HealthDay News — Primary care pediatricians feel less prepared to manage adolescents’ opioid use disorder (OUD) compared with other substances, according to a research letter published online Feb. 26 in JAMA Pediatrics. Scott E. Hadland, M.D., from Mass General for Children in Boston, and colleagues used data from 474 primary care pediatricians participating in the 2021 American Academy of Pediatrics Periodic Survey to assess their preparedness to provide adolescent OUD care. The researchers found that most agreed or strongly agreed that it is their responsibility to identify substance use disorders (93.9 percent) and refer patients to treatment (97.4 percent). However, fewer participants agreed or strongly agreed that it is their responsibility to treat substance use disorders (20.3 percent) or prescribe medications for addiction treatment (12.4 percent). Fewer respondents felt prepared or very prepared to counsel adolescents on opioid use (48.3 percent) with compared with alcohol (87.1 percent), cannabis (81.7 percent), and electronic cigarette use (80.1 percent). Compared with other substances, pediatricians were less likely to provide counseling (63.0 percent) and more likely to refer patients off-site for care (71.8 percent) for opioid use compared to alcohol (87.7 and 51.7 percent, respectively), cannabis (88.9 and 45.4 percent, respectively), and e-cigarette use (91.6 and 26.5 percent, respectively). Less than one-quarter of respondents (23.7 percent) reported ever diagnosing an adolescent with OUD, and only 5.5 percent had ever prescribed OUD medication. “With the growing problem of OUD, training on OUD management in primary care is needed,” the authors write.

Keypoint: Sleep disordered breathing and ADHD are highly cross-prevalent, particularly among children and adolescents. A targeted review published in the Journal of Attention Disorders found that the relationship between sleep disordered breathing (SDB) and attention-deficit/hyperactivity disorder (ADHD) was well-supported. In particular, SDB may contribute to the development and worsening of ADHD symptoms. Disordered sleep has been associated with impaired cognition and ADHD and SDB appears to be highly prevalent among children with ADHD. However, the relationship between ADHD and SDB may be under-recognized and relatively understudied. To provide a more comprehensive understanding of the effect of SDB on ADHD, investigators searched publication databases through September 2022 for studies of SDB and/or obstructive sleep apnea (OSA) in ADHD in their focused review. In evaluating the prevalence and co-occurrence of SDB/OSA and ADHD, the investigators found that the existing evidence indicates a high cross-prevalence between sleep disorders and ADHD (or ADHD symptoms), particularly among children and adolescents. One study found that among 3019 children aged 5 years, 25% had SDB. The children with SDB had a higher prevalence of hyperactivity (odds ratio [OR], 2.5; 95% CI, 2.0-3.0), inattention (OR, 2.1; 95% CI, 1.7-2.6), and aggressiveness (OR, 2.1; 95% CI, 1.6-2.6) than the children without SDB. Similarly, a review found that children with OSA had a high rate of attentional deficits (95%), and up to 20% to 30% of children with ADHD had OSA. Furthermore, a meta-analysis reported that youth with SDB were at higher risk of presenting with ADHD and that ADHD symptoms improved after adenotonsillectomy. The investigators found that several studies reported on the proposed mechanisms of the association between SDB and ADHD. Study authors posit that fluctuating levels of hypoxia and hypercapnia during sleep may affect brain function relating to working memory and attention. Another proposed mechanism is that SDB causes sleep fragmentation and micro-awakenings, which leads to fatigue, exhaustion, and excessive daytime sleepiness. Based on the published evidence, the review authors found a preponderance of evidence that supported the relationship between SBD and physiological processes, such as the activation of stress hormones and immunological activities. The activation of stress hormones and immunologic responses that affect blood oxygenation during sleep affects the brain regions associated with attention and executive function. These effects can, in turn, cause cognitive deficits consistent with symptoms of ADHD. The investigators stated, “Accumulating evidence on possible neurophysiological mechanisms that may link SDB to the development of ADHD-like symptoms further supports the recommendation that SDB should be considered in the initial assessment of young children exhibiting inattention, daytime fatigue and distractibility.” Review authors concluded, “While SDB and ADHD are not mutually exclusive, their comorbidity can influence the severity of each condition. Consequently, there is a need for more targeted assessment of possible sleep disturbances in children evaluated for ADHD.” Note: This article originally appeared on Psychiatry Advisor

