Enhancing Brain Health and Well-Being in Older Adults: Innovations in Lifestyle Interventions.

PURPOSE OF REVIEW: This article will provide clinicians with guidance on helping older adult patients make lifestyle changes to enhance brain health and well-being. RECENT FINDINGS: Evidence suggests that physical activity might be helpful in improving cognitive functioning. The data on the benefits of cognitive activity is inconsistent and not as robust. The MediDiet, DASH, and MIND diets have been associated with better cognitive health. Sleep hygiene and cognitive behavioral therapies are considered first line evidence-based treatments for insomnia and the maintenance of healthy sleep patterns. Mindfulness based interventions have been shown to reduce anxiety, depression, and stress, and can help some older adults manage pain more constructively. Evidence-based information regarding the four topics of exercise, nutrition, sleep, and mindfulness is reviewed, so that clinicians may be better able to optimize care for their older adult patients.

Ageism in the Mental Health Setting.

PURPOSE OF REVIEW: This paper summarizes the prevalence, impact, and presentation of ageism across multiple mental health care settings including inpatient, outpatient, long-term care, and criminal justice. Strategies for combating ageism are described. RECENT FINDINGS: Ageism is a common form of bias that has deleterious medical and psychosocial consequences for older adults. Ageism manifests in a variety of ways in mental health settings. Clinical, educational, and public policy strategies are recommended to combat ageism in mental health settings. Ageism remains pervasive in society and in mental health care settings. Ageism impacts healthcare trainees, healthcare providers, healthcare systems, and older adults themselves. Age-friendly practices and strategies for combating ageism exist and need broader dissemination.

Psy-feld: An Innovative Didactic Using the TV Show Seinfeld to Teach Delusional Disorder Subtypes.

OBJECTIVE: The primary purpose of this article is to introduce Psy-feld, an innovative didactic used to review mental disorders through discussion of the interpersonal relationships of the fictional characters created in Larry David's situational comedy, Seinfeld. To introduce this novel didactic, several peripheral Seinfeld characters were selected, who while not afflicted with a psychotic disorder, demonstrate traits that serve to facilitate discussion to review the different subtypes of Delusional Disorder. METHODS: Psy-feld is a 30-min faculty-facilitated didactic where a selected episode of the sitcom allows for review of multidisciplinary content areas considered germane to the practice of psychiatry. At Rutgers-Robert Wood Johnson Medical School, 104 third-year medical students rotated on the Consultation-Liaison Service from July 2011-March 2014 and participated in Psy-feld. RESULTS: Of the 104 students who participated in Psy-feld, 99 completed surveys on the didactic. Students found the didactic to be of high quality, believed it enhanced their learning, and thought that it prepared them for their final SHELF exam. Students also found it enjoyable and preferred the didactic to more traditional forms of teaching such as large group lectures. CONCLUSIONS: Psy-feld is an example of an innovative teaching method that medical students found informative in reviewing teaching points of Delusional Disorder.

Systems that promote mental health in the teeth of oppression.

Emotional distress can disproportionately disable individuals from minoritized groups, such as Black Americans, due to multiple intersecting factors. Addressing these challenges requires a comprehensive, culturally sensitive approach to mental health care that promotes inclusivity, accessibility, and representation within the field, to foster empowerment and resilience among minoritized communities. Given the weight of negative factors that can lead to psychological distress and mental illness, the wellness of Black Americans and how they support their mental health is important to acknowledge. In this Series paper, we propose that Black Americans have developed systems for managing many of these threats to their survival and wellbeing.

COVID-19: Brain Effects.

Severe acute respiratory syndrome coronavirus 2, the novel coronavirus responsible for the coronavirus disease (COVID-19), affects the brain. Neurologic and neuropsychiatric symptoms may manifest in the acute and post-acute phases of illness. The vulnerability of the brain with aging further increases the burden of disease in the elderly, who are at the highest risk of complications and death from COVID-19. The mechanisms underlying the effects of COVID-19 on the brain are not fully known. Emerging evidence vis-à-vis pathogenesis and etiologies of COVID-19 brain effects is promising and may pave the way for future research and development of interventions.

Mifepristone may halt progression of extensively metastatic human adenocarcinoma of the colon - case report.

BACKGROUND: Mifepristone, a progesterone receptor antagonist has been found to improve the length and quality of life in various spontaneous murine cancer models including tumors without progesterone receptors theoretically by inhibiting an immunomodulatory protein that suppresses natural killer cell function in the tumor microenvironment. MATERIALS AND METHODS: Mifepristone 200 mg per day by mouth was given to two patients with stage 4 colon cancer with extensive metastases. RESULTS: Both patients not only survived far longer than expected but had marked improvement in their quality of life similar to mice. Though the metastatic lesions did not disappear, no new ones appeared for a long time and the ones present did not grow. The drug was extremely well tolerated. CONCLUSION: The use of progesterone receptor antagonists may present a novel immunotherapy to help fight cancer. A larger controlled study is needed.

