Understanding the Use of Program Resources During Virtual Recruitment by Psychiatry Residency Applicants.

OBJECTIVE: This study aims to understand the residency resources used by psychiatry applicants who applied during the first two virtual recruitment seasons, match 2021 and 2022. METHODS: Between January 27, 2022, and February 24, 2022, a non-probabilistic sample of psychiatry residents from the match 2018 through match 2022 cycles were asked to complete a survey via email and social media. Due to the continuation of virtual recruitment post-pandemic, an analysis of psychiatry residents in the match 2021 and 2022 cycles was conducted. Questions assessed the use of recruitment resources, including websites, the Fellowship and Residency Electronic and Interactive Database, virtual open houses, video tours, away rotations, and social media platforms. Descriptive statistics and chi-square analyses were used. RESULTS: Psychiatry residents from the match 2021 and 2022 cycles completed the survey (n = 605), with 288 US allopathic medicine doctors (47.6%), 178 (29.4%) international medical graduates, and 139 (23.0%) osteopathic medicine doctors. More than half of respondents (n = 347, 57.4%) reported that the virtual interview season increased the number of programs they intended to apply to. Most respondents (n = 594, 88.3%) reported attending one or more psychiatry virtual open houses and 84.6% (n = 512) followed psychiatry residency programs on at least one social media platform. Program websites were reported to be the most influential digital platform for both applying and ranking. CONCLUSION: Understanding the influence of recruitment resources is essential for residents and program leadership to optimize time and resources to assist applicants with their decision-making.

Pharmacotherapy of Disruptive Behaviors in Children with Intellectual Disabilities.

Disruptive behaviors are a class of predominantly externalizing behaviors that include physical aggression, property destruction, temper outbursts, verbal aggression, and some forms of self-injurious behaviors. Externalizing behaviors are also major components of disruptive, impulse-control and conduct disorders, disruptive mood dysregulation disorder, trauma-related and stressor-related disorders, intermittent explosive disorder, personality disorders, and other neuropsychiatric and neurodevelopmental disorders. Disruptive behaviors and associated disorders are among the most frequent reasons for child behavioral health referrals and are the most common reason for referrals among children with intellectual disabilities. The focus of this paper is on the adjunctive role of integrated psychopharmacological treatment in the management of children with disruptive behaviors and co-occurring intellectual disabilities. The decision-making process for adding pharmacotherapy to a comprehensive treatment plan incorporates not only a working knowledge of basic behavioral neurobiology of disruptive behaviors but also an understanding of the strengths and weaknesses of various pharmacotherapies. Importantly, there is little evidence to support the use of psychopharmacologic agents in managing difficult behaviors in children with intellectual disabilities, but with that said, risperidone has the strongest evidence base for its use.

Social Cognition and Neurocognition in Schizophrenia and Healthy Controls: Intercorrelations of Performance and Effects of Manipulations Aimed at Increasing Task Difficulty.

Social cognition (SC) and neurocognition appear to predict different aspects of functional outcome in people with schizophrenia. However, the correlations between performance on these domains have not been tested extensively and compared cross-diagnostically with healthy controls. Further, some social cognitive measures appeared to have potential ceiling effects, particularly for healthy people, in previous research, so increasing their difficulty is of interest. In this paper we report on two studies wherein we examined the correlations between neurocognitive ability and performance on SC tests. In the first study the correlations between measures of social perception, emotion processing, and theory of mind and performance on a brief neuropsychological (NP) assessment were examined in 179 schizophrenia (SCZ) patients and 104 healthy controls (HC). In the second study, we instructed participants to perform a subset of the tasks as rapidly as possible in order to increase task difficulty, and we examined the effects of those instructions on task difficulty, task psychometrics, and correlations between SC and NP tests in 218 SCZ patients and 154 HC. In the first study, both HC and SCZ manifested a domain specific pattern of correlation between NP and SC test performance. Controlling for group differences in NP performance did not eliminate SC performance differences between the groups. In the second study, no differences in task performance, intercorrelations other SC tests, or test-retest stability were induced by the difficulty manipulation in the samples who performed the tasks with speed demands compared to the performance of the previous sample. These data suggest that simple manipulations aimed at increasing task difficulty may not have the desired effect and that despite consistent correlations between SC and NP test performance, impairments in social cognitive functioning are not fully explained by NP performance deficits.