Keypoint: Antidepressant dispensing to adolescent girls rose by 129.6% during the pandemic, relative to pre-pandemic levels. Antidepressant dispensing to adolescents and young adults increased by 63.5% during the COVID-19 pandemic, relative to pre-pandemic levels. This increase was largely driven by increased antidepressant dispensing to girls and women, according to study results published in Pediatrics. Although a wealth of evidence indicates that the COVID-19 pandemic was detrimental to mental health — particularly among adolescents — relatively little is known about the temporal changes in antidepressant dispensing rates during this period. To determine whether antidepressant dispensing patterns changed during the pandemic, researchers used the IQVIA Longitudinal Prescription Database, a comprehensive all-payer national database, to track the distribution of antidepressant prescriptions from 2016 to 2022 among US individuals aged 12 to 25 years. The researchers categorized individuals into 2 groups: adolescents (12 to 17 years of age) and young adults (18 to 25 years of age). The primary measure was the rate of antidepressant prescriptions dispensed monthly, calculated as the number of adolescents and young adults receiving at least 1 antidepressant prescription per 100,000 people aged 12 to 25 years. The researchers evaluated both slope and level changes in prescription rates and examined variations by sex and age group. Between 2016 and 2022, a total of 221,268,402 antidepressant prescriptions were dispensed to 18,395,915 individuals from the database. On average, individuals were 19.2 (SD, 3.9) years of age at the time of sample entry and 64.4% were girls/women. Geographically, 38.6% of individuals resided in the South, 25.7% in the Midwest, 19.6% in the West, and 16.1% in the Northeast. Of the total dispensed antidepressant prescriptions, 67.3% were for selective serotonin reuptake inhibitors (SSRIs), and the 3 most common medications were sertraline (24.1%), fluoxetine (18.5%), and escitalopram (16.3%). From 2016 to 2022, there was a 46.1% increase in the number of adolescents and young adults receiving at least 1 dispensed antidepressant prescription, and the rate of new initiations to antidepressant therapy grew by 31.0%. The monthly antidepressant dispensing rates increased by 66.3% from January 2016 to December 2022. Prior to March 2020, the monthly dispensing rate was rising at 17.0 (95% CI, 15.2-18.8) individuals per 100,000 per month. While the onset of the COVID-19 pandemic did not lead to an immediate level change in the dispensing rate (-37.4; 95% CI, -153.4 to 78.7), it was linked to an increase in the growth rate to 10.8 (95% CI, 4.9-16.7) per month. After March 2020, the monthly rate of antidepressant dispensing escalated to 27.8 per month (95% CI, 22.1-33.4), representing a 63.5% increase compared with the rate of change before March 2020. This increase in monthly antidepressant dispensing rates was largely driven by increased antidepressant dispensing to girls and women. Among adolescent girls, the monthly dispensing rate surged by 41.1 (95% CI, 32.9-49.2), a 129.6% increase from the pre-pandemic rate. Young adult women also experienced a 56.6% increase from the pre-pandemic levels, as the dispensing rate rose by 44.8 (95% CI, 33.3-56.3) per month. In contrast, the pandemic caused a level decrease (-224.3; 95% CI, -328.2 to -120.4) and no significant slope change (1.1 per month; 95% CI, -2.3-4.4) among adolescent boys. Young adult men also did not experience significant level (17.8; 95% CI, -51.3-86.8) or slope changes (3.7 per month; 95% CI, -0.8-8.2) after March 2020. Study authors concluded, “Using 2016 to 2022 data from a national prescription dispensing database, we found that antidepressant dispensing to adolescents and young adults rose 63.5% faster after the COVID-19 pandemic. This change was driven by increased antidepressant dispensing to female patients.” Study limitations include the lack of data for prescription indications and the modality of prescription encounters (in-person vs telehealth). Note: This article originally appeared on Psychiatry Advisor

Several morbidities, including bipolar disorder, dementia, and vitamin D deficiency, were associated with an increased risk for serious infection among patients with rheumatoid arthritis (RA), according to study results published in Seminars in Arthritis & Rheumatism. It is important to understand the significant factors contributing to the risk for serious infection and to what extent these risks can be reduced, especially in patients with RA. However, no prior studies have examined the association between serious infection risk and a comprehensive list of morbidities. To determine this association, researchers conducted a retrospective, observational, population-based cohort study that included adult patients with RA living in 8 counties within Minnesota. Patients were followed-up until death, migration, or until December 31, 2021. A total of 55 comorbidities were identified using medical records and selected based on their prevalence among the specific patient population. The relationship between each morbidity and the risk for serious infection