Mdedge Psychcast

This week, we decided to revisit three of the Psychcast episodes that examined various aspects of COVID-19. First, you will hear excerpts from the interview that host Lorenzo Norris, MD, did with Sheldon H. Preskorn, MD, on educating patients about SARS-CoV-2 and the disease. Next, Jay H. Shore, MD, MPH, conducts a Masterclass lecture on factors to consider while using telepsychiatry during the pandemic. And later, guest host Jacqueline Posada, MD, talks with Lynne S. Gots, PhD, about using cognitive-behavior therapy to treat patients with anxiety. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: [email protected]

Thomas Abt, JD, spoke with Nick Andrews about his talk at the TEDMED 2020 conference in Boston. Mr. Abt (@Abt_Thomas), senior fellow at the Council on Criminal Justice, discussed his evidence-based and community-informed strategies for reducing urban violence. Mr. Abt earned an undergraduate degree in economics from the University of Michigan in Ann Arbor, and a law degree from Georgetown University in Washington. Mr. Abt also worked as a prosecutor in the Manhattan District Attorney’s office in New York, and as a teacher in Washington. He has no conflicts of interest.  Summary  Mr. Abt said the three fundamental principles of focus, balance, and fairness are central to interventions for reducing urban violence.  This means focusing on people and places in which urban violence is concentrated, balancing between positive and negative incentives to reduce violence, and facilitating trust between the state and its citizens to foster a sense of fairness.  Mr. Abt’s book, “Bleeding Out: The Devastating Consequence

Igor Galynker, MD, returns to the Psychcast, this time to discuss his most recent work on suicidal crisis syndrome with host Lorenzo Norris, MD. Dr. Galynker is professor of psychiatry and director of the Galynker Research and Prevention Laboratory at the Icahn School of Medicine at Mount Sinai, New York. He reported receiving funding from the National Institute of Mental Health and the American Foundation for Suicide Prevention. Dr. Norris has no disclosures. Take-home points Suicide crisis syndrome (SCS) is a state or syndrome that develops shortly before a suicide attempt. Since the last Psychcast with Dr. Galynker, SCS has been replicated in several cohorts and countries. SCS has been refined to three primary factors instead of five. The factors of SCS include a state of entrapment which includes cognitive rigidity and flooding, insomnia/agitation, and social withdrawal. New data are emerging about how to treat the acute syndrome with medications, because patients are not susceptible to psychotherapy or

Lorenzo Norris, MD, spoke with Sheldon H. Preskorn, MD, about how to best educate patients about coronavirus. Dr. Preskorn is a professor in the department of psychiatry at the University of Kansas School of Medicine–Wichita. Neither Dr. Norris nor Dr. Preskorn have any relevant financial relationships to disclose. Take-home points Coronavirus 2019 (COVID-19) is the disease process caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).  SARS-CoV-2 is different from the previous SARS-type coronaviruses and is having a greater impact on society as a pandemic for three reasons: It’s highly transmissible person to person, it can be spread by infected individuals who are asymptomatic or presymptomatic, and it has a high level of morbidity but a lower level of mortality. Psychiatrists work with vulnerable populations, including older adults and individuals with medical comorbidities that put them at risk for COVID-19. Psychiatrists must understand the pertinent facts about COVID-19 to help their

SPECIAL: Lorenzo Norris, MD, welcomes fourth-year psychiatry resident Brandon C. Newsome, MD, for a discussion on race relations as a physician in the wake of the death of George Floyd, who was killed when a white police officer kneeled on his neck during an arrest.  Dr. Newsome was raised in Alabama and currently lives in Boston. He shares his experiences with Dr. Norris in an important conversation.  The pair discuss what their patients are experiencing and what they're experiencing as black physicians.  Dr. Norris is a consultation-liaison psychiatrist and medical school dean affiliated with George Washington University, Washington (@GWSMHS). Dr. Newsome will begin a fellowship in July at Children’s National Hospital (@ChildrensNatl). References American Medical Association (@AmerMedicalAssn) 2020 statement on police brutality (2020) American Psychiatric Association (@APAPsychiatric) statement   National Medical Association (@NationalMedAssn) statement    

