Journal of Clinical Psychiatry最新文献

Objective: To assess the viewpoints of psychedelic practitioners in research settings on approaches to psychological support for psychedelic treatments.

Methods: An anonymous survey was distributed via email to contacts listed on ClinicalTrials.gov for clinical trials of psilocybin and LSD, personal contacts of authors, and through snowball sampling. The survey included Likert type, multiple choice, free response, and demographic items. Responses to survey items were coded to represent either emotive (emphasizing human and spiritual elements) or neuromodulatory (emphasizing biological drug effects) approaches to psychedelic treatment. Summative scores ("E-Scores") were determined to quantitatively represent preferences. Data were collected from March 2023 to July 2023.

Results: Forty qualified respondents completed the survey. Respondents came from varying educational backgrounds (42.5% MD/DO and 57.5% other) and practiced in at least 4 countries, 11 U.S. states, and 16 institutions. Respondents had overseen a total of 1,656 psychedelic sessions (average = 41.4). There was a substantial range of response for many items (average range = 84.2% of maximum). Exploratory factor analysis identified 4 latent factors: The Importance of Trust, The Role of Spirituality, Creating an Emotional Setting, and Conceptualizing Negative Experiences. The average respondent held a slight preference for an emotive approach. Respondents who received training at the Multidisciplinary Association for Psychedelic Studies (MAPS) or the California Institute of Integral Studies (CIIS) had significantly greater emotive preference compared to other respondents (P < .05).

Conclusions: Among psychedelic researchers, there is no consensus on certain psychological support strategies for psychedelic treatments. There is an aggregate preference for an emotive approach to psychological support, which is higher among individuals receiving training at certain institutions.

Objective: To investigate racial disparities in the first-time prescription of mood stabilizers for first-episode mania in nonpsychotic, hospitalized patients with bipolar I disorder, specifically comparing the rates of lithium and valproic acid prescription between non-Hispanic Black and non-Hispanic White patients.

Methods: A retrospective cohort study was conducted using the TriNetX database. We included eligible hospitalized non Hispanic Black and non-Hispanic White patients newly diagnosed with bipolar I disorder without psychotic features between January 1, 2014, and December 31, 2023. Propensity score matching was employed to create balanced comparison populations of non-Hispanic Black and non-Hispanic White patients, controlling for factors that may influence medication selection. A measure of association analysis was performed to calculate and compare the fraction of patients with either lithium or valproic acid use in both cohorts. Odds ratios were assessed.

Results: The study included 1,582 patients (N = 791 per cohort). After propensity matching, baseline characteristics were well balanced. Lithium was prescribed to 24% of White patients compared to 15% of Black patients (odds ratio [OR] 1.82, 95% CI, 1.41-2.35, P < .05). Conversely, valproic acid was prescribed to 20% of Black patients compared to 12% of White patients (OR 0.53 95% CI, 0.40-0.71, P < .05).

Conclusions: Significant disparities in the prescription rates of valproic acid and lithium were observed, with Black patients more likely to receive valproic acid and less likely to receive lithium compared to their White counterparts. Efforts to address these inequities should involve addressing structural, patient-related, and clinician-related factors that may contribute to our findings.

Objectives: We studied the association between obstructive sleep apnea (OSA) based on STOP-Bang questionnaire and suicidal risk behaviors (ideations, plans, and attempts) in the general population using a nationally representative sample from South Korea.

Methods: Data were obtained from 11,917 adults (aged ≥40 years) who participated in the Korea National Health and Nutrition Examination Survey (2019-2020). Multiple logistic regression analyses were used to evaluate the association between suicidal behaviors and intermediate-high risk OSA (STOP-Bang score ≥3).