was evaluated using 3 different conditional frailty models. Serious infections included those that required hospitalization for at least 1 day. A total of 911 individuals with RA were included in the analysis, 70% of whom were women with a mean age of 56 years. Overall, 293 serious infections were reported among 155 individuals, corresponding to an infection incidence of 3.9 per 100 person-years. More than half of the participants had multiple comorbidities, the most common of which were osteoarthritis (55.2%), hyperlipidemia (54.6%), hypertension (53.6%), and chronic back pain (53.1%). Serious infections were most frequently reported in the lower respiratory tract (35.5%), the bloodstream/sepsis (28.3%), the skin and soft tissue (14.0%), and the intestines (10.9%). The risk for serious infection in each of the 55 morbidities was adjusted for age, sex, and calendar year in the first model; 27 morbidities were linked to an increased risk for serious infection. Bipolar disorder was associated with the greatest risk for serious infection, with a hazard ratio (HR) of 4.73 (95% CI, 1.57-14.21). With each additional morbidity, the risk for serious infection was increased by an average of 16%. The second and third models adjusted for Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) and Mayo serious infection risk scores, in addition to age, sex, and calendar year. Upon accounting for RABBIT risk scores, 11 of the 55 morbidities were linked to a significantly increased risk for serious infection, while 23 morbidities were associated with an increased risk after accounting for Mayo scores. Bipolar disorder maintained a marked risk association, emerging as the morbidity with the second-highest serious infection risk, following adjustment for RABBIT scores (HR, 6.23; 95% CI, 2.11-18.41). Bipolar disorder was associated with the greatest risk after adjusting for Mayo scores (HR, 5.24; 95% CI, 2.34-11.73), according to the second and third models. Additional morbidities that repeatedly ranked within the top 10 for effect size in all 3 adjustment models included dementia, vitamin D deficiency, and sleep apnea. Furthermore, patients with anemia, chronic kidney disease, chronic skin ulcers, hematologic cancers, post-traumatic stress disorder, liver disease, and leukopenia faced a 2-fold greater risk for serious infection in all 3 models. Study results were limited by the retrospective and observational nature. Additionally, the use of medical codes to identify morbidities has inherent weaknesses. Moreover, the number of observations that the RABBIT and Mayo risk models could adjust for was limited due to missing data. Study authors concluded, “Additional studies in other populations are needed to confirm the association between [serious infection] risk and morbidities included in this study, especially morbidities that do not have a clear biologic basis for increasing infection risk.” This article originally appeared on Rheumatology Advisor

HealthDay News — Exercise is an effective treatment for depression, especially when intense, according to a review published online Feb. 14 in The BMJ. Michael Noetel, Ph.D., from the University of Queensland in St. Lucia, Australia, and colleagues conducted a systematic review and network meta-analysis to identify the optimal dose and modality of exercise for treating major depressive disorder. A total of 218 unique studies with 495 arms and 14,170 participants were included. The researchers found moderate reductions in depression for walking or jogging, yoga, strength training, mixed aerobic exercises, and tai chi or qigong compared with active controls (e.g., usual care, placebo tablet; (Hedges’ g, −0.62, −0.55, −0.49, −0.43, and −0.42, respectively). The impact of exercise was proportional to the intensity. The most acceptable modalities seemed to be strength training and yoga. The results were robust to publication bias; only one study met the Cochrane criteria for a low risk for bias. Confidence in the network meta-analysis was considered low for walking and jogging and very low for other modalities. “Our findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous intensity exercise,” the authors write. “Doing so may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

This story is part of a special 75th Anniversary series featuring the experiences of people living with mental illnesses. The opinions of the interviewees are their own and do not reflect the opinions of NIMH, NIH, HHS, or the federal government. This content may not be reused without permission. Please see NIMH’s copyright policy for more information. Note: This feature article contains information and depictions of schizoaffective disorder (a mental illness characterized by symptoms similar to those of schizophrenia). If you or someone you know has a mental illness, is struggling emotionally, or has concerns about their mental health, there are ways to get help. If you are in crisis, call or text 988 to connect with the 988 Suicide Crisis Lifeline . To learn more about this disorder, visit NIMH’s schizophrenia health