The U.S. is officially withdrawing from the World Health Organization (WHO)—a move with far-reaching consequences for global health, research, and disease prevention. Here’s why this matters:
🔹 Pandemic Preparedness 🦠: The WHO coordinates global responses to pandemics. Without U.S. support, funding gaps could slow future outbreak responses.
🔹 Vaccine & Drug Research 💉: The U.S. plays a key role in funding and collaborating on medical breakthroughs. Withdrawing could disrupt research efforts in areas like HIV, TB, and malaria.
🔹 Health Security Risks 🚨: Global health threats don’t respect borders. A weaker WHO means less surveillance and slower containment of emerging diseases.
🔹 Loss of Influence 🇺🇸: The U.S. has historically shaped global health policies. Leaving the WHO could reduce its ability to set standards and priorities.
The long-term impact of this decision remains uncertain, but one thing is clear: global health is interconnected, and a fractured response benefits no one.
What do you think about this move? Drop your thoughts below. ⬇️ #GlobalHealth #WHO #PublicHealth
Modern medicine has given rise to a new culture of burnout. As physicians, we are already high achievers—it’s a prerequisite to make it through the intense training. However, this constant push for relentless productivity often leads to feelings of exhaustion and disconnection. In medicine, the focus is always on doing more—seeing more patients, finishing more tasks, and achieving more outcomes each day.
With digital technology, we’re constantly connected, always on call. Patients, colleagues, and administrators reach out through calls, texts, and emails at all hours. The pressure to respond immediately leads to guilt when we can’t meet these demands, even when they’re unreasonable. The result? We push ourselves beyond our limits, sacrificing our own well-being in the process.
This grind leaves little room to rest or tend to our mental health. The importance of downtime is overlooked, even though it’s essential for long-term sustainability in our profession. But it’s time we rethink the culture of busyness and productivity. We need to start focusing on slowing down, with an emphasis on not staying busy for the sake of being busy.
If you’re like me, you’ve probably tried this, only to find your mind immediately wandering to the next thing you need to do. The challenge is real. But to reclaim a deeper sense of meaning and purpose in both our personal and professional lives, we must commit to this change. By slowing down, we can begin to find more peace, love, and joy in our day-to-day activities.
As a psychiatrist, I’ve done countless consults, and one of the most challenging things to explain is that delirium is caused by an underlying medical condition—not a psychiatric one. There’s no specific psychiatric medication to directly treat delirium. Instead, treatment focuses on environmental adjustments, like placing a clock in the room, displaying the date clearly, and providing frequent reorientation to help ground the patient.
One area where psychiatry might make a difference, though, is in addressing sleep issues. Many patients with delirium also have irregular sleep patterns, which is why melatonin is often suggested. However, when orexin antagonists like Suvorexant came on the market, they offered improvements in both sleep quality and quantity without the risky side effects of benzodiazepines and Z-drugs. These medications became a potential option for preventing and possibly treating delirium in various forms.
Recently, Suvorexant underwent a phase-3 trial for delirium prevention, but the results weren’t as promising as hoped. While the Suvorexant group did show a lower incidence of delirium in older hospitalized adults compared to the placebo group, the difference wasn’t statistically significant. On the bright side, the drug was linked to significantly lower delirium rates in patients with hyperactive and mixed subtypes of dementia, which may open doors for further exploration in these specific cases.
There is an ongoing fascination in the world of social media with regards to certain psychiatric diagnoses. It begins with the rise of self-diagnosing, which is rampant on social media these days and ends with a lot of individuals believing they have autism, tic disorder, or dissociative identity disorder (multiple personalities). I’ve also seen a rise in my patients suggesting they have autism as an explanation for symptoms clearly caused by other disorders.
I can think of one specific example where an individual was convinced, they had autism. Later that day I observed the individual socializing with peers and staff making excellent eye contact, and all those symptoms they described in the diagnostic interview seemingly went away completely. It was clear at that point that autism was not the cause of this individual’s distress.
I feel like there is no better time to discuss autism spectrum disorders because we have a lot to clear up.
