Recent Advances in Psychopharmacology: From Bench to Bedside Novel Trends in Schizophrenia.

Research in the field of psychopharmacology is ongoing to develop novel compounds which can revolutionize the treatment of psychiatric disorders. The concept of bench-to-bedside is a tedious process, transforming the initial research performed in the laboratories into novel treatment options. Schizophrenia (SCZ) is a chronic psychiatric illness with significant morbidity and mortality. SCZ not only presents with psychotic symptoms including hallucinations and delusions but also with negative and cognitive symptoms. The negative symptoms include the diminished ability to express emotions, loss of pleasure, and motivation with minimal social interactions. Conventional antipsychotics primarily target positive symptoms with minimal therapeutic benefits for negative and cognitive symptoms along with metabolic side effects. Researchers have explored novel targets to develop new compounds to overcome the above limitations. The glutamatergic system has provided new hope in treating schizophrenia by targeting negative and cognitive symptoms. Other receptor modulators, including serotonergic, phosphodiesterase, trans-amine-associated receptors, etc., are novel targets for developing new compounds. Future research is required in this field to explore novel compounds and establish their efficacy and safety for the treatment of schizophrenia. Last but not least, pharmacogenomics has effectively utilized genetic information to develop novel compounds by minimizing the risk of failure of the clinical trials and enhancing efficacy and safety.

Gender bias in antidepressant direct-to-consumer pharmaceutical advertising.

BACKGROUND: Direct to consumer pharmaceutical advertising (DTCPA) may have significant impacts on public perception of diseases and treatments. Our objective was to examine whether DTCPA for antidepressants disproportionately portray and hence target women in the United States. METHODS: DTCPA for branded medications for depression, psoriasis and diabetes were analyzed to determine the gender of the main "patient" portrayed, as well as the content of the disease depiction. RESULTS: DTCPA for antidepressants included only women in 82% of ads, only men in 10.1% of ads, and both genders in 7.8% of ads. There were significantly higher representations of women versus men in DTCPA for antidepressants (82%) compared to either psoriasis (50.4%) or diabetes (37.6%) medications. These differences remained statistically significant even after adjusting for gender disparities in disease prevalence. CONCLUSIONS: Antidepressant DTCPA in the United States disproportionately target women. There are potential adverse consequences for both women and men resulting from unequal representations in DTCPA for antidepressant medications.

A Qualitative Inquiry of Parents' Observations of Their Children's Mental Health Needs During the COVID-19 Pandemic.

Given that children and adolescents are at critical periods of development, they may be particularly vulnerable to the effects of the COVID-19 pandemic. Using a descriptive phenomenological approach, 71 parents' observations of their child's mental health difficulties were explored. Parents sought out treatment because their children were experiencing significant distress. Data used were transcribed from baseline questionnaires and therapy summaries. Data analysis revealed three themes: emotion regulation difficulties, hypervigilance, and despair. The search for strategies and tailored interventions to help mitigate the potential harmful and long-term mental health impacts of the pandemic should be at the forefront of research and clinical practice.

Primary Outcomes for Adults Receiving the Unified Protocol after Hurricane Harvey in an Integrated Healthcare Setting.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy for treating anxiety and depression. However, there are limited effectiveness data when conducted in real-world settings with diverse populations, including those with trauma. We evaluated treatment outcomes in a naturalistic, community setting among 279 adults who received UP following Hurricane Harvey. We examined change in overall clinical severity, depression and anxiety symptoms, functional impairment, and baseline outcome predictors (i.e., demographic characteristics, impact from Hurricane Harvey, co-occurrence of depression and anxiety symptoms). Global clinical severity, depression and anxiety symptoms, and functional impairment decreased by end-of-treatment. Participants experienced global symptom improvement to a lesser degree than demonstrated in efficacy trials. Participants who experienced greater storm impact reported larger reductions in anxiety symptoms than those less impacted by Harvey. Further studies evaluating the effectiveness of the UP post-disaster and with diverse samples are needed.

Tracking and Predicting Depressive Symptoms of Adolescents Using Smartphone-Based Self-Reports, Parental Evaluations, and Passive Phone Sensor Data: Development and Usability Study.

