HOPE: A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients With Cancer.

CONTEXT/OBJECTIVES: Psilocybin-assisted psychotherapy shows promise in treating depression and existential distress in people with serious medical illness. However, its individual-based methodology poses challenges for scaling and resource availability. The HOPE trial (A Pilot Study of Psilocybin Enhanced Group Psychotherapy in Patients with Cancer) is an Institutional Review Boards-approved open-label feasibility and safety pilot study examining psilocybin-assisted group therapy in cancer patients with a DSM-5 depressive disorder (including major depressive disorder as well as adjustment disorder with depressed mood). We report here the safety and clinical outcome measures including six-months follow up data. METHODS: Outcome measures were collected at baseline, two-weeks and 26-weeks postintervention. The study involved three group preparatory sessions, one high-dose (25 mg) group psilocybin session, and three group integration sessions with cohorts of four participants over a three-week intervention. RESULTS: Twelve participants completed the trial. no serious adverse events attributed to psilocybin occurred. The primary clinical outcome measures of change in symptoms of depression on the clinician administered 17-item-HAM-D showed clinically substantial decrease in HAM-D scores from baseline to the two-week timepoint (21.5-10.09, P < 0.001) and the 26-week timepoint (21.5-14.83, P = 0.006). Six out of 12 participants met criteria for remission at two weeks, as defined by HAM-D < 7, three out 12 demonstrated a clinically significant change (4-6 points), and eight out of twelve demonstrated a clinically substantial change (7-12 points). CONCLUSION: This pilot study demonstrated the safety, feasibility, and possible efficacy of psilocybin-assisted group therapy for cancer patients dealing with depressive symptoms. Based on demonstrated efficacy and significant reductions in therapist time, future investigations with the group therapy model are warranted.

Response of US psychiatric programs to the COVID-19 pandemic and the impact on trainees.

BACKGROUND: Medical training program and hospital response to the COVID-19 pandemic has varied greatly and has impacted trainee well-being. Which factors have specifically related to trainee wellness, however, has not yet been examined in depth. The aim of the study was to understand trainee perspectives on the individual psychiatry trainee programs' hospitals' objective COVID-19 preparedness management. We also sought and to gauge how program changes, and general pandemic-related concerns, have been associated with trainee satisfaction and burnout. METHODS: A cross-sectional survey study of psychiatric trainees was distributed electronically throughout the country via various psychiatry residency program listservs in April 2020. Statistical analyses were performed utilizing simple linear regression. RESULTS: From 352 respondents (346 complete responses and 6 partial responses), the most frequent program changes were "decreased number of rotations requiring in-person patient care" and "increased call hours or duties." Of pandemic-related concerns surveyed, the two greatest were "spreading COVID-19 to family/friends" and "co-residents' burnout and anxiety." A positive relationship was found between trainee satisfaction with perceived COVID-19 departmental response and comfort level of residents/fellows in expressing concerns with attending clinicians and department leadership. CONCLUSIONS: Since the start of the COVID-19 pandemic, trainees have experienced a variety of changes to trainee program policies and guidelines. Overall, poor communication and trainee dissatisfaction with departmental response correlated with concern of infection and anxiety/burnout. Insights garnered from this study could provide scaffolding for the best practices to reduce trainee physician anxiety/burnout for the current and future pandemics of this variety and magnitude.

Do no harm in due process - a historical analysis of social determinates of institutionalization in the USA.

Involuntary hospitalization has been a fundamental function of psychiatric care for mentally ill persons in the USA for centuries. Procedural and judicial practices of inpatient psychiatric treatment and civil commitment in the USA have served as a by-product of socio-political pressures that demanded constant reform throughout history. The origin of modern commitment laws can best be understood through the lens of cultural paradigms that led to their creation and these suggest caution for future legislative amendments.

Effects of temporary psychiatric holds on length of stay and readmission risk among persons admitted for psychotic disorders.

