skittish, [this will] put you at higher risk,” said Dr. Bordini, executive director of Clinical Psychology Associates of North Central Florida in Gainesville. “That sense of intuition is something you should tend to,” he said, citing The Gift of Fear (New York: Dell, 1999) by Gavin de Becker as an example of a book that explores recognizing and reacting to subtle signs of danger. “If you’re not comfortable seeing a patient, listen to that.”
Neither Dr. Younggren nor Dr. Bordini had financial disclosures.
To access OSHA’s guidelines for workplace violence in health care settings, visit https://www.osha.gov/Publications/OSHA3826.pdf. The American Medical Association’s latest policy on workplace violence can be found at https://www.ama-assn.org/ama-adopts-new-public-health-policies-improve-health-nation.
[email protected]
On Twitter @ginalhenderson
WASHINGTON – Clinicians who treat patients with emotional and psychiatric problems must put risk management interventions in place for their safety, Jeffrey N. Younggren, PhD, said at the annual convention of the American Psychological Association.
“Many times, people lose sight of the nature of their therapeutic relationship,” said Dr. Younggren, professor of psychology at the University of Missouri in Columbia. To stay safe, clinicians must overreact, he said, just as they do with suicide risk assessments.
Dr. Younggren critiqued an American Psychological Association article on safety and offered his own recommendations. Among them:
- Think about evacuation strategies. “Don’t get between that individual and the door,” said Dr. Younggren, a clinical and forensic psychologist.
- Refuse to see patients who are inebriated or intoxicated. If such a patient shows up for an appointment in one of these conditions and refuses to leave, call the police.
- Remove yourself from physical danger. “I’m a very good ‘fall on the ground’ person,” said Dr. Younggren, who said he has been attacked by patients three times in his career. “That’s a risk management strategy.”
- Terminate patients appropriately in the absence of threats. However, “if someone threatens you, write them a letter, and you’re done,” he said.
Dr. Younggren suggested that other recommendations in the article were unrealistic, such as, don’t work alone at night, install security cameras, and learn self-defense techniques. “What does [learn self-defense techniques] mean,” he asked. “My best one is to fall down.”
Mismanagement of the therapeutic alliance can careen out of control, as it did in the case of Ensworth vs. Mullvain.
In that case, decided in 1990, Heather Ensworth, PhD, a psychologist who practiced in California, treated a patient named Cynthia Mullvain for just short of 2 years and then terminated the treatment. But Ms. Mullvain did not accept the termination and persuaded Dr. Ensworth to see her again “to resolve the termination issues to help [Mullvain] disengage from [Ensworth].”
After several harassing incidents, Dr. Ensworth terminated contact with Ms. Mullvain a second time. At this point, Dr. Ensworth sought and was granted a restraining order against the patient. Despite the restraining order, Ms. Mullvain’s harassing behavior continued. Among other things, she stalked Dr. Ensworth, sent her threatening letters, and started doing community service work at a library located about 150 feet away from Dr. Ensworth’s home, according to Dr. Ensworth’s petition seeking a second restraining order. Ultimately, the court ruled that Ms. Mullvain had “willfully engaged in a course of conduct that seriously alarmed, annoyed, or harassed Ensworth, and that Ensworth actually suffered substantial emotional distress.”
Ernest J. Bordini, PhD said that, beyond private offices, nurses and aides are at greatest risk when it comes to workplace violence. According to a report by the Occupational Health and Safety Administration (OSHA), in 2013, psychiatric aides had the highest rate among health care workers of violent injuries that led to days away from work: 590 per 10,000 full-time employees, compared with 55 such injuries per 10,000 for nursing assistants. The report said the highest risk areas were emergency departments, geriatrics, and behavioral health.
Psychiatric patients are more likely to be the victims of violence than perpetrators, but Dr. Bordini, a neuropsychologist with expertise in forensic assessment, said in an interview that he wanted to add a point.
“It is important to dismiss the notion that all psychiatric patients do not have elevated risks of assault,” he said. “Those who present with psychoses or bipolar disorder can have elevated risk, especially if they develop delusional thoughts or obsessions about the therapist or another individual. Paranoid individuals already feel threatened, and hence can strike out in anticipation.”
He said he and his colleagues are not advocating that all clinicians train in self defense or arm themselves. However, it is essential to be proactive. Falling down can work for some, Dr. Bordini said, but “experience teaches us that playing possum does not always cease an attack. I recommend de-escalation, escape, and/or self-defense plans that one has practiced, feels comfortable with, and feels confident that they can execute under stress.”