BACKGROUND: Depression carries significant financial, medical, and emotional burden on modern society. Various proof-of-concept studies have highlighted how apps can link dynamic mental health status changes to fluctuations in smartphone usage in adult patients with major depressive disorder (MDD). However, the use of such apps to monitor adolescents remains a challenge. OBJECTIVE: This study aimed to investigate whether smartphone apps are useful in evaluating and monitoring depression symptoms in a clinically depressed adolescent population compared with the following gold-standard clinical psychometric instruments: Patient Health Questionnaire (PHQ-9), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A). METHODS: We recruited 13 families with adolescent patients diagnosed with MDD with or without comorbid anxiety disorder. Over an 8-week period, daily self-reported moods and smartphone sensor data were collected by using the Smartphone- and OnLine usage-based eValuation for Depression (SOLVD) app. The evaluations from teens' parents were also collected. Baseline depression and anxiety symptoms were measured biweekly using PHQ-9, HAM-D, and HAM-A. RESULTS: We observed a significant correlation between the self-evaluated mood averaged over a 2-week period and the biweekly psychometric scores from PHQ-9, HAM-D, and HAM-A (0.45≤|r|≤0.63; P=.009, P=.01, and P=.003, respectively). The daily steps taken, SMS frequency, and average call duration were also highly correlated with clinical scores (0.44≤|r|≤0.72; all P<.05). By combining self-evaluations and smartphone sensor data of the teens, we could predict the PHQ-9 score with an accuracy of 88% (23.77/27). When adding the evaluations from the teens' parents, the prediction accuracy was further increased to 90% (24.35/27). CONCLUSIONS: Smartphone apps such as SOLVD represent a useful way to monitor depressive symptoms in clinically depressed adolescents, and these apps correlate well with current gold-standard psychometric instruments. This is a first study of its kind that was conducted on the adolescent population, and it included inputs from both teens and their parents as observers. The results are preliminary because of the small sample size, and we plan to expand the study to a larger population.

Evaluation of Depression and Suicidal Patients in the Emergency Room.

Depression is the leading cause of disability globally, and more than one-half of those suffering with depression are not receiving effective treatment. Untreated or undertreated depression poses a significant risk for suicide. Suicide is the 10th leading cause of death in the United States. The emergency room provides an essential opportunity to screen for depression as well as suicide and to provide important and evidence-based interventions. The Basic Suicide Assessment Five-step Evaluation (B-SAFE) model provides a structure for all physicians to assess suicide risk and intervene.

Behavioral Emergencies: Special Considerations in the Pregnant Patient.

This article describes psychiatric emergencies in pregnant women. The perinatal period is a time of psychiatric vulnerability. Up to 1 in 6 pregnant women experience major depressive disorder, and 1 in 4 pregnant women with bipolar disorder experience mood exacerbation. We discuss the management of severe mental illness in pregnancy, risk to mother and child of untreated psychiatric illness in pregnancy, risk of relapse of psychiatric disorders in pregnancy with medication discontinuation, psychopharmacologic considerations of teratogenicity and other fetal adverse effects, acute agitation in the pregnant patient, suicidality in pregnancy, and emergency considerations related to substance use disorders.

Behavioral Emergencies: Special Considerations in the Geriatric Psychiatric Patient.

This article reviews psychiatric considerations and common psychiatric emergencies in the elderly. The elderly are vulnerable to medication side-effects because of pharmacokinetic changes from aging, and require lower doses and slower titration. They are a high-risk group for suicide, with more serious intent, fewer warning signs, and more lethality. Prompt diagnosis and treatment of delirium in emergency settings is essential, given association with worse outcomes when undiagnosed. Pharmacologic options with demonstrable efficacy for agitation in dementia are limited to antipsychotics, which are, however, associated with an increased risk of mortality; behavioral interventions are universally recommended as first-line measures.

Pathophysiological Role of HERV-W in Schizophrenia.

