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Navigating racism while in medical training
SAN FRANCISCO – When Jessica Isom, MD, MPH, and her colleagues noticed the absence of good role modeling about how to address race and racism in interactions with supervisors at their long-term care clinic, they conducted a research study.
“Now, we’re working on rolling out what those solutions might be for addressing this gap in the education,” said Dr. Isom, a PGY-4 resident at Yale University, New Haven, Conn. Many of the issues Dr. Isom and her colleagues found are reminiscent of those identified almost 50 years ago by Billy E. Jones, MD, and his colleagues. Their article (1970 Dec; 127[6]:798-803) focusing on the problems of black residents in predominantly white institutions was published in the American Journal of Psychiatry, Constance E. Dunlap, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Dunlap interviews Dr. Isom about her experiences with both supervisors and patients on issues tied to race and racism – and examines possible solutions.
In one case, Dr. Isom said she created an opening for discussion with a supervisor by advising him to read the book White Fragility (Beacon Press, 2018). “He read the book,” Dr. Isom said. “And And he’s thinking about these things now as a white man and his relationship to racism. So that’s sort of a positive outcome from having that conversation in the first place.”
In another case involving a patient who declined treatment from Dr. Isom and an Asian male medical student, Dr. Isom said she respected the patient’s wishes and walked out of the room. When she shared the experience with her team, the incident was not addressed.
Dr. Isom’s experiences reflects that of African Americans and other ethnic minorities in the United States, Dr. Dunlap said. “I think about being in junior high school and reading ... and doing my own study outside of school and that has carried through college, medical school, and even in residency – and definitely psychoanalytic training – where psychoanalysts like Frantz Fanon, Frances Cress Welsing, even Dorothy Holmes ... were not included in the mainstream curriculum.” However, those thinkers are included in some curricula now.
“This is an example of how medicine and psychoanalysis have been functioning in parallel with the way the country functions,” Dr. Dunlap said. “This is a huge blind spot.”
Dr. Isom worked on the research study with fellow residents* Myra Mathis, MD; Flavia DeSouza, MHS, MD; and Natalie Lastra, MD. Dr. Isom is member of the American Psychiatric Association Assembly as the area 1 representative for resident fellow members. She also is one of the chief residents of diversity and inclusion, and a codirector of the social justice and health equity curriculum at the department of psychiatry at Yale. Dr. Dunlap is a psychiatrist and psychoanalyst with more than 25 years’ experience in clinical care, psychiatric education, patient advocacy, and community outreach. She is a member of the APA assembly representing the Washington Psychiatric Society. Dr. Isom and Dr. Dunlap had no disclosures.
*CLARIFICATION, 5/22/2019
SAN FRANCISCO – When Jessica Isom, MD, MPH, and her colleagues noticed the absence of good role modeling about how to address race and racism in interactions with supervisors at their long-term care clinic, they conducted a research study.
“Now, we’re working on rolling out what those solutions might be for addressing this gap in the education,” said Dr. Isom, a PGY-4 resident at Yale University, New Haven, Conn. Many of the issues Dr. Isom and her colleagues found are reminiscent of those identified almost 50 years ago by Billy E. Jones, MD, and his colleagues. Their article (1970 Dec; 127[6]:798-803) focusing on the problems of black residents in predominantly white institutions was published in the American Journal of Psychiatry, Constance E. Dunlap, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Dunlap interviews Dr. Isom about her experiences with both supervisors and patients on issues tied to race and racism – and examines possible solutions.
In one case, Dr. Isom said she created an opening for discussion with a supervisor by advising him to read the book White Fragility (Beacon Press, 2018). “He read the book,” Dr. Isom said. “And And he’s thinking about these things now as a white man and his relationship to racism. So that’s sort of a positive outcome from having that conversation in the first place.”
In another case involving a patient who declined treatment from Dr. Isom and an Asian male medical student, Dr. Isom said she respected the patient’s wishes and walked out of the room. When she shared the experience with her team, the incident was not addressed.
Dr. Isom’s experiences reflects that of African Americans and other ethnic minorities in the United States, Dr. Dunlap said. “I think about being in junior high school and reading ... and doing my own study outside of school and that has carried through college, medical school, and even in residency – and definitely psychoanalytic training – where psychoanalysts like Frantz Fanon, Frances Cress Welsing, even Dorothy Holmes ... were not included in the mainstream curriculum.” However, those thinkers are included in some curricula now.
“This is an example of how medicine and psychoanalysis have been functioning in parallel with the way the country functions,” Dr. Dunlap said. “This is a huge blind spot.”
Dr. Isom worked on the research study with fellow residents* Myra Mathis, MD; Flavia DeSouza, MHS, MD; and Natalie Lastra, MD. Dr. Isom is member of the American Psychiatric Association Assembly as the area 1 representative for resident fellow members. She also is one of the chief residents of diversity and inclusion, and a codirector of the social justice and health equity curriculum at the department of psychiatry at Yale. Dr. Dunlap is a psychiatrist and psychoanalyst with more than 25 years’ experience in clinical care, psychiatric education, patient advocacy, and community outreach. She is a member of the APA assembly representing the Washington Psychiatric Society. Dr. Isom and Dr. Dunlap had no disclosures.
*CLARIFICATION, 5/22/2019
SAN FRANCISCO – When Jessica Isom, MD, MPH, and her colleagues noticed the absence of good role modeling about how to address race and racism in interactions with supervisors at their long-term care clinic, they conducted a research study.
“Now, we’re working on rolling out what those solutions might be for addressing this gap in the education,” said Dr. Isom, a PGY-4 resident at Yale University, New Haven, Conn. Many of the issues Dr. Isom and her colleagues found are reminiscent of those identified almost 50 years ago by Billy E. Jones, MD, and his colleagues. Their article (1970 Dec; 127[6]:798-803) focusing on the problems of black residents in predominantly white institutions was published in the American Journal of Psychiatry, Constance E. Dunlap, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Dunlap interviews Dr. Isom about her experiences with both supervisors and patients on issues tied to race and racism – and examines possible solutions.
In one case, Dr. Isom said she created an opening for discussion with a supervisor by advising him to read the book White Fragility (Beacon Press, 2018). “He read the book,” Dr. Isom said. “And And he’s thinking about these things now as a white man and his relationship to racism. So that’s sort of a positive outcome from having that conversation in the first place.”
In another case involving a patient who declined treatment from Dr. Isom and an Asian male medical student, Dr. Isom said she respected the patient’s wishes and walked out of the room. When she shared the experience with her team, the incident was not addressed.
Dr. Isom’s experiences reflects that of African Americans and other ethnic minorities in the United States, Dr. Dunlap said. “I think about being in junior high school and reading ... and doing my own study outside of school and that has carried through college, medical school, and even in residency – and definitely psychoanalytic training – where psychoanalysts like Frantz Fanon, Frances Cress Welsing, even Dorothy Holmes ... were not included in the mainstream curriculum.” However, those thinkers are included in some curricula now.
“This is an example of how medicine and psychoanalysis have been functioning in parallel with the way the country functions,” Dr. Dunlap said. “This is a huge blind spot.”
