In ECT, there’s a common saying that “nothing good happens after 1 minute.” However, recent data suggests that nothing good happens if a seizure lasts less than 20 seconds either. Patients whose seizures lasted 30 seconds or longer during their first ECT session were more than twice as likely to achieve remission by the end of treatment compared to those with seizures under 20 seconds. Seizure durations around one minute appeared to provide the best chances for remission.
Tag: Psychiatrist
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Should Marijuana be Reclassified?
The potential reclassification of marijuana to Schedule III under the Controlled Substances Act would represent a significant shift in how the United States views and regulates the drug. Currently listed as a Schedule I substance, alongside drugs like heroin and LSD, marijuana is classified as having no accepted medical use and a high potential for abuse according to federal law. However, the mounting evidence of its medicinal benefits and changing attitudes toward its use have sparked discussions about revisiting its scheduling.
Moving marijuana to Schedule III would acknowledge its recognized medical applications while still imposing regulatory controls. Drugs in this category, such as certain opioids like codeine, have a moderate to low potential for physical and psychological dependence and are accepted for medical use with restrictions. This reclassification could facilitate further research into its therapeutic properties and enable easier access for patients who could benefit from its use.
However, the reclassification process is complex and involves various legal, political, and scientific considerations. Advocates argue that placing marijuana in Schedule III or lower would align its scheduling with scientific evidence and public opinion, potentially reducing stigma and barriers to research. Critics express concerns about the potential for increased recreational use and addiction, as well as the regulatory challenges of managing a substance with psychoactive properties.
Any decision to reschedule marijuana would require careful deliberation, weighing the potential benefits against the risks and ensuring that public health and safety remain paramount.
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Alcohol: The Socially Acceptable Drink That Could Be Killing You
While alcohol is widely accepted in social settings and deeply embedded in many cultures, it’s important to recognize that its social acceptance does not make it harmless. In fact, alcohol has caused far more harm than many illegal substances that are often perceived as more dangerous.
Alcohol is linked to numerous health problems, including liver disease, heart issues, and various forms of cancer. It’s also a leading contributor to accidents, violence, and fatalities, with drunk driving being one of the most deadly consequences. Beyond physical health, alcohol abuse can devastate relationships, contribute to domestic violence, and exacerbate mental health conditions like depression and anxiety.
Alcohol’s normalized presence in society often downplays the risks of dependency and addiction. Many people who drink don’t realize how easy it can be to develop problematic drinking, which can lead to a host of long-term issues, both physically and emotionally.
Despite its legal status and social acceptance, alcohol has proven to be one of the most harmful substances in terms of both individual and societal impact. Recognizing the risks and encouraging more mindful consumption can help reduce the extensive harm caused by this seemingly benign substance.
Link:
https://www.washingtonpost.com/wellness/2024/08/19/alcohol-drinking-deaths-worldwide
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Are all Delusions the Same Across Episodes of Psychosis?
As an inpatient psychiatrist, you encounter a wide array of stories and experiences. Many of my trainees find this to be the most fascinating and engaging part of the job. We have the unique opportunity to delve into the inner workings of the mind and understand the thought processes of patients with serious mental illnesses (SMI). One of the things that often emerges during our evaluations is the presence of various types of delusions. Some are more common than others, with persecutory and grandiose delusions being frequent examples. I often hear patients claim that unknown groups are conspiring to ruin their lives, or a manic patient might declare, “I’m Jesus Christ.”
Over the years, I’ve noticed that these delusions tend to remain consistent, with similar themes recurring during subsequent admissions. In case you’re wondering, I often see the same individuals with the same issues multiple times a year, giving me a wealth of data points to support this observation. This insight is supported by a recent article from JAMA Psychiatry, which found that delusional content remains consistent across episodes of psychosis. This consistency can help us recognize the early stages of decompensation and potentially intervene before hospitalization becomes necessary. For instance, if a patient claims, “I’m Jesus Christ” during one episode, it’s likely they will express the same delusion during future episodes.
Another significant finding from this study is the importance of maintaining the intensity of interventions throughout the follow-up period. Unfortunately, there are many reasons why this doesn’t always happen, but when it doesn’t, poor outcomes are often the result.
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Anxiety and Dementia is There a Link?
Anxiety is challenging to manage, and it’s something we all experience to some degree, no matter how mentally strong we might be. Research shows that individuals with chronic anxiety have increased activity in the limbic system, which includes the hippocampus, amygdala, hypothalamus, and thalamus—regions responsible for emotional processing. Over time, chronic anxiety can cause damage to these brain structures.
