Dietary intake of tryptophan tied emotion-related impulsivity in humans.

Emotion-related impulsivity, defined as the tendency to say or do things that one later regret during periods of heightened emotion, has been tied to a broad range of psychopathologies. Previous work has suggested that emotion-related impulsivity is tied to an impaired function of the serotonergic system. Central serotonin synthesis relies on the intake of the essential amino acid, tryptophan and its ability to pass through the blood brain barrier. Objective: The aim of this study was to determine the association between emotion-related impulsivity and tryptophan intake. Methods: Undergraduate participants (N = 25, 16 women, 9 men) completed a self-rated measure of impulsivity (Three Factor Impulsivity Index, TFI) and daily logs of their food intake and exercise. These data were coded using the software NutriNote to evaluate intakes of tryptophan, large neutral amino acids, vitamins B6/B12, and exercise. Results: Correlational analyses indicated that higher tryptophan intake was associated with significantly lower scores on two out of three subscales of the TFI, Pervasive Influence of Feelings scores r = -.502, p < .010, and (lack-of) Follow-Through scores, r = -.407, p < .050. Conclusion: Findings provide further evidence that emotion-related impulsivity is correlated to serotonergic indices, even when considering only food habits. It also suggests the need for more research on whether tryptophan supplements might be beneficial for impulsive persons suffering from a psychological disorder.

Preserved Cochlear Implant Function After Multiple Electroconvulsive Therapy Treatments.

This case report presents the successful use of multiple treatments of electroconvulsive therapy (ECT) in a patient with a cochlear implant (CI). A 60-year-old man with a left-sided CI and bipolar disorder presented with severe depression. A total of 9 separate sessions of unilateral ECT was administered to the contralateral side of the existing CI. We collected subjective, clinical, and audiological assessment of the patient and the CI prior, during, and after ECT therapy. The patient tolerated ECT well and there were no complications. Unilateral ECT was performed contralateral to the CI without any harm to the patient or implant. Laryngoscope, 131:E1695-E1698, 2021.

Teaching Systems Improvement to Early Medical Students: Strategies and Lessons Learned.

PURPOSE: Despite increasing emphasis in medical school education on quality and systems improvement, many medical schools lack sufficient faculty with expertise to teach systems improvement. Using the pedagogical content knowledge framework, this study explores how faculty engage students in systems improvement work and faculty perceptions of the outcomes for the health system and students. METHOD: In May-June 2017, the authors interviewed 12 of 13 invited faculty with experience in teaching and engaging first-year medical students in systems improvement work, the course of students' systems improvement work over time, the impact of students' projects on health systems, and students' learning and attitudes about systems improvement. The authors conducted qualitative analysis iteratively with data collection to sufficiency. RESULTS: Six emergent themes characterized faculty's approach to guiding students in systems improvement work: faculty-student relationship, faculty role, student role, faculty-student shared responsibility for projects, faculty and student content knowledge, and project outcomes. The faculty-student relationship was foundational for successful systems improvement work. Faculty roles included project selection, project management, and health systems interactions. Students engaged in systems improvement as their faculty leveraged their knowledge and skills and created meaningful student roles. Faculty and students shared responsibility and colearned systems improvement content knowledge. Faculty defined successful outcomes as students' learning about the systems improvement process and interprofessional collaboration. CONCLUSIONS: Findings highlight the critical importance of pedagogical content knowledge to engage early learners in systems improvement work, understand their learning interests and needs, and manage their projects longitudinally.

Does recent mania affect response to antidepressants in bipolar disorder? A re-analysis of STEP-BD data.

BACKGROUND: One previous study suggested that the presence of a manic episode before bipolar depression is related to worse response to antidepressants. METHOD: To examine this effect in a larger sample, we used data from the large, multi-site STEP-BD study. We hypothesized that among persons treated with antidepressants for bipolar depression, manic or mixed episodes before depression onset (as compared to euthymia) would predict lower rate of recovery, more sustained depressive symptoms and higher rate of switching into mania/hypomania after antidepressant treatment of bipolar depression. 320 participants were available for analyses (140 male) diagnosed with bipolar I, bipolar II, cyclothymia, bipolar disorder not otherwise specified, or schizoaffective disorder bipolar subtype. Patients were randomly assigned to 3 treatment randomization strata (placebo, bupropion, and paroxetine) as adjuncts to mood stabilizers. RESULTS: Analyses were conducted to examine the effect of episode status before the depressive episode on the degree of change in depressive symptoms at 3 and 6 months, the likelihood of depression recovery and the likelihood of anti-depressant induced switching. Presence of a manic episode before depression in patients with bipolar disorder did not significantly predict response to antidepressants. LIMITATIONS: The study was limited by a high rate of attrition, and consideration of only two antidepressant medications. CONCLUSIONS: Our findings are in agreement with other past studies suggesting that mania and depression may operate separately for those with bipolar disorder, with differential predictors of the onset and offset of mania versus depression. Future directions may consider vulnerability for these episodes separately.

Treating insomnia improves mood state, sleep, and functioning in bipolar disorder: a pilot randomized controlled trial.

OBJECTIVE: To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning. METHOD: Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder-specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates. RESULTS: During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed. CONCLUSIONS: CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder-specific sleep diary scoring standards is highlighted.

The electroconvulsive therapy and anesthesia exercise (ECTAE): the creation of an interdisciplinary learning activity for medical students.

OBJECTIVES: Demonstration of the effectiveness for medical student teaching of the electroconvulsive therapy (ECT)-anesthesia exercise (ECTAE). The ECTAE is a self-directed, interdisciplinary (psychiatry and anesthesia) learning exercise. Students are taught the assessment of mood and cognition using structured interviewing methods (psychiatry), basic airway and pharmacologic management (anesthesia), and informed consent and interdisciplinary communication (both). There are online pre-exercise and postexercise assessments. METHODS: Third-year medical students reviewed educational reference materials, participated in ECT clinical encounters with both psychiatry and anesthesia, and debriefed after completion of the interdisciplinary exercise. The impact of the exercise was evaluated through online pre- and postexercise assessments. Quantitative and qualitative results for 3 student cohorts (2007 through 2010) were analyzed. RESULTS: Thirty-eight students participated the study over 3 years. Mean scores for 21 true-false questions increased from 14.3 to 17.5 (n = 30) with P < 0.0001. Similarly, mean scores for 11 multiple choice questions increased from 6.8 to 8.9 (n = 22) with P < 0.0001. Thirty of 31 students who completed the program evaluation reported greater comfort level discussing and recommending ECT after participation in ECTAE. CONCLUSIONS: The ECTAE is an effective learning activity for medical students, which incorporates cross-disciplinary learning objectives through self-directed exercises, online assessments, and actual clinical experience of ECT. It improves student knowledge of both psychiatry and anesthesia learning objectives, as well as increasing comfort about ECT. Further research could determine if this activity is easily transportable to other academic settings.