Dr. Isom worked on the research study with fellow residents* Myra Mathis, MD; Flavia DeSouza, MHS, MD; and Natalie Lastra, MD. Dr. Isom is member of the American Psychiatric Association Assembly as the area 1 representative for resident fellow members. She also is one of the chief residents of diversity and inclusion, and a codirector of the social justice and health equity curriculum at the department of psychiatry at Yale. Dr. Dunlap is a psychiatrist and psychoanalyst with more than 25 years’ experience in clinical care, psychiatric education, patient advocacy, and community outreach. She is a member of the APA assembly representing the Washington Psychiatric Society. Dr. Isom and Dr. Dunlap had no disclosures.
*CLARIFICATION, 5/22/2019
REPORTING FROM APA 2019
Psychiatrists urged to raise awareness about human trafficking
SAN FRANCISCO – Psychiatrists see and interact with people who are being sex and labor trafficked “all the time” – and can learn more about how to identify these individuals, Rachel Robitz, MD, said at the annual meeting of the American Psychiatric Association.
In an exclusive video, Mollie Gordon, MD, interviewed Dr. Robitz about the intersection between trafficking and mental health. “What scares me the most is some of the statistics about self-harm,” said Dr. Robitz. “One study of sex-trafficked adults found that about 40% of them had a history of a suicide attempt. A study of sex-trafficked minors found that about 30% of them had a history of moderate to severe self-harm behavior.”
Dr. Robitz said. Other resources include those provided by the Department of Health & Human Services’s Office on Trafficking in Persons.
Dr. Robitz, who is double boarded in psychiatry and family medicine, is with the University of California, Davis. She previously worked for a program for homeless youth and for many programs aimed at helping adult and youth survivors of human trafficking. Dr. Robitz has no disclosures. Dr. Gordon is associate professor of psychiatry in the Menninger department of behavioral health at Baylor College of Medicine, Houston. She is a founding member of the Houston Area Human Trafficking Health Care Consortium. Dr. Gordon has no disclosures.
SAN FRANCISCO – Psychiatrists see and interact with people who are being sex and labor trafficked “all the time” – and can learn more about how to identify these individuals, Rachel Robitz, MD, said at the annual meeting of the American Psychiatric Association.
In an exclusive video, Mollie Gordon, MD, interviewed Dr. Robitz about the intersection between trafficking and mental health. “What scares me the most is some of the statistics about self-harm,” said Dr. Robitz. “One study of sex-trafficked adults found that about 40% of them had a history of a suicide attempt. A study of sex-trafficked minors found that about 30% of them had a history of moderate to severe self-harm behavior.”
Dr. Robitz said. Other resources include those provided by the Department of Health & Human Services’s Office on Trafficking in Persons.
Dr. Robitz, who is double boarded in psychiatry and family medicine, is with the University of California, Davis. She previously worked for a program for homeless youth and for many programs aimed at helping adult and youth survivors of human trafficking. Dr. Robitz has no disclosures. Dr. Gordon is associate professor of psychiatry in the Menninger department of behavioral health at Baylor College of Medicine, Houston. She is a founding member of the Houston Area Human Trafficking Health Care Consortium. Dr. Gordon has no disclosures.
SAN FRANCISCO – Psychiatrists see and interact with people who are being sex and labor trafficked “all the time” – and can learn more about how to identify these individuals, Rachel Robitz, MD, said at the annual meeting of the American Psychiatric Association.
In an exclusive video, Mollie Gordon, MD, interviewed Dr. Robitz about the intersection between trafficking and mental health. “What scares me the most is some of the statistics about self-harm,” said Dr. Robitz. “One study of sex-trafficked adults found that about 40% of them had a history of a suicide attempt. A study of sex-trafficked minors found that about 30% of them had a history of moderate to severe self-harm behavior.”
Dr. Robitz said. Other resources include those provided by the Department of Health & Human Services’s Office on Trafficking in Persons.
Dr. Robitz, who is double boarded in psychiatry and family medicine, is with the University of California, Davis. She previously worked for a program for homeless youth and for many programs aimed at helping adult and youth survivors of human trafficking. Dr. Robitz has no disclosures. Dr. Gordon is associate professor of psychiatry in the Menninger department of behavioral health at Baylor College of Medicine, Houston. She is a founding member of the Houston Area Human Trafficking Health Care Consortium. Dr. Gordon has no disclosures.
REPORTING FROM APA 2019
When the parent is a psychiatrist: How are children affected?
SAN FRANCISCO – Research into how the children of psychiatrists fare psychologically is sparse. But anecdotally, children report that having a psychiatrist parent is a gift – not only for them – but for their friends’ families, Michelle B. Riba, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Riba is interviewed by Carol A. Bernstein, MD, about what she expected when she helped start the Children of Psychiatrists workshop at the APA meeting with Leah J. Dickstein, MD, and how it draws a standing room–only crowd each year.
“In general ... people feel very appreciative of having an empathic, knowledgeable parent to help guide them – and not overguide them,” Dr. Riba said. Psychiatrists also can provide insight into the causes of societal challenges such as homelessness. One audience member in this year’s workshop discussed the value of having a psychiatrist parent put a school suicide into perspective. Dr. Bernstein said she is viewed by her daughter’s friends as “the psychiatrist in residence.”
The children of psychiatrists who spoke on the panel this year said they liked being able to facilitate care for their friends. “They didn’t feel burdened by [having a psychiatrist parent],” Dr. Riba said. “We asked about that very question today.”
Dr. Riba, a past president of the APA, is professor of psychiatry at the University of Michigan, Ann Arbor. She also serves as director of the consultation-liaison fellowship, and director of the PsychOncology program at the university’s Rogel Cancer Center. She had no disclosures.
Dr. Bernstein, also an APA past president, is professor of psychiatry and obstetrics and gynecology, and vice chair for faculty development in psychiatry at the Albert Einstein College of Medicine, New York. She previously served as vice chair for education in psychiatry and director of residency training in psychiatry at the NYU School of Medicine. Dr. Bernstein had no disclosures.
SAN FRANCISCO – Research into how the children of psychiatrists fare psychologically is sparse. But anecdotally, children report that having a psychiatrist parent is a gift – not only for them – but for their friends’ families, Michelle B. Riba, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Riba is interviewed by Carol A. Bernstein, MD, about what she expected when she helped start the Children of Psychiatrists workshop at the APA meeting with Leah J. Dickstein, MD, and how it draws a standing room–only crowd each year.
“In general ... people feel very appreciative of having an empathic, knowledgeable parent to help guide them – and not overguide them,” Dr. Riba said. Psychiatrists also can provide insight into the causes of societal challenges such as homelessness. One audience member in this year’s workshop discussed the value of having a psychiatrist parent put a school suicide into perspective. Dr. Bernstein said she is viewed by her daughter’s friends as “the psychiatrist in residence.”
The children of psychiatrists who spoke on the panel this year said they liked being able to facilitate care for their friends. “They didn’t feel burdened by [having a psychiatrist parent],” Dr. Riba said. “We asked about that very question today.”
Dr. Riba, a past president of the APA, is professor of psychiatry at the University of Michigan, Ann Arbor. She also serves as director of the consultation-liaison fellowship, and director of the PsychOncology program at the university’s Rogel Cancer Center. She had no disclosures.
