Current Psychiatry Reports

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Online ISSN: 1535-1645
Print ISSN: 1523-3812
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Psychedelic-assisted psychotherapy consists of 3 stages: preparation, dosing, and integration. Though there is some variation across clinical trials, in general, participants undergo an initial evaluation followed by meetings with the psychiatrist to taper off their medications. In preparation, the patient meets with the lead therapist 3 times over the course of 3 weeks, with the co-therapist joining for the final preparation session. Preparation focuses on getting the patient comfortable with the potential range of experiences they may experience under the influence of psychedelics, exploring expectations and setting intentions, and developing strategies for navigating any challenges that might emerge during dosing. Integration also has sessions with the therapist over 3 weeks, with the co-therapist joining only for the first integration session. In integration, the goal is to consolidate the insights gleaned during dosing and help the patient apply these changes to their daily life. Throughout this process, the therapist practices a non-directive, present-focused technique which encourages the patient to engage with all aspects of their current experience
Purpose of Review Few treatments are available for patients with mood disorders or post-traumatic stress disorder (PTSD) who have already failed multiple interventions. After several decades when research into psychedelics was effectively halted by federal legislation, the past several years have shown the re-emergence of thoughtful investigations studying the utility of compounds such as 3,4-methylenedioxymethamphetamine (MDMA) and psilocybin. Recent Findings Several studies have coupled the safe administration of psychedelic compounds in a controlled environment after several hours of preparation of study participants and followed by multiple sessions to integrate the psychedelic experience. The improvement participants experience appear related to the often profound perspective changes experienced and seem unlike the improvements seen in the currently available care paradigms. Studies cited include treatment resistant depression, end of life despair, and PTSD. Summary Psychedelic psychotherapy, a unique remarriage of biological therapy and psychotherapy, has the potential to transform mental health care.
Video vs Phone vs In-Person: Benefits Across Modalities
Purpose of Review The goal of this paper is to provide a comparative review of using phone (audio-only) or video for mental health treatments. Our review includes evidence of phone and video’s effectiveness in terms of reduced symptomology, retention, satisfaction, therapeutic alliance, and other outcomes of interest. This review also discusses how patients and providers’ experiences and attitudes differ between these two modalities. Finally, we present information on different usage rates of phone and video across patient populations and mental health provider types, and different implementation strategies. Recent Findings Treatments through phone and video are both able to reduce symptoms related to mental health conditions and have both been found to be non-inferior to in-person care. Both phone and video are more convenient to patients. Video offers important visual information that can be important to diagnosing mental health conditions. Phone, however, is more broadly accessible and may come with fewer technological issues. Summary In the context of mental health care, where non-verbal cues are tied to symptomology and diagnosing, and a strong relationship between patient and provider can enhance treatment, we encourage the use of video, especially for psychotherapeutic services. However, as phone is more accessible, we ultimately recommend an accommodating approach, one that flexibly makes use of both phone and video. Future studies on telehealth should focus on direct, head-to-head comparisons between phone and video and conduct more rigorous testing on whether clinical differences exist.
Illustrations of the described botanicals. Kava: Piper methysticum; lavender: Lavandula angustifolia; lemon balm: Melissa officinalis; passionflower: Passiflora incarnata
Purpose of Review The goal of this paper is to summarize the evidence for the use of botanical medicines for the treatment of anxiety disorders. We sought to make this review practical for psychiatrists and psychiatric prescribers. Recent Findings In 2018, the Natural Medicines database produced a Clinical Management of Anxiety guide that summarized the conventional and natural treatments of anxiety disorders. Based on this guide, four herbal supplements (also referred to as botanicals) were selected for deeper study including kava, lavender, lemon balm and passionflower. All four were considered possibly safe and possibly effective according to the Natural Medicines database. Summary There is scientific evidence supporting the use of kava, lavender, lemon balm and passionflower in anxiety disorders. Lavender appears to have the best available evidence including comparable efficacy to conventional first line treatments and is available in a patented form that was used in the cited studies (Silexan).
Purpose of Review This paper examines children’s physical activity and sedentary behavior and associated psychological outcomes coincident with the COVID-19 pandemic. Recent Findings Generally, the research has found decreased physical activity and increased sedentary behavior, both of which are associated with various psychological outcomes. The research on sedentary behavior has focused on screen time with minimal consideration of other sedentary behaviors or of specific physical activities or the context in which these behaviors occurred. Summary Changes in children’s daily routines and activities have received little attention in the mass trauma research despite the fact that disasters disrupt individual, family, and community life. Thus, the current report contributes to an understanding of the breadth of mass trauma effects, underscores the importance of physical activity and sedentary behavior and their associations with health and psychological outcomes, and is a reminder to consider children’s daily lives both during times of crisis and under usual circumstances.
Types of complementary and integrative approaches
Purpose of Review Integrative medicine is the practice of combining conventional medical treatments with “alternative” or “complementary” therapies. Integrative psychiatry is a holistic, person-centered approach to neuropsychiatric disorders that emphasizes a person’s physical, emotional, interpersonal, behavioral, nutritional, environmental, and spiritual dimensions to achieve well-being. Older adults are more prone to physical injury, interpersonal loss, chronic illnesses, and physical and cognitive decline that can manifest as anxiety, depression, with functional decline and inability to care for self. Additionally, stress of caring for older adults with dementia can adversely affect caregivers’ health. Although integrative approaches are perceived as safer and less stigmatizing, it is important to understand the risks and benefits of such therapies for older adults with neurocognitive disorders and their caregivers. Recent Findings Here, we summarize the results of the recent clinical trials and meta-analyses that provide evidence for integrative approaches to treating older adults with cognitive disorders and their caregivers which include the use of diet and supplements, and mind–body therapies. Summary Dietary and mind-body therapies have become increasingly popular and show the strongest evidence of effectiveness for cognitive disorders and caregiver stress. Vitamins and supplements are the most popular integrative intervention, but there is mixed evidence supporting their use and the concern for herb (supplement)-drug interactions. While there is increasing popularity of integrative treatments, information to guide clinicians providing care for older adults remains limited, with variable scientific rigor of the available RCTs for a large number of commonly used integrative interventions particularly for cognitive disorders and caregiver stress and well-being.