The practice of involuntary psychiatric commitment is central to the acute treatment of persons with severe mental illness and others in psychiatric crisis. Deciding whether a patient should be admitted involuntarily requires weighing respect for autonomy against beneficence, considering the clinical needs of the patient, and navigating ambiguous legal standards. The relative dearth of information about the impact of involuntary commitment on objective patient outcomes complicates matters ethically, legally, and clinically. To address this gap in the literature, we sought to determine the association between temporary psychiatric holds and length of stay and readmission rates among a retrospective sample of adult patients admitted to a large psychiatric hospital with diagnoses of schizophrenia, schizoaffective disorder, mania, and other psychotic disorders. In total, we identified 460 patients and 559 unique encounters meeting our inclusion criteria; 90 of the encounters were voluntary (involving a temporary psychiatric hold) and 469 were involuntary. Univariable and multivariable analyses suggested that temporary psychiatric holds were not significantly associated with either length of stay or readmission rate. These findings are relevant to clinicians who must decide whether to admit a patient involuntarily, as they suggest that making a patient involuntary is not associated with differences in length of stay or readmission risk.

Risk of suicide after discharge from inpatient psychiatric care: a systematic review.

OBJECTIVE: The period following discharge from inpatient psychiatric care is recognised as an especially high-risk time for patient suicide. Astonishingly, there is a dearth of comprehensive studies examining risk and protective factors in this specific population. The aim of this study was to establish the protective and risk factors for suicide in the first year post-discharge (PD) from psychiatric facilities and their utility in categorising patients as high or low risk in a meaningful way to benefit clinical care and improve patient outcomes. METHODS: A methodical search of three databases (PubMed, EMBASE, and PsychINFO) was used to identify reports describing risk factors for suicide after psychiatric discharge. RESULTS: Predominantly, male sex, a history of self-harm, a history of suicide attempts, admission with suicidal ideation or suicidal behaviour, and hopelessness were identified as being associated with death by suicide after discharge. Lithium appeared to be protective against suicide in the studies reviewed. Other variables examined showed mixed results. CONCLUSIONS: The findings of this review suggest that significant suicide predictors both common and unique to those established for suicide in the general population exist and can be utilised in a clinically meaningful way, despite the difficulties inherent in studying this population.KEY POINTSThe risk of suicide after psychiatric hospitalisation is high.Factors that predict suicide after psychiatric hospitalisation overlap only partially with risk factors for suicide in general.Important risk factors for suicide in the post-discharge period include male sex, a history of self-harm, a history of suicide attempts, the presence of suicidal ideation during the admission, and hopelessness.The conclusions that can be drawn from the existing literature are limited by small study sizes, different study populations, and different follow-up periods; additional research in this domain is needed.

Pseudologia Fantastica: An Elaborate Tale of Combat-related PTSD.

Pseudologia fantastica (PF), also known as mythomania or pathologic lying, is a well-known yet controversial phenomenon in psychiatry. There is no firm conceptualization of PF, nor are there any widely accepted diagnostic criteria for PF. The condition may be related to low self-esteem, and it shows some overlap with narcissistic personality disorder and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) cluster B personality disorders. Given the mysteriousness and rarity of PF, there is a dearth of information to guide diagnosis and even more limited information about effective treatments. Here, we discuss a case in which an adult male patient exhibited protracted symptoms that were consistent with PF, which consisted of elaborate falsifications pertaining to a history of military service that had duped even close family members. We describe the patient's presentation and the careful process of confrontation and acquisition of collateral information used to reach the diagnosis, along with the patient's efforts to avoid accepting the truth by constructing a series of even more elaborate stories. Finally, we underscore the importance of maintaining a therapeutic alliance in caring for patients with PF through frequent displays of uniform positive regard, and we describe the approach to treatment used during the patient's hospital stay.

A Case of Biopharmaceutical-Induced Catatonia and the Implication of a Novel Mechanism.