Dr. Bernstein, also an APA past president, is professor of psychiatry and obstetrics and gynecology, and vice chair for faculty development in psychiatry at the Albert Einstein College of Medicine, New York. She previously served as vice chair for education in psychiatry and director of residency training in psychiatry at the NYU School of Medicine. Dr. Bernstein had no disclosures.
SAN FRANCISCO – Research into how the children of psychiatrists fare psychologically is sparse. But anecdotally, children report that having a psychiatrist parent is a gift – not only for them – but for their friends’ families, Michelle B. Riba, MD, said at the annual meeting of the American Psychiatric Association.
In this video, Dr. Riba is interviewed by Carol A. Bernstein, MD, about what she expected when she helped start the Children of Psychiatrists workshop at the APA meeting with Leah J. Dickstein, MD, and how it draws a standing room–only crowd each year.
“In general ... people feel very appreciative of having an empathic, knowledgeable parent to help guide them – and not overguide them,” Dr. Riba said. Psychiatrists also can provide insight into the causes of societal challenges such as homelessness. One audience member in this year’s workshop discussed the value of having a psychiatrist parent put a school suicide into perspective. Dr. Bernstein said she is viewed by her daughter’s friends as “the psychiatrist in residence.”
The children of psychiatrists who spoke on the panel this year said they liked being able to facilitate care for their friends. “They didn’t feel burdened by [having a psychiatrist parent],” Dr. Riba said. “We asked about that very question today.”
Dr. Riba, a past president of the APA, is professor of psychiatry at the University of Michigan, Ann Arbor. She also serves as director of the consultation-liaison fellowship, and director of the PsychOncology program at the university’s Rogel Cancer Center. She had no disclosures.
Dr. Bernstein, also an APA past president, is professor of psychiatry and obstetrics and gynecology, and vice chair for faculty development in psychiatry at the Albert Einstein College of Medicine, New York. She previously served as vice chair for education in psychiatry and director of residency training in psychiatry at the NYU School of Medicine. Dr. Bernstein had no disclosures.
REPORTING FROM APA 2019
Toolkit for providing mental health care to Muslim patients launched
SAN FRANCISCO – A toolkit that seeks to help clinicians provide culturally and religiously informed mental health care for Muslim patients was officially launched at the annual meeting of the American Psychiatric Association.
Rania Awaad, MD, and Belinda S. Bandstra, MD, sat down at the annual meeting of the American Psychiatric Association to discuss how to use the toolkit and why it – and other resources on providing nuanced mental health care – are needed.
In this video, Dr. Awaad explores some of the origins of Islamophobia in the United States and how she came to do this work while in medical school. The travel ban affecting mostly Muslim countries has had a ripple effect on community members, she said. “The feeling is ‘My country isn’t named in the travel ban, but will I be next?’ ”
In addition to the fear and distrust fostered by the political climate are the challenges of abiding by the Islamic faith’s precepts.
“Patients will just do things on their own – and not consult their clinician,” Dr. Awaad said, referring to those might change the times in which they take medication during the sacred month of Ramadan because of fasting that is expected of observant Muslims. “It’s important for the patients to know that anyone acutely ill is exempt from fasting.” Medical- and faith-based consultation are important for these patients, Dr. Awaad said, pointing to a recent article that outlines best practices for treating patients with psychiatric disorders during Ramadan (Lancet Psychiatry. 2019 May 2. doi: 10.1016/S2215-0366[19]30161-0).
She also discussed “Islamophobia and Psychiatry” (Springer, 2019), a book she coedited that she said provides evidence of the detrimental effect that Islamophobia has on the mental health of Muslims.
Dr. Awaad is director of the Muslim Mental Health Lab and Wellness Program and codirector of the Diversity Clinic at Stanford (Calif.) University. Dr. Bandstra is assistant director of residency training in Stanford’s department of psychiatry and behavioral sciences. Dr. Awaad and Dr. Bandstra had no relevant disclosures.
SAN FRANCISCO – A toolkit that seeks to help clinicians provide culturally and religiously informed mental health care for Muslim patients was officially launched at the annual meeting of the American Psychiatric Association.
Rania Awaad, MD, and Belinda S. Bandstra, MD, sat down at the annual meeting of the American Psychiatric Association to discuss how to use the toolkit and why it – and other resources on providing nuanced mental health care – are needed.
In this video, Dr. Awaad explores some of the origins of Islamophobia in the United States and how she came to do this work while in medical school. The travel ban affecting mostly Muslim countries has had a ripple effect on community members, she said. “The feeling is ‘My country isn’t named in the travel ban, but will I be next?’ ”
In addition to the fear and distrust fostered by the political climate are the challenges of abiding by the Islamic faith’s precepts.
“Patients will just do things on their own – and not consult their clinician,” Dr. Awaad said, referring to those might change the times in which they take medication during the sacred month of Ramadan because of fasting that is expected of observant Muslims. “It’s important for the patients to know that anyone acutely ill is exempt from fasting.” Medical- and faith-based consultation are important for these patients, Dr. Awaad said, pointing to a recent article that outlines best practices for treating patients with psychiatric disorders during Ramadan (Lancet Psychiatry. 2019 May 2. doi: 10.1016/S2215-0366[19]30161-0).
She also discussed “Islamophobia and Psychiatry” (Springer, 2019), a book she coedited that she said provides evidence of the detrimental effect that Islamophobia has on the mental health of Muslims.
Dr. Awaad is director of the Muslim Mental Health Lab and Wellness Program and codirector of the Diversity Clinic at Stanford (Calif.) University. Dr. Bandstra is assistant director of residency training in Stanford’s department of psychiatry and behavioral sciences. Dr. Awaad and Dr. Bandstra had no relevant disclosures.
SAN FRANCISCO – A toolkit that seeks to help clinicians provide culturally and religiously informed mental health care for Muslim patients was officially launched at the annual meeting of the American Psychiatric Association.
Rania Awaad, MD, and Belinda S. Bandstra, MD, sat down at the annual meeting of the American Psychiatric Association to discuss how to use the toolkit and why it – and other resources on providing nuanced mental health care – are needed.
In this video, Dr. Awaad explores some of the origins of Islamophobia in the United States and how she came to do this work while in medical school. The travel ban affecting mostly Muslim countries has had a ripple effect on community members, she said. “The feeling is ‘My country isn’t named in the travel ban, but will I be next?’ ”
In addition to the fear and distrust fostered by the political climate are the challenges of abiding by the Islamic faith’s precepts.
“Patients will just do things on their own – and not consult their clinician,” Dr. Awaad said, referring to those might change the times in which they take medication during the sacred month of Ramadan because of fasting that is expected of observant Muslims. “It’s important for the patients to know that anyone acutely ill is exempt from fasting.” Medical- and faith-based consultation are important for these patients, Dr. Awaad said, pointing to a recent article that outlines best practices for treating patients with psychiatric disorders during Ramadan (Lancet Psychiatry. 2019 May 2. doi: 10.1016/S2215-0366[19]30161-0).
She also discussed “Islamophobia and Psychiatry” (Springer, 2019), a book she coedited that she said provides evidence of the detrimental effect that Islamophobia has on the mental health of Muslims.