Purpose of Review Telehealth-delivered medication-assisted treatment for opioid use disorder (tele-MOUD) has received increased attention, with the intersection of the opioid epidemic and COVID-19 pandemic, but research on recent develop- ments is scattered. We critically review recent literature on tele-MOUD and synthesize studies reporting primary data under four themes: clinical effectiveness, non-clinical effectiveness, perceptions, and regulatory considerations. Recent Findings Despite increasing publications, most failed to include long-term comprehensive assessments. Findings indicate favorable outcomes such as improvements in retention and abstinence rates, positive experiences, and improved feasibility with the relaxation of regulatory measures. With increased adoption, clinician and patient perceptions appeared largely positive. Negative findings, albeit minor, were primarily associated with workflow adaptation difficulties and limited access of underserved populations to technology and internet connection. Summary: Additional financial, logistical, outreach, and training support for clinicians, patients, and support staff is recommended, in addition to permanent evidence-based regulatory reforms, to scale and optimize tele-MOUD services. Comprehensive recommendations to overcome limitations are expanded therein.
Purpose of Review This review explores advances in the utilization of technology to address perinatal mood and anxiety disorders (PMADs). Specifically, we sought to assess the range of technologies available, their application to PMADs, and evidence supporting use. Recent Findings We identified a variety of technologies with promising capacity for direct intervention, prevention, and augmentation of clinical care for PMADs. These included wearable technology, electronic consultation, virtual and augmented reality, internet-based cognitive behavioral therapy, and predictive analytics using machine learning. Available evidence for these technologies in PMADs was almost uniformly positive. However, evidence for use in PMADs was limited compared to that in general mental health populations. Summary Proper attention to PMADs has been severely limited by issues of accessibility, affordability, and patient acceptance. Increased use of technology has the potential to address all three of these barriers by facilitating modes of communication, data collection, and patient experience.
The advantages and limitations identified by this review at the patient, provider, and systemic levels
Purpose of review: To review the role of digital health technologies in behavioral health treatment and promotion for sexual and gender minorities (SGM). Recent findings: Digital technologies have advantages and limitations at multiple levels in addressing SGM's behavioral health needs. For patients, digital technologies improve convenience and may reduce stigma; however, privacy concerns in the home may limit their utilization. Providers also benefit from the convenience of these technologies; however, not all providers are comfortable delivering virtual care to SGM. For society, digital technologies reduce transportation-related costs and increase access to healthcare in an increasingly hostile political climate for SGM; however, these advantages are limited by technological access and anti-SGM policies. Digital technologies can improve the behavioral health of SGM at the patient, provider, and systemic levels. Further efforts are necessary to standardize provider training, improve SUD-specific care delivery, and increase quality and accessibility of these technologies.
Purpose of review: We review recent work on applications of non-pharmacologic strategies to promote cognitive health in older adulthood and discuss potential network mechanisms, limitations, and considerations for improving intervention uptake and efficacy. Recent findings: In healthy older adults and patients with mild cognitive impairment, cognitive training produces global and domain-specific cognitive gains, though effect sizes tend to be modest and transfer is variable. Non-invasive brain stimulation has shown moderate success in enhancing cognitive function, though the optimum approach, parameters, and cortical targets require further investigation. Physical activity improves cognitive functions in late life, with emerging trials highlighting key intervention components that may maximize treatment outcomes. Multimodal interventions may be superior to single-component interventions in conferring cognitive gains, although interpretation is limited by modest sample sizes and variability in training components and parameters. Across modalities, individual differences in patient characteristics predict therapeutic response. These interventions may advance cognitive health by modulating functional networks that support core cognitive abilities including the default mode, executive control, and salience networks. Effectiveness of cognitive enhancement strategies may be increased with clinician-led coaching, booster sessions, gamification, integration of multiple intervention modalities, and concrete applications to everyday functioning. Future trials involving rigorous comparisons of training components, parameters, and delivery formats will be essential in establishing the precise approaches needed to maximize cognitive outcomes. Novel studies using patient-level clinical and neuroimaging features to predict individual differences in training gains may inform the development of personalized intervention prescriptions to optimize cognitive health in late life.
Purpose of review: To describe examples of adapting apps for use in mental healthcare and to formulate recommendations for successful adaptation in mental healthcare settings. Recent findings: International examples are given to explore implementation procedures to address this multitude of challenges. There are only few published examples of adapting apps for use in mental healthcare. From these examples and from results of studies in implementation science in general clinical settings, it can be concluded that the process of adapting apps for mental healthcare needs to address clinician training and information needs, user needs which include cultural adaptation and go beyond mere translation, and organizational needs for blending app use into everyday clinical mental healthcare workflows.
