Peter A. Shapiro’s research while affiliated with Columbia University and other places

Health emerges from coordinated psychobiological processes powered by mitochondrial energy transformation. But how do mitochondria regulate the multisystem responses that shape resilience and disease risk across the lifespan? The Mitochondrial Stress, Brain Imaging, and Epigenetics (MiSBIE) study was established to address this question and determine how mitochondria influence the interconnected neuroendocrine, immune, metabolic, cardiovascular, cognitive, and emotional systems among individuals spanning the spectrum of mitochondrial energy transformation capacity, including participants with rare mitochondrial DNA (mtDNA) lesions causing mitochondrial diseases (MitoDs). This interdisciplinary effort is expected to generate new insights into the pathophysiology of MitoDs, provide a foundation to develop novel biomarkers of human health, and integrate our fragmented knowledge of bioenergetic, brain–body, and mind–mitochondria processes relevant to medicine and public health.

Health emerges from coordinated psycho-biological processes powered by mitochondrial energy transformation. But how do mitochondria regulate the multi-system responses that shape resilience and disease risk across the human lifespan? The Mitochondrial Stress, Brain Imaging, and Epigenetics (MiSBIE) study was established to address this question. MiSBIE aims to determine how mitochondria influence the interconnected neuroendocrine, immune, metabolic, cardiovascular, cognitive, and emotional systems. This goal will be achieved by i) studying women and men with genetically defined mitochondrial DNA lesions causing mitochondrial diseases (MitoD) together with individuals spanning the natural spectrum of mitochondrial energy transformation capacity (Control); ii) combining systems-level, physiological, and single-cell methods across biospecimens, along with psychophysiological, self-reported subjective experiences, and neuroimaging modalities; and iii) harnessing complementary baseline, stress-evoked reactivity/recovery, and diurnal assessments including intensive repeated-measures that capture dynamic psychobiological states of allostasis. This interdisciplinary effort is expected to generate new insights into the pathophysiology of mitochondrial diseases, provide a foundation to develop novel biomarkers of human health, and integrate our fragmented knowledge of bioenergetic, brain-body, and mind-mitochondria processes relevant to modern medicine and public health.

Mood disorders affect around 1 in 5 people, but the diagnosis and management of these conditions can be challenging. This practical handbook presents a comprehensive overview of these disorders, as well as detailed guidelines for their treatment. The handbook takes a transdisciplinary approach to mood disorders, focusing not only on the biological aspects but also on psychosocial features of importance for optimal diagnosis and management. Content covers nosological considerations, historical aspects, peculiarities along the lifespan, and the associations between mood disorders and other conditions, with a focus on their implications for the optimal management of patients. Practical and evidence-based information is discussed on the role of guidelines related to treatment in selected population groups, including youth, the elderly, and women. With a practical, reader-friendly approach, this book will be invaluable for mental health professionals involved in the treatment of patients with mood disorders, including trainees from different mental health areas.

Background: Prevalence, incidence, and factors associated with posttraumatic stress disorder (PTSD) symptoms at follow-up among healthcare workers after the first wave of the COVID-19 pandemic are unknown. Methods: A web survey invitation was sent to healthcare worker listservs at a NYC medical center (April, 2020). The Primary Care (PC)-PTSD questionnaire was used to screen for PTSD symptoms at baseline and then every 2 weeks for 10 weeks. Incidence and prevalence of PTSD symptoms were determined at each time point. Multivariable generalized estimating equation models were performed to investigate the factors associated with a positive PC-PTSD screen at follow-up. Results: Median age (interquartile range) of N = 230 participants was 36 (31-48) years; 79.6% were women; 82.6% worked in COVID-19-focused settings. The prevalence of PTSD symptoms decreased from 55.2% at baseline to 25.0% at 10 weeks (p < 0.001). Among participants who had a baseline negative screen for PTSD symptoms, the incidence of PTSD at 10 weeks was 12.2% (p-trend 0.034). In multivariable-adjusted analyses, being a nurse (odds ratio [OR]: 1.70, 95% confidence interval [CI]: 1.06-2.71), female (OR: 3.00, 95% CI: 1.59, 5.72), and working in a COVID-19-focused location (OR: 1.51, 95% CI: 1.02, 2.21) were associated with increased odds of PTSD symptoms at 10-weeks. Conclusions: PTSD symptoms improved over 3 months following the first wave of the COVID-19 pandemic. However, one out of four NYC healthcare workers still had an increased risk for PTSD at 10-weeks. Screening healthcare workers for PTSD symptoms should be considered during the COVID-19 pandemic.