Introduction
Autism spectrum disorder (ASD) was introduced in the diagnostic and statistical manual (DSM-5) to replace the category of pervasive developmental disorders (PDD) which previously included Asperger’s disorder, Autistic disorder, and PDD not otherwise specified (NOS). You might ask, why did they change the category in DSM-5 to just autism spectrum disorder? This was thought to improve the ability to make a diagnosis of ASD while maintaining the sensitivity of its criteria. In fact, research suggests that 91% of those who met the previous criteria would meet the new DSM-5 criteria. They also grandfathered in those with a previously well-established diagnosis of Asperger’s, autistic disorder, or PDD NOS.
Epidemiology
In 2021, the CDC reported that approximately 1 in 44 children in the U.S. is diagnosed with ASD. The prevalence has been rising over the years, and this is largely thought to be related to better detection and awareness of the disorder not vaccinations or other environmental factors. ASD is 4.5 times more common in males than females. The median age when ASD is diagnosed in the U.S. is 50 months which is about 4 years of age. ASD can be found in all racial and ethnic groups although the prevalence does appear to be higher in Caucasian children.
Clinical Features of ASD
The focus in DSM-5 was in two domains and not the three domains from the prior classification. These domains are social communication impairment and restricted/repetitive patterns of behavior, and an individual must have had these symptoms in early childhood. Specifiers were added to indicate the level of impairment, level 1: requiring support, level 2: requiring substantial support, and level 3: requiring very substantial support.
DSM-5 Criteria
Persistent deficits in social communication and social interaction, as manifested by all 3 of the following:
-Deficits in social-emotional exchange: failure of back-and-forth communication, reduced sharing of interests, emotions, or affect, or failure to respond to social interactions.
-Deficits in nonverbal communicative behaviors used for social interaction: difficulty understanding facial expressions, body language, or eye contact
-Deficits in developing and maintaining relationships appropriate for the developmental level: difficulty adjusting behavior based on social context, difficult engaging in imaginative paly, or difficulty making friends
These symptoms can be seen in other disorders in the adult population including social anxiety, OCD, schizoid personality disorder, schizotypal personality disorder, avoidant personality disorder, schizophrenia, bipolar disorder, and intellectual disability. Therefore, it’s important to establish that these deficits were present at an early age.
Restricted, Repetitive Patterns of Behavior, Interests, or activities
At least two of the following must be present:
Stereotyped or repetitive speech, motor movements, or use of objects (simple motor stereotypies, lining up toys, or repetitive use of objects).
Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change
-Highly restricted, fixated interests that are abnormal in intensity or focus
-Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment
These individuals may have a rigid greeting ritual or struggle with small changes to normal activity. I had a case where the family took a different route to school one day and child became so upset that they jumped out of a moving car. This is the level of insistence on sameness and routine that we are talking about.
Gender Impact on ASD
The prevalence of ASD is lower in females, but females are noted to have a greater impairment in social communication, lower cognitive abilities, and more difficulty externalizing problems than males.
Causes of ASD
ASD is a complex neurodevelopmental disorder with both genetic and environmental factors. Family and genetic studies identified ASD as a highly heritable disorder. The heritability can range from 37% to more than 90% with only 15% of cases being attributed to a known genetic mutation. ASD is polygenic meaning there are multiple genes that contribute to the disease. Many inherited genetic variants contribute to a small additive risk of developing ASD.
Neuroimaging research has found that ASD is often associated with atypical brain maturation. Children with autism usually have an excessive number of synapses in the cerebral cortex, this indicates abnormal pruning may be part of the etiology. Pruning occurs at a critical period in childhood where excess synapses are eliminated, it’s critical for proper cortical maturation. Other findings include abnormalities in neurotransmitter levels, immune dysfunction, and neuroinflammation.
One of the greatest areas of controversy has focused on the impact on childhood vaccinations as a causative factor for ASD. The current evidence does not support this theory, and ASD is not associated with childhood vaccinations.
Environmental factors including exposure to valproate, air pollution, low birth weight, and increased maternal and paternal age are all associated with increased risk for the development of ASD.
Co-Morbidity
The most common co-morbid disorders in ASD include intellectual disability, ADHD, and seizure disorder. Approximately one-third of individuals with ASD meet criteria for intellectual disability. ADHD can be seen in 30% to 50% of individuals with ASD. Seizure disorders in these individuals can be difficult to treat, and often refractory to treatment. There is also increased risk of gastrointestinal disturbances such as constipation and restricted food intake.