Purpose of review: We reviewed recent evidence on the use of electroconvulsive therapy (ECT) in the geriatric population. This review looked at the literature on depression, for which there is a breadth of data, as well as other conditions that have historically not been as well studied, as well as attempting to provide practical recommendations for ECT practitioners. This review also examined the impact of the COVID-19 pandemic on ECT in the elderly. Recent findings: ECT shows robust efficacy across many psychiatric diseases, from depression and bipolar disorder to psychosis and catatonia. It has also shown positive results at improving behavioral symptoms of dementia, as well as improving motor symptoms seen in Parkinson's disease. It is routinely found to be a safe treatment as well, generally with only minimal transient side effects. ECT should not be considered a "last-resort" treatment for geriatric patients suffering from psychiatric disorders. It has historical and recent literature supporting its use in many psychiatric disorders and has been shown to be safe with minimal side effects when appropriate considerations are taken for the elderly population.
Purpose of Review Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population. Recent Findings Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Summary Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.
Purpose of Review Modern methods of communication and engagement, such as social media, video games, and online shopping, use a variety of behavioral techniques to encourage and reward frequent use, opening the door to addiction. The technological addictions (TAs) are a set of disorders that accompany the technological advances that define the digital age. The TAs are an active source of research in the literature, with promising treatment options already available. Recent Findings There are promising therapeutic and psychopharmacologic treatments for a broad range of TAs. Stimulants, antidepressants, and cognitive therapies may all be effective for internet gaming disorder (IGD). Cognitive therapies may be effective for other TAs, such as social media addiction (SMA), online shopping addiction (OSA), and online porn addiction. Summary Society’s dependence on addictive technologies will only increase. Many of the TAs can be addressed with medication and therapy, with more research and literature developing at a rapid pace.
Purpose of Review To provide a comprehensive overview on the evaluation and management of behavioral and psychological symptoms of dementia (BPSD) using evidence from literature. Recent Findings Evidence indicates efficacy for some non-pharmacological techniques including education of caregivers and cognitive stimulation therapy and pharmacological agents like antidepressant and antipsychotics for the management of BPSD. The use of antipsychotics has generated controversy due to the recognition of their serious adverse effect profile including the risk of cerebrovascular adverse events and death. Summary BPSD is associated with worsening of cognition and function among individuals with dementia, greater caregiver burden, more frequent institutionalization, overall poorer quality of life, and greater cost of caring for these individuals. Future management strategies for BPSD should include the use of technology for the provision of non-pharmacological interventions and the judicious use of cannabinoids and interventional procedures like ECT for the management of refractory symptoms.
Diagnostic procedure and Codes for ICD-11 Personality Disorders and Related Traits
Purpose of Review The International Classification of Diseases 11th revision (ICD-11) introduced a new approach to personality disorders and related traits. This paper reviews recent literature on the assessment of ICD-11 personality disorders and implications for clinical diagnosis, decision-making, and treatment. Recent Findings We reviewed findings on two measures developed for the ICD-11 model of personality dysfunction and six inventories for the ICD-11 trait specifiers. The psychometric qualities of these tools are promising, and they allow for both rapid screening and fine-grained assessment. Implications for clinical diagnosis and treatment of personality disorders are reviewed including utility for forensic practice. Based on evidence and our experience, we provide some recommendations for severity- and trait-informed interventions. Summary Initial evidence supports the available instruments for assessing ICD-11 personality disorders. More research is needed including development of clinician-rating forms and diagnostic interviews as well as treatment protocols and trials based on the new ICD-11 classification.
Purpose of Review We review recent developments within digital phenotyping for mental health, a field dedicated to using digital data for diagnosing, predicting, and monitoring mental health problems. We especially focus on recent critiques and challenges to digital phenotyping from within the social sciences. Recent Findings Three significant strands of criticism against digital phenotyping for mental health have been developed within the social sciences. This literature problematizes the idea that digital data can be objective, that it can be unbiased, and argues that it has multiple ethical and practical challenges. Summary Digital phenotyping for mental health is a rapidly growing and developing field, but with considerable challenges that are not easily solvable. This includes when, and if, data from digital phenotyping is actionable in practice; the involvement of user and patient perspectives in digital phenotyping research; the possibility of biased data; and challenges to the idea that digital phenotyping can be more objective than other forms of psychiatric assessment.
Purpose of Review We review recent evidence on the use of orexin receptor antagonists (ORAs) for treating insomnia. We evaluate studies on five dual ORAs and one selective ORA. Recent Findings Research on suvorexant in recent years gradually focus on comorbid insomnia, while lemborexant and daridorexant were still being validated in primary insomnia. Almorexant is now mainly used as a commercial specific inhibitor of the orexin system in animal studies due to safety issues. Although filorexant has also shown a certain sleep-promoting effect, there are few clinical or experimental studies on sleep-related aspects of filorexant in recent years. As for selective ORAs, orexin receptor 2 antagonist seltorexant still has not yet reached phase 3. Summary High-quality clinical trials in insomnia populations are needed which directly compare authorized ORAs and investigate non-approved ORAs, the use of ORAs in comorbid insomnia, and the orexin signaling system pathophysiology in insomnia.
PRISMA flow diagram
Purpose of Review Provision of mental health services through digital technologies (e-mental health) can potentially expand access to treatments for personality disorders (PDs). We evaluated studies on e-mental health for PDs published over the last 3 years (2019–2022). Recent Findings Studies published in English that used e-mental health to treat people with PDs or PD-related symptoms were identified. We identified 19 studies, including four randomized controlled trials and one meta-analysis. Most interventions were based on Dialectical Behavior Therapy and delivered through smartphone applications for adults with Borderline Personality Disorder [BPD] or related symptoms. User experiences of the interventions were generally positive. Evidence for efficacy was limited. Summary The current literature on e-mental health for PDs is limited in scope. Research in understudied populations and randomized controlled trials designed to establish efficacy are warranted. It is not yet clear whether e-mental health may be helpful for the treatment of PDs.