information page. Everything about Ray Lay exudes positivity. He’s friendly, outgoing, and a role model. But behind his gray beard and warm smile, there’s a story: part tragedy, part hope and redemption. Once a happy kid who used to help his father fix cars, everything changed on a fateful road trip in 1960. The changes Five-year-old Lay and his family were on a cross-country drive in Mississippi when they got into a car accident. “The next thing I remember, I came to, and I’m looking down on the windshield. I’m seeing the blood, and I passed out again,” Lay said. “I woke up, and I’m in a man’s lap, in the ambulance.” Slipping into a coma, Lay awoke 3 weeks later with more than 300 stitches. Once back in the schoolyard, his peers teased him. “When I went to school, the kids—mean kids,” he recalled, “they used to call me Scarface.” Lay didn’t know it then, but other changes were underway. He had begun talking to people who weren’t there. The first of these was Mel. “When I woke up … after I went through the windshield, I saw my guardian angel, Mel,” Lay said. “He had white hair, white beard, dressed in all white, and as he would open his robe, he had snakes or worms in his chest. And I remember that part like it was yesterday. That was when he told me who he was and that he was there to protect me.” To Lay, Mel was as real as a parent or teacher. And when he told Lay to do things, Lay listened. At Mel’s urging, Lay began fighting the school bullies. Then, other kids. The rapid changes in his behavior left his father mystified. “My daddy said I was the sweetest little boy,” Lay recalled. “And then, when I went through that windshield, he said, it was like the devil got in me.” Childhood lost At 7, Lay was expelled and shuffled to another school, where he routinely skipped class. By 8, authorities had sent him to a state juvenile detention center. “I can’t say I was conflicted because, more likely than not, I probably didn’t even understand what that meant,” Lay said. “As far as the right or wrong, all the right was what Mel said to do.” While they disciplined him often, Lay’s parents were quickly losing control of the situation. And though they brought him to see doctors, Lay said the treatments didn’t work. Outside the home, he started fighting more, and stealing—first little things, then cars. Later, he joined a gang and quickly became mixed up in the violence. One day, after being beaten by rivals, Mel insisted Lay act. Approaching the 20-year-old he thought led the attack, Lay took out a gun and shot him. The police later caught Lay and charged him with first-degree murder. He was 15. Into adulthood and confinement It would take Lay decades to learn he has schizoaffective disorder. With this mental illness, symptoms of schizophrenia, such as hallucinations or delusions, occur at the same time as symptoms of a mood disorder, such as depression or mania. Although Lay acted violently, most people with schizophrenia are not violent or dangerous, said Sarah Morris, Ph.D., Chief of the Adult Psychopathology and Psychosocial Interventions Research Branch at the National Institute of Mental Health (NIMH). As Lay’s mental illness played a role in the shooting, the court found him incompetent to stand trial by reason of insanity. In hopes of providing the teen with treatment, the judge sentenced Lay to 2 years in a state maximum-security mental health facility. While the measure had the potential to help, Lay said he had difficulties adjusting to the realities of long-term confinement. He also said that staff mistreated him and would tie him down, place him in straitjackets, or lock him in padded rooms. Some of the ineffective and harmful practices of the past created a stigma for psychiatric treatment. Dr. Morris said that stigma still exists today and inhibits some people from getting the help they need. However, treatment for schizophrenia has improved since then, she added. “There are many more medications now with better options for managing side effects,” she said. “Also, many clinics now use a coordinated specialty care approach, where teams of providers work together with patients and their families to provide care that includes psychotherapy, medication management, family education and support, service coordination, case management, and supported employment and education services.” While mental health care has improved since then, Lay didn’t have the advantage of modern treatments for psychosis. His treatment at the maximum-security facility would remain unchanged, and through this process, facility staff shepherded Lay into adulthood. Reentering the free world at 18, Lay dropped out of school and later joined the military. He thrived there for a few years, but was discharged after a psychotic break. Without a purpose, Lay lost his way and embarked on a crime spree that ended after police arrested him for robbing a man of empty bottles. This time, there would be no insanity plea. In considering Lay’s prior record, the judge sentenced Lay to 12 years in a maximum-security prison. He wouldn’t emerge from prison until he was 