Candrice R. Heath, MD, and Nicole B. Washington, DO, MPH, spoke with Psychcast host Lorenzo Norris, MD, about physician mental health. Dr. Heath is affiliated with Temple University Hospital, Philadelphia. She has no disclosures. Dr. Washington disclosed serving as chief medical officer and founder of Elocin Psychiatric Services, a telemedicine company that provides care to physicians. Dr. Norris is a consultation-liaison psychiatrist and medical school dean affiliated with George Washington University, Washington. He has no disclosures. And stick around for Renee Kohanski, MD, who talks about expectations. Take-home points Physicians often delay seeking mental health treatment. Compared with the general population, the risk of suicide is 2.27 times higher in female physicians and 1.4 times higher in male physicians. The COVID-19 pandemic has created additional risk factors for all physicians, including those on the front lines and others whose clinical practices and home lives have changed because of the pa

Bill Scheidler, MD, is assistant clinical professor of psychiatry at the University of North Carolina, Chapel Hill. He also is associate training director for the consultation-liaison fellowship at UNC and is a lead consultant at UNC Hospitals Hillsborough. Dr. Scheidler spoke with host Lorenzo Norris, MD, about how to think through patients’ decision-making capacity in medical (rather than psychiatric) hospitals. Neither Dr. Scheidler nor Dr. Norris have disclosures. Take-home points Decision-making capacity (DMC) is essential to informed consent, which is providing patients with the information necessary to make an informed decision about medical or surgical care. Standards differ, depending on the U.S. state. DMC has four components, as defined by Paul Appelbaum, MD, and colleagues: The ability to make and communicate a consistent choice The ability to understand the information provided about medical conditions and decisions The ability to appreciate the consequences of a choice The ability to reason

Renae Beaumont, PhD, assistant professor of clinical psychology at New York–Presbyterian/Weill Cornell Medical Center, spoke with host Lorenzo Norris, MD, about the Secret Agent Society. The Secret Agent Society is a video gaming–based therapy program aimed at helping children with a range of social and emotional challenges learn the social skills required to make and keep friends. The program also helps children feel happier, calmer, and braver. Dr. Beaumont disclosed her role as creator of the Secret Agent Society program. Dr. Norris has no disclosures. Take-home points The Secret Agent Society is a video gaming–based program that helps children detect how another person is feeling through the interpretation of facial expressions, body language, and vocal tone; use skills to socially engage; and to internally detect their own emotions. Secret Agent Society is meant to engage children. It can be used during clinical/therapy sessions to stimulate discussion as well as at home with parents. The indicated age

Frederick S. Barrett, PhD, is affiliated with the Center for Psychedelic & Consciousness Research (@JHPsychedelics) at Johns Hopkins University, Baltimore (@Hopkins Medicine). Dr. Barrett spoke with Nick Andrews (@Nick_Andrews_) at @TEDMED 2020, about the research that has been conducted by the Center for Psychedelic & Consciousness Research on the impact of psychedelics, or hallucinogens, on psychiatric disorders. He has no disclosures. Take-home points Dr. Barrett transitioned into neuroscience research through his interest in the effect of music on human emotions and the brain. Until 1970, psychedelics such as psilocybin were widely used in clinical research, with more than 1,000 academic papers published about their use. For example, psychedelics were used as a model for schizophrenia and helped identify the role of serotonin in psychosis. They were also studied to treat addiction and as a treatment for existential anxiety in cancer. In 1970, psychedelics were deemed illegal by the Controlled Sub

Anne Marie Albano, PhD, professor of medical psychology and psychiatry at Columbia University, New York, and director of the Youth Anxiety Center at New York–Presbyterian Hospital, discusses strategies for treating childhood, youth, and young adult anxiety with Nick Andrews. Dr. Albano (@AnneMarieAlbano), who also is director of Modern Minds, an anxiety and depression program in Charleston, S.C., spoke with Nick (@Nick_Andrews_) at @TEDMed 2020. Dr. Albano has no conflicts of interest. Take-home points Early identification of activity avoidance is essential because it is difficult to reverse the cycle of escape and avoidance, and this is all the more difficult with school avoidance. Parents should validate that facing anxiety is difficult and that the child might be afraid. The parental role is to help problem-solve ways to manage anxiety, continue to provide exposures, and help the child cope with their fears rather than to accommodating and enabling. In 2008, Dr. Albano and colleagues published a randomize