Purpose of Review We reviewed the literature from 2017 to 2022 on autistic adults’ use of mental healthcare and barriers to care. To encourage immediate improvement in mental healthcare, we provide five strategies mental health providers can use to better care for autistic adults. Recent Findings Most autistic adults use mental healthcare and use it more often than non-autistic adults. Autistic adults’ experiences with mental healthcare are characterized by (1) lack of providers knowledgeable about autism, (2) use of treatments that may not be accommodating to individual needs, and (3) difficulty navigating the complex healthcare system. These barriers contribute to prevalent unmet needs for mental healthcare. Summary Autistic adults use mental healthcare frequently but have unmet mental health needs. As necessary systemic changes develop, providers can begin immediately to better care for autistic adults by learning about their needs and taking personalized care approaches to meet those needs.
Main neurobiological mechanistic hypotheses of psilocybin and their supposed therapeutic effects in depression. FC = functional connectivity, DMN = default-mode-network, PH = para-hippocampal, PF = prefrontal, BDNF = brain-derived neurotrophic factor. Blue area = medial prefrontal cortex, red area = parahippocampal gyrus, yellow area = precuneus (one of the main node of the DMN)
Purpose of the Review We aim to provide an overview of the current state of knowledge about the efficacy of psilocybin in the treatment of depression, as well as its mechanisms of action. Recent Findings Psilocybin has a large, rapid, and persistent clinical effect in the treatment of resistant or end-of-life depression. Tolerance is good, with mild side effects limited to a few hours after dosing. The studies conducted to date have had small sample sizes. One clinical trial has been conducted against a reference treatment (escitalopram) without showing a significant superiority of psilocybin in the main outcome. The neurobiological mechanisms, mostly unknown, differ from those of SSRI antidepressants. Summary Psilocybin represents a promising alternative in the treatment of depression. Further research with larger sample sizes, particularly against reference treatments, is needed to better understand the neurobiological factors of its effects and to investigate its potential for use in everyday practice.
Purpose of Review Disasters and traumatic events are ever present globally but disproportionally impact culturally diverse low resource environments. Culture is an important context through which people experience disasters, develop adaptive strategies, and process external aid and support. This is even more critical for children and youth who are in the process of forming their cultural/ethnic identities. This review identifies literature on these important aspects of culture in disaster response. Recent Findings The literature supports that culture influences the experience of disasters, the development of coping and adaptational approaches, and the acceptability of external aid and support, especially mental health services. Summary Cultural humility, awareness, and sensitivity are crucial in addressing the traumatic impact of disasters in children and youth, especially in the areas of the world that are most at risk for them.
Flow diagram for the systematic review as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
Risk of bias assessment results for the included literature at the domain level, wherein (A) shows results for randomized controlled studies as per Cochrane’s Risk of Bias tool (RoB), and (B) shows results for open label studies as per Cochrane’s Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool. Figures were generated using the open-
source RobVis ShinyApp:
Purpose of Review Lumateperone (LUM) is the U.S. Food and Drug Administration approved atypical antipsychotic agent for adults with schizophrenia (SCZ) and bipolar depression (for both bipolar I and bipolar II disorder as as monotherapy or as adjunctive treatment to lithium or valproate). LUM simultaneously modulates serotonin, dopamine, and glutamate neurotransmission. The foregoing pleiotropic mechanism of action is predictive of therapeutic benefits across multiple domains of psychopathology in SCZ (i.e., positive, negative, cognitive, and prosocial symptoms). Herein, the overarching aim is to synthesize the extant literature reporting on the efficacy, safety, and tolerability of LUM in adults with SCZ. Recent Findings Four clinical studies (i.e., three RCTs and one open-label trial) were included in this synthesis. Overall, LUM significantly reduced the severity of SCZ compared with placebo. The open label study provided the real-world effectiveness of shifting stable patients with SCZ to LUM from other atypical antipsychotics. With respect to safety and tolerability profile, LUM demonstrated placebo-level rates of weight gain, metabolic shift, prolactin elevation, extrapyramidal side effects (EPS), and akathisia across short term trials (i.e., 4-6 weeks). Summary Taken together, our results indicate that LUM significantly improves symptoms severity in adults with SCZ. LUM also exhibits a favorable tolerability and safety profile with placebo level rates of weight gain, metabolic disruption, akathisia, extrapyramidal side effects (excluding akathisia), and prolactin elevation. Lumateperone should be conceptualized as a first-line treatment strategy for adults with SCZ.
Purpose of Review Born out of necessity, military medicine continues to find itself at the forefront of medical innovation. This generation of military physicians has never previously been challenged with continuing to provide top notch medical support to servicemembers in a variety of operational settings in the midst of a global pandemic. While military medicine has always been able to uniquely meet the educational goals of residency training, COVID-19 brought new challenges to the forefront. Recent Findings While the threat presented by COVID-19 was different from the historical battlefield threats and challenges that have given birth to military medicine, it was nevertheless ready to pivot and adjust course, focusing on how to best meet the medical needs of the military patient population in an ever-changing geopolitical environment while continuing to meet and exceed the educational standards that training programs are held to. Historically and currently, mental health remains one of the most common reasons that servicemembers are evacuated from combat zones. Summary The COVID-19 pandemic provided an opportunity for modern military psychiatry to showcase its ability to adjust the educational focus in certain areas of residency training to prepare the next generation of military psychiatrists to be able to face the newest threat to force wellness.