Steroid-Induced Psychosis in the Pediatric Population: A New Case and Review of the Literature.

OBJECTIVES: Iatrogenic steroid-induced psychosis is a rare but serious adverse side effect seen largely in the adult population that less commonly affects children and adolescents. Given the significant distress steroid-induced psychosis may cause, recommendations are needed for effective management. Here we conducted a systematic review of the literature and report a new case of steroid-induced psychosis in a 12-year-old patient. METHODS: We performed a systematic search using Embase, PubMed, Scopus, and PsychInfo. Key terms included ("steroid induced" or "corticosteroid induced" or "glucocorticoid induced") and ("psychosis" or "hallucinations" or "delusions") and ("child" or "adolescent" or "pediatric"). A total of 15 articles of steroid-induced psychosis in children and adolescents were found in the scientific literature. This report includes those articles and a novel case of steroid-induced psychosis. RESULTS: Children with asthma, autoimmune diseases, and cancer have been reported to experience steroid-induced psychosis. The mean age of children with steroid-induced psychosis was 12 ± 3.6 years. Our team presents a report of steroid-induced psychosis in a 12-year-old patient with discoid-type lupus erythematosus. Within days of treatment with 40 mg prednisone daily, this patient began to drool, became mute, and was responding to internal stimuli. Treatment was difficult secondary to the acute exacerbation of lupus, requiring ongoing therapy. It was initially unclear whether the acute psychosis was a manifestation of lupus, a side effect of medication, or a combination of the two risk factors. Neurology consultation ruled out lupus cerebritis. Psychosis was treated with haloperidol 5 mg. Psychosis did not resolve until the steroid taper was complete and the patient was no longer taking any prednisone. CONCLUSIONS: Given the common use of glucocorticoid therapy in children, it is important that physicians and parents recognize the signs of steroid-induced psychosis and are aware of the data on treating this complication.

Placebo Effects Across Self-Report, Clinician Rating, and Objective Performance Tasks Among Women With Post-Traumatic Stress Disorder: Investigation of Placebo Response in a Pharmacological Treatment Study of Post-Traumatic Stress Disorder.

PURPOSE/BACKGROUND: For a drug to acquire Food and Drug Administration approval, it must significantly outperform placebo treatment. In recent years, the placebo effect seems to be increasing in neuropsychiatric conditions. Here, we examine placebo effects across self-reported, clinically rated, and performance-based data from a trial using a corticotropin-releasing hormone receptor type 1 (CRHR1) antagonist for treatment of post-traumatic stress disorder (PTSD). METHODS/PROCEDURES: Women with chronic PTSD were randomized to treatment with either GSK561679, a CRHR1 antagonist, or placebo. Before randomization, participants completed self-report scales, clinician-rated measures of PTSD and depression symptoms, and objective tests of cognition and functioning. Differences in change scores on measures were compared between GSK561679 and placebo-treated participants. FINDINGS/RESULTS: GSK561679 failed to produce any significant improvement in the participants. A substantial placebo effect was observed in both self-report and clinical rating scales, with effect sizes up to 1.5 SD. No single variable predicted placebo-related changes. Notably, there was an improvement on objective performance measures of cognition that exceeded previous standards for practice effects. IMPLICATIONS/CONCLUSIONS: Participants in this trial manifested retest effects on performance-based measures of cognition. Notably, they had minimal prior experience with performance-based assessments. Experiencing the structure and support of a clinical trial may have contributed to significant reductions in subject-reported and clinician-rated PTSD symptom levels. The improvement seen across all assessment domains was consistent with that seen in previous studies where the active treatments separated from placebo. Investigators conducting clinical trials treating PTSD patients should expect placebo effects and design studies accordingly.