PSYCHIATRIC VIEWS ON THE DAILY NEWS Today is E-Day, Eclipse Day, an event of historical lore and meaning over millennia. Though many hope to see the total eclipse of the sun by the moon, certain expectations may be dashed with cloudy weather that obscures and eclipses what we see. Religious One set of reactions and meanings are religious and generally developed before current scientific information, such as the following: Christianity: There are some who believe this eclipse heralds the second coming of Christ and the “end times,” when Jesus will return to Earth, when the wicked will be judged and the righteous rewarded. Islam: It is generally felt to be a time to turn to God and pray, confirming that the occurrences of the whole universe are in God’s hands. Judaism: In the Talmud from hundreds of years ago, a total eclipse is “an ill omen for the world,” with the Orthodox recommending prayer, introspection, and a desire to do better. Hinduism. There are legends that incorporate the eclipse, which is generally viewed as a bad omen, so praying, meditating, and chanting are recommended to ward off evil. Buddhism: Buddhism can be put under the spiritual rubric perhaps more than religious given the absence of a God figure and views it as an auspicious day for spiritual practices like chanting mantras. Psychology Before scientific understanding, the eclipse seemed to elicit a primal fear, followed by relief, awe, and euphoria when the sun returned.2 People seem to care and cooperate more in its wake. Some, though, become obsessed with such solar eclipses, doing everything possible to see them. Social Being part of it tends to elicit a collective sense of wonder, inspiration, and reconciliation. A study after the last total eclipse in the US in 2017 found that individuals became, at least for a time, more oriented to their collectives.3 There is an accompanying sociological term called “collective effervescence.” Folk Beliefs Outside of formal religious beliefs, some common folk beliefs emerged in history. One is that a total eclipse is a disruption of the natural order and thereby a bad omen. Another is the common idea and image of the sun being eaten, such as by dragons, wolves, or demons. Human sacrifice could be a form of expiation, but alternatively, as with the Tlingit tribes, that the sun and moon were having more children. With a nod toward modern psychology, there is the interpretation of solar fighting with the moon, with the evolving expectation that everything would be worked out, just what we need for current polarizing times. Some have noticed how the pathway of this eclipse as well as the one in 2017, crosses in Carbondale, Illinois. Not only does that evoke Christ, but the famous legend about the blues great from the 1930s, Robert Johnson. At a crossroad in Clarksdale, Mississippi, in a combination of religious, folk, and sociological beliefs, it is said that he made a deal with the devil to obtain his great skill, then was poisoned by a jealous woman after a short, but great, career. The United States Today Coming into the midst of such a unique event makes analyzing it difficult. Certainly, there is much interest and plans to try to see the totality for the last time in 20 more years, even if by now the cloud cover is a concern. Many areas in the totality will have business benefits, including alcohol sales (which may boom if there is disappointment). Perhaps the biggest controversy and divisiveness now has been what to do with going to school—or not—for kids, sort of a mini version of what to do during COVID-19. While I have not found any major survey, many schools, with parental support, are operating from “an abundance of safety” and closing down for parts of today, providing e-classes at best. That leaves the parents to handle the watching process. Sometimes this is called an era of “safetyism” and helicopter parenting, too much of a good safety and security thing, but that also prevents necessary book and practical living learning. Perhaps we will get a better perspective on this strategy after the eclipse. Concluding Thoughts In general, most who view a total solar eclipse live are left with a sense of awe, though for how long is unclear. We also do not know much about the potential disappointment of not seeing it due to cloud cover, paralleling so many dashed expectations in life. The hoped for collective effervescence can certainly fizzle out. Perhaps the Robert Johnson legend reminds us of moral priorities. Conspiracy theories, which are common for this eclipse, evoke such moral questioning. Keeping any sense of spiritual awe alive is important for eclipses and other similar events. That can be done by deliberate memory recalls and searching for awe-inspiring events. The benefits of awe are both positive for mental and physical health. This article originally appeared on Psychiatric Times