Purpose of Review This article will provide a brief review of most recent findings of sleep, insomnia, obstructive sleep apnea, and restless leg syndrome during pregnancy. Recent Findings Recent meta-analyses have found that 38.2% of pregnant women experience insomnia, 15% experience obstructive sleep apnea, and 20% experience restless leg syndrome. Poor sleep during pregnancy is associated with increased odds of preterm birth, cesarean section, hypertension, gestational diabetes, and longer deliveries. OSA is also associated with poor outcomes such as maternal hypertension, gestational diabetes, preterm birth, and low infant Apgar score. Incidence of new-onset RLS increases with parity, gestational age, maternal age, and increased maternal adiposity. Typical treatments have been found to be effective for treating sleep disorders in pregnant women. Summary Obtaining sufficient sleep quality and quantity in addition to assessing and treating sleep disorders should be a priority for pregnant women and their providers.
BH Pulse dashboard allows the commander or the behavioral health officer (BHO) of a military unit to assess findings. The tool permits to compare the unit’s data to comparative baseline data and analyze the information by age, gender, and rank. The tool also enables the BHO to select recommendations based on findings in BH Pulse
Purpose of Review This paper focuses on how mental health professionals working with Army commanders can help them make decisions based on valid population-based metrics. We first summarize the scope of the impact of suicides on the Army. We then describe the process by which decision-making can be optimized. Recent Findings The currently available tools in the US Army including BH Pulse, Unit Risk Inventory, The Azimuth Check, and the Army Readiness Assessment Program have a role in assisting mental health professionals. The specific advantages of BH Pulse over the other tools are highlighted. Summary The US Army has been committed to enhancing its suicide prevention program through comprehensive policies, procedures, and provisions of resources. Commanders are expected to interact with the suicide prevention programs in their units and maximize the systems in place to prevent suicides and other negative mental health outcomes. Commanders are expected to receive cues and signals from a variety of data sources to assist their decision-making process. We discuss the specific advantages of BH Pulse and recommend its routine use for primary prevention and utilizing this tool after incidents to make data-driven, justifiable decisions. Finally, recommendations are provided on enhancing a unit’s suicide prevention program.
Purpose of Review Identifying medications that may be used as therapeutic agents for eating disorders is a longstanding focus of research, with varying degrees of success. The present review consolidates the most recent findings on pharmacological treatment of three eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Recent Findings Recent research suggests that olanzapine demonstrates positive effects on weight gain among outpatients with AN. There are fewer recent advances in psychopharmacological treatment for BN and BED, likely due to the relative success of prior medication trials. Summary Olanzapine is the first medication to safely promote weight gain among individuals with AN. Fluoxetine is FDA-approved for BN treatment, and lisdexamfetamine is FDA-approved for BED treatment. BN and BED also generally respond well to SSRIs prescribed off-label. Research on psychopharmacological treatments for other eating disorders, such as avoidant-restrictive food intake disorder and other specified feeding and eating disorders, are sorely needed.
Purpose of Review Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). Recent Findings Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. Summary The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.
PRISMA flow diagram of the bibliographic search. The 15 Web of Science databases included: Arts & Humanities Citation Index, Book Citation Index, Emerging Sources Citation Index, BIOSIS Citation Index, BIOSIS Previews, Conference Proceedings Citation Index, Data Citation Index, Derwent Innovations Index, KCI-Korean Journal Database, MEDLINE®, Russian Science Citation Index, Science Citation Index Expanded, Social Sciences Citation Index, SciELO Citation Index, Zoological Record, Zoological Record (1864-present). Reasons for excluding reports included the following: reason 1, accidentally included/wrong topic; reason 2, not a research article; and reason 3, date of publications prior to the COVID-19 outbreak
Purpose of Review To review the literature on the trends in substance use among youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic. Recent Findings The pandemic has given rise to concerns about the mental health and social well-being of youth, including its potential to increase or exacerbate substance use behaviors. This systematic review identified and included 49 studies of use across alcohol, cannabis, tobacco, e-cigarettes/vaping, and other drugs, and unspecified substances. The majority of studies across all categories of youth substance use reported reductions in prevalence, except in the case of other drugs and unspecified drug and substance use, which included three studies that reported an increase in use and three studies that reported decrease in use. Summary Overall, the results of this review suggest that the prevalence of youth substance use has largely declined during the pandemic. Youth substance use in the post-pandemic years will require monitoring and continued surveillance.
Mother, fetus, and infant influences on the bidirectional mother–offspring neuroendocrine relationship observed in the prenatal and postnatal periods
Purpose of Review We review ontogeny of the maternal-offspring neuroendocrine relationship in human pregnancy. We present bidirectional genetic, physiological, and behavioral influences that enhance or disrupt HPA activity and its end product cortisol at the individual level and within the dyad. Recent Findings Consistent evidence supports that maternal mood and caregiving behavior are associated with maternal and offspring cortisol levels. Select studies support the buffering effects of antidepressant use and maternal positive affect on offspring cortisol. Growing research highlights evocative effects of fetal neuroendocrine activity, antenatal gene transfer, and infant behavioral distress and risk characteristics on maternal cortisol levels and dyadic attunement. Summary There is potential to advance our understanding of the mother–offspring neuroendocrine relationship by consideration of other neuroactive steroids in addition to cortisol, and to consider developmental timing and measurement source in study design. Future study should emphasize in what context or for whom neuroendocrine attunement is adaptive versus maladaptive for mother and child.