31. Life on the streets Once free, Lay sought to reinvent himself. He got married and moved to Indianapolis, which offered steady work. But remaining untreated, the symptoms of his mental illness never left. “I was trying to make a life, but … I was a functioning drug addict and alcoholic with a mental health condition,” Lay said. “I was paying the bills, going to work, but I was messing up at work, I was messing up at home, and … I didn’t realize it then, but treatment is really what I needed.” On the advice of his mother, Lay moved back to his hometown. But the situation was untenable. Cycling between drug abuse and psychotic breaks, Lay became unhoused. Sometimes, he’d couch surf or burn through his disability checks to get off the streets, but mostly, he bounced in and out of homelessness. He lived like that for 12 years. While those close to him reached out, Lay denied his addictions. And though nearing 50, he still didn’t realize he had schizoaffective disorder. “I didn’t accept it,” Lay said of his mental illness. “I felt … a sense of straddling the fence, with some hole in the role of me.” Then, a chance encounter changed everything. What is schizophrenia? One day, while in a shelter, a clinical social worker approached Lay and asked if he was in treatment for schizophrenia. “What is schizophrenia?” he asked. The conversation opened doors, and for the first time in his life, Lay voluntarily enrolled in treatment. While other doctors had talked “at him,” this new one listened, allowing Lay to open up. In doing so, he began to heal. “Do not be afraid to talk with a mental health provider—and I mean, talk,” he said. “Let them have your deepest, darkest so-called secrets, because I have found that giving mine away has helped me get a whole lot better.” His psychiatrist prescribed medication, and this time, Lay stuck with it. Though adjusting to the side effects wasn’t easy, Lay said his desire to “live life” outweighed all else. “While it might be initially frustrating, finding a treatment that works can have life-changing outcomes, especially if doctors catch the disorder early,” Dr. Morris said. “Modern treatment plans—developed with the patient’s input and goals in mind—help many people with schizophrenia and related disorders lead rich and fulfilling lives.” As for Lay, therapy taught him how to work with his thoughts, feelings, and behaviors. In accepting his situation, his past, his challenges—everything started making sense. Therapy also helped Lay get off drugs and alcohol. Recently, he marked 16 years of sobriety. While he still faces challenges, he approaches them differently. “I sometimes still talk to my voices, and when I do talk with them now, I know that they are not real,” he said. “But I realized that I need to keep taking my medication, stay away from illegal drugs and alcohol, and don’t miss none of my appointments: In other words, I need to stay in treatment.” After making significant progress with his recovery, doctors felt Lay was ready to live a more independent life. In 2011, Lay took charge of his finances and secured an apartment, ending 12 years of homelessness. Helping others Between hospitalization, incarceration, and homelessness, Lay lost more than two decades of his life. Having missed out on so much, he tries to make up for it. Lay began the new chapter of his life about 8 years ago, successfully running for a seat on the National Alliance on Mental Illness (NAMI), Indiana Board of Directors. He later earned a seat on NAMI’s national board, where he's worked to further outreach about mental illnesses. Lay also began working as a peer support specialist at the Department of Veterans Affairs, where he’s spent over 5,000 hours helping other veterans work through mental illness. Now 68, while some people would be relaxing in retirement, Lay runs a business giving presentations on mental health. “I get to take my sorrow, my pain, my hurt, my tears, and help others,” he said. “I get to go to some of the places I was incarcerated and hospitalized, and talk with some of the first responders and try to prepare them for what they might encounter.” Much of his work seeks to bridge the gap of misunderstanding with law enforcement—his message: A little compassion goes a long way. “I try to instill in the police that persons with mental health issues are still persons,” he said. Recently, Ken Duckworth, M.D., Chief Medical Officer of NAMI, featured Lay in his book, “You Are Not Alone.” Reflecting on his journey with mental illness, Lay told Dr. Duckworth that helping people gives him purpose. It’s his way, in part, of trying to forgive himself. Through treatment, Lay’s become a better man. And for as long as he can, he wants to give back. In reclaiming the kindness in his soul, Lay’s rediscovered who he was meant to be. He’s also now able to do something once unthinkable: connect with people. He’s married to his wife, Dianna. They own a house in Indianapolis and care for their pet Chihuahua, Bentley. He spends his days busy, optimistic, and trying to do good in the world. It’s all he ever wanted.