Evaluating Someone with Suspected ASD
The assessment of ASD requires both an evaluation of the individual and collateral information from caregivers and teachers. ASD remains a clinical diagnosis, but there are several screening and diagnostic assessments that may help support the diagnosis. The most well-known is the ADOS autism diagnostic observation schedule, and the ADI-R autism diagnostic interview revised.
A delay in spoken language is common first symptom that prompts referral in younger children for autism screening. The starting point is usually to check hearing and vision to be sure the individual is not suffering from deficit in either of these sensory domains. If there are dysmorphic characteristics, genetic testing for specific genetic disorders may also be completed prior to the evaluation.
Treatment
There is no FDA approved medication for the treatment of ASD. The primary intervention is behavioral, and these interventions should be started as soon as possible. Applied behavioral analysis (ABA) is a type of therapy that focuses in developing specific behaviors such as social skills, communication, reading, and academics as well as fine motor dexterity, hygiene, grooming, domestic capabilities, and job competence. This should be the core of treatment and has good evidence to support its use.
If medications are used, it’s important to note that they do change the underlying communication or social deficits seen in these children. They are used to target specific co-morbidities such as ADHD, or symptoms that include irritability and aggression. There are only two FDA approved medications for ASD-related symptoms. These medications are risperidone, and aripiprazole and they are approved to treat irritability in children.
Conclusion
ASD is a complex disorder with multiple genetic and environmental factors contributing to the development of the disorder. Since it’s a neurodevelopmental disorder it’s often present at an early age and suspicion of ASD should be followed up with a proper diagnostic evaluation. I think it’s important for people to avoid self-diagnosis and be careful what information they are consuming on social media.
We Spend a significant amount of time as doctors monitoring for adverse outcomes.
We use the absence of disease as an indicator of health.
But the mere absence of disease is not enough to proclaim good health.
If we only monitor for the absence of disease, we miss the things that are most important in our patients’ daily lives.
The things I’ve found to be most important in my life, and often lacking in my patient’s lives are…
Being happy, having a sense of purpose and meaning, and having good relationships which are sometimes ignored if overt signs and symptoms of disease are not present.
Being “well” is a state of complete mental, physical, and social wellbeing.
Having a purpose in life is associated with reduced mortality risk, so is life satisfaction. Things like loneliness and social isolation are associated with increased mortality.
When these needs are met people not only live longer but they live with intention.
Oh, wait a minute I love everything about my work. In fact, I spend a great deal of time doing things outside of clinical practice related to psychiatry. Things like writing on this blog. I love doing therapy and even started psychoanalytic training. I even like being able to prescribe medications and have done enough clinical work and reading to know they are effective. Basically, this seems like the right place for me, to think I initially thought I wanted to be a surgeon.
When I entered college, I treated it like high school and never thought medicine had a place for me. I was actually in training to be a police officer and figured that would be a good enough life. I started in community college and by chance took an introductory biology course with a professor who I clicked with right away. As I moved on from the community college setting, I knew I had to decide, did I want to do basic science research, or was I going to continue on the premedical path with intentions of being a doctor. This was all very shocking for me, a person who barely graduated high school, and scored almost as low as you can on the SAT. I really did not understand anything about getting into medical school, and after transferring to a small college near my hometown that lacked a true premedical curriculum, I was defiantly at a disadvantage. I then dabbled in the possibility of studying naturopathic medicine but was convinced by my research supervisor that a traditional medical school would offer me more opportunities and I could still do many of the lifestyle medicine things I wanted to. Given my lack of understanding about building a medical school application, I did not get any offers to attend a U.S. MD program. At least I had gained acceptance to St. George’s University, and I was determined to prove every U.S. school wrong about their assessment of my abilities.
I honestly had no idea psychiatry would be my choice of specialty. In the whole 2 weeks of teaching, I received in the first two years of medical school about the subject, it did not seem very appealing. However, I was sold after my third-year clerkship in psychiatry and have since dedicated my life to the field.
So, what does all this have to do with making the wrong choice? Well, if you truly understand psychiatry you will know that what passes as psychiatric care these days is far from ideal. I never thought the majority of my time would be reviewing screening scales, asking about side effects of medication, and writing notes mostly filled with legal jargon. I feel like I’m longing for the good old days when you could spend an hour with a patient and really understand what the problem is. Sometimes I feel stuck in this situation, but I always remember I could have been a surgeon.