Keypoint: Cancer survival rates are worse in adults with female breast, colorectal, or lung cancer who also have an intellectual or developmental disability. Patients with vs patients without intellectual or developmental disabilities have worse cancer survival rates, according to study findings published in the Canadian Journal of Public Health. Researchers conducted a population-based retrospective cohort study to explore the association between intellectual and developmental disabilities and cancer survival in adults with female breast, colorectal (CRC), or lung cancer. Outcomes of interest included death attributable to any cause and death attributable to cancer. Statistical analyses included Cox proportional hazards models and competing events analyses. The researchers sourced data from multiple linked databases in Ontario, Canada. Adult patients diagnosed with malignant breast (n=123,695), colorectal (n=98,809), or lung (n=116,232) cancer between 2007 and 2019 were evaluated for mortality on the basis of intellectual and developmental disability status. Requirements for intellectual and developmental disability status included the individual to have at least: 1 hospital admission, 1 complex continuing care admission, 1 emergency department visit, 1 home care visit, or 2 physician visits with an eligible diagnoses code in addition to a health encounter before cancer diagnosis. Overall, 486 (0.39%) patients with breast cancer (28.4% aged 50-59; 100% women), 506 (0.51%) patients with CRC (24.1% aged 60-69; 56.3% men), and 385 (0.33%) patients with lung cancer (30.4% aged 60-69; 54.0% men) met the criteria for intellectual or developmental disability. Among all cohorts, survival differed significantly on the basis of intellectual or developmental disability (P <.001). Compared with the patients with breast cancer, CRC, and lung cancer without intellectual or developmental disabilities, patients with these disabilities had lower 5-year overall survival rates across all cohorts (breast cancer: 81.7% vs 61.5%; CRC: 56.6% vs 34.2%; lung cancer: 19.7% vs 11.9%). After adjusting for cofounders, intellectual or developmental disability was associated with worse overall survival among patients with breast cancer (adjusted hazard ratio [aHR], 2.74; 95% CI, 2.41-3.12; P <.001), CRC (aHR, 2.42; 95% CI, 2.18-2.68; P <.001), or lung cancer (aHR, 1.49; 95% CI, 1.34-1.66; P <.001). Similarly, intellectual or developmental disability was associated with worse cancer-specific survival among patients with breast cancer (aHR, 2.28; 95% CI, 1.86-2.78; P <.001), CRC (aHR, 2.57; 95% CI, 2.26-2.92; P <.001), or lung cancer (aHR, 1.38; 95% CI, 1.21-1.57; P <.001). After stratifying cancer-specific survival by patient characteristics, intellectual or developmental disability was determined to be a significant predictor for mortality among all subgroups with breast cancer except for those with tumor, node, metastasis (TNM) stage 0 or I (aHR, 0.86; 95% CI, 0.32-2.30); among all subgroups with CRC; and among all subgroups with lung cancer except for those aged 49 and younger (aHR, 0.89; 95% CI, 0.48-1.66). Study limitations included documented prevalence of intellectual or developmental disabilities among patients with breast cancer, CRC, or lung cancer that were lower than estimated the prevalence of the same in Canada; potential misclassification of intellectual or developmental disability; the inability to differentiate types of intellectual or developmental disability; and loss to follow-up. “High-quality knowledge to inform patient-centered, evidence-based care gaps for people with IDD [intellectual or developmental disabilities] and cancer is urgently needed,” the researchers concluded. This article originally appeared on Neurology Advisor

Here’s some news you may have missed in the world of psychiatry from throughout the month of March, as featured in Psychiatric Times®. Phase 3 Trial of AXS-12 for Narcolepsy Meets Primary Endpoint The SYMPHONY phase 3 trial evaluating the efficacy of AXS-12 (reboxetine) for the treatment of narcolepsy has achieved positive results by meeting its primary endpoint. The trial revealed that AXS-12, a highly selective norepinephrine reuptake inhibitor and cortical dopamine modulator that was granted Orphan Drug Designation for the treatment of narcolepsy in 2018, successfully met its primary endpoint by significantly reducing the frequency of cataplexy attacks in patients with narcolepsy compared with placebo. “AXS-12 is a novel therapeutic approach to the treatment of narcolepsy as evidenced by the strong clinical results generated from the phase 3 SYMPHONY trial, including a rapid and significant reduction in cataplexy events compared to placebo,” said Michael Thorpy, MD, director of the Sleep-Wake Disorders Center at the Montefiore Medical Center and professor of neurology at Albert Einstein College of Medicine, in a press release. Continue Reading Phase 3 Antipsychotic Candidate Pimavanserin Fails to Achieve Primary Efficacy Endpoint Recently released topline data from the phase 3 ADVANCE-2 trial reveals that the antipsychotic candidate pimavanserin did not achieve the primary efficacy endpoint of control of negative symptoms in patients with schizophrenia. Acadia Pharmaceuticals intends to discontinue research on pimavanserin for schizophrenia, following this failure. "Treatments to improve the negative symptoms in schizophrenia, a large unmet need, remain elusive," said John J. Miller, MD, Editor in Chief of Psychiatric Times. "Pimavanserin (Nuplazid), an inverse serotonin 2A receptor agonist, failed to separate from placebo in a Phase 3 double-blind study of 454 adults with schizophrenia treated for 26 weeks. We will await ongoing clinical