From the Pages of Psychiatric Times: January 2023

In the January issue of Psychiatric Times^TM, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric topics, from the treatment of chronic traumatic encephalopathy in athletes to practicing psychiatry in post-Dobbs America.

Here are some highlights from the issue.

Rx Evolution: Pharmacological Paradigms for the Treatment of Schizophrenia

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Much has been written about the stagnation of psychopharmacology for the treatment of schizophrenia. All US Food and Drug Administration (FDA)-approved medications for the treatment of the core symptoms of schizophrenia—psychosis, negative symptoms, and cognitive symptoms—are dopamine-2 (D₂) receptor blockers, each of which has unique additional properties at other receptor systems.

D₂-blocking antipsychotics appear very close to finding themselves in the company of novel medications that treat schizophrenia by their action on non–D₂ receptors, most notably as agonists at muscarinic acetylcholine receptors (mAChRs) 1 and 4, and the trace amine–associated receptor (TAAR) 1. Before exploring these novel mechanisms, let us review our current armamentarium for treating individuals with schizophrenia. Continue Reading

Is Alzheimer Disease Research Key to Effective Treatment of CTE in Athletes?

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Unfortunately, our retired sporting heroes often share more than medals, memories, and magical moments. Increasingly, many are united in suffering from chronic traumatic encephalopathy (CTE) due to repeated head injuries and concussions sustained during their competitive careers.

CTE has been known for more than a century, but is now recognized as a prevalent condition among former stars of many high-impact sports, including American football, soccer, boxing, rugby, and ice hockey. It shares features with Alzheimer disease (AD), and with possible research breakthroughs into treatment for AD, could we start to hope for a treatment for generations of sports people with the condition as well? Continue Reading

Analyzing the Effects of Lithium Withdrawal on Renal Function

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Lithium is related to risk of chronic kidney disease (CKD), with an estimated prevalence of 10% to 35%. Fortunately, only a small percentage of chronic lithium users (maybe 0.5% to 1%) develop stage 4 or 5 CKD (requiring hemodialysis or transplant).

Data on the effects of discontinuing lithium on renal function are scarce and conflicting, and they are based on small samples. However, a Danish cohort study found that continuing lithium after a diagnosis of CKD was not associated with an increased risk of developing end-stage CKD. Therefore, understanding the effects of lithium discontinuation on renal function is important for clinical decision-making. Continue Reading

Abortion and the Psychiatrist: Practicing in Post-Dobbs America

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In Dobbs v Jackson Women’s Health Organization, the US Supreme Court held that there is no constitutional right to abortion, overruling Roe v Wade and nearly 5 decades of precedent. The Dobbs decision allows states to regulate abortion, resulting in a patchwork of laws that vary considerably by jurisdiction, from outright bans on abortion to very early gestational limits. For an up-to-date summary of state laws, we refer the interested reader to the Guttmacher Institute state legislation tracker.

Changes to abortion law will affect both patients and providers. Although obstetrician- gynecologists face direct liability in a variety of scenarios following Dobbs, other medical providers, such as psychiatrists, face less obvious challenges. In this article, we explore some abortion-related dilemmas confronting psychiatrists and provide guidance on how we might approach the many complex clinical, ethical, and legal issues that may arise. Continue Reading

See the full January issue of Psychiatric Times^TM here. And be sure to stay up-to-date by subscribing to the Psychiatric Times^TM E-newsletter.

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at PTeditor@mmhgroup.com.