David Meagher, MD, PhD
Department of Adult Psychiatry, University Hospital Limerick, Ireland
Disclosure: Dr. Meagher reports no affiliations with, or financial interests in, any organization that may pose a conflict of interest. This article includes discussion of off-label treatment with atypical antipsychotics.
PP: You led a study1 reviewing the current evidence on pharmacotherapy for delirium. How did the need for this type of study became apparent to you and your co-authors?
DM: In 2006, during a gathering at Duke University, a group of delirium researchers from Europe decided to start the European Delirium Association. Very soon afterward, the American Delirium Society was started. These two organizations have served as a hub to attract delirium researchers and to encourage them to collaborate in their efforts. We’ve gone from perhaps a dozen active researchers 15 years ago to between 200–300 researchers today, which is still a relatively small number considering how common delirium is. For example, delirium occurs in 11%–42% of general hospital inpatients.2 We did the first point prevalence study of delirium in hospitals, which we published in the British Medical Journal.3 In that study we tested the longstanding assumption that one out of every five people in hospitals have delirium. Even I didn’t really believe that adage until we did this study, in which we found a delirium prevalence of approximately 18% in the general hospital population. Read >
Stephen I. Deutsch, MD, PhD
Anne Armistead Robinson Endowed Chair in Psychiatry; Professor and Chairman, Department of Psychiatry and Behavioral Sciences, Eastern Virginia Medical School; Attending Psychiatrist, Sentara Norfolk General Hospital, Norfolk, Va.
Disclosure: Dr. Deutsch has received grant support from the Commonwealth Health Research Board (State of Virginia).
Working memory is the ability to retain information on-line for short periods of time—seconds to minutes—in order to use this information to guide goal-directed behavior, eg, retention of a telephone number long enough to actually make the call. Working memory is commonly referred to as the “mental sketchpad” and is itself composed of component processes that are necessary for maintaining relevant information during encoding, inhibiting encoded information that is irrelevant to the desired goal from entering consciousness, and minimizing interference from distractors or irrelevant information at the time of retrieval when a goal-directed response is chosen, among other processes. Working memory is critical to learning, reasoning, verbal comprehension, and academic and vocational success, so it is perhaps unsurprising that a deficit in working memory—a cognitive deficit—would be likely to contribute to the poorer functional outcomes experienced by many schizophrenia patients.1
Importance Exposure to trauma increases the risk for developing threat (ie, fear) symptoms, such as reexperiencing and hyperarousal symptoms, and loss (ie, dysphoria) symptoms, such as emotional numbing and depressive symptoms. While preclinical data have implicated the activated dynorphin/κ-opioid receptor (KOR) system in relation to these symptoms, the role of the KOR system in mediating these phenotypes in humans is unknown. Elucidation of molecular targets implicated in threat and loss symptoms is important because it can help inform the development of novel, mechanism-based treatments for trauma-related psychopathology.
Importance Obesity has emerged as a leading health threat but its biological basis remains insufficiently known, hampering the search for novel treatments. Here, we study oleoylethanolamide, a naturally occurring lipid that has been clearly implicated in weight regulation in animals. However, its role for weight regulation and obesity in humans is still unclear
Importance Posttraumatic stress disorder (PTSD) appears to increase obesity risk but the pathways by which PTSD leads to weight gain are not known. Identification of the links between PTSD and obesogenic eating behaviors is necessary to clarify this pathway and inform development of obesity prevention strategies in PTSD-affected populations. Objective To determine whether women with PTSD symptoms are more likely to report food addiction, a measure of perceived dependence on food, than women without PTSD symptoms
Importance Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management.
Importance It has been observed that suicidal behavior is influenced by sunshine and follows a seasonal pattern. However, seasons bring about changes in several other meteorological factors and a seasonal rhythm in social behavior may also contribute to fluctuations in suicide rates. Objective To investigate the effects of sunshine on suicide incidence that are independent of seasonal variation.
Importance Reward-related disturbances after withdrawal from nicotine are hypothesized to contribute to relapse to tobacco smoking but mechanisms underlying and linking such processes remain largely unknown. Objective To determine whether withdrawal from nicotine affects reward responsiveness (ie, the propensity to modulate behavior as a function of prior reinforcement experience) across species using translational behavioral assessments in humans and rats. Design, Setting, Participants Experimental studies used analogous reward responsiveness tasks in both humans and rats to examine whether reward responsiveness varied in (1) an ad libitum smoking condition compared with a 24-hour acute nicotine abstinence condition in 31 human smokers with (n = 17) or without (n = 14) a history of depression; (2) rats 24 hours after withdrawal from chronic nicotine (n = 19) or saline (n = 20); and (3) rats following acute nicotine exposure after withdrawal from either chronic nicotine or saline administration
Director’s Blog The Research!America awards dinner is like a lot of DC galas, complete with members of Congress, celebrities, and speeches to honor those who have contributed to a cause. For Research!America, the cause is biomedical research and this year, as in each of the past 25 years, there were honors bestowed on advocates for cancer and rare diseases. Kathy Giusti, diagnosed with multiple myeloma in 1998, spoke passionately about the lack of research on this blood cancer and her singular fight to create a registry and clinical trials, leading to new treatments that have extended her own life and the lives of many others well beyond all predictions. The parents of Sam Berns, an icon for the rare disease progeria, spoke of their son’s commitment to find a cure for this disorder in which children age rapidly and die early. Sam died last month at age 17, but during his brief life, and partly through his efforts working with the world’s foremost genetics labs, the genetic cause was found and new treatments were developed that will almost certainly extend life for others with this rare mutation (see Sam’s inspirational Ted talk ). For me, what made this event different from previous years was the recognition of advocates for people with mental illness. The actress Glenn Close was recognized for co-founding BringChange2Mind, a campaign to reduce negative attitudes toward those with mental illness. In her eloquent remarks accepting the award, Glenn introduced her sister, Jessie Close, and her nephew, Calen Pick, who each battle serious mental illness. Jessie has struggled with bipolar disorder and Calen with schizophrenia. When Glenn invited Jessie and Calen to make a few remarks, the evening really became historic. Together, they described a journey undertaken with Deborah Levy and her colleagues at McLean Hospital and elsewhere over the past 3 years. The research team found that Calen and Jessie shared a rare genomic copy number variant resulting in extra copies of the gene for glycine decarboxylase. This gene encodes the enzyme that degrades glycine, a key modulator of the NMDA receptor, which has been implicated in psychosis. Having extra copies of this gene, it seemed possible that Jessie and Calen would be deficient in glycine, with less activity of the NMDA receptor. When Dr. Levy and her colleagues gave glycine to Jessie and Calen under double blind conditions (in which neither doctor nor patient know whether glycine or placebo is being given), the response was like giving insulin to a person with diabetes—their psychiatric symptoms largely resolved. When the drug was stopped, their symptoms returned. When they received glycine again under non-blind conditions, the same improvements were observed.
Director’s Blog Despite careful monitoring and daily insulin, many people with type I diabetes experience emergencies like diabetic coma that require hospital care. Imagine a dystopic world where this care was not given in hospitals but in jails alongside inmates convicted of violent crimes.