Atypical anorexia nervosa (AN) is more prevalent among people of color and is associated with increasing anxiety and stable binge-eating trajectories over time, according to study results published in the International Journal of Eating Disorders. Atypical AN is categorized by significant weight loss and psychological symptoms that closely resemble AN, but with “normal” or higher weight relative to typical AN. Although atypical AN has become increasingly recognized as an eating disorder following its inclusion in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is still relatively understudied and underrepresented in clinical settings. To address this knowledge gap, investigators explored the natural course of atypical AN compared with AN and bulimia nervosa (BN) among college students. The investigators conducted a prospective cohort study at a public university in the United States to delineate the progression of eating disorder and internalizing symptoms among college students with and without histories of atypical AN, AN, and BN. First-year college students (18 years of age and older) were recruited to complete a self-reported questionnaire on sociodemographic information, psychiatric symptoms, and health behaviors, and follow-up assessments were conducted each year of college. Eating disorder symptoms were evaluated using the Eating Disorder Examination Questionnaire, while internalizing symptoms were assessed using the 8-item Symptom Checklist-90. The investigators included data from 989 first-year students, 1208 sophomores, 1727 juniors, and 1854 seniors. Overall, 61.4% of included students were women and 47.2% were White. Participants were categorized into 4 groups: those who met the criteria for atypical AN (n=125), AN (n=160), BN (n=617), or non-eating disorder controls (NCs, n=5876). Relative to the AN group, participants with atypical AN were significantly more likely to identify as non-White (B=0.74; P =.004). Across all groups, body mass index (BMI) significantly increased over time and BMI trajectory did not differ across groups. Relative to NCs, participants with atypical AN were significantly more likely to report fasting (P <.001), driven exercise (P =.006), purging (P =.007), anxiety (P =.002), and depression (P <.001). However, only anxiety (P =.038) and fasting (P <.001) remained elevated over time. Among the eating disorder groups, students with atypical AN had more stable binge eating trajectories (B=0.25; 95% CI, -0.21 to 0.70) relative to BN participants who displayed decreases in binge eating over time (B= -2.84; 95% CI, -3.18 to -2.49; P <.001). The atypical AN, AN, and BN groups did not significantly differ for the remaining eating disorder and internalizing symptom trajectories. “Given that atypical AN is under-represented in treatment settings and affects a greater proportion of people of color than AN, healthcare providers should be aware of biases that may delay diagnosis and care,” the investigators noted. Study authors concluded, “[Current] results improve understanding of atypical AN symptom trajectories relative to AN and BN, emphasizing the need for ongoing research in nonclinical samples beyond the context of college.” Study limitations include reliance on self-reported data, potential sample size suppression in the atypical AN group, varying assessment times, and participant attrition. Note: This article originally appeared on Psychiatry Advisor

PSYCHIATRIC VIEWS ON THE DAILY NEWS The publication of the book Dune in 1965 came at the height of the use and abuse of psychedelics in what could be called the first coming of the psychedelics in the United States. Now, years after they became federally illegal in 1970, they are being researched and used again in what could then be called their second coming. Besides their potential to help treatment-resistant depression, anxiety, and trauma, they may be beneficial for loneliness, opiate addiction, and traumatic brain injuries. We also should not forget the long world-wide use of psychedelics by the indigenous over millennia. In the “Stoned Ape Theory,” ingesting psilocybin regularly in diets is said to have potentially led to the rapid evolution of brain size and abilities. Ketamine, which seems to have some psychedelics properties, has been practically available because it had approval from the US Food and Drug Administration (FDA) as an anesthetic years ago. Research has indicated its potential usefulness for treating depression more rapidly. No wonder, then, that this promise and availability of ketamine has led to numerous so-called ketamine clinics. I was asked to consult on one locally and suggested following the American Psychiatric Association’s (APA) 2017 guidelines,2 as well as to make sure that there was a psychiatrist onsite. As far as I can tell, that has not been followed locally or nationally. No wonder, then, that the APA has recently told MedPage that those clinics are like the “wild west,” where patients do not received adequate informed consent on the downsides.3 The profit potential on refined psychedelic doses is another influence. The hope is that when other purer psychedelics receive FDA approval, that they are more carefully regulated and monitored. However, even if that proves so, underground usage will likely continue as usual. If we can skip the imagined 10,000 years to reach “Dune: Part Two,” the third coming of psychedelics seems in full swing. A highly addictive and very power psychedelic is in planetary use for producing a longer life, vitality, and awareness. At higher doses, it produces increased computational skills, making interstellar travel practical. As what seems to be a key ingredient in the poisonous narcotic Waters of Life, past memories and clairvoyant visions of the future can become available. However, in “Dune: Part 2,” we see very little, if any, of the touted cosmic connections from our current psychedelics. Instead, competition for spice seems to have escalated conflict and colonialism, once again depicting both the promise and perils of psychedelics. Although there is no formal psychiatry depicted in the movies or book, real life psychiatry has the knowledge and some power to guide our psychedelic future for the better. Note: This article originally appeared on Psychiatric Times