Cheryl A. King, PhD, clinical psychologist and professor in the department of psychiatry at Michigan Medicine, the academic health system at the University of Michigan, Ann Arbor, joined Nick Andrews at TEDMED2020. Dr. King spoke with Nick (@Nick_Andrews_) at @TEDMed about a suicide risk screen for teens that is based on computerized algorithm. Take-home points Dr. King is a longtime researcher in teen suicide, and her current project is creating a personalized adaptive suicide risk screen for teens called CASSY (Computerized Adaptive Screen for Suicidal Youth). In an adaptive algorithm, subsequent questions will change based on the previous answer. The aim is to create a profile of risk factors and warning signs to generate a risk level that will guide the type of mental health interventions required in the ED and beyond. CASSY also is being developed as a universal screen for those who might come to the ED without a mental health history. Many teens who die by suicide do not have previous contact with ment

Lorenzo Norris, MD, touches base with Nick Andrews to discuss COVID-19 and to welcome Jacqueline Posada, MD, as an occasional cohost of the MDedge Psychcast. Dr. Posada, associate producer, interviews Lynne S. Gots, PhD, about treating anxiety, obsessive-compulsive disorder, and other disorders in the midst of the COVID-19 pandemic. Dr. Gots is an assistant clinical professor in the department of psychiatry and behavioral sciences at George Washington University, Washington. She has a private psychotherapy practice and has no financial relationships to disclosure.   Take-home points Anxiety during COVID-19 will not only be an exacerbation of current anxieties but also of underlying vulnerabilities. Presently, the most common vulnerability is intolerance of anxiety. It is helpful to reassure patients (and clinicians) that everyone is anxious right now. Anxiety is an adaptive response to a threat, and COVID-19 and its repercussions makes this a threatening time. In the midst of this anxiety, think about creati

Lorenzo Norris, MD, interviews Mary D. Moller, DNP, MSN, about taking advantage of the polyvagal theory of anxiety and social engagement during psychotherapy. Dr. Moller is associate professor of nursing at Pacific Lutheran University in Tacoma, Wash., where she coordinates the psychiatric mental health nurse practitioner doctorate nursing practice program. She also is in practice at Northwest Integrated Health. Dr. Moller has no conflicts of interest. Later, Renee Kohanski, MD, discusses the sacred relationship that exists between doctors and patients. Take-home points The polyvagal (PV) theory relates autonomic nervous system functions to human behavior and response to trauma. The PV theory presents the autonomic nervous system as a combination of the dorsal and ventral vagus nerve, which together regulate the autonomic state in response to the environment and influence behavior. The unmyelinated dorsal vagus nerve controls the “freeze response,” while the myelinated ventral vagus nerve modulates social co

Jay H. Shore, MD, MPH, returns to the Psychcast, this time to conduct a Masterclass lecture on using telepsychiatry in a regulatory environment that is quickly changing because of the physical distancing forced by the COVID-19 pandemic. Dr. Shore is director of telemedicine at the Helen and Arthur E. Johnson Depression Center at the University of Colorado at Denver, Aurora. He also directs telemedicine programming at the medical center’s department of psychiatry. He disclosed serving as chief medical officer of AccessCare Services and receiving royalties from American Psychiatric Association Publishing and Springer. Take-home points Practicing telepsychiatry has administrative, technological, and clinical considerations. Administrative concerns include licensure, prescribing, billing, and establishing a procedure and protocol, especially about emergencies. Technological considerations include choosing software, understanding HIPAA compliance during the current COVID-19 crisis (and afterward), and incorporat

As the nation’s health care system braces for COVID-19 cases, physicians who’ve faced the pandemic first have critical lessons for everyone. In this bonus episode, two Seattle-area critical care leaders explain how their medical centers are preparing for and responding to their region’s early outbreaks. And they share some creative approaches that are uniting Seattle’s critical care departments.