trials with drugs of different mechanisms of action in our continued attempt to develop a treatment to improve negative symptoms." Continue Reading FDA Approves NeuroStar TMS for Treatment of MDD in Adolescents NeuroStar Advanced Therapy has received clearance from the US Food and Drug Administration (FDA) as an adjunct in the treatment of major depressive disorder (MDD) in adolescent patients aged 15 to 21 years. This clearance marks NeuroStar as the first and only transcranial magnetic stimulation (TMS) treatment that is FDA-cleared for this age group. MDD in adolescent patients is also the fourth FDA-cleared indication for NeuroStar, along with treatment of MDD in adults, treatment of obsessive-compulsive disorder in adults, and anxiety symptoms in adults with MDD. Continue Reading Note: This article originally appeared on Psychiatric Times

Studies in preclinical models hint that familial Alzheimer's disease (AD) may be transmissible via bone marrow transplant, but the researchers and outside experts caution against making the immediate leap to humans. The researchers observed that adoptive transplantation of donor bone marrow stem cells harboring a mutant human amyloid precursor protein (APP) transgene into both APP-deficient and healthy wild-type mice resulted in the rapid development of AD pathologic hallmarks. These pathologic features included compromised blood-brain barrier integrity, heightened cerebral vascular neoangiogenesis, elevated brain-associated beta-amyloid levels, and cognitive impairment. In addition, symptoms of cognitive decline presented rapidly — 6 months after transplant in the APP-knockout mice and 9 months in the wild-type mice vs 12 months shown previously in AD transgenic mice. "Contrary to prevailing beliefs regarding AD occurring solely in familial or sporadic forms, our study reveals an unexpected transplantable form of AD in a preclinical model, suggesting potential iatrogenic transmission in AD patients," the investigators, led by Wilfred Jefferies, BSc, DPhil, write. Although this is probably an "infrequent" occurrence, it's still "concerning," Jefferies told Medscape Medical News, and it suggests that "human donors of blood, tissue, organ, and stem cells should be screened to prevent its inadvertent transfer of disease during blood product transfusions and cellular therapies." The study was published March 28 in Stem Cell Reports. Intriguing, but Limited Human Relevance The researchers note the study also demonstrates that beta-amyloid accumulation originating outside of the central nervous system contributes to AD pathology, providing an opportunity for the development of new biomarkers for AD. Several experts weighed in on this research in a statement from the UK-based nonprofit and independent Science Media Centre (SMC). David Curtis, MBBS, MD, PhD, with University College London's Genetics Institute, United Kingdom, noted that the study suggests that "theoretically there could be a risk of acquiring Alzheimer's disease if one received a stem cell transplant from somebody carrying the severe, familial form of the disease. However, this form is extremely rare so in practice the risk seems low and there are many safeguards around stem cell transplantation. I do not see that the risks extend to other areas such as organ transplantation or blood transfusion because these procedures do not involve large numbers of stem cells which can go on to form glial cells." Paul Morgan, PhD, with UK Dementia Research Institute Cardiff, Cardiff University, said the study is "scientifically intriguing" in demonstrating in this "very specific experimental situation, that bone marrow cells are sufficient to transfer the gene and the disease. Relevance to human organ and cell transplant is limited." Morgan cautioned against making the "gargantuan leap to propose that tissue, organ and cell transplantation, and even blood transfusion, carry a risk of transferring Alzheimer's disease and other neuropathologies in man." Bart De Strooper, MD, PhD, with University College London, agreed. "There is not sufficient evidence here to suggest that anyone receiving a bone marrow transplant is at risk of developing Alzheimer's disease as a result of the procedure, and nobody should forgo a transplant for this reason," he said in the SMC release. The study had no specific funding. The authors hold equity in the start-up company, Cava Healthcare, which possesses intellectual property related to these findings. This had no role in the study design, data collection, analysis, or interpretation of data, or in the writing of the paper. Morgan, De Strooper, and Curtis have no relevant disclosures. Note: This article originally appeared on Medscape