Dr. Awaad is director of the Muslim Mental Health Lab and Wellness Program and codirector of the Diversity Clinic at Stanford (Calif.) University. Dr. Bandstra is assistant director of residency training in Stanford’s department of psychiatry and behavioral sciences. Dr. Awaad and Dr. Bandstra had no relevant disclosures.
REPORTING FROM APA 2019
Hip-hop offers lens into psyche of black boys, men
SAN FRANCISCO – The lyrics found in hip-hop can help mental health professionals understand the triumphs and trauma experienced by African American boys and men, Sarah Y. Vinson, MD, said at the annual meeting of the American Psychiatric Association. This understanding can enable clinicians to recognize hopelessness and pain in those patients that they otherwise might have missed.
In this video, Dr. Vinson said her session at the APA meeting looked at the history of hip-hop and focused on the perspectives embedded in the work of several artists/groups, including N.W.A, Tupac Shakur, Childish Gambino (aka Donald Glover), J. Cole, and Kendrick Lamar.
One of the take-home points for clinicians, Dr. Vinson said, is that hip-hop, an art form that has spread across the world, came out of resilience. Another is that suicidality in black men might not look the same as it does in other patients. “It doesn’t necessarily look like cutting your own wrists or having thoughts of killing yourself – it may look like reckless behaviors that put you at risk of being killed by somebody else.”
Dr. Vinson, who is triple boarded in child and adolescent, adult, and forensic psychiatry, is in private practice in Atlanta. She had no financial disclosures.
SAN FRANCISCO – The lyrics found in hip-hop can help mental health professionals understand the triumphs and trauma experienced by African American boys and men, Sarah Y. Vinson, MD, said at the annual meeting of the American Psychiatric Association. This understanding can enable clinicians to recognize hopelessness and pain in those patients that they otherwise might have missed.
In this video, Dr. Vinson said her session at the APA meeting looked at the history of hip-hop and focused on the perspectives embedded in the work of several artists/groups, including N.W.A, Tupac Shakur, Childish Gambino (aka Donald Glover), J. Cole, and Kendrick Lamar.
One of the take-home points for clinicians, Dr. Vinson said, is that hip-hop, an art form that has spread across the world, came out of resilience. Another is that suicidality in black men might not look the same as it does in other patients. “It doesn’t necessarily look like cutting your own wrists or having thoughts of killing yourself – it may look like reckless behaviors that put you at risk of being killed by somebody else.”
Dr. Vinson, who is triple boarded in child and adolescent, adult, and forensic psychiatry, is in private practice in Atlanta. She had no financial disclosures.
SAN FRANCISCO – The lyrics found in hip-hop can help mental health professionals understand the triumphs and trauma experienced by African American boys and men, Sarah Y. Vinson, MD, said at the annual meeting of the American Psychiatric Association. This understanding can enable clinicians to recognize hopelessness and pain in those patients that they otherwise might have missed.
In this video, Dr. Vinson said her session at the APA meeting looked at the history of hip-hop and focused on the perspectives embedded in the work of several artists/groups, including N.W.A, Tupac Shakur, Childish Gambino (aka Donald Glover), J. Cole, and Kendrick Lamar.
One of the take-home points for clinicians, Dr. Vinson said, is that hip-hop, an art form that has spread across the world, came out of resilience. Another is that suicidality in black men might not look the same as it does in other patients. “It doesn’t necessarily look like cutting your own wrists or having thoughts of killing yourself – it may look like reckless behaviors that put you at risk of being killed by somebody else.”
Dr. Vinson, who is triple boarded in child and adolescent, adult, and forensic psychiatry, is in private practice in Atlanta. She had no financial disclosures.
REPORTING FROM APA 2019
FDA approves brexanolone for postpartum depression
The Food and Drug Administration on March 19 approved the first medication specifically for the treatment of postpartum depression.
The drug, brexanolone (Zulresso), is to be administered as a single continuous 60-hour infusion for each episode of postpartum depression. . By binding to GABA A receptors, brexanolone increases receptor functionality. The recommended maximum dose of brexanolone is 90 µg/kg/h, and the infusion includes three dosing phases.
Brexanolone provides “an important new treatment option,” said Tiffany Farchione, MD, acting director of the division of psychiatry products in the FDA’s Center for Drug Evaluation and Research, in a press release. “Because of concerns about serious risks, including excessive sedation or sudden loss of consciousness during administration, Zulresso has been approved with a Risk Evaluation and Mitigation Strategy (REMS) and is only available to patients through a restricted distribution program at certified health care facilities where the health care provider can carefully monitor the patient.”
The approval was based on results of three phase 3 trials, which were double-blind, randomized, and placebo-controlled studies in which the primary efficacy endpoint was a change in baseline 60 hours after the start of the infusion on the Hamilton Depression Rating Scale (HAM-D). In all two of the trials, known as Hummingbird 202B and 202C, brexanolone’s impact on the patients’ HAM-D scores was greater than that of placebo, the FDA reported in briefing document released late last year. In addition, the impact of brexanolone on postpartum depression proved both rapid and durable.
Side effects observed in about 3% of the brexanolone patients included dizziness, dry mouth, fatigue, headache, infusion site pain, somnolence, and loss of consciousness. The FDA’s concern about loss of consciousness led the agency to recommend a REMS protocol before a hearing of its Psychopharmacologic Drugs Advisory and Drug Safety and Risk Management Advisory panels late last year. The Zulresso REMS Program will require that the drug be administered by a clinician in a health care facility that is certified. Patients will have to be monitored for excessive sedation and “sudden loss of consciousness and have continuous pulse oximetry monitoring (monitors oxygen levels in the blood),” the FDA said. Another requirement is that patients who receive the infusion will have to be accompanied while interacting with their children. Patients will be advised not to drive, operate machinery or engage in other dangerous activities until they feel totally alert. Those requirements will be addressed in a boxed warning.
The drug should be either adjusted or discontinued for patients whose postpartum depression becomes worse or for those experience suicidal thoughts and behaviors after taking brexanolone, the agency said.
Some physicians use antidepressants to treat postpartum depression, but their effectiveness is limited, according to the FDA. Interventions such as electroconvulsive therapy and psychotherapy also are used, but getting results can several weeks.
The symptoms of postpartum depression are indistinguishable from major depressive disorder, but “the timing of its onset has led to its recognition as potentially unique illness,” the FDA said. Postpartum depression in the United States affects up to 12% of births. In the developed world, suicide is the most common cause of maternal death after childbirth. This suicide risk makes postpartum depression a condition that is life-threatening. In addition, the condition has “profound negative effects on the maternal-infant bond and later infant development,” the FDA said.
SAGE Therapeutics, developer of brexanolone, secured the approval through the FDA’s breakthrough therapy designation process.
Heidi Splete contributed to this article.
The Food and Drug Administration on March 19 approved the first medication specifically for the treatment of postpartum depression.
The drug, brexanolone (Zulresso), is to be administered as a single continuous 60-hour infusion for each episode of postpartum depression. . By binding to GABA A receptors, brexanolone increases receptor functionality. The recommended maximum dose of brexanolone is 90 µg/kg/h, and the infusion includes three dosing phases.