At the meeting, he said some patients are able to sense fear from the clinician. “If you’re skittish, [this will] put you at higher risk,” said Dr. Bordini, executive director of Clinical Psychology Associates of North Central Florida in Gainesville. “That sense of intuition is something you should tend to,” he said, citing The Gift of Fear (New York: Dell, 1999) by Gavin de Becker as an example of a book that explores recognizing and reacting to subtle signs of danger. “If you’re not comfortable seeing a patient, listen to that.”
Neither Dr. Younggren nor Dr. Bordini had financial disclosures.
To access OSHA’s guidelines for workplace violence in health care settings, visit https://www.osha.gov/Publications/OSHA3826.pdf. The American Medical Association’s latest policy on workplace violence can be found at https://www.ama-assn.org/ama-adopts-new-public-health-policies-improve-health-nation.
[email protected]
On Twitter @ginalhenderson
WASHINGTON – Clinicians who treat patients with emotional and psychiatric problems must put risk management interventions in place for their safety, Jeffrey N. Younggren, PhD, said at the annual convention of the American Psychological Association.
“Many times, people lose sight of the nature of their therapeutic relationship,” said Dr. Younggren, professor of psychology at the University of Missouri in Columbia. To stay safe, clinicians must overreact, he said, just as they do with suicide risk assessments.
Dr. Younggren critiqued an American Psychological Association article on safety and offered his own recommendations. Among them:
- Think about evacuation strategies. “Don’t get between that individual and the door,” said Dr. Younggren, a clinical and forensic psychologist.
- Refuse to see patients who are inebriated or intoxicated. If such a patient shows up for an appointment in one of these conditions and refuses to leave, call the police.
- Remove yourself from physical danger. “I’m a very good ‘fall on the ground’ person,” said Dr. Younggren, who said he has been attacked by patients three times in his career. “That’s a risk management strategy.”
- Terminate patients appropriately in the absence of threats. However, “if someone threatens you, write them a letter, and you’re done,” he said.
Dr. Younggren suggested that other recommendations in the article were unrealistic, such as, don’t work alone at night, install security cameras, and learn self-defense techniques. “What does [learn self-defense techniques] mean,” he asked. “My best one is to fall down.”
Mismanagement of the therapeutic alliance can careen out of control, as it did in the case of Ensworth vs. Mullvain.
In that case, decided in 1990, Heather Ensworth, PhD, a psychologist who practiced in California, treated a patient named Cynthia Mullvain for just short of 2 years and then terminated the treatment. But Ms. Mullvain did not accept the termination and persuaded Dr. Ensworth to see her again “to resolve the termination issues to help [Mullvain] disengage from [Ensworth].”
After several harassing incidents, Dr. Ensworth terminated contact with Ms. Mullvain a second time. At this point, Dr. Ensworth sought and was granted a restraining order against the patient. Despite the restraining order, Ms. Mullvain’s harassing behavior continued. Among other things, she stalked Dr. Ensworth, sent her threatening letters, and started doing community service work at a library located about 150 feet away from Dr. Ensworth’s home, according to Dr. Ensworth’s petition seeking a second restraining order. Ultimately, the court ruled that Ms. Mullvain had “willfully engaged in a course of conduct that seriously alarmed, annoyed, or harassed Ensworth, and that Ensworth actually suffered substantial emotional distress.”
Ernest J. Bordini, PhD said that, beyond private offices, nurses and aides are at greatest risk when it comes to workplace violence. According to a report by the Occupational Health and Safety Administration (OSHA), in 2013, psychiatric aides had the highest rate among health care workers of violent injuries that led to days away from work: 590 per 10,000 full-time employees, compared with 55 such injuries per 10,000 for nursing assistants. The report said the highest risk areas were emergency departments, geriatrics, and behavioral health.
Psychiatric patients are more likely to be the victims of violence than perpetrators, but Dr. Bordini, a neuropsychologist with expertise in forensic assessment, said in an interview that he wanted to add a point.
“It is important to dismiss the notion that all psychiatric patients do not have elevated risks of assault,” he said. “Those who present with psychoses or bipolar disorder can have elevated risk, especially if they develop delusional thoughts or obsessions about the therapist or another individual. Paranoid individuals already feel threatened, and hence can strike out in anticipation.”
He said he and his colleagues are not advocating that all clinicians train in self defense or arm themselves. However, it is essential to be proactive. Falling down can work for some, Dr. Bordini said, but “experience teaches us that playing possum does not always cease an attack. I recommend de-escalation, escape, and/or self-defense plans that one has practiced, feels comfortable with, and feels confident that they can execute under stress.”