A study published in the Journal of the American Geriatrics Society found that chronic anxiety was linked to a 2.8-fold higher risk of dementia, while new-onset anxiety was associated with a 3.2-fold increased risk. Participants under 70 with chronic anxiety had an even higher 4.6-fold increased risk. Interestingly, no significant risk was found in participants whose anxiety had resolved. The researchers attributed the increased dementia risk to unhealthy lifestyle choices. While this is an interesting conclusion, it seems to overlook the potential physiological changes caused by chronic anxiety, which could also play a role. The researchers suggest that individuals with anxiety may be more likely to engage in unhealthy behaviors, such as poor diet, smoking, and drinking—all of which increase the risk of cardiovascular disease, a major risk factor for dementia.
I’ve always believed that the key to effective dementia treatment lies in prevention, and lifestyle modification can be a powerful tool in this battle.
Link to the article: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.19078
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Matthew Perry’s Doctors Charged
Everyone told me not to comment on this situation a few months ago and here we are:
Recent developments in the case of Matthew Perry’s death have taken a serious turn as two doctors have been charged with the illegal distribution of ketamine. The charges allege that these physicians were involved in prescribing the powerful anesthetic, known for its potential misuse as a recreational drug, outside the bounds of medical necessity.
This case has raised significant concerns about the role of medical professionals in the broader issue of prescription drug abuse. Ketamine, while valuable in certain psychiatric contexts such as treatment resistant depression, carries a high risk of abuse and dependence, making its distribution tightly regulated.
The charges against Perry’s doctors highlight the ongoing challenges in ensuring that powerful medications are prescribed responsibly and underscore the need for stricter oversight in the medical community. The legal proceedings will likely shed more light on the extent of the alleged misconduct and its impact on Perry and others.
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Major Barriers to psychotherapy treatment
Have you ever had one of those weeks where every patient you see could greatly benefit from psychotherapy, but finding them a therapist seems impossible? There are many barriers to accessing mental health care, including inadequate or nonexistent insurance coverage and a shortage of therapists trained in specific types of therapy. For instance, I’m always on the lookout for specialists in dialectical behavior therapy (DBT), but finding even one has been a struggle. Recently, I’ve seen many patients who would benefit far more from psychotherapy than from medication, yet I haven’t been able to connect them with the quality therapy they need. We talk a lot about helping people, but I’m not seeing the commitment to providing effective treatment for our most vulnerable patients.
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Is Self-Injurious Behavior The Same Everywhere?
Non-suicidal self-injury (NSSI) is generally believed to be more prevalent among females, but there is limited research exploring the sex and geographic-specific factors influencing its prevalence among adolescents. This meta-analysis, which reviewed 38 studies, found that NSSI is twice as common in female teenagers compared to males in North America, though this pattern is not observed in Asia. This raises an important question: what factors are driving such significant distress in young women? Mood disorders, body image issues, and anxiety are all recognized as contributing factors that increase the likelihood of NSSI. We are lucky to have some treatments that help with NSSI including dialectical behavioral therapy (DBT). If you or someone you know is struggling with NSSI please reach out for help.
Link to the Article:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820026
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FDA Approves the first nalmefene auto-injector for Opioid Overdose
The FDA has just approved the first nalmefene auto-injector, a significant development in the fight against opioid overdoses. Nalmefene is an opioid antagonist, like naloxone, but with a longer duration of action. This new auto-injector is designed for easy use by non-medical personnel, making it accessible in emergency situations where time is critical.
The approval of this device reflects the ongoing need for effective tools to combat the opioid overdose, providing another layer of protection for individuals at risk of overdose. With its extended action, the nalmefene auto-injector offers a prolonged response compared to existing naloxone, especially in situations where multiple doses of naloxone might be required.
This innovation will play a crucial role in reducing overdose fatalities, offering hope to communities impacted by the opioid epidemic. As it becomes available, it is expected to be a vital addition to public health strategies aimed at saving lives.
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This Changes What We Know About How ECT Works
I’ve had tremendous success with Electroconvulsive Therapy (ECT) in treating resistant depression (TRD). I’ve witnessed remarkable turnarounds, where individuals on the brink of despair have found new joy in life. Such rapid improvements are often not seen with medication alone.
Until now, there have been various theories about how ECT works in treating depression. I’ve always viewed it as a combination of increased neuroplasticity, which allows new, more adaptive connections to form quickly, and a boost in all major monoamine neurotransmitters.
However, new research published in Translational Psychiatry suggests that aperiodic brain activity might be key to the improvements we see with ECT. There’s a significant increase in this type of brain activity after patients undergo ECT, which enhances inhibitory activity in the brain, effectively “pumping the brakes” and alleviating depressive symptoms.
Unfortunately, ECT remains one of the most stigmatized and underutilized treatments in psychiatry. It’s estimated that less than 1% of those with treatment-resistant depression (TRD) receive ECT—a disheartening statistic that contributes to depression’s status as a leading cause of disability.
For patients where medications have repeatedly failed, ECT can be a life-saving treatment. There are many compelling stories of lives transformed by ECT, but the public rarely hears them. We need to create more opportunities to share these powerful success stories.
