Palliative Care: Critical Concepts for the Geropsychiatrist.

Psychiatrists can make a significant contribution to improving quality end-of-life care for psychiatric patients, beyond managing their psychiatric and psychological conditions. Geriatric psychiatrists can build expertise in enhancing end-of-life care when caring for older adults with serious illnesses and their families, given the biopsychosociospiritual approach that significantly overlaps with palliative and hospice care approaches. To effectively add quality to end-of-life care, it is essential for psychiatrists to understand the core principles and practices of palliative and hospice care, learn basic symptom management skills, and hone the ability to have crucial conversations regarding prognosis and advance care planning. Also important is recognizing when to refer to hospice and palliative medicine subspecialists. This article provides an overview of palliative and hospice care, uses a case study to illustrate components of palliative and hospice care relevant to geriatric psychiatry practice, and comments on considerations pertinent to the coronavirus disease 2019 (COVID-19) pandemic.

Transgender health education for medical students.

BACKGROUND: Transgender individuals face numerous health disparities and report negative experiences with health care providers related to their gender identity. Significant gaps in medical education regarding transgender health persist despite calls for increased sexual and gender minority content. The purpose of this student-led study was to assess the effectiveness of a half-day educational intervention on first- and second-year medical students' attitudes and knowledge of transgender health. METHODS: Students and faculty members collaborated to develop an educational session on transgender health. This content was presented to first- and second-year medical students at Integrated Grand Rounds, a pedagogical method in which basic science and clinical faculty members co-present didactic content interspersed between live patient interviews and student-led small group discussions. Student participants (n = 138) completed voluntary 9-item pre- and post-session surveys assessing comfort with and knowledge of transgender medicine. RESULTS: Students' comfort with and perceived knowledge about transgender patients increased significantly between pre- and post-test. Students' knowledge of transgender medicine standards of care also improved, though not all items reached significance. DISCUSSION: A half-day educational intervention improved many facets of medical students' attitudes and knowledge about transgender patients. The significant disparities in physical health, mental health and access to care currently experienced by transgender persons in the United States warrants the continued testing and refinement of educational interventions for future and practising providers. Students' comfort with transgender patients increased significantly between pre- and post-test.

Effects of acute tryptophan depletion on raphé functional connectivity in depression.

Depression remains a great societal burden and a major treatment challenge. Most antidepressant medications target serotonergic raphé nuclei. Acute tryptophan depletion (ATD) modulates serotonin function. To better understand the raphé's role in mood networks, we studied raphé functional connectivity in depression. Fifteen depressed patients were treated with sertraline for 12 weeks and scanned during ATD and sham conditions. Based on our previous findings in a separate cohort, resting state MRI functional connectivity between raphé and other depression-related regions (ROIs) was analyzed in narrow frequency bands. ATD decreased raphé functional connectivity with the bilateral thalamus within 0.025-0.05 Hz, and also decreased raphé functional connectivity with the right pregenual anterior cingulate cortex within 0.05-0.1 Hz. Using the control broadband filter 0.01-0.1 Hz, no significant differences in raphé-ROI functional connectivity were observed. Post-hoc analysis by remission status suggested increased raphé functional connectivity with left pregenual anterior cingulate cortex in remitters (n=10) and decreased raphé functional connectivity with left thalamus in non-remitters (n=5), both within 0.025-0.05 Hz. Reducing serotonin function appears to alter coordination of these mood-related networks in specific, low frequency ranges. For examination of effects of reduced serotonin function on mood-related networks, specific low frequency BOLD fMRI signals can identify regions implicated in neural circuitry and may enable clinically-relevant interpretation of functional connectivity measures. The biological significance of these low frequency signals detected in the raphé merits further study.