Treatment algorithm for perinatal OCD. From Hutner et al. eds., The APA Textbook of Women’s Reproductive Mental Health (Washington, DC: APA Publishing, 2021)
Purpose of Review We review recent evidence concerning the epidemiology, etiology, and treatment of obsessive–compulsive disorder (OCD) in the perinatal period. We examine studies reporting on rates of both new-onset OCD and exacerbation in both pregnancy and postpartum; explore both biological and psychosocial risk factors for the disorder; and review the latest evidence concerning treatment. Recent Findings Evidence is limited in all areas, with rates of both OCD and subthreshold obsessive–compulsive symptoms varying widely across studies. Prevalence is likely higher in the perinatal period than in the general population. Clinical features in the perinatal period are more likely than at other times to concern harm to the child, with contamination and aggressive obsessions and cleaning and checking compulsions especially common. Research into the biological etiology is too limited at this time to be definitive. Both observational and randomized controlled trials support cognitive behavioral therapy with exposure and response prevention (CBT with ERP) as a first-line treatment, with limited evidence also supporting the use of selective serotonin reuptake inhibitors (SSRIs). Treatment considerations in the perinatal period must weigh the risks of treatment vs. the risks of untreated illness. Summary Perinatal OCD is common and can be impairing. Clinical features differ somewhat compared to non-perinatal periods. Treatment does not differ from that used in the general population, though evidence pertaining specifically to the perinatal period is sparse.
Purpose of Review Suicide is a leading cause of death in the perinatal period (pregnancy and 1 year postpartum). We review recent findings on prevalence, risk factors, outcomes, and prevention and intervention for suicide during pregnancy and the first year postpartum. Recent Findings Standardization of definitions and ascertainment of maternal deaths have improved identification of perinatal deaths by suicide and risk factors for perinatal suicide. Reports of a protective effect of pregnancy and postpartum on suicide risk may be inflated. Clinicians must be vigilant for risk of suicide among their perinatal patients, especially those with mental health diagnoses or prior suicide attempts. Summary Pregnancy and the year postpartum are a time of increased access to healthcare for many, offering many opportunities to identify and intervene for suicide risk. Universal screening for suicide as part of assessment of depression and anxiety along with improved access to mental health treatments can reduce risk of perinatal suicide.
Self-reported duration of impaired functioning and combat-related acute stress reaction
Purpose of Review This paper highlights the topic of combat-related acute stress reactions (ASRs) in service members. Specifically, we contrast ASRs with related psychiatric conditions, report the estimated prevalence of ASRs for soldiers deployed to combat, and discuss how team members can effectively respond to these reactions. Recent Findings Although not regarded as a clinical disorder, ASRs can have a significant impact on high-risk occupations like the military in which impaired functioning can imperil team members and others. Based on self-report, 17.2% of soldiers who have deployed to combat report having experienced a possible ASR. To our knowledge, this is the first such prevalence estimate. Summary The prevalence of ASRs underscores the need for improved prevention, management, and recovery strategies. Peer-based intervention protocols such as iCOVER may provide a useful starting point to address ASRs in team members.
Purpose of Review This paper reviews the literature on the prevalence, risk factors, and effects of traumatic experiences on the mental health outcomes of minority youth in the USA. Recent Findings The USA has an increasing number of children and youth from minority backgrounds. Research reveals that traumatic experiences disproportionately affect minority youth. These experiences include historical/generational trauma, immigration and acculturation stressors, natural and manmade disasters, experiences of discrimination, family violence, and community violence. The COVID-19 pandemic has also disproportionately affected minority youth resulting in illness and hospitalizations. Despite the higher incidence of trauma exposure, minority youth are less likely to access medical and mental health care. These disparities are resulting in increasing rates of depression, anxiety, post-traumatic stress, substance use disorders, and suicide in minority youth. Summary Recognizing and understanding the impact of trauma is critical to the healthy development and successful functioning of minority youth, and to the success of our nation.
Purpose of Review Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. Recent Findings There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Summary Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
Purpose of Review To summarize recent findings regarding anxiety and trauma-related disorders in children diagnosed with autism spectrum disorder (autism), focusing on the distinct ways in which these conditions may be expressed, as well as advances in evidence-based assessment and treatment. Recent Findings Current findings suggest both anxiety and trauma-related disorders may be more prevalent, yet more complicated to address in autistic relative to non-autistic children. Overlapping symptoms and distinct manifestations of these disorders pose challenges for the accurate identification, assessment, and treatment of anxiety and trauma-related disorders in autistic children. Emerging evidence recommends adapting traditional assessment and treatment approaches to better meet the needs of autistic children. Summary Recent research suggests autism-centered conceptualizations, which accommodate complexity in how anxiety and trauma-related disorders are experienced and expressed by autistic people, are needed to enhance the psychiatric care of this population.
Purpose of Review We reviewed the existing and recent community models of care in schizophrenia. We examine characteristics, recent updates, evidence, cost-effectiveness, and patients’ acceptance for existing and new community-based care models in high-income (HI) and low- and middle-income (LAMI) countries. Recent Findings Assertive Community Treatment (ACT), Intensive Case Management (ICM), and Crisis Intervention are cost-effective interventions for schizophrenia and time tested in the last few decades in HI countries. The growing evidence suggests that tailor-made ACTs and ICM can effectively reduce substance use, homelessness, and criminal activity in persons with schizophrenia who live in the community. Similarly, in LAMI Countries, a few community-based care models for schizophrenia have been developed and tested based on community-based rehabilitation principles. Summary The modality of a community model of care and interventions for a person with schizophrenia should be chosen based on the person’s co-existing psychosocial difficulties and challenges such as homelessness, criminal behaviour, and substance use.