MDedge Psychcast host Lorenzo Norris, MD, interviews Steven Wengel, MD, about the challenges of loneliness in geriatric populations in nursing homes, especially during the current COVID-19 pandemic. Dr. Norris also discusses potential interventions with Dr. Wengel, who is a geriatric psychiatrist at the University of Nebraska Medical Center in Omaha. And later, in the “Dr. RK” segment, Renee Kohanski, MD, talks about how, in the midst of the pandemic, we are slowing down while we’re speeding up … and are learning how to use – and not abuse – technology. Take-home points Loneliness has been defined as a form of social pain; it is more than sadness or a “state of mind.” Loneliness and being alone are separate issues suggesting that loneliness is more of an emotional state and being alone is often a choice. Loneliness can be characterized as deficits in authentic interactions and connection because you can be surrounded by people and still feel lonely. Loneliness has been studied as a predictor of health proble

MDedge Psychcast host Lorenzo Norris, MD, interviews Sy Atezaz Saeed, MD, MS, about his annual analysis of the key studies that could change day-to-day psychiatric practice. Dr. Norris’s conversation with Dr. Saeed is based on a two-part evidence-based review that identified the top 12 research findings for clinical practice from July 2018 to June 2019. Part 1, which Dr. Saeed wrote with Jennifer B. Stanley, MD, and Part 2 were published in Current Psychiatry. Take-home points Each year, Dr. Saeed identifies 10-20 high-quality journal articles with direct impact on clinical practice that, if used appropriately, can generate better outcomes for psychiatric patients. The goal of the list is to close the gap between cutting-edge science and clinical practice. Secondary literature (for example, Cochrane Reviews, NEJM Journal Watch, and so on) is used to differentiate the clinically relevant “signal” from the noise of all the research produced. Knowledge changes over time, so it’s important to be up to date but

Col. (Ret.) Elspeth Cameron Ritchie, MD, MPH, conducts a Masterclass on what psychiatrists and other mental health clinicians can do to mitigate the impact of COVID-19. Dr. Ritchie is writing additional commentaries on this topic for MDedge Psychiatry. And later, in the “Dr. RK” segment, Renee Kohanski, MD, says that, with simple tools or guidelines, humans have the ability to withstand adversity that is stronger than we will ever know. Take-home points Epidemics and pandemics are characterized by fear and anxiety. Quarantine will be a challenge for patients with addictions and vulnerable populations such as individuals who are homeless. Psychiatrists can aid with social distancing by providing patients refills for psychotropic medications without requiring an in-person visit and switching to telepsychiatry where possible. The Coronavirus Preparedness and Response Supplemental Appropriations Act waives Medicare telehealth reimbursement restrictions for mental health services during certain emergency periods

Lorenzo Norris, MD, interviews Nina J. Gutin, PhD, a psychologist with a private practice in Pasadena, Calif., about losing patients and loved ones to suicide. Dr. Gutin wrote two evidence-based reviews on the topic late last year. The reviews were published in Current Psychiatry. *  *  *   Take-home points When mental health clinicians lose a patient to suicide, the sequelae can include stigma, potential legal consequences, impact on future clinical work, and restraints on processing the loss because of confidentiality concerns. The American Association of Suicidology founded the Clinician Survivor Task Force (CSTF), which provides consultation, support, and education to mental health professionals to help them respond to the personal/professional loss from the suicide of a patient or loved one. Mental health institutions can benefit from protocols on how to respond to a potential completed suicide, so clinicians and families are not left in a vacuum of uncertainty and blame. After a patient suicide, clinic

Jonathan Meyer, MD, returns to the Psychcast, this time to conduct a Masterclass lecture on treating patients with lumateperone. Dr. Meyer, of the University of California, San Diego, disclosed receiving either speaking honoraria or advising fees from several companies, including Intra-Cellular Therapies, which developed lumateperone (Caplyta). Later, Renee Kohanski, MD, discusses tailored interventions psychiatrists can incorporate into their practices to address overweight and obesity resulting from medications tied to weight gain. Take-home points Lumateperone, an atypical antipsychotic, was approved by the Food and Drug Administration for the treatment of adults with schizophrenia on Dec. 20, 2019. It has only one approved effective dose of 42 mg given with food. Further studies might define doses higher or lower, but those data are not available yet. The only adverse effect found with lumateperone was somnolence or sedation. Lumateperone was 24%; placebo was 10%. The medication has a low affinity and