Keypoint: These findings provide specific recommendations for the most efficacious psychotic depression treatment options. The combination of a selective serotonin reuptake inhibitor (SSRI) and a second-generation antipsychotic (SGA) may be the most effective psychotic depression treatment approach, according to results from a systematic review and meta-analysis published in Lancet Psychiatry. Psychotic depression, characterized by hallucinations or delusions occurring during a major depressive episode, is associated with greater symptom severity and duration than non-psychotic depression. While current psychotic depression treatment guidelines recommend polytherapy with an antidepressant and antipsychotic, there is limited research regarding the most efficacious options and combinations for specific medications. The current study aimed to address this research gap through a network meta-analysis to determine the efficacy of pharmacological treatments for psychotic depression, contributing to a more comprehensive understanding of treatment options. The investigators searched publication databases from inception to November 23, 2023 for randomized controlled trials evaluating the efficacy and safety of pharmacological treatments for acute major depressive episodes with psychotic features. The primary endpoints were treatment response rate and treatment acceptability, with secondary outcomes including changes in depressive symptom severity, remission rates, tolerability, and frequency of adverse events. The investigators included a total of 15 studies in the systematic review, for a pooled sample size of 1161 individuals with psychotic depression. On average, participants were 50.5 years of age, 44.4% were women, and 42.1% identified as White. The meta-analysis included 13 reports, encompassing 14 randomized controlled trials. Overall, 2 trials assessed depressive symptom severity using the Montgomery-Asberg Depression Rating Scale while the remaining studies used the Hamilton Rating Scale for depression. Relative to placebo, the investigators found that only the combination of SSRIs plus SGAs was associated with a higher proportion of participants with a treatment response (risk ratio [RR] 1.89; 95% CI, 1.17-3.04). By specific medications, only the combination of fluoxetine and olanzapine outperformed placebo (RR, 1.91; 95% CI, 1.27-2.85) for the proportion of patients with a treatment response. Additionally, the investigators found that antipsychotic plus antidepressant combinations were consistently more efficacious than monotherapy alone with either drug class. Among monotherapies, tricyclic antidepressants (TCAs) were associated with the most favorable response profile. These findings suggest that the combination of an SSRI plus an SGA may be the most optimal and effective treatment option for patients with psychotic depression. The study authors concluded, “This expansion of evidence for the pharmacological treatment of psychotic depression should improve clinical care, facilitate the development of treatment guidelines, and provide valuable insights for future clinical research, which remains insufficiently developed.” Limitations of the study include its reliance on data from randomized controlled trials published between 1985 and 2013, which excludes recent medications like ketamine or esketamine. Additionally, small sample sizes and the limited number of trials may affect the precision of effect estimates, while the inclusion of both major depressive disorder and bipolar disorder patients challenges the transitivity assumption and complicates the assessment of treatment effectiveness across the spectrum of psychotic depression. Note: This article originally appeared on Psychiatry Advisor

NeuroStar Advanced Therapy has received clearance from the US Food and Drug Administration (FDA) as an adjunct in the treatment of major depressive disorder (MDD) in adolescent patients aged 15 to 21 years. This clearance marks NeuroStar as the first and only transcranial magnetic stimulation (TMS) treatment that is FDA-cleared for this age group. MDD in adolescent patients is also the fourth FDA-cleared indication for NeuroStar,1 along with treatment of MDD in adults, treatment of obsessive-compulsive disorder in adults, and anxiety symptoms in adults with MDD. “The prevalence of depression in adolescents and young adults has been accelerating since the COVID-19 pandemic,” said Kenneth Pages, MD, medical director of TMS of South Tampa, in a press release. “The current treatment options available for adolescents are extremely limited, compared to those available for adults. NeuroStar’s TMS therapy now offers a promising first-line treatment for adolescents, backed by real-world data and impressive response rates consistent with response rates for adults. This advancement has the potential to set a new treatment paradigm for how we address depression in our youth.” The FDA’s decision to grant clearance for this indication is informed by an analysis of real-world data collected through NeuroStar’s proprietary TrakStar® platform. Among the 1169 adolescents analyzed, 78% showed clinically meaningful improvement in depression severity. The FDA reviewed this data set alongside clinical literature and concluded that NeuroStar TMS, when used as an adjunct to antidepressant therapy, is substantially equivalent in terms of safety and effectiveness compared to antidepressant therapy alone in this population. The coil design versatility of NeuroStar also allows providers to address the immediate treatment needs of adolescents with MDD symptoms without requiring additional hardware upgrades or purchases. This feature gives adolescent patients and their families a new option when weighing alternative treatments for depression. Access to effective treatment for MDD is important for all patient populations, as MDD is the fourth leading cause of disease burden globally. “Receiving FDA clearance to treat the adolescent segment aged 15 and up is a treatment solution that is long overdue in the mental health industry,” said Keith J. Sullivan, president and CEO of NeuroStar developer Neuronetics Inc, in a press release. “We are excited to offer NeuroStar TMS therapy as a new option for young people and for their concerned parents who have struggled to find a treatment they can be confident in. As a company, we will be focused on driving even more awareness and education about NeuroStar given that this new clearance grows our total advdnhfjshydfdressable market in MDD by 35%.” Note: This article originally appeared on Psychiatric Times

