Scott Beach

Massachusetts General Hospital | MGH · Department of Psychiatry

Objectives: Electroconvulsive therapy (ECT) is an essential procedure for a range of psychiatric conditions. Multiple single-center studies have documented reduction in ECT administration in 2020 because of the coronavirus disease 2019 pandemic, but there have been little nationally representative data from the United States. The aim of this study...

Catatonia occurs secondary to both primary psychiatric and neuromedical etiologies. Emerging evidence suggests possible linkages between causes of catatonia and neuroinflammation. These include obvious infectious and inflammatory etiologies, common neuromedical illnesses such as delirium, and psychiatric entities such as depression and autism-spect...

Objective: Electroconvulsive therapy (ECT) devices are classified as class II (moderate risk) for the treatment of depressive disorders and catatonia in patients aged 13 and older, but it is unknown how often the treatment is utilized by child and adolescent patients. The aim of this study was to examine the demographics of child and adolescent ho...

Identifying the correlates of out-of-pocket (OOP) health care spending is an important step for ensuring the financial security of older adults. Whether or not someone has a family member providing assistance is one such factor that could be associated with OOP spending. If family caregivers facilitate better health, health care spending could be r...

Objective: COVID-19 is associated with a range of neuropsychiatric manifestations. While case reports and case series have reported catatonia in the setting of COVID-19 infection, its rate has been poorly characterized. This study reports the co-occurrence of catatonia and COVID-19 diagnoses among acute care hospital discharges in the United State...

Introduction Delirium is common in the setting of infection with SARS-CoV-2. Anecdotal evidence and case reports suggest that patients with delirium in the setting of COVID-19 may exhibit specific features, including increased tone, abulia and alogia. Objective To determine whether differences exist in sociodemographic and medical characteristics,...

Objective Catatonia is a neuropsychiatric disorder that can occur in the setting of many illnesses, but the frequency of catatonia diagnosis among hospitalized patients is poorly characterized. This study reports the occurrence of catatonia diagnosis among acute care hospital discharges in the United States and the cooccurring diagnoses of these pa...

Objective: The Food and Drug Administration (FDA) warned about lamotrigine's arrhythmogenicity based on in vitro data. This systematic review investigates lamotrigine's effect on cardiac conduction and risk of sudden cardiac death (SCD) in individuals with and without cardiovascular disease. Methods: We searched Web of Science and PubMed from in...

Objective The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors of moderate or severe forms of COVID-19. Method 425 adults were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview, psychometric tests and a cognitive battery. A large, multidisciplin...

Objective: To review the most common mental health strategies aimed at alleviating and/or preventing mental health problems in individuals during the coronavirus disease 2019 (COVID-19) and other coronavirus pandemics. Methods: We conducted a systematic review of the literature assessing three databases (PubMed, SCOPUS, and PsycINFO). A meta-analy...

Objectives : Assess a conceptual model linking caregiving factors to care recipient mortality in a large representative sample of older adults with disability. Design : Descriptive longitudinal study with five-year mortality follow-up among older adults with disability. Baseline in person and telephone interviews / assessments of older adults with...

Introduction Neuropsychiatric manifestations of the coronavirus disease 2019 (COVID-19) have been described, including anosmia, ageusia, headache, paresthesia, encephalitis and encephalopathy. Little is known about the mechanisms by which the virus causes central nervous system (CNS) symptoms, and therefore little guidance is available regarding po...

Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies t...

Objective The authors surveyed psychiatry residents to determine who participates in moonlighting and to understand their views and opinions on the necessity, importance, and educational value of moonlighting. Methods An electronic survey was distributed to psychiatry residents at 16 programs nationally. Descriptive characteristics were calculated...

Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patie...

Objective: The therapeutic discharge of patients assessed as misrepresenting suicidal ideation, though in the best interests of the patient, physician, and health care system, is an inherently risk-assuming action. The rationale and conduct of the therapeutic discharge has been written on previously. Here, we propose a method of documenting the th...

Background Some psychotropic medications have been associated with prolongation of the QT interval, and QT prolongation, especially in those with medical illness, is linked to lethal ventricular arrhythmias, such as Torsades de Pointes (TdP). In 2013, we published a review of QT prolongation, TdP, and psychotropic medications. Methods We provide a...

Introduction Intentional self-inflicted burn injuries are a rare occurrence in the United States, but represent a considerable portion of all burn injuries in the developing world. Compared to non-intentional burns, patients with intentional self-inflicted burns have increased rates of higher total body surface area (TBSA) involvement and associate...

Background Catatonia is a commonly encountered syndrome, affecting 10–20% of various psychiatric populations and carrying significant medical co-morbidities. However, there are few established alternative treatment strategies when benzodiazepines are ineffective and electroconvulsive therapy is unavailable. Objective The authors systematically rev...