At the meeting, he said some patients are able to sense fear from the clinician. “If you’re skittish, [this will] put you at higher risk,” said Dr. Bordini, executive director of Clinical Psychology Associates of North Central Florida in Gainesville. “That sense of intuition is something you should tend to,” he said, citing The Gift of Fear (New York: Dell, 1999) by Gavin de Becker as an example of a book that explores recognizing and reacting to subtle signs of danger. “If you’re not comfortable seeing a patient, listen to that.”
Neither Dr. Younggren nor Dr. Bordini had financial disclosures.
To access OSHA’s guidelines for workplace violence in health care settings, visit https://www.osha.gov/Publications/OSHA3826.pdf. The American Medical Association’s latest policy on workplace violence can be found at https://www.ama-assn.org/ama-adopts-new-public-health-policies-improve-health-nation.
[email protected]
On Twitter @ginalhenderson
EXPERT ANALYSIS FROM THE 2017 APA CONVENTION
Fat shaming interferes with patients’ medical care, experts say
WASHINGTON – Stereotypical views held by physicians, psychologists, nurses, and other medical professionals about overweight and obese patients need to change, panelists said at the annual convention of the American Psychological Association.
“We have a lot of negative attitudes toward heavy-weight people. Judging patients as too big or too fat produces physical and mental health effects,” said Joan C. Chrisler, PhD, the Class of ’43 Professor of Psychology at Connecticut College, New London. “Shame and disrespectful treatment can lead to delay in seeking health care, reluctance to return visits, or lower trust in the providers and their recommendations.”
A study of more than 300 autopsy reports showed that obese patients were 1.65 times more likely than normal weight and underweight groups combined were to have medical conditions such as endocarditis, ischemic bowel disease, and lung cancer that were not diagnosed, Dr. Chrisler said in a press release (Am J Clin Pathol. 2006 Jan;125[1]:127-31).
In addition to preventing patients from seeking care, Dr. Chrisler said in the release, unfamiliarity with the dosing adjustments sometimes required on medications based on the body mass index of patients affects the quality of care. She cited a retrospective study showing that emergency physicians frequently underdose common antibiotics in the emergency department (Am J Emerg Med. 2012 Sep;30[7]:1212-4).
“People aren’t born repulsed by fat people,” said Dr. McHugh, professor of psychology at Indiana University of Pennsylvania. “Fat hate is learned within the family.”
They encouraged more sensitivity from medical professionals when it comes to treating overweight and obese patients, such as providing changing gowns of different sizes in examination rooms and weighing patients in private areas of the medical office.
Dr. Chrisler and Dr. McHugh said weight stigma should be addressed in medicine and psychology through training and research, and in working with patients who are obese. “Treatments should focus on mental and physical health as the desired outcomes for therapy rather than weight,” Dr. McHugh said.
Dr. Chrisler, coauthor of a recent article on sizeism (Fat Studies. 2017 Aug;6[1]:38-53), had no disclosures. Dr. McHugh also had no disclosures.
[email protected]
On Twitter @ginalhenderson
WASHINGTON – Stereotypical views held by physicians, psychologists, nurses, and other medical professionals about overweight and obese patients need to change, panelists said at the annual convention of the American Psychological Association.
“We have a lot of negative attitudes toward heavy-weight people. Judging patients as too big or too fat produces physical and mental health effects,” said Joan C. Chrisler, PhD, the Class of ’43 Professor of Psychology at Connecticut College, New London. “Shame and disrespectful treatment can lead to delay in seeking health care, reluctance to return visits, or lower trust in the providers and their recommendations.”
A study of more than 300 autopsy reports showed that obese patients were 1.65 times more likely than normal weight and underweight groups combined were to have medical conditions such as endocarditis, ischemic bowel disease, and lung cancer that were not diagnosed, Dr. Chrisler said in a press release (Am J Clin Pathol. 2006 Jan;125[1]:127-31).
In addition to preventing patients from seeking care, Dr. Chrisler said in the release, unfamiliarity with the dosing adjustments sometimes required on medications based on the body mass index of patients affects the quality of care. She cited a retrospective study showing that emergency physicians frequently underdose common antibiotics in the emergency department (Am J Emerg Med. 2012 Sep;30[7]:1212-4).
“People aren’t born repulsed by fat people,” said Dr. McHugh, professor of psychology at Indiana University of Pennsylvania. “Fat hate is learned within the family.”
They encouraged more sensitivity from medical professionals when it comes to treating overweight and obese patients, such as providing changing gowns of different sizes in examination rooms and weighing patients in private areas of the medical office.
Dr. Chrisler and Dr. McHugh said weight stigma should be addressed in medicine and psychology through training and research, and in working with patients who are obese. “Treatments should focus on mental and physical health as the desired outcomes for therapy rather than weight,” Dr. McHugh said.