The size of the human brain has increased over time, a new finding that may help explain a previously reported decline in incident dementia. A secular trends analysis using brain imaging data from the long-running Framingham Heart Study, revealed an increase in intracranial volume (ICV), cortical gray matter, white matter, and hippocampal volumes, as well as cortical surface area in people born in the 1970s vs those born in the 1930s. "We hypothesize that the increased size of the brain will lead to increased 'reserve' against the diseases of aging, consequently reducing overall risk of dementia," Charles DeCarli, MD, director of the Alzheimer's Disease Research Center and Imaging of Dementia and Aging Laboratory, Department of Neurology and Center for Neuroscience, University of California at Davis, told Medscape Medical News. The study was published online on March 25, 2024, in JAMA Neurology. Dementia Protection? As previously reported by Medscape Medical News, an earlier paper from the Framingham Heart Study suggested dementia incidence is declining. "This difference occurred among persons with at least high school education and was not affected by differences in vascular risk. Our work was stimulated by this finding and the possibility that differences in brain size might be occurring over the three generations of the Framingham Heart Study which might explain an increased resilience to dementia," said DeCarli. The cross-sectional study used data from 3226 Framingham participants (53% women) born in the decades 1930-1970. None had dementia or a history of stroke. At a mean age of 57.7 years, they underwent brain MRI. Compared with the 1930s birth decade, the 1970s birth decade had a 6.6% greater ICV (1321 mL vs 1234 mL), 7.7% greater white matter volume (476.3 mL vs 441.9 mL), 5.7% greater hippocampal volume (6.69 mL vs 6.51 mL), and 14.9% greater cortical surface area (2222 cm2 vs 1933 cm2). Cortical thickness was thinner by 21% over the same period, coinciding with larger intracranial volume, cerebral white matter volume, and cortical surface area. "We were surprised to find that the brain is getting larger, but the cortex is thinning very slightly. The apparent thinning of the cortex is related to the increased need for expansion of the cortical ribbon. This is based on hypotheses related to the effects of evolution and cortical development designed to make neuronal integration most efficient," said DeCarli. Repeat analysis applied to a subgroup of 1145 individuals of similar age range born in the 1940s (mean age, 60 years) and 1950s (mean age, 59 years) resulted in similar findings. "These findings likely reflect both secular improvements in early life environmental influences through health, social-cultural, and educational factors, as well as secular improvements in modifiable dementia risk factors leading to better brain health and reserve," the authors wrote. While the effects observed are "likely to be small at the level of the individual, they are likely to be substantial at the population level, adding to growing literature that suggests optimized brain development and ideal health through modification of risk factors could substantially modify the effect of common neurodegenerative diseases such as stroke and Alzheimer disease on dementia incidence," they added. Limitations included the predominately non-Hispanic White, healthy, and well-educated population that is the Framingham cohort, which is not representative of the broader US population. The cross-sectional nature of the study also limited causal inference. Exciting Work "If these results are confirmed by others and the observed differences by decade are as large as those reported, it has important implications for aging and dementia studies," Prashanthi Lemuria, PhD, with Mayo Clinic, Rochester, Minnesota, wrote in an accompanying editorial. "First, studies that use brain charts for the human life span to understand the mechanisms of aging, by stitching together data from individuals across the decades, are significantly overestimating the degree of brain health decline using volumes across the life span because the baseline brain health in individuals who are in their older decades is likely lower to begin with," Lemuria noted. "Second, cortical thickness measurements, often used in dementia studies as a cross-sectional marker for neurodegeneration, showed greatest decline due to secular trends and are not scaled for ICV. Therefore, these should be traded in favor of gray matter volumes after consideration of ICV to estimate the true degree of neurodegeneration," Vemuri added. The data also suggest that longitudinal imaging study designs should be preferred when testing hypotheses on brain health, Vemuri wrote. Although this work is "exciting and will bring attention to secular trends in brain health, much work is yet to be done to validate and replicate these findings and, more importantly, understand the mechanistic basis of these trends," she added. "Do these secular trends in improvement of brain health underlie the decrease in dementia risk? The jury may be still out, but the authors are commended for investigating new avenues," Vemuri concluded. Note: This article originally appeared on Medscape

