Inpatient psychiatry unit devoted to COVID-19 patients.

The COVID-19 pandemic has significantly changed the mental health care. Treating psychiatric patients with COVID-19 poses multiple challenges in the inpatient psychiatric setting in terms of mitigating transmission of the virus. Gracie Square Hospital, a freestanding psychiatric hospital located in New York City, dedicated a unit for treating COVID-19 patients requiring inpatient psychiatric treatment. We faced different challenges including treatment refusal, difficulty complying with safety precautions due to psychosis, agitated behavior, and staff psychological well-being. We considered reformation of protocols, expansion of the use of technology, development of a supportive platform, and standardization of clinical practice. This paper describes our strategies to manage the challenges while providing acute psychiatric treatment to COVID-19 patients.

An Inpatient Psychiatric Program Targeting Opioid Overdoses.

The United States is currently experiencing an opioid epidemic, as drug overdose deaths have become a leading cause of death. According to the Centers for Disease Control, in 2017, opioids were responsible for 47,000 deaths, which involved both illicit and prescription opioids. A multifaceted public health approach that utilizes public health authorities, health care providers, local hospitals, and affected communities is required to effectively reduce opioid-related morbidity and mortality. The authors of this paper developed an inpatient program on the dual-diagnosis unit at Gracie Square Psychiatric Hospital in New York to target the opioid crisis. The purpose of this program was to train patients and their families on how to respond to an opioid overdose and administer naloxone spray. The paper describes the implementation of this program.

Synthetic Cannabinoids Use in Elderly Patients.

Synthetic cannabinoids are becoming a public health concern. No data are apparently available concerning use of synthetic cannabinoids in the elderly. We report two cases of elderly individuals who used synthetic cannabinoids and were admitted to a psychiatric hospital.

Amyloid Hypothesis: Is There a Role for Antiamyloid Treatment in Late-Life Depression?

Antidepressants have modest efficacy in late-life depression (LLD), perhaps because various neurobiologic processes compromise frontolimbic networks required for antidepressant response. We propose that amyloid accumulation is an etiologic factor for frontolimbic compromise that predisposes to depression and increases treatment resistance in a subgroup of older adults. In patients without history of depression, amyloid accumulation during the preclinical phase of Alzheimer disease (AD) may result in the prodromal depression syndrome that precedes cognitive impairment. In patients with early-onset depression, pathophysiologic changes during recurrent episodes may promote amyloid accumulation, further compromise neurocircuitry required for antidepressant response, and increase treatment resistance during successive depressive episodes. The findings that support the amyloid hypothesis of LLD are (1) Depression is a risk factor, a prodrome, and a common behavioral manifestation of AD; (2) amyloid deposition occurs during a long predementia period when depression is prevalent; (3) patients with lifetime history of depression have significant amyloid accumulation in brain regions related to mood regulation; and (4) amyloid deposition leads to neurobiologic processes, including vascular damage, neurodegeneration, neuroinflammation, and disrupted functional connectivity, that impair networks implicated in depression. The amyloid hypothesis of LLD is timely because availability of ligands allows in vivo assessment of amyloid in the human brain, a number of antiamyloid agents are relatively safe, and there is evidence that some antidepressants may reduce amyloid production. A model of LLD introducing the role of amyloid may guide the design of studies aiming to identify novel antidepressant approaches and prevention strategies of AD.

Symptoms and observations: differences in time course during electroconvulsive therapy in geriatric depressed patients.

Electroconvulsive therapy is used for the management of severe and refractory depression across the age spectrum. Treatment is guided by clinical response. However, there may be differences between the time course of improvement in clinical observations and patients' self-report of improvements. We report 4 cases of depression in late life that illustrate this issue. We discuss the potential significance of such differences and the need for research.