Rapid Fire Part 1: Heart to Heart with Psychiatry Trailblazers
Introduction
This month our Rapid Fire covers hot topics with trailblazers in the field of psychiatry—highlighting the most significant advances and treatments of 2022, major challenges of the past year, what they look forward to in 2023, and the level of patient severity—has it increased? Read on for some tidbits and insights from these thought leaders, including Dr. Christoph Correll, Dr. Margaret Sibley, Dr. Ann Childers, Dr. Holly Swartz, and Dr. Donald Black. Part 2 next month will focus on the most promising new treatment, preference on meeting/conference—live or virtual, and best recent publication!
Our last issue featured Dr. Sangar Parikh discussing the land mines to avoid in applying genetic tests in the context of antidepressant choice, pearls regarding the mental health crisis on college campuses, current key evidence on use of pharmacogenomic results to help tailor medication strategies, and where we will be with pharmacogenomic treatment options in 10 years. If you missed it, you can find that interview here.
Don’t Miss!
June 8-10, 2023; Marriott Marquis Chicago, Chicago, Illinois
· Full 2.5-day meeting with interactive presentations, discussion and networking opportunities, and in addition to the scientific sessions, there will be informative Bonus Presentations and an exciting Keynote speaker.
· Major Depressive Disorder, ADHD, Schizophrenia, and Bipolar Disorder, plus other clinically relevant hot topics: healthcare resilience, updates and innovations in fast-acting antidepressants, newly emerging digital therapeutics and updates in neuropsychiatry.
· Register here: https://events.medscapelive.org/ereg/newreg.php?eventid=720766
Keep up to date with this month’s Psych Resource section, featuring articles from Clinical Psychiatry News, Current Psychiatry, MDEdge Psychiatry, New England Journal of Medicine, and JAMA Psychiatry—check them out below!
I’d like to thank these participants for this month’s roundtable and a Suggested Reading as well! Please contact me at colleen@cmhadvisors.com with any comments. –Colleen Hutchinson
Thought Leader Rapid Fire
· Christoph Correll, MD, is Professor of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and Investigator, Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York.
· Margaret H. Sibley, Ph.D. is Associate Professor of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Licensed Clinical Psychologist at Seattle Children’s Hospital and a researcher who specializes in the diagnosis and treatment of ADHD in adolescence and adulthood, having published over 100 scientific works on this topic, as well as a book on the psychosocial treatment of adolescent ADHD.
· Ann Childress, MD, is President of the Center for Psychiatry and Behavioral Medicine, Clinical Associate Professor, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas and Adjunct Associate Professor, Touro University Nevada College of Osteopathic Medicine.
· Holly A. Swartz, MD, is Professor of Psychiatry at the University of Pittsburgh; Editor-in-Chief, American Journal of Psychotherapy; and Treasurer of the International Society for Bipolar Disorders, Pittsburgh, PA.
· Donald W. Black is Past-President of the American Academy of Clinical Psychiatrists (AACP) and Professor of Psychiatry at University of Iowa Carver College of Medicine in Iowa City, Iowa.
2022 brought significant advances in psychiatric research and treatment options. What is the most exciting or effective of these advances for your practice?
Dr. Black: What’s exciting is the potential to treat negative symptoms. Cariprazine, which is a dopamine D3/D2 receptor partial agonist, and serotonin 5-HT1A receptor partial agonist, are showing promise and paving the way for newer antipsychotics. The next generation of antipsychotics may well be a game changer for schizophrenia treatment.
Dr. Childress: I specialize in treating ADHD, so the approval of viloxazine extended-release for the treatment of ADHD in adults had the biggest impact on my practice. Previously we had only one option when using a nonstimulant to treat adult ADHD.
Dr. Swartz: I am excited to see new classes of medications becoming available to treat psychiatric disorders. Hopefully this will help the field move beyond its focus on “me too” drugs that represent small incremental improvements from antecedent therapeutics. Examples of medications that point toward new pathways to care include dextromethorphan-bupropion combination for depression which targets glutamatergic pathways, serotonergic hallucinogens like psilocybin that seem to remodel neural circuits, and brexanalone for postpartum depression, which enhances the inhibitory effects of GABA-A.