Keypoint: There are significant racial disparities in the risk for psychotic continuum outcomes. The risk for schizophrenia, psychotic symptoms (PSs), and psychotic experiences (PEs) are higher among Black and Latinx patients compared with White patients, according to study results published in JAMA Psychiatry. Although previous research has indicated that Black individuals are at higher risk for psychotic disorder diagnoses, relatively little is known about how risk varies across ethnoracial groups for other psychosis continuum outcomes — namely PSs, PEs, and clinical high risk for psychotic disorder [CHR-P]). To this aim, investigators conducted a systematic review and meta-analysis to assess the risk variation for these psychosis continuum outcomes across multiple racial and ethnic groups. The investigators searched publication databases from inception to December 2022 for observational studies conducted in the United States that evaluated psychotic disorder diagnoses, CHR-P, or PSs/PEs as outcomes among at least 2 ethnoracial groups. The primary outcome of the meta-analysis was schizophrenia spectrum diagnoses, while secondary analyses evaluated the risk for CHR-P and PSs/PEs. Overall, a total of 47 studies were included in the meta-analysis for a pooled total of 54,929 patients with schizophrenia (Asian: 4653; Black: 15,146; Latinx: 14,516; White: 19,744; Other: 870) and 223,097 patients with PSs/PEs (Asian: 16,951; Black: 25,528; Latinx: 17,683; White: 156,627; Other: 6308). Of the included studies, 32 evaluated a psychotic disorder, 29 assessed PSs/PEs, and 3 investigated CHR-P. Relative to White individuals, the investigators observed higher odds of a schizophrenia spectrum diagnosis among Black patients (odds ratio [OR], 2.07; 95% CI, 1.64-2.61; P <.01) and individuals who identified as Other (OR, 1.81; 95% CI, 1.31-2.50; P <.01). The investigators also found that the risk for PSs/PEs was higher among Black (pooled standardized mean difference [SMD]; 0.10; 95% CI, 0.03-0.16) and Latinx individuals (pooled SMD, 0.15; 95% CI, 0.08- 0.22) compared with White participants. The investigators also conducted sensitivity analyses based on treatment setting, diagnosis, and sampling characteristics. When compared with White individuals, the investigators found that Asian individuals displayed greater odds of a schizophrenia spectrum diagnosis when treated in inpatient settings (OR, 1.84; 95% CI, 1.19-2.84; P <.05) and when participants were sampled in a college setting (Cohen d, 0.16; 95% CI, 0.02-0.29; P <.05). The investigators did note a high level of heterogeneity across the included studies. Researchers concluded, “Ethnoracial risk variation in the US is present across multiple psychosis-related outcomes, suggesting that factors other than diagnostic bias alone underlie these disparities.” These results may be limited, given the risk for bias due to the included studies’ insufficient controlling of confound variables, the low representativeness of sample populations, high heterogeneity, and poorly assessed and defined ethnoracial groups. Note: This article originally appeared on Psychiatry Advisor

Executive dysfunction among young people with autism spectrum disorder (ASD), aged 16 to 21 years, is a significant indicator of suicide risk, according to study findings published in Autism. Previous research has established that individuals with ASD are at higher risk for suicide relative to neurotypical individuals. While issues with executive function have been associated with suicide risk in other populations, it has been an underexamined factor among people with ASD — particularly younger individuals. To this aim, investigators evaluated the suicide risk for individuals with ASD, aged 16 to 21 years, and examined depression, autistic traits, and executive function as potential predictors. The investigators conducted a cross-sectional study using data from the TEACCH School Transition to Employment and Post-Secondary Education (T-STEP) program, a community college-based intervention. At intake, demographic information was collected and participants completed the Wechsler Abbreviated Scales of Intelligence-II (WASI-II), P4 Suicide Screener, Behavior Rating Inventory of Executive Functioning — Adult Version (BRIEF-A), Center for Epidemiological Studies — Depression, Revised (CESDR), and Social Responsiveness Scale, 2nd Edition (SRS-2). A total of 183 individuals with a medically confirmed diagnosis of ASD were included for analysis. On average, participants were 18.75 (SD, 1.40) years of age, 73.2% were boys/men, and 74.9% identified as White. These findings highlight the need for integrated intervention