This is a book for clinicians at every level of training and experience who want to understand the essentials of the legal system and how it affects their practice. Written by established experts and rising stars of the next generation of forensic clinicians, the 16 chapters in this book offer readers a basic understanding of legal principles encou...

Background: Despite the prevalence with which trainees encounter patients who attempt to manipulate, deceive, or withhold information from them, trainees receive little formal training in "thinking dirty"-that is, incorporating elements of hidden patient motives into their interview, formulation, and plan. Lack of acknowledgment of these aspects o...

Objective: Patients with factitious disorder or malingering behaviors pose particular problems in acute care settings. We sought to describe a manner to effectively discharge these patients and keep further harm, iatrogenic or otherwise, from being inflicted. Method: Once an indication has been identified, the therapeutic discharge can be carrie...

Background: Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patien...

By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients’ perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-...

Optimism has been associated with reduced suicidal ideation, but there have been few studies in patients at high suicide risk. We analyzed data from three study populations (total N=319) with elevated risk of suicide: (1) patients with a recent acute cardiovascular event, (2) patients hospitalized for heart disease who had depression or an anxiety...

Background: Positive psychologic characteristics have been linked to superior cardiac outcomes. Objective: Accordingly, in this exploratory study, we assessed positive psychology interventions in patients who had recently undergone a procedure to treat cardiovascular disease. Method: Participants were randomly assigned to receive 1 of 3 differ...

Cardiac illness is frequently comorbid with psychiatric disorders, and patients with heart disease are often prescribed psychotropic medications. Although psychotropics are in general well tolerated and efficacious in patients with cardiac disease, physicians need to be aware of key concerns related to side effects and safety. Among the antidepress...

Cardiac illness is frequently comorbid with psychiatric disorders, and patients with heart disease are often prescribed psychotropic medications. Although psychotropics are in general well tolerated and efficacious in patients with cardiac disease, physicians need to be aware of key concerns related to side effects and safety. Among the antidepress...

Background: Positive psychological constructs, such as optimism, are associated with beneficial health outcomes. However, no study has separately examined the effects of multiple positive psychological constructs on behavioral, biological, and clinical outcomes after an acute coronary syndrome (ACS). Accordingly, we aimed to investigate associatio...

Background: Functional assessment may represent a valuable addition to postpartum depression screening, providing a more thorough characterization of the mother's health and quality of life. To the authors' knowledge, this analysis represents the first examination of postpartum maternal functioning, as measured by a patient-centered validated tool...

Electroconvulsive therapy (ECT) is a safe and effective treatment for catatonia when benzodiazepines fail to work or when more immediate resolution is required. ECT may be used for all forms of catatonia, regardless of etiology, and may be particularly useful in cases of refractory catatonia. ECT appears to be more rapidly effective in stuporous ca...

Positive psychological constructs, especially optimism, have been linked with superior cardiovascular health. However, there has been minimal study of positive constructs in patients with acute coronary syndrome (ACS), despite the prevalence and importance of this condition. Furthermore, few studies have examined multiple positive psychological con...

Collaborative care is a systematic, team-based approach to the management of depression and other psychiatric disorders in medical settings. Collaborative care has been found to be effective and cost-effective, but there is little information to guide its implementation in clinical care. The objective of this article is to provide a practical guide...

The amount of literature published annually related to psychosomatic medicine is vast; this poses a challenge for practitioners to keep up-to-date in all but a small area of expertise. To introduce how a group process using volunteer experts can be harnessed to provide clinicians with a manageable selection of important publications in psychosomati...

The risk of suicide is elevated in patients with cardiac disease in comparison with the general population. In distressed cardiac inpatients, we explored the use of Item 9 of the Patient Health Questionnaire-9, which inquires about thoughts of death or suicide, and a detailed suicide evaluation (DSE) triggered by positive responses to Item 9 as mea...

A 35-year-old woman with a history of drug dependency was seen in the emergency department because of a rash that was thought to be due to mite infestation. She reported seeing bugs on her skin. Examination revealed excoriations on her skin, but the midback was spared.

Objective: To evaluate the association between selective serotonin reuptake inhibitors (SSRIs) and corrected QT interval (QTc) prolongation via meta-analysis of prospective studies. Data sources: PubMed/MEDLINE database (January 1, 1975-August 15, 2012), with additional reports identified using hand searches of reference lists of relevant articl...

Importance: Depression and anxiety are associated with adverse cardiovascular outcomes in patients with recent acute cardiac events. There has been minimal study of collaborative care (CC) management models for mental health disorders in high-risk cardiac inpatients, and no prior CC intervention has simultaneously managed depression and anxiety di...