Dr. Correll: First approval of an oral NMDA antagonist agent for depression, and speeding up treatment response in patients with major depressive disorder.
Dr. Sibley: We have been expanding a peer-delivered organization skills intervention for high school students with ADHD throughout the Seattle metropolitan area. This intervention is very popular with teens, and our research is showing that it has lasting impacts on academic motivation and academic engagement.
Generally speaking, would you say the level of patient severity has increased?
Dr. Correll: Greater illness severity and later access to care due to the ongoing pandemic.
Dr. Black: Yes. Patient severity level keeps increasing as insurers make it difficult to hospitalize all but the sickest patients, and the number of hospital beds shrink. I rarely see simple and straightforward cases like I did 40 years ago.
Dr. Childress: Yes, and patients are waiting until symptoms are more severe to seek treatment than they were before the pandemic began.
Dr. Sibley: I am not sure. This is not the case in the patients I see, but it might be true in other patients.
Dr. Swartz: Absolutely. In the wake of the COVID pandemic, we have seen rising rates of suicide, anxiety, depression, and trauma. Without a commensurate increase in available services, those who suffer languish without care until they are so sick that they end up in emergency rooms or hospitals.
A major challenge of 2022:
Dr. Correll: Dealing with more and more severely ill patients in part due to the ongoing pandemic and in the context of reduced staff availability.
Dr. Sibley: Running clinical groups over telehealth continues to be a challenge. Although it means that many more families can receive care that were previously too far from the hospital, it is hard to create engaging experiences for youth over telehealth.
Dr. Black: Many of my patients have dementia and finding an appropriate memory-care facility for placement is very difficult. We need more and better facilities for these patients.
Dr. Childress: Dealing with the stimulant shortage that started in the third quarter of 2022 and is now continuing into 2023.
Dr. Swartz: I think about a depressed teenager for whom no inpatient beds could be located state-wide following a suicide attempt, anxious college students who are unable to find therapists, and family members paying out of pocket at great personal sacrifice for a partial hospitalization program for their suicidal adult child because their insurance did not cover extended care. We are in the midst of a huge mental health pandemic and our current services fall woefully short of public health need. We urgently need to build capacity to deliver more care to meet the mental health needs of our communities.
What I am most looking forward to in 2023:
Dr. Correll: Hopefully positive trial results for several agents that are in phase 2 and, especially, phase 3 studies, helping to increase the availability of safe and (more) effective treatment options for individuals with severe mental illness.
Dr. Sibley: I am hoping to start some new projects with old colleagues. We are investigating the best way to support patients with ADHD at the transition from adolescence to young adulthood.
Dr. Black: Attending in-person meetings again.
Dr. Childress: Getting back to normal. We aren't there yet.
Dr. Swartz: Perhaps this is aspirational, but I hope to see a return to civil discourse in our public spaces and equitable access to care for all.
Psychiatry Resource Section
JAMA Psychiatry Viewpoint: Methadone on Wheels—A New Option to Expand Access to Care Through Mobile Units
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2787665
MDEdge Clinical Psychiatry News Article: FDA clears once-weekly transdermal patch for Alzheimer’s
APA Learning Center Free Members November Course of the Month: Brain Networks in Psychiatric Disorders —Credits CME:1.25, Participation: 1.25
https://education.psychiatry.org/diweb/catalog/item?id=9166674
JAMA Psychiatry Viewpoint: The Rapid Rise in Investment in Psychedelics—Cart Before the Horse
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2787968
MDEdge Clinical Psychiatry News Article: Study: Majority of research on homeopathic remedies unpublished or unregistered
Current Psychiatry Sponsored CME Supplement: Challenges in Treating Patients with Tardive Dyskinesia—Credits CME: 0.5, Participation: 0.5
https://cdn.mdedge.com/files/s3fs-public/1121_cp_td_supplement_v8.pdf
New England Journal of Medicine Article: Electroconvulsive Therapy
https://www.nejm.org/doi/full/10.1056/NEJMra2034954
Current Psychiatry Review: Autism spectrum disorder: Keys to early detection and accurate diagnosis