Purpose of Review Emotion artificial intelligence (AI) is technology for emotion detection and recognition. Emotion AI is expanding rapidly in commercial and government settings outside of medicine, and will increasingly become a routine part of daily life. The goal of this narrative review is to increase awareness both of the widespread use of emotion AI, and of the concerns with commercial use of emotion AI in relation to people with mental illness. Recent Findings This paper discusses emotion AI fundamentals, a general overview of commercial emotion AI outside of medicine, and examples of the use of emotion AI in employee hiring and workplace monitoring. Summary The successful re-integration of patients with mental illness into society must recognize the increasing commercial use of emotion AI. There are concerns that commercial use of emotion AI will increase stigma and discrimination, and have negative consequences in daily life for people with mental illness. Commercial emotion AI algorithm predictions about mental illness should not be treated as medical fact.
Flowchart of the literature search
Purpose of Review This paper reports a review of the empirical research examining the association between mass trauma media contact and depression in children, the factors that may influence the association, and the difficulties encountered in the study of media effects on depression. Recent Findings All of the included studies assessed general population samples. Pre-COVID-19 research focused primarily on television coverage alone or on multiple media forms including television, while COVID-19 media studies examined various media forms including social media. Most studies used cross-sectional design and non-probability sampling. The review revealed inconclusive findings across studies. Summary The study of mass trauma media effects on depression in children is complicated by a number of potential confounding factors and by the relatively high prevalence of depression in the general population. Media contact was a relatively minor consideration among other interests in the extant studies which failed to explore numerous issues that warrant attention in future research.
Purpose of Review This review provides a highlight of existing evidence-based practices and community support systems that exist to enhance employment outcomes for autistic transition-age youth (TAY) and adults. An update is provided on the current status of these programs and the impact they are having on employment outcomes for this population. Recent Findings Many programs exist that prove to be efficacious in improving employment outcomes. These programs can be categorized as vocational rehabilitation service system level interventions, provider and consumer level interventions targeting skills related to employment, and consumer level interventions delivered within community vocational rehabilitation or education settings. A more recent increase in programs is consistent with multiple research and policy calls for amplified programming in this area. Summary Despite these recent increases, there is still a need to further develop effective programming to support employment outcomes as the growing autistic population age into adulthood. Community-based research and practice should continue to be developed and tested.
Purpose of Review The goal of this review is to describe how emerging technological developments in pre-clinical animal research can be harnessed to accelerate research in anorexia nervosa (AN). Recent Findings The activity-based anorexia (ABA) paradigm, the best characterized animal model of AN, combines restricted feeding, excessive exercise, and weight loss. A growing body of evidence supports the idea that pathophysiological weight loss in this model is due to cognitive inflexibility, a clinical feature of AN. Targeted manipulations that recapitulate brain changes reported in AN — hyperdopaminergia or hyperactivity of cortical inputs to the nucleus accumbens — exacerbate weight loss in the ABA paradigm, providing the first evidence of causality. Summary The power of preclinical research lies in the ability to assess the consequences of targeted manipulations of neuronal circuits that have been implicated in clinical research. Additional paradigms are needed to capture other features of AN that are not seen in ABA.
Flow chart of the bibliographical search
Purpose of review To review the evidence about video game-based therapeutic intervention for people diagnosed with depressive disorders. Recent findings Psychotherapy has been proved to reduce depressive symptoms and is a key element in the treatment of depressive disorders. However, geographical, economical and stigmatized concerns are barriers to access to psychotherapy. New technologies and videos games can overcome some of these barriers by providing teleconferencing evidence-based therapy as time as they may offer an interactive entertainment. Summary Overall, video game-based interventions were useful and effective in reducing symptoms of depressive disorders. Seven of the studies were published in the last 5 years, which reflects the increased research interest in video game-based interventions for depression. Overall, when adherence was reported, rates of acceptability and feasibility were high.
Purpose of Review The perinatal period is a time of increased vulnerability for people with bipolar disorder (BD). The purpose of this review is to provide an update of the literature from the last 3 years regarding course of illness and treatments for BD in the perinatal period to guide clinical care. Recent Findings Postpartum manic and depressive episodes are emerging as having a unique presentation that may differentiate them from non-perinatal mood episodes. Many important updates regarding medication treatment in the perinatal period have been published recently that have considered the risks of untreated illness versus treatment risks in this population.’ Summary Despite significant research, there are still gaps in knowledge regarding safety and efficacy of medications for the mother and child. Crucial future areas of study include improved screening guidelines, randomized controlled trials examining medication safety in pregnancy and lactation, and efficacy of nonpharmacologic treatments.
Flowchart of the bibliographical search
Purpose of Review Suicide risk assessment is a challenge in clinical practice. Implicit measures may present with advantages with respect to explicit methods, and therefore may be useful for the assessment of suicide risk. We conducted a systematic review of 2 databases (PubMed and EMBASE) about implicit tests that measure suicide risk to explore their validity and reliability. Recent Findings Initial research revealed 321 articles. After the selection process, 31 articles were included in the review. The most death-related implicit cognition test used was the Death/Suicide Implicit association test (D/S IAT), followed by the Suicide Stroop Task. The Suicide Affect Misattribution Procedure (S-AMP) and the Death version of the Implicit Relational Assessment Procedure (D-IRAP) were also used. Summary We found that the measures reviewed were generally valid for the assessment of past and future suicidal thoughts and behaviors, with statistically significant results regarding retrospective and prospective associations.
