Catatonia and Maintenance Electroconvulsive Therapy in a 15-Year-Old Patient With MED13L Haploinsufficiency Syndrome in the Context of Epilepsy Diathesis.

ABSTRACT: This is the first report of pediatric catatonia syndrome in MED13L haploinsufficiency syndrome. This report describes unique challenges in diagnosis and management of catatonia in rare genetic conditions. The case also illustrates the use of electroconvulsive therapy in patients with epilepsy, epileptic encephalopathy, or other epileptic diathesis and the clinical conundrum in determining the course of maintenance electroconvulsive therapy.

Trainees Unprepared for Advances in Psychedelic Medicine: A Survey Study.

This study aimed to characterize attitudes and identify gaps in trainee knowledge and education that may impact the field's readiness for the reemergence of psychedelic use in psychiatry. A two-part survey was sent out targeting medical and allied professional trainees who may interact with patients using or planning to use psychedelics therapeutically. Collected data for part one characterized demographics, sources of information, attitudes, experiences, and amount and type of education available about psychedelics in training programs. Part two was an assessment of psychedelic literacy, and predictors of trainee knowledge were analyzed. A total of 473 responses were obtained, 221 of which were unique, complete, thought to be authentic, and therefore included. Results indicated trainees had learned about psychedelics and related therapies from a wide variety of sources, most notably social media and word-of-mouth, which did not correlate with increased knowledge. There is limited structured education available, and although overall knowledge is low, participation in programming at home institutions did predict greater psychedelic literacy. As psychedelics are becoming increasingly available and research into their use in medicine advances, inclusion of relevant material in academic training programs will be essential to prepare future professionals to effectively educate and counsel patients.

Clinical Outcomes of Intravenous Ketamine Treatment for Depression in the VA Health System.

Objective/Background: Intravenous (IV) ketamine is effective for reducing symptoms of major depressive disorder in short-term clinical trials; this study characterized clinical outcomes of repeated infusions in routine clinical practice and the frequency and number of infusions used to sustain symptom improvement.Methods: Records of IV ketamine infusions for depression and associated Patient Health Questionnaire-9 (PHQ-9) scores were identified from Veterans Health Administration (VA) electronic medical records for patients treated in Fiscal Year 2020 and up to 12 months following the date of their first infusion.Results: Sample patients (n = 215) had a mean baseline PHQ-9 score of 18.6 and a mean of 2.1 antidepressant medication trials in the past year and 6.1 antidepressant trials in the 20 years prior to their first ketamine infusion. Frequency of infusions decreased from every 5 days to every 3-4 weeks over the first 5 months of infusions, with a mean of 18 total infusions over 12 months. After 6 weeks of treatment, 26% had a 50% improvement in PHQ-9 score (response) and 15% had PHQ-9 score ≤ 5 (remission). These improvements were similar at 12 and 26 weeks. No demographic characteristics or comorbid diagnoses were associated with 6-week PHQ-9 scores.Conclusions: While only a minority of patients treated with IV ketamine for depression experienced response or remission, symptom improvements achieved within the first 6 weeks were sustained over at least 6 months with decreasing infusion frequency. Further study is needed to determine optimal infusion frequency and potential for adverse effects with repeated ketamine infusions for depression.

Vital Sign Changes During Intravenous Ketamine Infusions for Depression: An Exploratory Study of Prognostic Indications.

PURPOSE/BACKGROUND: Subanesthetic dosing of intravenous ketamine has shown to be an effective treatment for patients with major depressive disorder. It is unknown whether sympathetic response is related to treatment outcomes. The purpose of this study is to evaluate sympathetic response to ketamine infusions as it relates to treatment outcomes. METHODS/PROCEDURES: This retrospective study examines an outpatient population diagnosed with major depressive disorder or bipolar depression treated with ketamine infusions. Patient characteristics, depressive symptoms measured with the Patient Health Questionnaire (PHQ-9), and vital signs were retrieved by chart review. Patients (n = 145) were categorized as responders (50% reduction in PHQ-9 or less than 10 on final PHQ-9) or nonresponders. Changes in vital signs were recorded during each infusion for the initiation series. FINDINGS/RESULTS: Ketamine responders (51.7%) showed a significant greater increase in systolic blood pressure response during the first infusion when compared with nonresponders. There was no difference seen in diastolic pressure, heart rate, or rate pressure product. Changes in vital signs for subsequent infusions also did not approach significance. IMPLICATIONS/CONCLUSIONS: Physiologic sensitivity to the effects of ketamine may predict treatment responsiveness. Blood pressure and heart rate did not always increase. Further work should examine possible influences on physiologic responses.