approaches between both mental health and developmental disability service systems in order to target complex treatment needs. The investigators found that 33.3% (n=61) of individuals with ASD had experienced suicidal ideation in their lifetime. Among the group with ideation, 34% reported prior suicide attempt(s), 43% made a suicide plan, and 10% reported an intent to act on thoughts of self-harm within the next 30 days. The investigators then categorized subjects into risk categories based on their responses. Of the total sample, 65.6% of respondents were “no risk”, 16.4% reported ideation with no additional risk factors and were categorized as “minimal risk”, 14.2% reported ideation and 1 additional risk factor and were categorized as having lower risk, and 3.8% of participants who reported ideation and had multiple additional risk factors and were categorized as “higher risk”. The investigators found that higher levels of executive dysfunction were correlated with higher autistic traits (r, 0.49; P <.01), increased depression (r, 0.15; P <.05), and suicidal risk (r, 0.22; P <.01). Conversely, autistic traits were not significantly associated with overall suicide risk. In evaluating predictors of suicide risk, the investigators conducted regression analysis and found that executive dysfunction uniquely predicted suicidality (χ2, 30.36; P <.001), even when controlling for depression (b, 0.02; SE, 0.01; P <.05). The model that included executive dysfunction accounted for approximately 16% of the variance in reported suicidal ideation (R2, 0.16). Note: This article originally appeared on Psychiatry Advisor

Keypoint: Dementia rates were lower than a comparison cohort of people with Parkinson disease. HealthDay News — Dementia rates are substantially higher among people with essential tremor than the general population, according to a study scheduled for presentation at the annual meeting of the American Academy of Neurology, to be held from April 13 to 18 in Denver. Elan Louis, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues examined the prevalence, incidence, and annual rates of mild cognitive impairment (MCI) and dementia among individuals with essential tremor. The analysis included 177 participants, with follow-up evaluations at 18, 36, 54, and 72 months (mean years of observation, 5.1). The researchers found that the cumulative prevalence of dementia and average annual conversion rate of MCI to dementia were 18.5 and 12.2 percent, respectively. These rates were nearly three times higher than in the general population and were approximately half the magnitude of a Parkinson disease comparison cohort. Similarly, the cumulative prevalence of MCI (26.6 percent) was almost double that seen in the general population, but less than that observed in patients with Parkinson disease. “While the majority of people with essential tremor will not develop dementia, our findings provide the basis for physicians to educate people with essential tremor and their families about the heightened risk, and any potential life changes likely to accompany this diagnosis,” Louis said in a statement. Note: This article originally appeared on Psychiatry Advisor

Keypoint: Duration of depressive symptoms in preschool-aged children is positively correlated with daily impairment and distress. Study results published in The Journal of Child Psychology and Psychiatry found that among preschool-aged children, episodes of tantrums, sadness, tearfulness, and irritability needed to last an average total of more than 30 to 38 minutes per day to be considered psychometrically severe. Longer durations of these depressive behaviors were significantly correlated with increased daily impairment. Although depressive moods and behaviors (ie, sadness, irritability, and tearfulness) are developmentally normative for children, the length of time that children exhibit these behaviors may be a risk factor for depression and other clinically significant difficulties. However, it remains unclear what duration of time is considered “normative” for these episodes. To assess the daily duration of depressive mood behaviors, researchers recruited the parents and primary caregivers (N=900) of 3- to 5-year-old children at 2 sites in Maryland and California through flyer advertisements at local establishments and on social media. Participants completed a daily online diary for 14 days in which they described the duration of their child’s depressive moods and behaviors and how their mood affected the impairment and/or distress of the child and family. The diary items were adapted from the Early Childhood Inventory (ECI) and the impairment and distress items were adapted from the ECI and Preschool Age Psychiatric assessment (PAPA). On average, the children were 4.25 (SD, 0.79) years of age, attended 21.49 (SD, 16.88) hours of childcare per week, 48.0% were girls, and 62.8% were White. Most parents or guardians were married (87.8%), earned more than $100,000 annually (43.9%), and graduated college (78.3%). Although the original confirmatory factor analysis model did not fit the data, including the covariance between low energy or fatigue and change in activity level resulted in a well-fit model (c2, 77.23; P <.001). The researchers stratified the daily duration of behaviors and moods