EDITORIAL article Front. Psychiatry, 13 September 2023Sec. Schizophrenia Volume 14 - 2023 | https://doi.org/10.3389/fpsyt.2023.1282780

EDITORIAL article Front. Psychiatry, 16 January 2024Sec. Schizophrenia Volume 14 - 2023 | https://doi.org/10.3389/fpsyt.2023.1357838

Back to table of contents Previous article Next article Clinical Case Conference in Behavioral Neurology & NeuropsychiatryNo AccessCase Study 4: A 68-Year-Old Woman With Progressive Cognitive Decline and AnxietyRishab Gupta, M.D., Vihar Patel, M.D., Scott M. McGinnis, M.D., David Silbersweig, M.D., Michael B. Miller, M.D., Ph.D., Mel B. Feany, M.D., Ph.D., Kirk Daffner, M.D., Seth A. Gale, M.D.Rishab Gupta, M.D., Vihar Patel, M.D., Scott M. McGinnis, M.D., David Silbersweig, M.D., Michael B. Miller, M.D., Ph.D., Mel B. Feany, M.D., Ph.D., Kirk Daffner, M.D., Seth A. Gale, M.D.Published Online:12 Jan 2023https://doi.org/10.1176/appi.neuropsych.20220151AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Purchase Save for later Item saved, go to cart PPV Articles - Journal of Neuropsychiatry and Clinical Neurosciences $35.00 Add to cart PPV Articles - Journal of Neuropsychiatry and Clinical Neurosciences Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 35Issue 1 Winter 2023Pages 4-11 Metrics KeywordsAlzheimer DiseaseAnxietyDementiaAlcohol UseNeuropathologyPDF download History Received 13 August 2022 Accepted 14 November 2022 Published online 12 January 2023 Published in print 1 January 2023

ABSTRACT:In this commentary, we critique the Indian government's decision to approve endoxifen for the treatment of acute mania among adults.

Abstract In this commentary, we critique the Indian government's decision to approve endoxifen for the treatment of acute mania among adults.

Background: Serious mental illnesses, including schizophrenia, bipolar disorder and depression are heritable, highly multifactorial disorders and major causes of disability worldwide. Polygenic risk scores (PRS) aggregate variants identified from genome-wide association studies (GWAS) into individual-level estimates of liability, and are a promising tool for clinical risk stratification. Methods: By leveraging the VA’s extensive electronic health record (EHR) and a cohort of 9 378 individuals with confirmed diagnoses of schizophrenia or bipolar I disorder, we validated automated case-control assignments based on ICD-9/10 codes, and benchmarked the performance of current PRS for schizophrenia, bipolar disorder, and major depression in 400 000 Million Veteran Program (MVP) participants. We explored broader relationships between PRS and 1 650 disease categories via phenome-wide association studies (PheWAS). Finally, we applied genomic structural equation modeling (gSEM) to derive novel PRS indexing common and disorder-specific latent genetic factors. Findings: Among 3 953 and 5 425 individuals with diagnoses of schizophrenia or bipolar disorder type I that were confirmed by structured clinical interviews, 95% were correctly identified using ICD-9/10 codes (2 or more). Current PRS were robustly associated with case status in European (p <10-254) and African (p<10-5) participants and were higher among more frequently hospitalized patients (p<10-4). PheWAS confirmed previous associations among higher neuropsychiatric PRS and elevated risk for psychiatric and physical health problems and extended these findings to African Americans. Interpretation: Using diagnoses confirmed by in-person structured clinical interviews and current neuropsychiatric PRS, we demonstrated the validity of an EHR-based phenotyping approach in US veterans, highlighting the potential of PRS for disentangling biological and mediated pleiotropy. Funding Information: Department of Veterans Affairs Cooperative Studies Program (CSP) #572; Million Veteran Program (MVP-000, MVP-006); Office of Research and Development, Department of Veterans Affairs. Declaration of Interests: Dr. Bigdeli is the recipient of a 2019 NARSAD Young Investigator Grant (#28276). Dr. Voloudakis is supported by the National Institutes of Health (NIH) under award number K08MH122911 and is the recipient of a 2020 NARSAD Young Investigator Grant (#29350). We are grateful to Drs. R. Karlsson Linnér and T.T. Mallard for sharing their script for plotting PheWAS results, which served as the basis of the figure presented herein.Dr. Harvey has served as a consultant to multiple pharmaceutical companies and device manufacturers on phase 2 or 3 treatment development; this consulting work has been determined to be unrelated to the content of the paper. No other authors report any relevant conflicts of interest. Ethics Approval Statement: This study was approved by the VA Central Institutional Review Board (IRB), and all patients provided written informed consent.