Treatment Outcome Comparison Between Telepsychiatry and Face-to-face Buprenorphine Medication-assisted Treatment for Opioid Use Disorder: A 2-Year Retrospective Data Analysis.

OBJECTIVES: To retrospectively review clinic records to assess the difference between face-to-face and telepsychiatry buprenorphine medication-assisted treatment (MAT) programs for the treatment of opioid use disorder on 3 outcomes: additional substance use, average time to achieve 30 and 90 consecutive days of abstinence, and treatment retention rates at 90 and 365 days. METHODS: Medical records of patients (N = 100) who were participating in telepsychiatry and in face-to-face group-based outpatient buprenorphine MAT programs were reviewed and assessed using descriptive statistical analysis. RESULTS: In comparison with the telepsychiatry MAT group, the face-to-face MAT group showed no significant difference in terms of additional substance use, time to 30 days (P = 0.09) and 90 days of abstinence (P = 0.22), or retention rates at 90 and 365 days (P = 0.99). CONCLUSIONS: We did not find any significant statistical difference between telepsychiatry buprenorphine MAT intervention through videoconference and face-to-face MAT treatment in our Comprehensive Opioid Addiction Treatment model for individuals diagnosed with opioid use disorder in terms of additional substance use, average time to 30 and 90 days of abstinence, and treatment retention rates.

Mifepristone treatment improves length and quality of survival of mice with spontaneous lung cancer.

BACKGROUND: There are data showing that human leukemia cell lines have mRNA for an immunomodulatory protein found in normal pregnancy that is stimulated by progesterone. One of the functions of this progesterone-induced blocking factor (PIBF) is to suppress natural killer cell activity. Mifepristone has not only been shown to down-regulate PIBF expression by human leukemic cell lines but has also been shown to prolong and improve the length of life of mice with spontaneous leukemia. MATERIALS AND METHODS: Mifepristone at 0.3 mg was gavaged three times weekly from 8 weeks vs. olive oil in the controls. RESULTS: The survival at one year for mice treated with mifepristone was 57.6% vs. 26.6% for controls (p=0.056). There were 66.7% of mice treated with mifepristone with no sick days whereas there was not one control mouse that did not become sick within the first year. The mean number of days sick was 11.6 for mifepristone vs. 57.6 days for controls (p=0.05) and 66.7% of the survival group had no sick days vs. none of the controls. CONCLUSION: These data suggest a possible novel cancer therapy using progesterone receptor antagonist drugs even in tumors not known to have progesterone receptors to try to change the tumor microenvironment and re-activate suppressed natural killer cells.

Progesterone receptor antagonist therapy has therapeutic potential even in cancer restricted to males as evidenced from murine testicular and prostate cancer studies.

BACKGROUND: Treatment with the progesterone receptor antagonist mifepristone has been shown to improve the length and quality of life in mice with spontaneous leukemia, breast cancer, and lung cancer. The present study evaluated the efficacy of mifepristone therapy in murine tumors restricted to males, i.e. testicular and prostate cancer. MATERIALS AND METHODS: Eight-week-old mice with a strong predisposition to testicular or prostate cancer were gavaged with mifepristone. Olive oil was used in place of mifepristone in order to provide a control. Survival rates and body conditioning scores were compared after one year of treatment. RESULTS: Non-significant trends in survival rates were found in both types of murine cancers. Mifepristone significantly reduced the number of sick days in mice with testicular cancer. There was a significant reduction of adverse events (i.e. a tumor >1 cm or bleeding from the penis) in those with prostate cancer treated with mifepristone. CONCLUSION: These data support the hypothesis that various cancers may utilize a mechanism that is present in normal pregnancy that involves secretion of a progesterone-induced protein that blocks natural killer cell activity. The hypothesis that the cancer cells have the capacity to direct local progesterone production is supported by demonstrating the benefit of a progesterone receptor antagonist in tumors restricted to males.

Efficacy of the progesterone receptor antagonist mifepristone for palliative therapy of patients with a variety of advanced cancer types.

BACKGROUND: Mifepristone has been demonstrated to improve longevity and quality of life in mice with spontaneous murine cancer without progesterone receptors and in human colon cancer. The present study evaluated the palliative effect of mifepristone in a variety of different types of human cancer. PATIENTS AND METHODS: Mifepristone was given at 200 mg daily orally with permission from the Food and Drug Administration to people with widely metastatic human cancer no longer responsive to other chemotherapy regimens. RESULTS: Improvement in pain and energy and/or length of life was found in thymic epithelial cell carcinoma, transitional cell carcinoma of the renal pelvis, leiomyosarcoma, pancreatic carcinoma, malignant fibrous histiocytoma and another case of adenocarcinoma of the colon. CONCLUSION: Our data demonstrate a palliative role for the use of mifepristone in cancer therapy. Progesterone receptor antagonists should be given a therapeutic trial in larger controlled studies of various malignancies in humans.