Risk and protective factors of externalized disorders in adolescents during the COVID-19 pandemic
Risk and protective factors of internalized disorders in adolescents during the COVID-19 pandemic
Purpose of Review This review of the literature aims to explore the impact of the COVID-19 pandemic and the lockdown on teenagers’ mental health. We distinguish two groups: adolescents who had already been diagnosed with a mental disorder and the general population of adolescents. Recent Findings An increase in the number of mental health-related difficulties in adolescents has already been reported in previous health crises. Accordingly, the perceived well-being of teenagers declined during the COVID-19 pandemic. Adolescents with mental disorders were significantly more affected by the lockdown than those in the general population. Summary The effect of the COVID-19 crisis on the mental health of adolescents has been heterogeneous. The first pandemic wave was essentially associated with an increase of internalizing symptoms in adolescents, particularly anxiety, depression and eating disorders. The impact on externalizing symptoms was less clear, and seem to concern mostly adolescents with pre-existing behavioral disorders. During the second and later waves of the pandemic, an upsurge of suicidal ideation and attempts among adolescents have been reported in many countries.
Purpose of Review This review article discusses the controversy in the DSM-5 conceptualization and diagnostic criteria for female sexual dysfunction (FSD). An overview of recent studies on available treatments for hypoactive sexual desire disorder (HSDD), female sexual arousal disorder (FSAD), and genitopelvic pain/penetration disorder (GPPD) is provided. Recent Findings Include delineation of the process of care for pre- and postmenopausal women with HSDD; release of global position statement on testosterone therapy in women; updates on efficacy and safety of vaginal estrogen for genitourinary syndrome of menopause and bremelanotide for HSDD; removal of flibanserin alcohol REMS; and development of new technology to enhance bioavailability and brain delivery of treatments. Summary The DSM-5 revision combining HSDD and FSAD into one diagnostic category is a less accurate characterization of these separate disorders and may hinder access to demonstrated effective treatments for the women with these conditions. There are a wide range of pharmacological, other physiological, and psychological treatment options available for women with FSD, which can be offered based on their specific symptoms, potential benefits/risks, and preferences.
The hypothesis of SAD development secondary to childhood ADHD (based on Koyuncu et al. (2018) Fig. 1) (ADHD attention deficit/hyperactivity disorder, SAD social anxiety disorder)
Purpose of the Review In this review, we focus on overlapping features of ADHD and anxiety disorders, and will discuss how an anxiety disorder comorbidity leads to diagnostic and treatment challenges in patients with ADHD, in consideration of the accumulated available knowledge. Recent Findings The presence of overlapping symptoms, changes in the diagnostic criteria, and the use of divergent diagnostic tools and informant effects can complicate the diagnosis of this comorbidity. Due to the ongoing debate about the etiology, psychopathology, and diagnostic features of the association between ADHD and anxiety disorders, choosing appropriate treatment options emerges as a challenge. Summary A novel methodology, standardized interview tools, and new statistical analysis methods are needed to define the phenotype of this co-occurrence more clearly. It is important to uncover the developmental nature of this comorbidity with follow-up studies that may explain the etiology and underlying neurobiological basis, and ultimately lead to more effective treatment approaches.
Purpose of Review With a focus on reviewing adequately powered randomized controlled trials, we present recent research on the potential of cognitive behavioral therapy for insomnia (CBT-I) to improve depression and anxiety outcomes among patients with insomnia and one of the following comorbid psychiatric disorders: major depressive disorder (MDD), generalized anxiety disorder (GAD), or posttraumatic stress disorder (PTSD). We also examine potential moderators of CBT-I on depression and anxiety outcomes in this population. Recent Findings Despite high comorbidity rates, current behavioral and pharmacological treatments for MDD, GAD, and PTSD do not substantially target or improve insomnia symptoms; residual insomnia is exceedingly common even among patients who experience remission. Insomnia plays a critical role in the onset and maintenance of depression and anxiety, and treating insomnia with CBT-I may improve global outcomes for patients with MDD, GAD, and PTSD. Summary CBT-I is superior to traditional depression/anxiety treatment in improving insomnia symptoms among patients with comorbid psychiatric disorders. Results are mixed on whether CBT-I (either alone or augmented with depression/anxiety treatment) is effective in improving overall MDD, GAD, and PTSD outcomes. Evening circadian preference and depression/anxiety symptom severity may moderate the effect of CBT-I on depression and anxiety outcomes.
Purpose of Review Since the declaration of the COVID-19 pandemic, there have been numerous social changes to try to contain the spread of the disease. These sudden changes in daily life have also changed the way we relate to others, in addition to creating a climate of uncertainty and fear. Therefore, the objective of this review is to compile published data of the consequences of suicidal behavior in the first months from the onset of the pandemic. Recent Findings The analysis reflects a concern about issues related to suicide since the beginning of the pandemic. A large number of online surveys have been released and have provided data on relatively large populations. The percentage of the population with suicidal ideation in that period seems to be approximately 5–15%. Many studies associate suicidal ideation with being young, female, and presence of sleep problems. Surveys of healthcare workers do not seem to indicate a higher prevalence of suicidal ideation compared to the general population. The incidence of suicide attempts seen in emergency departments did not seem to change, while the number of visits for other issues, unrelated to suicide, did decrease. The few studies on completed suicide do not indicate an increase in incidence in these first 6 months since March 2020, when the WHO declared the start of the pandemic. Summary It does not seem that there have been major changes in the figures related to suicidal behavior in the studies from the first wave of the COVID-19 pandemic, although it is still too early to know the consequences it will have long term. The social and economic damages resulting from the pandemic will certainly take a long time to recover.
Top-cited authors
Hans Wijbrand Hoek
  • University of Groningen
Yuval Neria
  • Columbia University
James M Shultz
  • University of Miami Miller School of Medicine
Milton L Wainberg
  • Columbia University
Raffaella Calati
  • Università degli Studi di Milano-Bicocca