A pandemic, as defined by the World Health Organization [1], is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people. Presently, the COVID-19 pandemic is raging through the USA, and as time is progressing, the larger undercurrent of neuropsychiatric ailments and disorders is making its presence felt. At the time of writing this paper, in the last week of November 2020, 1 year after the detection of the first case of COVID-19 in Wuhan, China, there have been over 57.8 million cases and 1.3 million deaths worldwide [2]. Most patients with COVID-19 present initially with fever (83%–99%), cough (59%–82%), fatigue (44%–70%), anorexia (40%–84%), and shortness of breath (31%–40%) [3]. However, the signs and symptoms present at the illness onset may vary widely and involve various organ systems. Recent literature is beginning to shed light on the impact of COVID-19 on the nervous system and its neuropsychiatric sequelae. Studies describing the association between COVID-19 and neuropsychiatric symptoms are limited. Large-scale cohort studies are currently not available in the extant literature. A recent study assessing the potential relationship between COVID-19 and psychiatric disorders found a reciprocal relationship between the two [4]. This study included 62,354 patients diagnosed with COVID-19 with the primary outcomes being the incidence and hazard ratios for psychiatric disorders, dementia, and insomnia during the first 14 to 90 days after a diagnosis of COVID-19 was established. The authors observed that the patients recovering from COVID-19 had a significantly higher rate of psychiatric disorders. There was a 5.8% probability of being newly diagnosed with a psychiatric illness within 90 days post COVID-19 diagnosis. The most frequently acquired psychiatric diagnosis was anxiety disorder, with a probability of outcome within 90 days of 4.7%. Among anxiety disorders, adjustment disorder, generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), and panic disorder were the most frequent. The probability of a new diagnosis of mood disorder within 14 to 90 days after COVID-19 diagnosis was 2%. Interestingly, previous psychiatric illness was found to be independently associated with an increased risk of being diagnosed with COVID-19. A diagnosis of a psychiatric disorder 1 year prior to the onset of the COVID-19 pandemic was associated with a 65% increased risk of COVID-19 compared with a cohort matched for established physical risk factors for COVID-19, but without a psychiatric diagnosis. This finding held ground in sensitivity analyses. In this article, we will review and discuss the existing evidence regarding various neuropsychiatric manifestations of COVID-19, including delirium, cognitive impairment, psychosis, depression, suicide, mania, and anxiety in patients with COVID-19 and COVID-19 survivors. We will also discuss the neurobiological mechanisms that are hypothesized to be involved in developing neuropsychiatric symptoms. Furthermore, we will discuss the potential role of medications used for treatment of COVID-19 in causing/worsening neuropsychiatric symptoms. Lastly, we will review the psychosocial factors contributing to the psychiatric presentations of infected individuals considering how important psychosocial factors are in the occurrence of primary psychiatric disorders.