Brexanolone provides “an important new treatment option,” said Tiffany Farchione, MD, acting director of the division of psychiatry products in the FDA’s Center for Drug Evaluation and Research, in a press release. “Because of concerns about serious risks, including excessive sedation or sudden loss of consciousness during administration, Zulresso has been approved with a Risk Evaluation and Mitigation Strategy (REMS) and is only available to patients through a restricted distribution program at certified health care facilities where the health care provider can carefully monitor the patient.”
The approval was based on results of three phase 3 trials, which were double-blind, randomized, and placebo-controlled studies in which the primary efficacy endpoint was a change in baseline 60 hours after the start of the infusion on the Hamilton Depression Rating Scale (HAM-D). In all two of the trials, known as Hummingbird 202B and 202C, brexanolone’s impact on the patients’ HAM-D scores was greater than that of placebo, the FDA reported in briefing document released late last year. In addition, the impact of brexanolone on postpartum depression proved both rapid and durable.
Side effects observed in about 3% of the brexanolone patients included dizziness, dry mouth, fatigue, headache, infusion site pain, somnolence, and loss of consciousness. The FDA’s concern about loss of consciousness led the agency to recommend a REMS protocol before a hearing of its Psychopharmacologic Drugs Advisory and Drug Safety and Risk Management Advisory panels late last year. The Zulresso REMS Program will require that the drug be administered by a clinician in a health care facility that is certified. Patients will have to be monitored for excessive sedation and “sudden loss of consciousness and have continuous pulse oximetry monitoring (monitors oxygen levels in the blood),” the FDA said. Another requirement is that patients who receive the infusion will have to be accompanied while interacting with their children. Patients will be advised not to drive, operate machinery or engage in other dangerous activities until they feel totally alert. Those requirements will be addressed in a boxed warning.
The drug should be either adjusted or discontinued for patients whose postpartum depression becomes worse or for those experience suicidal thoughts and behaviors after taking brexanolone, the agency said.
Some physicians use antidepressants to treat postpartum depression, but their effectiveness is limited, according to the FDA. Interventions such as electroconvulsive therapy and psychotherapy also are used, but getting results can several weeks.
The symptoms of postpartum depression are indistinguishable from major depressive disorder, but “the timing of its onset has led to its recognition as potentially unique illness,” the FDA said. Postpartum depression in the United States affects up to 12% of births. In the developed world, suicide is the most common cause of maternal death after childbirth. This suicide risk makes postpartum depression a condition that is life-threatening. In addition, the condition has “profound negative effects on the maternal-infant bond and later infant development,” the FDA said.
SAGE Therapeutics, developer of brexanolone, secured the approval through the FDA’s breakthrough therapy designation process.
Heidi Splete contributed to this article.
The Food and Drug Administration on March 19 approved the first medication specifically for the treatment of postpartum depression.
The drug, brexanolone (Zulresso), is to be administered as a single continuous 60-hour infusion for each episode of postpartum depression. . By binding to GABA A receptors, brexanolone increases receptor functionality. The recommended maximum dose of brexanolone is 90 µg/kg/h, and the infusion includes three dosing phases.
Brexanolone provides “an important new treatment option,” said Tiffany Farchione, MD, acting director of the division of psychiatry products in the FDA’s Center for Drug Evaluation and Research, in a press release. “Because of concerns about serious risks, including excessive sedation or sudden loss of consciousness during administration, Zulresso has been approved with a Risk Evaluation and Mitigation Strategy (REMS) and is only available to patients through a restricted distribution program at certified health care facilities where the health care provider can carefully monitor the patient.”
The approval was based on results of three phase 3 trials, which were double-blind, randomized, and placebo-controlled studies in which the primary efficacy endpoint was a change in baseline 60 hours after the start of the infusion on the Hamilton Depression Rating Scale (HAM-D). In all two of the trials, known as Hummingbird 202B and 202C, brexanolone’s impact on the patients’ HAM-D scores was greater than that of placebo, the FDA reported in briefing document released late last year. In addition, the impact of brexanolone on postpartum depression proved both rapid and durable.
Side effects observed in about 3% of the brexanolone patients included dizziness, dry mouth, fatigue, headache, infusion site pain, somnolence, and loss of consciousness. The FDA’s concern about loss of consciousness led the agency to recommend a REMS protocol before a hearing of its Psychopharmacologic Drugs Advisory and Drug Safety and Risk Management Advisory panels late last year. The Zulresso REMS Program will require that the drug be administered by a clinician in a health care facility that is certified. Patients will have to be monitored for excessive sedation and “sudden loss of consciousness and have continuous pulse oximetry monitoring (monitors oxygen levels in the blood),” the FDA said. Another requirement is that patients who receive the infusion will have to be accompanied while interacting with their children. Patients will be advised not to drive, operate machinery or engage in other dangerous activities until they feel totally alert. Those requirements will be addressed in a boxed warning.
The drug should be either adjusted or discontinued for patients whose postpartum depression becomes worse or for those experience suicidal thoughts and behaviors after taking brexanolone, the agency said.
Some physicians use antidepressants to treat postpartum depression, but their effectiveness is limited, according to the FDA. Interventions such as electroconvulsive therapy and psychotherapy also are used, but getting results can several weeks.
The symptoms of postpartum depression are indistinguishable from major depressive disorder, but “the timing of its onset has led to its recognition as potentially unique illness,” the FDA said. Postpartum depression in the United States affects up to 12% of births. In the developed world, suicide is the most common cause of maternal death after childbirth. This suicide risk makes postpartum depression a condition that is life-threatening. In addition, the condition has “profound negative effects on the maternal-infant bond and later infant development,” the FDA said.
SAGE Therapeutics, developer of brexanolone, secured the approval through the FDA’s breakthrough therapy designation process.
Heidi Splete contributed to this article.
Low and high BMI tied to higher postpartum depression risk
Women with high and low body mass index in the first trimester of their first pregnancies are at an increased risk of developing postpartum depression, a population-based study of more than 600,000 new mothers shows.
“Our findings show a U-shaped association between BMI extremes and clinically significant depression after childbirth,” Michael E. Silverman, PhD, and his associates reported in the Journal of Affective Disorders. “Specifically, women in the lowest and highest groups were at a significantly increased risk for developing [postpartum depression].”
Dr. Silverman and his associates used the Swedish Medical Birth Register to identify women who delivered first live singleton infants from 1997 to 2008. They then calculated the risk of postpartum depression in relation to each woman’s BMI and history of depression. Postpartum depression was defined as a clinical depression diagnosis within 1 year after delivery, Dr. Silverman and his associates wrote.
The investigators found that women with low BMI (less than 18.5 kg/m2) were at an increased postpartum depression risk (relative risk [RR], 1.52; 95% confidence interval, 1.30-1.78), as were those with high BMI (greater than 35 kg/m2) (RR, 1.23; 95% CI, 1.04-1.45).
In addition, an important difference was found between women with low and high BMI.
“Women in the highest BMI group were only at an increased risk for [postpartum depression] if they had no history of depression, showing for the first time how [postpartum depression] risk factors associated with BMI are modified by maternal depression history,” said Dr. Silverman of the department of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, and his associates.