Catatonia can be described structurally as a motor dysregulation syndrome with a concomitant behavioral component. However, despite its initial recognition nearly 150 years ago, the exact pathophysiological causes underlying this syndrome are still somewhat unknown and are potentially variable. This report reviews a case of a patient with multiple catatonic episodes precipitated by the use of an immunomodulator medication, and in doing so suggests a possible mechanism speaking to the immune system's role in the etiology of some cases of catatonia.

A Medical Student-Run Child and Adolescent Psychiatry Clinic: One Institution's Experience.

OBJECTIVE: This report examines the experience of one institution's development of the first student-run psychiatry clinic that serves both adult and pediatric populations. METHODS: The clinic is held weekly with pre-clinical and clinical medical student volunteers under the supervision of board-certified adult and child psychiatrists. The development and evolution of the clinic over time are evaluated with particular attention to obstacles overcome. Medical student volunteers were surveyed retrospectively to evaluate their experience with patients with psychiatric illness, skill development, and interest in psychiatry. RESULTS: Since January 2016, the clinic has scheduled 90 patients, 32% of which were pediatric patients. Ninety-six medical students have volunteered, with roughly equal parts from all four medical school classes. Respondents to the experience survey showed marked improvement in their comfort working with patients with mental illness. Additionally, 40% "strongly agreed" or "agreed" that their experience influenced their interest in pursuing psychiatry as a career. CONCLUSION: This report describes a student-run psychiatry clinic with a dual mission of education and service, and the challenges associated with these sometimes competing goals. This clinic serves a vital need within our community and may be an example of the role that student-run clinics can have in fostering interdisciplinary care, psychiatric recruitment, and training for medical students.

Systematic screens for proteins that interact with the mucolipidosis type IV protein TRPML1.

Mucolipidosis type IV is a lysosomal storage disorder resulting from mutations in the MCOLN1 gene, which encodes the endosomal/lysosomal Transient Receptor Potential channel protein mucolipin-1/TRPML1. Cells isolated from Mucolipidosis type IV patients and grown in vitro and in in vivo models of this disease both show several lysosome-associated defects. However, it is still unclear how TRPML1 regulates the transport steps implicated by these defects. Identifying proteins that associate with TRPML1 will facilitate the elucidation of its cellular and biochemical functions. We report here two saturation screens for proteins that interact with TRPML1: one that is based on immunoprecipitation/mass spectrometry and the other using a genetic yeast two-hybrid approach. From these screens, we identified largely non-overlapping proteins, which represent potential TRPML1-interactors., Using additional interaction assays on some of the potential interactors from each screen, we validated some proteins as candidate TRPML1 interactors In addition, our analysis indicates that each of the two screens not only identified some false-positive interactors, as expected from any screen, but also failed to uncover potential TRPML1 interactors. Future studies on the true interactors, first identified in these screens, will help elucidate the structure and function of protein complexes containing TRPML1.

Derlin-dependent retrograde transport from endosomes to the Golgi apparatus.

Cells have to maintain stable plasma membrane protein and lipid compositions under normal conditions and to remodel their plasma membranes in response to stimuli. This maintenance and remodeling require that integral membrane proteins at the plasma membrane that become misfolded, because of the relatively harsher extracellular milieu or carbohydrate and amino acid sequence changes, are degraded. We had previously shown that Derlin proteins, required for quality control mechanisms in the endoplasmic reticulum, also localize to endosomes and function in the degradation of misfolded integral membrane proteins at the plasma membrane. In this study, we show that Derlin proteins physically associate with sorting nexins that function in retrograde membrane transport from endosomes to the Golgi apparatus. Using genetic studies in Caenorhabditis elegans and ricin pulse-chase analyses in murine RAW264.7 macrophages, we show that the Derlin-sorting nexin interaction is physiologically relevant. Our studies suggest that at least some integral membrane proteins that are misfolded at the plasma membrane are retrogradely transported to the Golgi apparatus and ultimately to the endoplasmic reticulum for degradation via resident quality control mechanisms.