Introduction: The interplay between sleep duration and inflammation on the baseline and incident cardiovascular (CV) risk is unknown. We sought to evaluate the association between sleep duration, C-reactive protein (CRP), baseline CV risk, and incident CV mortality. Methods: We used data from the National Health and Nutrition Examination Survey 2005-2010 linked with the cause of death data from the National Center for Health Statistics for adults aged >= 18 years. The associations between self-reported sleep duration and CRP, 10-year atherosclerotic CV disease risk score (ASCVD) and CV mortality were assessed using Linear, Poisson and Cox proportional hazard modeling as appropriate. Results: There were 17,635 eligible participants with a median age of 46 years (interquartile range [IQR] 31, 63). Among them, 51.3% were women and 46.9% were non-Hispanic Whites. Over a median follow-up of 7.5 years (IQR 6.0, 9.1), 350 CV deaths occurred at an incident rate of 2.7 per 1000-person years (IQR 2.4, 3.0). We observed a U-shaped associations between sleep duration and incident CV mortality rate ( P-trend=0.011), sleep duration and 10-year ASCVD risk ( P-trend <0.001), as well as sleep duration and CRP ( P-trend <0.001). A self-reported sleep duration of 6-7 hours appeared most optimal. We observed that those participants who reported <6 or >7 hours of sleep had higher risk of CV death attributable to inflammation after accounting for confounders. Conclusions: There was a U-shaped relationship of incident CV mortality, 10-year ASCVD risk, and CRP with sleep duration. These findings suggest an interplay between sleep duration, inflammation, and CV risk.

Abstract Background Schizophrenia and bipolar disorder are debilitating neuropsychiatric illnesses collectively affecting 2% of the world’s population, and which cause tremendous human suffering that impacts patients, their families and their communities. Recognizing the major impact of these disorders on the psychosocial function of more than 200,000 US Veterans, the Department of Veterans Affairs (VA) recently genotyping of nearly 9,000 veterans with schizophrenia or bipolar I disorder in Cooperative Studies Program (CSP) #572: “Genetics of Functional Disability in Schizophrenia and Bipolar Illness”, all of whom were extensively assessed for neurocognitive function and disability, and genotyped using a custom Affymetrix Axiom Biobank array. Methods Primary genome-wide association studies (GWAS) of schizophrenia and bipolar disorder were performed across and within ancestry goups, with attempted replication in matched subjects from the PGC and Genomic Psychiatry Cohort (GPC). We combined results for CSP#572 with available summary statistics from the PGC, Indonesia Schizophrenia Consortium and Genetic REsearch on schizophreniA neTwork-China and Netherland (GREAT-CN) study, and multi-ethnic GPC cohorts, achieving among the largest and most diverse studies of these disorders to date. Results Polygenic risk scores based on published PGC summary statistics for schizophrenia or bipolar disorder were significantly associated with case status among EA (P<10–30) and AA (P<0.0005) participants in CSP#572. Our primary analyses of schizophrenia yielded a single genome-wide significant association with variants in CHD7 at 8q12.2 for European-American (EA) participants, which remained significant in a joint analysis of EA and African-American (AA) subjects (P=4.62e-08). While no genome-wide significant associations were detected by our within-ancestry analyses of bipolar disorder, a cross-ancestry meta-analysis of CSP#572 participants yielded a significant finding at 10q25 with variants in SORCS3 (P=2.62e-08). Among loci attaining P<0.0001 in our within-ancestry analyses, 4 and 8 subsequently achieved genome-wide significance, respectively, when jointly analyzed with matched subjects from the PGC and GPC. Combining our results with published summary statistics, we performed a cross-ancestry GWAS meta-analysis of 69,280 schizophrenia cases and 138,379 controls, identifying 200 genome-wide significant loci of which 76 are newly reported here. Cross-ancestry analysis of 28,326 bipolar cases and 90,570 controls identified 24 genome-wide significant loci, including novel associations with common variants in PAX5, DOCK2, MACROD2, BRE, KCNG1, and LINC01378. Discussion We newly describe genome-wide analyses in a diverse cohort of US Veterans with schizophrenia or bipolar disorder, benchmarking the predictive value of polygenic risk scores based on published GWAS findings. Leveraging available summary statistics from studies of global populations, we add to burgeoning lists of genomic loci implicated in the etiologies of these disorders.