The investigators cited several limitations. For example, only first births were analyzed, which suggests that the incidence of postpartum depression might have been underestimated. Another limitation is that the registry might not have captured women with mild depression. Nevertheless, they said, the study has important implications.
“ Because pregnant women represent a medically captured population,” they wrote, the findings support implementing preventive strategies for postpartum depression and health literacy for high-risk women.
Dr. Silverman and his associates reported having no conflicts of interest. The study was supported by a grant from the National Institutes of Health.
SOURCE: Silverman ME et al. J Affect Disord. 2018 Nov;240:193-8.
Women with high and low body mass index in the first trimester of their first pregnancies are at an increased risk of developing postpartum depression, a population-based study of more than 600,000 new mothers shows.
“Our findings show a U-shaped association between BMI extremes and clinically significant depression after childbirth,” Michael E. Silverman, PhD, and his associates reported in the Journal of Affective Disorders. “Specifically, women in the lowest and highest groups were at a significantly increased risk for developing [postpartum depression].”
Dr. Silverman and his associates used the Swedish Medical Birth Register to identify women who delivered first live singleton infants from 1997 to 2008. They then calculated the risk of postpartum depression in relation to each woman’s BMI and history of depression. Postpartum depression was defined as a clinical depression diagnosis within 1 year after delivery, Dr. Silverman and his associates wrote.
The investigators found that women with low BMI (less than 18.5 kg/m2) were at an increased postpartum depression risk (relative risk [RR], 1.52; 95% confidence interval, 1.30-1.78), as were those with high BMI (greater than 35 kg/m2) (RR, 1.23; 95% CI, 1.04-1.45).
In addition, an important difference was found between women with low and high BMI.
“Women in the highest BMI group were only at an increased risk for [postpartum depression] if they had no history of depression, showing for the first time how [postpartum depression] risk factors associated with BMI are modified by maternal depression history,” said Dr. Silverman of the department of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, and his associates.
The investigators cited several limitations. For example, only first births were analyzed, which suggests that the incidence of postpartum depression might have been underestimated. Another limitation is that the registry might not have captured women with mild depression. Nevertheless, they said, the study has important implications.
“ Because pregnant women represent a medically captured population,” they wrote, the findings support implementing preventive strategies for postpartum depression and health literacy for high-risk women.
Dr. Silverman and his associates reported having no conflicts of interest. The study was supported by a grant from the National Institutes of Health.
SOURCE: Silverman ME et al. J Affect Disord. 2018 Nov;240:193-8.
Women with high and low body mass index in the first trimester of their first pregnancies are at an increased risk of developing postpartum depression, a population-based study of more than 600,000 new mothers shows.
“Our findings show a U-shaped association between BMI extremes and clinically significant depression after childbirth,” Michael E. Silverman, PhD, and his associates reported in the Journal of Affective Disorders. “Specifically, women in the lowest and highest groups were at a significantly increased risk for developing [postpartum depression].”
Dr. Silverman and his associates used the Swedish Medical Birth Register to identify women who delivered first live singleton infants from 1997 to 2008. They then calculated the risk of postpartum depression in relation to each woman’s BMI and history of depression. Postpartum depression was defined as a clinical depression diagnosis within 1 year after delivery, Dr. Silverman and his associates wrote.
The investigators found that women with low BMI (less than 18.5 kg/m2) were at an increased postpartum depression risk (relative risk [RR], 1.52; 95% confidence interval, 1.30-1.78), as were those with high BMI (greater than 35 kg/m2) (RR, 1.23; 95% CI, 1.04-1.45).
In addition, an important difference was found between women with low and high BMI.
“Women in the highest BMI group were only at an increased risk for [postpartum depression] if they had no history of depression, showing for the first time how [postpartum depression] risk factors associated with BMI are modified by maternal depression history,” said Dr. Silverman of the department of psychiatry at the Icahn School of Medicine at Mount Sinai, New York, and his associates.
The investigators cited several limitations. For example, only first births were analyzed, which suggests that the incidence of postpartum depression might have been underestimated. Another limitation is that the registry might not have captured women with mild depression. Nevertheless, they said, the study has important implications.
“ Because pregnant women represent a medically captured population,” they wrote, the findings support implementing preventive strategies for postpartum depression and health literacy for high-risk women.
Dr. Silverman and his associates reported having no conflicts of interest. The study was supported by a grant from the National Institutes of Health.
SOURCE: Silverman ME et al. J Affect Disord. 2018 Nov;240:193-8.
FROM THE JOURNAL OF AFFECTIVE DISORDERS
Inflammation in schizophrenia tied to poor functioning
Targeting inflammation in people with schizophrenia could lead to improvements in daily functioning, a study by Sophia Kogan, MD, PhD, and her associates at the Icahn School of Medicine at Mount Sinai, New York, has suggested.
“Our findings invite speculation about the underlying link between inflammation and neurocognitive dysfunction in schizophrenia,” Dr. Kogan and her associates wrote in Brain, Behavior, and Immunity. “Our results suggest that these associations also extend to poor daily functioning in this population.”
to analyze neurocognition, functions of daily living, and inflammatory markers in 41 adults aged 18-55 years with schizophrenia, schizoaffective disorder, or psychosis. Among the individuals in the trial, 36% were female, the average age was 37 years, and the average body mass index was 31 kg/m2. In addition, all of the individuals were either taking antipsychotics or were on doses of injectable depot antipsychotics. People with active substance use and mild depressive symptoms were excluded.
Dr. Kogan and her associates found that poorer neurocognition was tied to increased levels of peripheral tumor necrosis factor–alpha (TNF-a) and interleukin-12 (IL-12p70).
“For TNF-a, these findings were driven primarily by significant associations with poorer neurocognitive performance in the domains of speed of processing (P = .02), visual learning (P = .02), and reasoning and problem solving (P = .03),” wrote Dr. Kogan and her associates. “Similarly, the association between neurocognition and IL-12p70 was driven primarily by decreased speed of processing (P less than .01) and visual learning (P = .05).”
The small sample size was cited as a limitation, as was the exclusion of people with substance use and mild depressive symptoms.
The National Institute of Mental Health funded the study. Dr. Kogan reported no conflicts of interest. Coauthor David Kimhy, PhD, is a consultant to NeuroCog Trials relating to another project.
SOURCE: Kogan S et al. Brain Behav Immun. 2018 Sep 12. doi: 10.1016/j.bbi.2018.09.016.
Targeting inflammation in people with schizophrenia could lead to improvements in daily functioning, a study by Sophia Kogan, MD, PhD, and her associates at the Icahn School of Medicine at Mount Sinai, New York, has suggested.
“Our findings invite speculation about the underlying link between inflammation and neurocognitive dysfunction in schizophrenia,” Dr. Kogan and her associates wrote in Brain, Behavior, and Immunity. “Our results suggest that these associations also extend to poor daily functioning in this population.”
to analyze neurocognition, functions of daily living, and inflammatory markers in 41 adults aged 18-55 years with schizophrenia, schizoaffective disorder, or psychosis. Among the individuals in the trial, 36% were female, the average age was 37 years, and the average body mass index was 31 kg/m2. In addition, all of the individuals were either taking antipsychotics or were on doses of injectable depot antipsychotics. People with active substance use and mild depressive symptoms were excluded.