The Patient Health Questionnaire-9 (PHQ-9) is increasingly used as a depression assessment tool in cardiac patients. However, in contrast to older depression instruments, there is little data linking PHQ-9 scores to adverse cardiac outcomes. Our goal was to evaluate whether higher PHQ-9 scores were predictive of subsequent cardiac readmissions amon...

Objective: Despite high rates and increased risk of mortality, delirium remains underdiagnosed and a minimal focus of formal medical education. This is the first study to examine the educational impact of a psychiatric liaison on beliefs and knowledge about delirium among both nurses and residents. Method: One psychiatrist spent 9 months roundin...

Depression and anxiety in cardiac patients are independently associated with adverse cardiovascular outcomes, including mortality. Collaborative care (CC) programs, which use care managers to assess patients, coordinate care, and perform therapeutic interventions, have proven effective in managing depression in this population. However, no prior CC...

In patients with cardiovascular disease (CVD), depression is common, persistent, and associated with worse health-related quality of life, recurrent cardiac events, and mortality. Both physiological and behavioral factors-including endothelial dysfunction, platelet abnormalities, inflammation, autonomic nervous system dysfunction, and reduced engag...

Prolongation of the corrected QT (QTc) interval is a key issue for patients who receive psychotropic medications. Such patients may have baseline clinical risk factors for QTc prolongation, and many psychotropic medications may further prolong this interval. This has great clinical relevance, as QTc prolongation is linked with dangerous arrhythmias...

Intervention research at the intersection of psychiatry and cardiology has primarily focused on the relationship between negative psychological syndromes (e.g., depression) and cardiac outcomes, with less emphasis on positive psychological attributes, such as optimism, gratitude, and well-being, as they relate to cardiac disease. Literature is revi...

Depression is common in patients with cardiac illness and is independently associated with elevated morbidity and mortality. There are screening guidelines for depression in cardiac patients, but the feasibility and cost-effectiveness of screening all cardiac patients is controversial. This process may be improved if a subset of cardiac patients at...

Using data from a national sample of informal caregivers to older adults, we identify predictors of lack of choice and the consequences of lack of choice in taking on the caregiving role. A national telephone survey with 1397 caregivers was carried out to assess whether respondents had a choice in taking on the caregiving role, their demographic ch...

Impaired adherence to medications and health behaviors may mediate the connection between psychiatric symptoms and mortality in cardiac patients. This study assessed the association between improvements in depression/anxiety and self-reported adherence to health behaviors in depressed cardiac patients in the 6 months after cardiac hospitalization....

Using telephone interview data from retired seniors to explore how inter-individual differences in circadian type (morningness) and bed-timing regularity might be related to subjective sleep quality and quantity. MANCOVA with binary measures of morningness, stability of bedtimes, and stability of rise-times as independent variables; sleep measures...

End-stage renal disease patients experience significant impairments in health-related quality of life (HRQOL). Testing various strategies to improve patient HRQOL in multicenter clinical trials, such as the Frequent Hemodialysis Network (FHN) trials is vitally important. The aim of this paper is to describe the design and conduct of HRQOL and patie...

assess psychometric properties of scales developed to assess experience and perception of physical, psychological, and existential suffering in older individuals. scales were administered to 3 populations of older persons and/or their family caregivers: individuals with Alzheimer's disease (AD) and their family caregivers (N = 105 dyads), married c...

to examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience-perpetrator, frequency, and degree of upset-of psychological mistreatment in the past 6 months. random digit dial telephone recruitment and population-based survey (telephone a...

Maternal functional status is important to capture in the 12 months after childbirth, as this period marks a critical window for both mother and child. In most cases, mothers are the primary caregivers and are, therefore, responsible for the majority of the work related to infant care tasks, such as feeding, diaper changes, and doctor's appointment...

Takotsubo cardiomyopathy is a novel acute cardiac syndrome characterized by transient regional systolic dysfunction of the left-ventricular apex and mid-ventricle, with hyperkinesis of the basal left ventricular segments, which has been associated with severe emotional or physical stress. This is the second published case report of takotsubo cardio...

Demographic trends indicate an aging population, highlighting the importance of collecting valid survey data from older adults. One potential issue when surveying older adults is use of technology to collect data on sensitive topics. Survey technologies like A-CASI and IVR have not been used with older adults to measure elder mistreatment. We surve...

Assessment of mothers in the year after childbirth is important for a number of reasons, including the well-being of the mother and healthy development of the child. There exists a body of instruments that measure a range of maternal characteristics, such as maternal confidence and self-efficacy. It remains unclear if any of these assessments can b...

This study examined the relationship between internalized and public stigma on treatment-related attitudes and behaviors in a community sample of 449 African American and white adults aged 18 years and older. Telephone surveys were administered to assess level of depressive symptoms, demographic characteristics, stigma, and treatment-related attitu...