Schizophrenia and bipolar disorder were the first psychiatric illnesses to demonstrate familial aggregation in systematic studies. Twin studies demonstrate high (up to 80%) heritability. Several decades of research using linkage, candidate gene, genome-wide association studies (GWASs), and next-generation sequencing studies ensued in the effort to identify etiologically relevant genetic variants. Over the last decade, GWASs using consortium-based datasets of tens of thousands of participants led to the confirmation of polygenic architectures in both illnesses, which overlapped with each other, as well as the identification of hundreds of mostly non-coding variants. Large, recurrent copy number variants (CNVs) and a higher CNV burden have been robustly identified in schizophrenia, but not bipolar disorder. Polygenic risk scores have emerged as promising signatures of underlying illness risk, which might be useful in predicting treatment response and other outcome phenotypes. Pharmacogenetic studies show promise to identify variants that predict drug response and adverse effects. However, they are currently underpowered because of the expense of conducting trials with sample sizes adequate to detect genetic variants of small effect. Large-scale precision medicine efforts such as All of Us and the Million Veteran Program are in process and might yet yield such information. [ Psychiatr Ann . 2021;51(4):158–164.]

Introduction: The present is the future of the past, and the past of the future. This journal as well as this paper endeavour to document the lives and practices of psychiatrists and other mental health care professionals for the future mental health community and to help the clinicians of the future to understand the history and practice of psychiatry and mental health care in 2019/20. We, therefore, report the current days in the lives of psychiatrists and other mental health care professionals. Material and Methods: To obtain reports of days in the lives of psychiatrists and other mental health professionals, we published the request on eight occasions from May 2019 to May 2020. We invited the prospective respondents/participants to send a relevant report of their psychiatric practice in a day with a maximum word count of 750 words. Results: We received 20 reports of variable lengths from 10 countries from six continents, including from psychiatrists, psychiatrists in training, clinical psychologists and from medical students about their psychiatric training. The reports revealed a wide and highly variable range of psychiatric and mental health practices, experiences and expectations. Last but not least, the reports we received were informative and provided much information to reflect on. Conclusions: There is a common strong commitment to support patients with mental health problems, but the ways this is achieved are so diverse that generalisations about a typical common practice seem impossible. Future studies should focus more systematically on the procedures and practices applied in helping patients with mental health problems in different countries and communities. This knowledge might eventually help identify the procedures and services that are most efficient and helpful in various clinical contexts.

Introduction: Sleep disturbance is associated with higher inflammation and cardiovascular mortality. The interplay between sleep duration and inflammation as an effect modifier for cardiovascular risk is unknown. Hypothesis: We sought to evaluate the association between sleep duration, C-reactive protein (CRP), and cardiovascular mortality. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2005-2010 linked with the cause of death data from the National Center for Health Statistics for adults aged ≥18 years. The associations between short (<6 hours), adequate (6-9 hours), and long (>9 hours) sleep duration with inflammation (CRP) and cardiovascular mortality were explored using linear, Poisson and Cox proportional hazard modeling. Results: There were 17,635 eligible participants. The mean age was 47.5±19.2 years with 51% women and 47% self-identified non-Hispanic Whites. There were 2,755 (15.6%), 14,340 (81.3%), and 540 (3.1%) participants in the short, adequate, and long sleep duration groups, respectively. There were 60 (2.2%), 268 (1.9%), and 22 (4.1%) cardiovascular deaths in the short, adequate, and long sleep duration groups, respectively. The adjusted hazard of cardiovascular mortality was 24% (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.05-1.47, p=0.012) and 78% (HR 1.78, 95% CI 1.37, 2.30, p<0.001) higher among participants with short and long sleep duration, respectively, compared to adequate sleep duration (Figure, panel A). A similar U-shaped trend was observed between log-transformed CRP with higher CRP among participants with short (b=0.06, p=0.01) and long (b=0.26, p<0.001) sleep duration versus adequate sleep duration (Figure, panel B). Conclusions: Short and long sleep duration are independently associated with a higher hazard of cardiovascular mortality and CRP. These findings suggest an association between circadian rhythm, mortality, and inflammation.