Dr. Chrisler, coauthor of a recent article on sizeism (Fat Studies. 2017 Aug;6[1]:38-53), had no disclosures. Dr. McHugh also had no disclosures.
[email protected]
On Twitter @ginalhenderson
WASHINGTON – Stereotypical views held by physicians, psychologists, nurses, and other medical professionals about overweight and obese patients need to change, panelists said at the annual convention of the American Psychological Association.
“We have a lot of negative attitudes toward heavy-weight people. Judging patients as too big or too fat produces physical and mental health effects,” said Joan C. Chrisler, PhD, the Class of ’43 Professor of Psychology at Connecticut College, New London. “Shame and disrespectful treatment can lead to delay in seeking health care, reluctance to return visits, or lower trust in the providers and their recommendations.”
A study of more than 300 autopsy reports showed that obese patients were 1.65 times more likely than normal weight and underweight groups combined were to have medical conditions such as endocarditis, ischemic bowel disease, and lung cancer that were not diagnosed, Dr. Chrisler said in a press release (Am J Clin Pathol. 2006 Jan;125[1]:127-31).
In addition to preventing patients from seeking care, Dr. Chrisler said in the release, unfamiliarity with the dosing adjustments sometimes required on medications based on the body mass index of patients affects the quality of care. She cited a retrospective study showing that emergency physicians frequently underdose common antibiotics in the emergency department (Am J Emerg Med. 2012 Sep;30[7]:1212-4).
“People aren’t born repulsed by fat people,” said Dr. McHugh, professor of psychology at Indiana University of Pennsylvania. “Fat hate is learned within the family.”
They encouraged more sensitivity from medical professionals when it comes to treating overweight and obese patients, such as providing changing gowns of different sizes in examination rooms and weighing patients in private areas of the medical office.
Dr. Chrisler and Dr. McHugh said weight stigma should be addressed in medicine and psychology through training and research, and in working with patients who are obese. “Treatments should focus on mental and physical health as the desired outcomes for therapy rather than weight,” Dr. McHugh said.
Dr. Chrisler, coauthor of a recent article on sizeism (Fat Studies. 2017 Aug;6[1]:38-53), had no disclosures. Dr. McHugh also had no disclosures.
[email protected]
On Twitter @ginalhenderson
EXPERT ANALYSIS FROM THE 2017 APA CONVENTION
Cognitive declines tied to stress in older African Americans
Higher levels of perceived stress appear to be associated with faster declines in two cognitive domains – episodic memory and visuospatial ability – among older African Americans without dementia, results from a longitudinal study of 467 participants suggest.
“To our knowledge, this is the first study to examine the relationship between perceived stress and cognition in specific cognitive domains in general and in a minority population in particular,” reported Arlener D. Turner, PhD, of the Rush Alzheimer’s Disease Center and the department of behavioral sciences at Rush University, Chicago, and her associates.
Each participant took a battery of neuropsychological tests, including the MMSE, annually for up to 9 years. The participants’ stress levels were assessed using a 4-item version of Cohen’s Perceived Stress Scale (PSS), “an index of the degree to which a person finds their lives unpredictable, uncontrollable, and overloading – characteristics central to the evaluation of stress” (Am J Geriatr Psychiatry. 2017;25[1]:25-34).
Dr. Turner and her associates found that participants with a mean age and education level, and a PSS score 1 point above the mean experienced annual declines in episodic memory of 0.022 points (P = .047) and in visuospatial ability of 0.021 points (P = .017). No such associations were found for semantic or working memory or for perceptual speed.
The investigators said that the study did not pinpoint the mechanisms that link stress to cognition. “The well-established mechanism of hypothalamic-pituitary-adrenal-axis dysregulation in chronic stress may play a role,” they wrote. Another contributing factor could be inflammation, they said, citing research showing that discrimination is “a persistent stressor in African Americans and that perceived discrimination is associated with elevated levels of C-reactive protein.” Future studies are needed, they said, to test which mechanisms might be pathways between perceived stress and cognitive decline.
They cited several limitations. For example, because less educational attainment is associated with higher levels of stress and this cohort had achieved educational levels that were relatively high, this cohort’s reports of perceived stress might have been modest. In addition, “perception of stress is, by nature, a self-report measure,” the investigators wrote.
The National Institute on Aging and the Illinois Department of Public Health funded the study. Neither Dr. Turner nor her associates had any conflicts of interest.
[email protected]
On Twitter @ginahenderson
Higher levels of perceived stress appear to be associated with faster declines in two cognitive domains – episodic memory and visuospatial ability – among older African Americans without dementia, results from a longitudinal study of 467 participants suggest.