Dr. Kogan and her associates found that poorer neurocognition was tied to increased levels of peripheral tumor necrosis factor–alpha (TNF-a) and interleukin-12 (IL-12p70).
“For TNF-a, these findings were driven primarily by significant associations with poorer neurocognitive performance in the domains of speed of processing (P = .02), visual learning (P = .02), and reasoning and problem solving (P = .03),” wrote Dr. Kogan and her associates. “Similarly, the association between neurocognition and IL-12p70 was driven primarily by decreased speed of processing (P less than .01) and visual learning (P = .05).”
The small sample size was cited as a limitation, as was the exclusion of people with substance use and mild depressive symptoms.
The National Institute of Mental Health funded the study. Dr. Kogan reported no conflicts of interest. Coauthor David Kimhy, PhD, is a consultant to NeuroCog Trials relating to another project.
SOURCE: Kogan S et al. Brain Behav Immun. 2018 Sep 12. doi: 10.1016/j.bbi.2018.09.016.
Targeting inflammation in people with schizophrenia could lead to improvements in daily functioning, a study by Sophia Kogan, MD, PhD, and her associates at the Icahn School of Medicine at Mount Sinai, New York, has suggested.
“Our findings invite speculation about the underlying link between inflammation and neurocognitive dysfunction in schizophrenia,” Dr. Kogan and her associates wrote in Brain, Behavior, and Immunity. “Our results suggest that these associations also extend to poor daily functioning in this population.”
to analyze neurocognition, functions of daily living, and inflammatory markers in 41 adults aged 18-55 years with schizophrenia, schizoaffective disorder, or psychosis. Among the individuals in the trial, 36% were female, the average age was 37 years, and the average body mass index was 31 kg/m2. In addition, all of the individuals were either taking antipsychotics or were on doses of injectable depot antipsychotics. People with active substance use and mild depressive symptoms were excluded.
Dr. Kogan and her associates found that poorer neurocognition was tied to increased levels of peripheral tumor necrosis factor–alpha (TNF-a) and interleukin-12 (IL-12p70).
“For TNF-a, these findings were driven primarily by significant associations with poorer neurocognitive performance in the domains of speed of processing (P = .02), visual learning (P = .02), and reasoning and problem solving (P = .03),” wrote Dr. Kogan and her associates. “Similarly, the association between neurocognition and IL-12p70 was driven primarily by decreased speed of processing (P less than .01) and visual learning (P = .05).”
The small sample size was cited as a limitation, as was the exclusion of people with substance use and mild depressive symptoms.
The National Institute of Mental Health funded the study. Dr. Kogan reported no conflicts of interest. Coauthor David Kimhy, PhD, is a consultant to NeuroCog Trials relating to another project.
SOURCE: Kogan S et al. Brain Behav Immun. 2018 Sep 12. doi: 10.1016/j.bbi.2018.09.016.
FROM BRAIN, BEHAVIOR, AND IMMUNITY
Poor sleep tied to suicidal behaviors in college students
Poor sleep is associated with increased suicidal behaviors in college students – even when controlling for depression, a study of 1,700 students shows.
“Furthermore, findings suggest that some specific sleep components – shorter sleep duration, more frequent bad dreams, feeling too cold while sleeping, and greater sleep medication use – are particularly associated with increased suicidal behaviors in college students,” reported Stephen P. Becker, PhD, of the Cincinnati Children’s Hospital Center, and his associates.
The researchers recruited students from two universities. Most of the students (65%) were female, white (82%), and in their first year of college (63%). The participants’ sleep was assessed using the nine-item Pittsburgh Sleep Quality Index (PSQI), their depressive symptoms were assessed using the Depressive Anxiety Stress Scales-21, and their suicidal behavior was assessed using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is a four-item, self-report measure.
About two-thirds of the students (64%) were found to have sleep problems (total PSQI score greater than 5), and 24% were found to have suicide risk (total SBQ-R score of at least 7). Of the students who were found to have suicide risk, 83% also had sleep problems.
Using regression analysis, Dr. Becker and his associates found that the odds of being classified with suicide risk were 6.5 times greater for students with depression and 2.7 times greater for those with sleep problems.
The results add to the literature suggesting that the researchers wrote.
SOURCE: Becker SP et al. J Psychiatr Res. 2018 Apr;99:123-8.
Poor sleep is associated with increased suicidal behaviors in college students – even when controlling for depression, a study of 1,700 students shows.
“Furthermore, findings suggest that some specific sleep components – shorter sleep duration, more frequent bad dreams, feeling too cold while sleeping, and greater sleep medication use – are particularly associated with increased suicidal behaviors in college students,” reported Stephen P. Becker, PhD, of the Cincinnati Children’s Hospital Center, and his associates.
The researchers recruited students from two universities. Most of the students (65%) were female, white (82%), and in their first year of college (63%). The participants’ sleep was assessed using the nine-item Pittsburgh Sleep Quality Index (PSQI), their depressive symptoms were assessed using the Depressive Anxiety Stress Scales-21, and their suicidal behavior was assessed using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is a four-item, self-report measure.
About two-thirds of the students (64%) were found to have sleep problems (total PSQI score greater than 5), and 24% were found to have suicide risk (total SBQ-R score of at least 7). Of the students who were found to have suicide risk, 83% also had sleep problems.
Using regression analysis, Dr. Becker and his associates found that the odds of being classified with suicide risk were 6.5 times greater for students with depression and 2.7 times greater for those with sleep problems.
The results add to the literature suggesting that the researchers wrote.
SOURCE: Becker SP et al. J Psychiatr Res. 2018 Apr;99:123-8.
Poor sleep is associated with increased suicidal behaviors in college students – even when controlling for depression, a study of 1,700 students shows.
“Furthermore, findings suggest that some specific sleep components – shorter sleep duration, more frequent bad dreams, feeling too cold while sleeping, and greater sleep medication use – are particularly associated with increased suicidal behaviors in college students,” reported Stephen P. Becker, PhD, of the Cincinnati Children’s Hospital Center, and his associates.
The researchers recruited students from two universities. Most of the students (65%) were female, white (82%), and in their first year of college (63%). The participants’ sleep was assessed using the nine-item Pittsburgh Sleep Quality Index (PSQI), their depressive symptoms were assessed using the Depressive Anxiety Stress Scales-21, and their suicidal behavior was assessed using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is a four-item, self-report measure.
About two-thirds of the students (64%) were found to have sleep problems (total PSQI score greater than 5), and 24% were found to have suicide risk (total SBQ-R score of at least 7). Of the students who were found to have suicide risk, 83% also had sleep problems.
Using regression analysis, Dr. Becker and his associates found that the odds of being classified with suicide risk were 6.5 times greater for students with depression and 2.7 times greater for those with sleep problems.
The results add to the literature suggesting that the researchers wrote.
SOURCE: Becker SP et al. J Psychiatr Res. 2018 Apr;99:123-8.
FROM THE JOURNAL OF PSYCHIATRIC RESEARCH
Targeting obesity could slow brain aging in psychosis
, new research suggests.