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18-60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.

BACKGROUND:Eighty percent of premature mortality from cardiovascular disease occurs in low- and middle-income countries. Hypertension, diabetes, and smoking are the top risk factors causing this disease burden. OBJECTIVES:The study aimed to test the hypothesis that utilizing community health workers (CHWs) to manage hypertension, diabetes and smoking in an integrated manner would lead to improved control of these conditions. METHODS:This was a 2-year cluster (n = 12) randomized controlled trial of 3,556 adults (35 to 70 years of age) in a single town in India, who were screened at home for hypertension, diabetes, and smoking. Of these adults, 1,242 (35%) had at least 1 risk factor (hypertension = 650, diabetes = 317, smoking = 500) and were enrolled in the study. The intervention group had behavioral change communication through regular home visits from community health workers. The control group received usual care in the community. The primary outcomes were changes in systolic blood pressure, fasting blood glucose, and average number of cigarettes/bidis smoked daily among individuals with respective risk factors. RESULTS:The mean ± SD change in systolic blood pressure at 2 years was -12.2 ± 19.5 mm Hg in the intervention group as compared with -6.4 ± 26.1 mm Hg in the control group, resulting in an adjusted difference of -8.9 mm Hg (95% confidence interval [CI]: -3.5 to -14.4 mm Hg; p = 0.001). The change in fasting blood glucose was -43.0 ± 83.5 mg/dl in the intervention group and -16.3 ± 77.2 mg/dl in the control group, leading to an adjusted difference of -21.3 mg/dl (95% CI: 18.4 to -61 mg/dl; p = 0.29). The change in mean number of cigarettes/bidis smoked was nonsignificant at +0.2 cigarettes/bidis (95% CI: 5.6 to -5.2 cigarettes/bidis; p = 0.93). CONCLUSIONS:A population-based strategy of integrated risk factor management through community health workers led to improved systolic blood pressure in hypertension, an inconclusive effect on fasting blood glucose in diabetes, and no demonstrable effect on smoking. (Study of a Community-Based Approach to Control Cardiovascular Risk Factors in India [SEHAT]; NCT02115711).

Background:Meditation is associated with health benefits; however, there are reports that it may trigger or exacerbate psychotic states. In this review, we aim to collate case reports of psychotic disorders occurring in association with meditative practice and to discuss the relationship between psychosis and meditation. Methodology:We performed case-based analysis of all the existing studies published in English language using PubMed, PsycINFO, Cochrane, Scopus, EMBASE, CINAHL and Google Scholar with the search terms; 'Psychosis' OR 'Psychotic Symptoms' OR 'Schizophrenia' AND 'Meditation.' Results:A total of 19 studies and 28 cases were included in the review. The patients described had an age range of 18-57 years; there was equal distribution of males and females. The diagnoses included acute psychosis in 14 cases, schizophrenia in 7 cases, mania with psychotic symptoms in 3 cases, and schizoaffective disorder in 1 case. The types of meditation described were Transcendent, Mindfulness, Buddhist Meditation like Qigong, Zen, and Theraveda, and others like Bikram yoga, Pranic Healing, and Hindustan Type meditation. Of the 28 cases reported, 14 patients had certain precipitating factors like insomnia, lack of food intake, history of mental illness, stress, and psychoactive substance use. Conclusion:There are case reports of psychotic disorder arising in association with meditative practice; however, it is difficult to attribute a causal relationship between the two. At the same time, there is a body of research describing the beneficial effect of meditative practice in clinical settings for patients with psychotic disorders. Appropriately designed studies are needed to further investigate the relationship between meditative practice and psychosis.