Higher body mass index (BMI) at 7 years of age is associated with increased body dissatisfaction in late childhood and greater depressive symptoms in adolescence, according to study results published in Lancet Psychiatry. However, body dissatisfaction in late childhood was independent of BMI as a risk factor for depressive symptoms in adolescence. The prevalence of depressive symptoms among adolescents is increasing, highlighting the need for effective preventative interventions and a better understanding of potential modifiable risk factors. The current study sought to explore the relationship between childhood BMI, late childhood body dissatisfaction, and adolescent depressive symptoms. Investigators utilized data from the Millennium Cohort Study, an ongoing UK longitudinal birth cohort study involving over 18,000 families with children born between 2000 and 2002. The primary outcome was depressive symptoms at 14 years of age, assessed using the 13-item Short Mood and Feelings Questionnaire (sMFQ). Objective BMI measurements were recorded at 7 years of age by trained interviewers and were standardized by age and sex. Body dissatisfaction was measured at 11 years of age using a single-question scale from 0 to 6, derived from a broader happiness questionnaire. A total of 13,135 children with available BMI data at 7 years of age were included in the analysis, of which 49.6% were girls and 84.4% were White. Our findings suggest that greater body dissatisfaction in late childhood is an important risk factor for adolescent depression, regardless of the child’s BMI. In univariable models, higher BMI at 7 years of age was associated with greater depressive symptoms at 14 years of age (β, 0.38; 95% CI, 0.25-0.50; P <.0001) and with greater body dissatisfaction at 11 years of age (β, 0.17; 95% CI, 0.14-0.19; P <.0001). Greater body dissatisfaction at 11 years of age was also associated with higher depressive symptoms at 14 years of age (β, 0.83; 95% CI, 0.74-0.92; P <.0001). All associations were higher in magnitude among girls relative to boys and all sensitivity analyses were consistent with results from the main analyses. In mediation analyses, the investigators found that 26% of the association between BMI and depression was mediated by body dissatisfaction. This relationship varied by sex, with body dissatisfaction accounting for 43% of the relationship between BMI and depression in girls (P =.005), and 39% in boys (P =.822). These findings indicate that children with higher BMI in childhood have greater body dissatisfaction at 11 years of age and higher depressive symptoms in adolescence. Additionally, children who were more dissatisfied with their appearance at 11 years of age had greater depressive symptoms by 14 years of age. Study authors concluded, “Our findings suggest that greater body dissatisfaction in late childhood is an important risk factor for adolescent depression, regardless of the child’s BMI.” Study limitations include the reliance on a single-item question to measure body dissatisfaction and a lack of information on disordered eating behaviors. Note: This article originally appeared on Psychiatry Advisor

Long-acting injectable (LAI) antipsychotics reduce 30-day rehospitalizations relative to oral antipsychotics, according to study results published in the Journal of Clinical Psychopharmacology. Hospital inpatient free trial programs were also found to aid in LAI antipsychotic acquisition. Prior literature has demonstrated the efficacy of LAI antipsychotics over oral formulations in diminishing the frequency of readmissions. However, there is limited evidence supporting the role of LAI antipsychotics in the prevention of rehospitalizations. To address this knowledge gap, investigators conducted a single-center retrospective cohort study to compare psychiatric readmission rates among patients with schizophrenia or schizoaffective disorder who were prescribed either LAI or oral antipsychotics upon discharge between August 1, 2019, and June 30, 2022. The study also evaluated the benefits of leveraging pharmaceutical free trial programs for LAI medications. Screening a total of 1574 patients, researchers identified 343 individuals who were discharged with prescriptions for at least 1 oral or LAI antipsychotic. Within this cohort, 62.7% were diagnosed with schizophrenia and 37.3% with schizoaffective disorder. On average, patients were 40.3 years of age, 55.4% were male, and 32.9% were African American. Patients discharged from an inpatient psychiatric unit on LAI medications had a statistically significant decrease in 30-day readmission rates as compared with patients discharged on oral antipsychotics. In the study, 30% of patients were discharged on an LAI antipsychotic, while 70% were on oral antipsychotics. The LAI antipsychotic prescriptions included aripiprazole lauroxil (45.6%), haloperidol decanoate (35%), paliperidone palmitate (15.5%), extended-release aripiprazole injection (2.9%), fluphenazine decanoate (1%), and risperidone long-acting injection (1%). Among patients discharged on oral antipsychotics, the majority were prescribed risperidone (27.5%) or olanzapine (21.3%). The investigators also found that the average chlorpromazine equivalent dose was higher for the LAI group (477.3 mg/d) compared with the oral group (278.6 mg/d, P <.001). Additionally, 64% of LAI antipsychotics were accessed through hospital inpatient free trial programs. The investigators observed a 6.4% readmission rate for schizophrenic or schizoaffective exacerbation within 30 days following discharge. Patients on a LAI antipsychotic had a significantly lower rate of readmission at 1.9% compared with 8.3% for the oral antipsychotic group (P =.03; 95% CI, 1.05–20.02). Of those readmitted, 43% were diagnosed with schizophrenia and 57% with schizoaffective disorder. The researchers concluded, “Patients discharged from an inpatient psychiatric unit on LAI medications had a statistically significant decrease in 30-day readmission rates as compared with patients discharged on oral antipsychotics.” Study limitations include the retrospective study design, small sample size, and incomplete accounting of patient history and admissions to other facilities. Note: This article originally appeared on Psychiatry Advisor