Schizophrenia is a neuropsychiatric disorder of complex etiology. Human endogenous retroviruses (HERVs) have been presented as possible candidates explaining the connections between the genetic, infectious, neurodevelopmental, and neuroinflammatory aspects of schizophrenia, with the human endogenous retrovirus type W family (HERV-W) showing the greatest evidence of association. Studies have identified retroviral nucleotide sequences, envelope and capsid proteins, and elevated transcription of HERV-W elements in CSF, blood, and brain samples from individuals with schizophrenia. The HERV-W elements can trigger the immune system in a variety of ways. HERV genetic elements may be activated by various prenatal maternal infections, leading to neuroinflammation and genetic abnormalities, altering the development of the brain, and eventually culminating in the development of schizophrenia. This review presents a concise synthesis of available evidence and theoretical speculation regarding the role of HERV-W in schizophrenia. The need for further investigation is highlighted before any conclusions can be stated with confidence.

Stabilization and Management of the Acutely Agitated or Psychotic Patient.

Acutely agitated or psychotic patients are particularly challenging to manage in the emergency department. Often these patients present with little or no history, and an adequate assessment may initially be difficult because of the condition of the patient. This article discusses basic concepts regarding agitation, and the related management goals and strategies.

Depression and the Suicidal Patient.

Depression is the most common psychiatric illness in the general community, with 3% to 4% of depressives dying by suicide today. Studies have shown that depression has considerable morbidity and mortality. This article focuses on depressed patients and their management within the emergency department. Understanding the intricacies of the interview process and identifying which patients need immediate attention are important skills for the emergency physician.

Psychiatric Emergencies in Pregnant Women.

Psychiatric emergencies in pregnancy can be difficult to manage. The authors (both practicing psychiatrists and emergency clinicians) review the evaluation and treatment of common mental health diagnoses in pregnancy.

Health Policy Considerations in Treating Mental and Behavioral Health Emergencies in the United States.

In recent years, health care providers have sounded the call that the US mental health system is in crisis. With decreases in funding and eroding access to care, the availability of psychiatric services has become increasingly limited, failing to meet growing needs. This article provides a brief history of mental health services in the United States and describes the current landscape of US psychiatric care; it touches upon some of the most important policy considerations, describing some of the glaring issues in US mental health care today. Last, it offers some potential remedies to improve care in acute behavioral emergencies.

Anxiety.

PURPOSE OF REVIEW: This article provides an overview of anxiety disorders including the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria with practical key features. The article discusses neurologic and other medical comorbidities as well as treatment strategies, keeping in mind the co-occurrence of anxiety disorders with depression. RECENT FINDINGS: Several studies have emphasized the high prevalence of comorbid mental and medical conditions including, but not limited to, cardiovascular and neurologic illnesses, making the overall management of these patients more costly and complex, ultimately leading to decreased length and quality of life. However, several research studies have suggested that appropriate and effective comanagement of anxiety and depression improves overall outcomes of those individuals with chronic medical conditions. SUMMARY: Anxiety and depression are common psychiatric conditions that not only co-occur, but also co-occur with other neurologic illnesses. Early recognition and treatment of these comorbidities are imperative in order to achieve better health outcomes for patients.

QTc prolongation with antipsychotics: is routine ECG monitoring recommended?

Whether or not QTc interval should be routinely monitored in patients receiving antipsychotics is a controversial issue, given logistic and fiscal dilemmas. There is a link between antipsychotic medications and prolongation of QTc interval, which is associated with an increased risk of torsade de pointes (TdP). Our goal is to provide clinically practical guidelines for monitoring QTc intervals in patients being treated with antipsychotics. We provide an overview of the pathophysiology of the QT interval, its relationship to TdP, and a discussion of the QT prolonging effects of antipsychotics. A literature search for articles relevant to the QTc prolonging effects of antipsychotics and TdP was conducted utilizing the databases PubMed and Embase with various combinations of search words. The overall risk of TdP and sudden death associated with antipsychotics has been observed to be low. Medications, genetics, gender, cardiovascular status, pathological conditions, and electrolyte disturbances have been found to be related to prolongation of the QTc interval. We conclude that, while electrocardiogram (ECG) monitoring is useful when administering antipsychotic medications in the presence of co-existing risk factors, it is not mandatory to perform ECG monitoring as a prerequisite in the absence of cardiac risk factors. An ECG should be performed if the initial evaluation suggests increased cardiac risk or if the antipsychotic to be prescribed has been established to have an increased risk of TdP and sudden death.