Provider Perspectives on the Current Use of Lithium Medications and Lithium Monitoring Practices for Psychiatric Conditions.

Purpose: Despite lithium being a gold standard treatment for bipolar disorder, the percentage of patients with bipolar disorder who are prescribed lithium medication has declined in many parts of the world over the past two decades. The use of lithium is limited by its narrow therapeutic window and adverse side effects, which necessitates frequent serum lithium monitoring; hence, there is a critical need for improved ways to monitor lithium levels in psychiatric patients. We have recently shown that saliva lithium levels are highly correlated with those in blood, thereby presenting an alternative to venipuncture. Saliva sampling could open the door for at-home collections - potential that has been exemplified throughout the COVID-19 pandemic - thereby allowing samples to be collected remotely and delivered to a specific site for testing. In addition, prototype point-of-care devices have been developed by others for serum lithium monitoring, suggesting potential for a saliva lithium monitoring device. Our objective was to query the perspectives of American psychiatrists on lithium treatment practices and obstacles, the potential for at-home saliva collection and point-of-care devices, for lithium monitoring, as an alternative to pathology-based blood testing. Methods: Data was collected through an online, anonymous survey, distributed to American psychiatric societies. Results: Sixty-five respondents from 21 American states completed the survey. The majority of respondents were female, over 65 years of age, and/or had practiced for 30 years or more. The most frequent obstacles encountered with regard to lithium monitoring were adverse drug effects, and the need for monitoring. Overall, respondents believed saliva lithium monitoring and point-of-care devices would be useful, however raised concerns regarding validity and time-delay. Conclusion: Point-of-care devices and saliva lithium monitoring are promising alternatives to blood testing that would be welcomed by psychiatric societies, however, require extensive development and validation before implementation into a clinical setting.

The effects of the COVID-19 pandemic on weight loss in participants in a behavioral weight-loss intervention.

OBJECTIVE: This study aimed to assess the effects of the COVID-19 pandemic on weight loss, physical activity, and sleep in adults with overweight or obesity participating in a 39-week weight-loss intervention. METHODS: Participants (n = 81, 85% female, mean [SD] age 38.0 [7.8] years, BMI 34.1 [5.7] kg/m2 ) were enrolled in 3 separate cohorts. Cohorts 1 and 2 were studied prior to the pandemic (pre-COVID cohorts). Cohort 3 (COVID cohort) transitioned to a virtual intervention at week 6, when "stay-at-home" orders were implemented in Colorado. Weight was assessed at baseline, week 12, and week 39 with clinic scales before the pandemic and home scales during the pandemic. Diet was assessed with Likert scales at weeks 4, 8, and 12. Physical activity and sleep were assessed at baseline and week 12 with actigraphy. RESULTS: Participants in the COVID cohort reported greater dietary adherence (p = 0.004) and lost more weight than those in the pre-COVID cohorts at week 12 (-7.7 [3.3] kg vs. -3.7 [3.0] kg, p < 0.001) and week 39 (-8.5 [4.4] kg vs. -2.8 [4.6] kg, p < 0.001). Energy intake did not differ between cohorts (p = 0.51). The COVID cohort increased both sedentary time while awake and time in bed at night. CONCLUSIONS: Although the pandemic caused disruptions for the COVID cohort, participants still achieved weight loss with continued behavioral support.

Improving lifestyle obesity treatment during the COVID-19 pandemic and beyond: New challenges for weight management.

Objective: The COVID-19 pandemic has resulted in significant changes to daily life and many health-related behaviors. The objective of this study was to examine how the stay-at-home/safer-at-home mandates issued in Colorado (March 2020-May 2020) impacted lifestyle behaviors and mental health among individuals with overweight or obesity participating in two separate behavioral weight loss trials (n = 82). Methods: Questionnaires were used to collect qualitative and quantitative data on challenges to weight loss presented by the COVID-19 pandemic, including changes in dietary intake, physical activity, sedentary behavior, and mental health during the stay-at-home/safer-at-home mandates. Results: Using a convergent mixed method approach integrating qualitative and quantitative data, the greatest challenge experienced by participants was increased stress and anxiety, which led to more unhealthy behaviors. The majority perceived it to be harder to adhere to the prescribed diet (81%) and recommended physical activity (68%); however, self-reported exercise on weekdays increased significantly and 92% of participants lost weight or maintained weight within ±1% 5-6 weeks following the stay-at-home mandate. Conclusion: Study results suggest that obesity treatment programs should consider and attempt to address the burden of stress and anxiety stemming from the COVID-19 pandemic and other sources due to the negative effects they can have on weight management and associated behaviors.