Selective Serotonin Reuptake Inhibitors and Other Treatment Modalities for Deep Space Missions.

INTRODUCTION: As humankind ventures further into the depths of space, planning is already underway for long-duration exploration missions that will test the bounds of human performance. Deep space travel will include added risk related to stressors from the isolated, confined, and extreme environment that lies outside the boundaries of low Earth orbit. Currently, selective serotonin reuptake inhibitors (SSRIs) are considered the standard of care for many mental health diagnoses, including anxiety and depression; however, SSRIs are also associated with several undesired side effects. The utility of nonpharmacological therapies for the management of behavioral health conditions has not yet been fully explored.METHODS: A comprehensive literature search was performed using PubMed. Relevant articles pertaining to the psychological impacts of isolated, confined, and extreme environments, use of SSRIs in spaceflight, side effects associated with SSRIs, and nonpharmacological treatments for anxiety and depression were reviewed. Over 70 studies were reviewed in total.RESULTS: Reduced bone mineral density, impaired hemostatic function, significant individual variability resulting from gene polymorphisms, and drug-drug interactions are well described adverse effects of SSRIs that may complicate their operational use in the deep space environment. Four alternative therapies for the treatment of anxiety and depression may show promise for long duration missions.DISCUSSION: Although SSRIs have long been considered standard of care treatment for many behavioral health conditions, we cannot trivialize the risk that prolonged pharmacological therapy may pose. The need to mitigate these risks by exploring alternative therapies has never been more relevant.El-Khoury BB, Ray KL, Altchuler SI, Reichard JF, Dukes CH. Selective serotonin reuptake inhibitors and other treatment modalities for deep space missions. Aerosp Med Hum Perform. 2023; 94(11):843-851.

Using modeling and rehearsal to teach fire safety to children with autism.

We evaluated the efficacy of an instructional procedure to teach young children with autism to evacuate settings and notify an adult during a fire alarm. A multiple baseline design across children showed that an intervention that included modeling, rehearsal, and praise was effective in teaching fire safety skills. Safety skills generalized to novel settings and maintained during a 5-week follow-up in both training and generalization settings.

The Effectiveness of Direct Instruction in Teaching Students with Autism Spectrum Disorder to Answer "Wh-" Questions.

Research on the effects of Direct Instruction (DI) among students with Autism Spectrum Disorder (ASD) has only recently emerged. A benefit of DI is that it can be implemented with groups of students, which makes it potentially a cost effective method of instruction for some skills. In this study, we examined the effects of DI on teaching secondary students with ASD to answer three "wh-" questions. Using a multiple probe design across behaviors, results indicated the participants mastered two of the three "wh-" question types and made progress with the remaining question type. These results are discussed along with implications for educators instructing students with ASD.

Using WatchMinder to Increase the On-Task Behavior of Students with Autism Spectrum Disorder.

This study assessed the use of WatchMinder™, a vibrating prompt watch, and self-graphing on the on-task behavior of students with autism spectrum disorder in an elementary special education setting. Using a multiple baseline across subjects design, results showed an immediate increase in on-task behavior when the intervention was introduced. Participants maintained high levels of on-task behavior during the follow-up phase. Implications for expanded self-monitoring treatment packages are discussed.

Consultation Dilemma Catatonia in a Patient with Prior TBI: MentaI or Medical Disorder?

Mr. R, a 27 year old Hispanic male with history of traumatic brain injury (TBI) over ten years prior but no psychiatric history, presents to the psychiatric consultation service with recent onset of mutism, psychotic behavior and new diagnosis of epilepsy. The differential diagnosis is broad and includes both medical and psychiatric causes: post-ictal state, non-convulsive status epilepticus, delirium due to metabolic conditions, drugs, catatonia, conversion disorder, major depression with psychotic features, new onset schizophrenia or a combination of these possible diagnoses. We explore different medical causes that can present with symptoms of catatonia, as it is crucial to rule out a possible treatable medical cause.