“To our knowledge, this is the first study to examine the relationship between perceived stress and cognition in specific cognitive domains in general and in a minority population in particular,” reported Arlener D. Turner, PhD, of the Rush Alzheimer’s Disease Center and the department of behavioral sciences at Rush University, Chicago, and her associates.
Each participant took a battery of neuropsychological tests, including the MMSE, annually for up to 9 years. The participants’ stress levels were assessed using a 4-item version of Cohen’s Perceived Stress Scale (PSS), “an index of the degree to which a person finds their lives unpredictable, uncontrollable, and overloading – characteristics central to the evaluation of stress” (Am J Geriatr Psychiatry. 2017;25[1]:25-34).
Dr. Turner and her associates found that participants with a mean age and education level, and a PSS score 1 point above the mean experienced annual declines in episodic memory of 0.022 points (P = .047) and in visuospatial ability of 0.021 points (P = .017). No such associations were found for semantic or working memory or for perceptual speed.
The investigators said that the study did not pinpoint the mechanisms that link stress to cognition. “The well-established mechanism of hypothalamic-pituitary-adrenal-axis dysregulation in chronic stress may play a role,” they wrote. Another contributing factor could be inflammation, they said, citing research showing that discrimination is “a persistent stressor in African Americans and that perceived discrimination is associated with elevated levels of C-reactive protein.” Future studies are needed, they said, to test which mechanisms might be pathways between perceived stress and cognitive decline.
They cited several limitations. For example, because less educational attainment is associated with higher levels of stress and this cohort had achieved educational levels that were relatively high, this cohort’s reports of perceived stress might have been modest. In addition, “perception of stress is, by nature, a self-report measure,” the investigators wrote.
The National Institute on Aging and the Illinois Department of Public Health funded the study. Neither Dr. Turner nor her associates had any conflicts of interest.
[email protected]
On Twitter @ginahenderson
Higher levels of perceived stress appear to be associated with faster declines in two cognitive domains – episodic memory and visuospatial ability – among older African Americans without dementia, results from a longitudinal study of 467 participants suggest.
“To our knowledge, this is the first study to examine the relationship between perceived stress and cognition in specific cognitive domains in general and in a minority population in particular,” reported Arlener D. Turner, PhD, of the Rush Alzheimer’s Disease Center and the department of behavioral sciences at Rush University, Chicago, and her associates.
Each participant took a battery of neuropsychological tests, including the MMSE, annually for up to 9 years. The participants’ stress levels were assessed using a 4-item version of Cohen’s Perceived Stress Scale (PSS), “an index of the degree to which a person finds their lives unpredictable, uncontrollable, and overloading – characteristics central to the evaluation of stress” (Am J Geriatr Psychiatry. 2017;25[1]:25-34).
Dr. Turner and her associates found that participants with a mean age and education level, and a PSS score 1 point above the mean experienced annual declines in episodic memory of 0.022 points (P = .047) and in visuospatial ability of 0.021 points (P = .017). No such associations were found for semantic or working memory or for perceptual speed.
The investigators said that the study did not pinpoint the mechanisms that link stress to cognition. “The well-established mechanism of hypothalamic-pituitary-adrenal-axis dysregulation in chronic stress may play a role,” they wrote. Another contributing factor could be inflammation, they said, citing research showing that discrimination is “a persistent stressor in African Americans and that perceived discrimination is associated with elevated levels of C-reactive protein.” Future studies are needed, they said, to test which mechanisms might be pathways between perceived stress and cognitive decline.
They cited several limitations. For example, because less educational attainment is associated with higher levels of stress and this cohort had achieved educational levels that were relatively high, this cohort’s reports of perceived stress might have been modest. In addition, “perception of stress is, by nature, a self-report measure,” the investigators wrote.
The National Institute on Aging and the Illinois Department of Public Health funded the study. Neither Dr. Turner nor her associates had any conflicts of interest.
[email protected]
On Twitter @ginahenderson
FROM THE AMERICAN JOURNAL OF GERIATRIC PSYCHIATRY
Key clinical point:
Major finding: Participants with a mean age of 73.4 years and education level of 15 years and a score 1 point above the mean on Cohen’s Perceived Stress Scale experienced annual declines in episodic memory of 0.022 points (P = .047) and in visuospatial ability of 0.021 points (P = .017).
Data source: An analysis of 467 African Americans enrolled in the longitudinal Minority Aging Research Study.
Disclosures: The National Institute on Aging and the Illinois Department of Public Health funded the study. Neither Dr. Turner nor her associates had any conflicts of interest.