The investigators found significant associations between BrainAGE scores and a diagnosis of FEP (P = .005), overweight/obesity category (P = .007), and body mass index (P = .02). Furthermore, the association found between BrainAGE score and BMI was related to an association between BrainAGE score and weight (P = .009), but not to height (P = .13).
“These findings raise the possibility that targeting metabolic health in FEP and intervening already at the level of overweight/obesity could slow brain aging in schizophrenia and related disorders,” reported Marian Kolenic of the National Institute of Mental Health in Klecany, Czech Republic, and his coauthors.
The researchers recruited 120 patients with FEP as defined by the ICD-10 during their first psychiatric hospitalization. People with psychotic mood disorders were excluded.
“We wanted to recruit participants at the early stages of illness, to minimize the effects of illness and medications on brain structure,” the investigators wrote.
One hundred fourteen healthy controls were recruited through advertisements, and exclusion criteria included a lifetime history of any psychiatric disorders and the presence of psychotic disorders in either first- or second-degree relatives.
All participants were asked about their medical history, including their use and/or abuse of substances. Fasting blood samples were collected on the scanning day.
A psychiatrist used the Mini-International Neuropsychiatric Interview and the Positive and Negative Syndrome Scale to determine diagnostic assessments and symptom ratings. Several CV risk factors were measured, including blood pressure, triglycerides, HDL, and LDL. Using the charts, the researchers verified the absence of diabetes by fasting glucose. They also checked participants’ BMI and height.
“This study suggests that overweight/obesity, which is frequent in schizophrenia, may contribute to neurostructural changes already early in the course of illness,” the investigators wrote. “Specifically, the brains of participants with FEP appeared on average 2.64 years older than their chronological age.”
Among participants with both FEP and overweight/obesity, the investigators found the average discrepancy between brain and chronological age to be as high as 3.83 years.
They cited several limitations. Because the study was not prospective, the researchers could not establish causality of the association between metabolic alterations and brain structure. In addition, the existence of insulin resistance could not be ruled out – although none of the participants reported a history of type 2 diabetes.
Still, “,” the investigators wrote.
They reported no conflicts of interest.
ghenderson@mdedge.com
SOURCE: Kolenic M et al. J Psychiatric Res. 2018 Apr. 99:151-8.
, new research suggests.
The investigators found significant associations between BrainAGE scores and a diagnosis of FEP (P = .005), overweight/obesity category (P = .007), and body mass index (P = .02). Furthermore, the association found between BrainAGE score and BMI was related to an association between BrainAGE score and weight (P = .009), but not to height (P = .13).
“These findings raise the possibility that targeting metabolic health in FEP and intervening already at the level of overweight/obesity could slow brain aging in schizophrenia and related disorders,” reported Marian Kolenic of the National Institute of Mental Health in Klecany, Czech Republic, and his coauthors.
The researchers recruited 120 patients with FEP as defined by the ICD-10 during their first psychiatric hospitalization. People with psychotic mood disorders were excluded.
“We wanted to recruit participants at the early stages of illness, to minimize the effects of illness and medications on brain structure,” the investigators wrote.
One hundred fourteen healthy controls were recruited through advertisements, and exclusion criteria included a lifetime history of any psychiatric disorders and the presence of psychotic disorders in either first- or second-degree relatives.
All participants were asked about their medical history, including their use and/or abuse of substances. Fasting blood samples were collected on the scanning day.
A psychiatrist used the Mini-International Neuropsychiatric Interview and the Positive and Negative Syndrome Scale to determine diagnostic assessments and symptom ratings. Several CV risk factors were measured, including blood pressure, triglycerides, HDL, and LDL. Using the charts, the researchers verified the absence of diabetes by fasting glucose. They also checked participants’ BMI and height.
“This study suggests that overweight/obesity, which is frequent in schizophrenia, may contribute to neurostructural changes already early in the course of illness,” the investigators wrote. “Specifically, the brains of participants with FEP appeared on average 2.64 years older than their chronological age.”
Among participants with both FEP and overweight/obesity, the investigators found the average discrepancy between brain and chronological age to be as high as 3.83 years.
They cited several limitations. Because the study was not prospective, the researchers could not establish causality of the association between metabolic alterations and brain structure. In addition, the existence of insulin resistance could not be ruled out – although none of the participants reported a history of type 2 diabetes.
Still, “,” the investigators wrote.
They reported no conflicts of interest.
ghenderson@mdedge.com
SOURCE: Kolenic M et al. J Psychiatric Res. 2018 Apr. 99:151-8.
, new research suggests.
The investigators found significant associations between BrainAGE scores and a diagnosis of FEP (P = .005), overweight/obesity category (P = .007), and body mass index (P = .02). Furthermore, the association found between BrainAGE score and BMI was related to an association between BrainAGE score and weight (P = .009), but not to height (P = .13).
“These findings raise the possibility that targeting metabolic health in FEP and intervening already at the level of overweight/obesity could slow brain aging in schizophrenia and related disorders,” reported Marian Kolenic of the National Institute of Mental Health in Klecany, Czech Republic, and his coauthors.
The researchers recruited 120 patients with FEP as defined by the ICD-10 during their first psychiatric hospitalization. People with psychotic mood disorders were excluded.
“We wanted to recruit participants at the early stages of illness, to minimize the effects of illness and medications on brain structure,” the investigators wrote.
One hundred fourteen healthy controls were recruited through advertisements, and exclusion criteria included a lifetime history of any psychiatric disorders and the presence of psychotic disorders in either first- or second-degree relatives.
All participants were asked about their medical history, including their use and/or abuse of substances. Fasting blood samples were collected on the scanning day.
A psychiatrist used the Mini-International Neuropsychiatric Interview and the Positive and Negative Syndrome Scale to determine diagnostic assessments and symptom ratings. Several CV risk factors were measured, including blood pressure, triglycerides, HDL, and LDL. Using the charts, the researchers verified the absence of diabetes by fasting glucose. They also checked participants’ BMI and height.
“This study suggests that overweight/obesity, which is frequent in schizophrenia, may contribute to neurostructural changes already early in the course of illness,” the investigators wrote. “Specifically, the brains of participants with FEP appeared on average 2.64 years older than their chronological age.”
Among participants with both FEP and overweight/obesity, the investigators found the average discrepancy between brain and chronological age to be as high as 3.83 years.
They cited several limitations. Because the study was not prospective, the researchers could not establish causality of the association between metabolic alterations and brain structure. In addition, the existence of insulin resistance could not be ruled out – although none of the participants reported a history of type 2 diabetes.
Still, “,” the investigators wrote.
They reported no conflicts of interest.
ghenderson@mdedge.com
SOURCE: Kolenic M et al. J Psychiatric Res. 2018 Apr. 99:151-8.
FROM THE JOURNAL OF PSYCHIATRIC RESEARCH
Key clinical point: Being overweight or obese could be a risk factor for the kind of brain aging seen in some patients with first-episode psychosis.
Major finding: The investigators found significant associations between BrainAGE scores and a diagnosis of FEP (P = .005), overweight/obesity category (P = .007) and BMI (P = .02).
Study details: A analysis of 120 patients with first-episode psychosis and 114 healthy controls.
Disclosures: .The authors reported no conflicts of interest.
Source: Kolenic M et al. J Psychiatric Res. 2018 Apr. 99:151-8.