To assess the effects of suffering in a spouse on prevalent and incident psychiatric (depression) and physical morbidity (cardiovascular disease [CVD]) in their partner, controlling for known risk factors for depression and CVD. Descriptive longitudinal study. A total of 1,330 older married couples enrolled in the Cardiovascular Health Study, a lar...

Cross-sectional and longitudinal analyses were carried out to assess the relationship between dementia patient suffering, caregiver depression, and antidepressant medication use in 1222 dementia patients and their caregivers. We assessed the prevalence of 2 types of patient suffering, emotional and existential distress, and examined their independe...

The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.

The purpose of this article is to stimulate discussion and research about patient suffering and caregiver compassion. It is our view that these constructs are central to understanding phenomena such as family caregiving, and that recognizing their unique role in the caregiving experience provides new directions for intervention research, clinical p...

This study of older patients with osteoarthritis and their spouses examined concordance between patients' and spouses' reports of patients' pain severity and the association of concordance with support and caregiving outcomes. Patients and spouses independently viewed videotapes of the patient performing simulated household tasks and provided ratin...

Caring for a sick or disabled relative has been linked to compromised caregiver health, and risk factors for negative caregiver outcomes have been studied extensively, but little attention has been given to care recipient and caregiver health as risk factors for potentially harmful behavior by informal caregivers. This article explores such risk fa...

Previous research suggests that 3 general processes underlie the decision of property crime victims to notify the police: One that is cognitively driven by reward/cost considerations, one that is affectively driven, and another that is socially driven. This study is the first to employ a community sample of crime victims to compare the 3 processes...

To determine the concordance of 4 methods of disability assessment with the criterion method. Performance testing in the home was selected as the criterion. The task performance of 57 community-dwelling older women (>/=70 years) with knee osteoarthritis was examined through self report, proxy report, clinical judgment based on impairment measures,...

The effects of a 12-week intervention on a patient-focused skills training group and a caregiver-focused skills training group were compared with those on a control group that received comparable attention, but no training. Intervention effects were monitored at the completion of the treatment phase and at 3- and 6-months postintervention. Treatmen...

To examine the constructs of task independence, safety, and adequacy. Fifty-seven nondisabled (ND) and 56 osteoarthritis-disabled (OAK) women were observed performing daily tasks. Intercorrelations among the constructs of independence and adequacy were uniformly high, while the relationship of safety to these constructs was moderate and more variab...

Context Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative.Objective To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath...

It is well known that depression can be a consequence of medical illness and disability, but a growing literature suggests also that depression can cause biological changes linked to morbidity and mortality. Depression is strongly implicated as a contributor to cardiovascular disease and mortality. Using the cascade-to-death model as a conceptual f...

Data from the first 2 waves of the Caregiver Health Effects Study (n = 680) were analyzed to examine the effects of changes in caregiving involvement on changes in caregiver health-related outcomes in a population-based sample of elders caring for a disabled spouse. Caregiving involvement was indexed by levels of (a) spouse physical impairment, (b)...

Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elder...

Data from the first 2 waves of the Caregiver Health Effects Study (n = 680) were analyzed to examine the effects of changes in caregiving involvement on changes in caregiver health-related outcomes in a population-based sample of elders caring for a disabled spouse. Caregiving involvement was indexed by levels of (a) spouse physical impairment, (b)...

This study investigated for the first time several characteristics of underachievement in a large sample of Hong Kong elementary schoolchildren. More males were identified as underachievers than females, but the ratio was substantially less than the two-to-one rate typically found in the American literature. The stability and persistence of underac...

There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may comp...

Seven caregivers of a home-dwelling spouse with Alzheimer's disease were trained during 12 weekly home visits to implement behavior management programs including written cuing procedures in response to repetitive verbalizations. Data from 7 trained caregivers and 7 matched control caregivers who only tracked repetitive behavior were compared. Resul...

The purpose of this study was to investigate primary caregiving spouses' and their lay helpers' divergent opinions about the caregiving environment. Through parallel assessments, both primary and secondary caregivers of a patient with Alzheimer's disease were asked to rate the degree of patient problem behaviors; the degree of strain the primary ca...

The purpose of this study was to investigate primary caregiving spouses' and their lay helpers' divergent opinions about the caregiving environment. Through parallel assessments, both primary and secondary caregivers of a patient with Alzheimer's disease were asked to rate the degree of patient problem behaviors; the degree of strain the primary ca...

Acceptance and ultimate adoption of quality of life technology by older and disabled adults will likely involve numerous trade-offs. For example, users of such technology may need to give up some privacy due to monitoring of their behavior; to expend time and effort to learn to use and maintain the system; and/or give up efficiency and social inter...