into 4 percentile categories: below the 50th percentile, between the 50th and 80th percentile, between the 81st and 95th percentile, and above the 95th percentile. The following cumulative durations of depressive behaviors/moods were considered psychometrically severe (either between the 81st and 95th percentile or above the 95th percentile): Tantrums: 30 minutes or greater Sadness: 32 minutes or greater Tearfulness: 35 minutes or greater Irritability: 38 minutes or greater Low interest or pleasure: 48 minutes or greater Low energy or fatigue: 59 minutes or greater Change in activity level: 101 minutes or greater The researchers observed significant correlations between depressive behavior duration and average daily impairment (r, 0.243; P <.001), all depressive behaviors and average daily impairment (r, 0.182; P <.001), and all depressive behaviors and overall distress for parent and child (r, 0.200; P <.001). A longer duration of depressive behaviors was also positively correlated with the child’s age (r, 0.122; P <.001) and negatively correlated with parental education (r, -0.181; P <.001), family income (r, -0.209; P <.001), and parental marital status (r, -0.172; P <.001). Parents of a Black (P =.038), multiracial (P <.001), or Hispanic (P =.009) child reported significantly longer duration of depressive behaviors than parents of a White child. Study authors concluded, “To our knowledge, this is the first study to delineate specific duration ranges for behaviors related to depression in preschool-aged children. These data can assist child practitioners in differentiating normative patterns from less normative mood problems to determine which children may be at risk.” Study limitations include the potential overlap between moods and behaviors, a lack of data on guilt, and possibly inaccurate estimates given the only once-daily behavior reporting. Note: This article originally appeared on Psychiatry Advisor

Keypoint: Opioids during pregnancy increase the risk for spontaneous preterm birth. Prescription opioid exposure during pregnancy is positively associated with increased odds of spontaneous preterm birth in a dose-dependent manner. These findings, published in JAMA Network Open, emphasize the importance of prescribing the lowest necessary dose of opioids for pain management during pregnancy. For pregnant individuals, there are limited options beyond acetaminophen for managing moderate to severe pain during pregnancy due to the fetal risks associated with nonsteroidal anti-inflammatory drugs. Despite the high opioid prescription rates among pregnant individuals in the United States, the effect of short-term opioid exposure on perinatal outcomes remains inadequately characterized. To this aim, investigators conducted a retrospective, nested case-control study that examined pregnant patients enrolled in Tennessee Medicaid between 2007 and 2019. Eligible participants were comprised of pregnant individuals aged 15 to 44 years without a diagnosed opioid use disorder who gave birth to a single fetus at 24 weeks gestation or later. The primary exposure of interest was the total opioid morphine milligram equivalents (MMEs) filled within the 60 days preceding the delivery date. The investigators documented instances of spontaneous preterm birth and matched these cases with up to 10 controls by pregnancy commencement date, race, ethnicity, age at delivery within a 2-year range, and previous history of preterm birth. The investigators included 25,391 cases involving spontaneous preterm birth and 225,696 paired controls, for a pooled sample of 251,087 patients. On average, patients were 23 years of age and were mostly non-Hispanic White (cases, 58.1%; controls, 58.5%). Overall, 18,702 patients (7.4%) filled an opioid prescription in the 60 days before the index date. The investigators found that higher opioid MME doses were associated with increased odds of spontaneous preterm birth in a dose-dependent manner, as each doubling of MME was associated with a 4% increase in spontaneous preterm delivery risk (adjusted odds ratio [aOR], 1.04; 95% CI, 1.01-1.08). Elevated odds of preterm delivery began at 150 MME (aOR, 1.08; 95% CI, 1.03-1.14), and reached a 21% increased risk at 900 MME. The odds remained relatively consistent across different opioid types after accounting for confounding factors and opioid MME. These results indicate that even low doses of prescription opioids during pregnancy increase the risk for spontaneous preterm delivery. The investigators noted, “We also caution against the conclusion that lower doses especially those below 100 MME are safe; the confidence bands over the low dose range still include odds ratios that are consistent with meaningful harm.” In conclusion, study authors stated, “These findings support guidance to prescribe the lowest opioid dose necessary in pregnancy to manage pain.” Study limitations include potential residual confounding in the case-control design, reliance on opioid dispensing data, lack of nonprescription analgesics information, potential protopathic concerns, focus on births at 24 weeks or later, and representation from Medicaid-enrolled individuals limiting generalizability. Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. Note: This article originally appeared on Psychiatry Advisor