Results: Poor health status, severe stress, less sleep time, poor quality of life, and depression were significantly more common in the intermediate-high risk OSA group compared to the low risk OSA group. The proportions of the intermediate-high risk OSA group who had suicidal ideation (2.5%), suicidal planning (1.8%), and suicidal attempts (0.5%) were higher than those in the low risk OSA group (1.1%, 1.2%, 0.1%; P < .001, respectively). A multivariate analysis after adjusting revealed that the odds ratios for suicidal ideations, planning, and attempts were 1.42 (95% confidence interval [CI]: 1.00-2.02), 1.21 (95% CI: 1.01-1.77), and 3.29 (95% CI: 1.50-7.24), respectively, in the intermediate-high risk OSA group.

Conclusions: Moderate-high risk groups of OSA based on the STOP-Bang questionnaire were associated with suicidal behaviors in a Korean population.

Background: Individuals experiencing major depression with psychotic features (MD-P) may respond better and have fewer cognitive effects with electroconvulsive therapy (ECT) than those without psychotic features (MD-NP). However, this may be due to differences in patient characteristics aside from psychotic symptoms. The objectives of this study were to (1a) compare ECT treatment response and (1b) adverse cognitive effects between patients with MD-P and MD-NP and (2a) explore factors associated with treatment response or (2b) adverse cognitive effects.

Methods: This was a retrospective cohort study of adult inpatients with MD-P or MD-NP treated with an acute course of ECT at an academic psychiatric hospital June 2010-September 2021 in Toronto, Canada. Logistic regression was used to account for differences in patient characteristics between groups. Outcomes were identified using the clinical global impression improvement and cognitive function scales.

Results: 542 patients were included, 115 (21%) with MD-P and 427 (79%) with MD-NP. MD-P patients were more likely to be rated "very much improved" with ECT (41% vs 27%, P = .003) while adverse cognitive effects were similar (21% MD-NP vs 24% MD-P; P > .05). However, after accounting for confounders, psychotic symptoms were not associated with response (adjusted odds ratio [AOR]: 1.04; 95% confidence interval [CI], 0.95-1.14) or adverse cognitive effects (AOR: 1.30; 95% CI, 0.78-2.18).

Conclusions: Individuals with MD-P had a higher rate of response and similar rates of adverse cognitive effects compared to patients with MD-NP with ECT treatment. However, after accounting for differences in patient characteristics, we no longer identified an association between psychotic symptoms and treatment response.

Objective: This post hoc analysis of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs among patients with treatment-resistant depression (TRD) receiving esketamine nasal spray or quetiapine extended release in combination with an oral antidepressant.

Methods: Adults with TRD randomized to receive esketamine (56/84 mg) or quetiapine (150-300 mg) combined with ongoing antidepressant therapy were included. WPL was assessed using the Work Productivity and Activity Impairment questionnaire. Least squares (LS) mean WPL change versus baseline (treatment initiation date), and LS mean differences (MDs) between esketamine and quetiapine cohorts were reported at weeks 8-32 of treatment using mixed models for repeated measurements. Per patient productivity cost savings were estimated using mean 2021 weekly wages from US Bureau of Labor Statistics.

Results: The esketamine cohort included 165 patients, and quetiapine cohort included 156 patients. At baseline, total WPL was 77.0% and 72.5% in the esketamine and quetiapine cohorts, respectively. By week 8, total WPL decreased from baseline by 30.3 and 17.3 percentage points (pp) in the esketamine and quetiapine cohorts (MD = 13.0 pp; 95% confidence interval [CI], 6.3-19.8 pp), resulting in weekly cost savings of $363 and $207 (MD = $156; 95% CI, $76-$237), respectively. By week 32, total WPL decreased from baseline by 45.3 pp and 32.5 pp in the esketamine and quetiapine cohorts (MD = 12.7 pp; 95% CI, 4.7-20.7 pp), with weekly cost savings of $543 and $390 (MD = $153; 95% CI, $57-$250), respectively.

Conclusion: Among employed adults with TRD, esketamine treatment was associated with significantly larger improvements in WPL and related costs compared to quetiapine, suggesting greater benefits from patient well-being and employer perspectives.