Grandparent care is associated with increased internalizing, externalizing, and overall mental health problems among children, according to study results published in the Journal of Child Psychology and Psychiatry. These findings indicate that grandparental care may be a risk factor for children’s mental health. Previous research has demonstrated that parental characteristics exert a major impact on children’s mental health outcomes. Given the global increase in the number of children residing in grandfamilies, investigators conducted a systematic review and meta-analysis to characterize and evaluate the effect of grandparental care on children’s mental health. The investigators searched publication databases in November 2021 and a second-round search in June 2023 for studies that focused on grandparental care and reported at least 1 mental health outcome for grandchildren. The primary outcome of interest was children’s mental health outcomes, including internalizing problems, externalizing problems, overall mental problems, and socioemotional well-being. Additionally, the investigators evaluated potential moderators in the effects of grandparental care. A total of 38 studies (cross-sectional: k =27; longitudinal, k =11) were included for analyses, for a pooled sample size of 344,860 children. On average, children were 10.29 years of age and there was a generally balanced gender distribution. Most studies evaluated internalizing problems (k =18), followed by externalizing problems (k =14), overall mental problems (k =10), and socioemotional well-being (k =7). Additionally, mental health outcomes were reported through child self-report (k =17), caregiver report (k =11), mental health professional report (k =3), and teacher report (k =3). Our findings also call for more supportive preventions and early mental health interventions for children living in grandfamilies. The investigators found that children who were cared for by their grandparents had more internalizing (d = -.20; 95% CI, -0.31, -.09; P=.001), externalizing (d = -.11; 95% CI, -0.21 to -.01; P =.03), and overall mental problems (d = -.37; 95% CI, -.70 to -.04; P =.03) and poorer socioemotional well-being (d = -.26; 95% CI, -.49 to -.03; P = -.03), relative to children without parental care. However, the wide confidence intervals suggest variability in the association between grandparental care and child mental health across populations. When evaluating potential moderators to this relationship, the investigators observed that study design (Q =4.97; P =.03) and child gender (Q =5.96; P =.02) contributed significantly to effect size variance. Specifically, there were larger negative effects of grandparental care associated with longitudinal studies (d = -.08; 95% CI, -.53 to -.19) relative to cross-sectional studies (d = -.29; 95% CI, -.41 to -.18) and for girls (d = -.10; 95% CI, -.25 to .04) compared with boys (d = -.10; 95% CI, -.25 to .04). Recruitment setting, child age group, study region, cultural context, living area, and family type did not significantly moderate the effects of grandparental care. “These results underscore the need for additional research on grandparental care with more nuanced and comprehensive measurements of the context and extent of grandparental care,” the investigators noted. “Our findings also call for more supportive preventions and early mental health interventions for children living in grandfamilies,” study authors concluded. These findings may be limited by the lack of information on parental factors and family dynamics, inability to establish causal relationships, and small sample size. Note: This article originally appeared on Psychiatry Advisor

Ed. The US Department of Health and Human Services (HHS) announced on February 6 the launch of 2 grant programs through the Substance Abuse and Mental Health Services Administration (SAMHSA) intended to expand substance use disorder (SUD) treatment services. What does this mean for the future of SUD treatment? Psychiatric Times® Substance Use Section Editor Roueen Rafeyan, MD, DFAPA, FASAM, weighs in. It is nice to have the support of the Biden-Harris Administration in recognizing the tremendous need for SUD treatment and mental health services. Our patients with SUD also have high psychiatric comorbidities. It is never sufficient to treat one disorder and overlook the other. We need resources; our patients need access to resources. Grants provide the opportunity for many of us to create or expand on our resources to help those seeking treatment. This grant also helps with addressing mental health issues and providing treatment to patients involved in our legal system due to SUDs. Let us not forget the old saying: “An ounce of prevention is worth a pound of cure.” We know treatment works and saves lives. However, we all need to invest in prevention before the disease becomes deadly. We need to educate the public, we need to educate our youth, and we need to prevent access and use. I am personally grateful that this grant also recognizes the need for treatment for pregnant patients with SUDs—another area with scarce resources and expertise. Let us keep in mind that alcohol and SUDs cost around $500 billion a year. The National Institute on Drug Abuse (NIDS) has an annual budget of $1 billion a year. The numbers are high, but it is not hard to see the disproportion and to feel the weakness against the $500 billion giant. Any amount dedicated to fighting this battle is better than none—however, we need more. Twenty-eight million dollars is just not enough, but it is a start. Those of us in the trenches appreciate any help we can get to continue saving lives. This article originally appeared on Psychiatry Advisor