Objectives: Palliative care is an essential part of the standard of care for individuals with serious medical illnesses. Integration of palliative care and mental health is important for elderly patients with medical and psychiatric comorbidities. Geriatric psychiatrists are natural stewards of palliative care-mental health integration, however this is contingent on palliative care training. Currently, palliative care training in geriatric psychiatry fellowship programs is uncharacterized. We surveyed geriatric psychiatry fellowship program directors in the United States to assess current palliative care training practices. Methods: Web-based anonymous survey of geriatric psychiatry fellowship training directors Results: 46% (28/61) of program directors responded. 71% (20/28) of programs provide didactics on palliative care. 77% (20/26) of programs provide clinical experiences in palliative care. 63% (15/24) have formalized interactions between geriatric psychiatry and palliative care fellows. Conclusions: Palliative care training for geriatric psychiatry fellows is robust but unstandardized. Operationalizing palliative care training for geriatric psychiatrists may improve mental health integration into serious illness care.

Background: The COVID-19 pandemic forced consultation-liaison psychiatrists to adapt to unprecedented circumstances. The Academy of Consultation-Liaison Psychiatry (ACLP) recognized the need and opportunity to assess its response and convened a task force in mid-2020 to review the lessons learned from the initial experience of the COVID-19 pandemic. Objective: The aim of the study was to summarize experience and make recommendations to the ACLP Board of Directors about potential ACLP directions related to current and future pandemic response. Methods: In August-November 2020, the task force reviewed local experiences, ACLP list-serv contributions, and the published literature and generated recommendations for ACLP actions. Results: Recommendations addressed telepsychiatry, hospital staff wellness, support for consultation-liaison psychiatrists, the need for additional research on psychiatric and neuropsychiatric aspects of COVID-19, and the ACLP's role in advocacy and dissemination of information. The task force report was submitted to the ACLP Board of Directors in November 2020. Conclusions: As the preeminent American organization of consultation-liaison psychiatrists, the ACLP can implement actions related to pandemic awareness and preparedness for the benefit of consultation-liaison psychiatrists, other health care workers, patients, and the general population.

Background Delirium affects many patients undergoing stem cell transplantation (SCT). Delirium is treatable but prevention is a better goal, making it desirable to identify patients at heightened risk for delirium. A standardized pre-transplant psychosocial assessment rating scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), has been demonstrated to predict outcomes in solid organ transplant recipients, and non-adherence in SCT patients. In this study we evaluated the association of SIPAT score, and post-SCT incident delirium. Methods We retrospectively reviewed records of SCT recipients who had SIPAT evaluations prior to SCT, for indications of delirium in the 6 months post-transplant. We tested the association between SIPAT score and delirium by logistic regression, controlling for relevant co-variates such as transplant type (allogeneic vs. autologous). Results Of 85 patients (median age of 49 years, range 18-74), 56 (66%) were male, and 43 (50.5%) were autologous SCT recipients. The median pre-transplant SIPAT score was 8, range 0-40. There were 15 cases (17.6%) of delirium in the 6 months following transplant. In univariate analyses, transplant type and SIPAT score were significantly associated with incident delirium. Multivariate analysis confirmed the significant association of the SIPAT score and incident delirium (OR 1.090, p = 0.021). Conclusions Psychosocial risk as quantified by the SIPAT is associated with development of delirium in SCT recipients. This scale can therefore be integrated into medical risk models to anticipate which patients are at higher risk for delirium in their hospital course, enabling preventative measures tailored to the needs of the individual patient.