From the Pages of Psychiatric Times: September 2022

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In the September issue of Psychiatric Times^TM, we worked with experts from multiple psychiatric areas to bring you thoughtful articles about a wide variety of psychiatric issues, from contingency management treatment for substance use disorders to burnout prevention tips for psychiatrists. Here are some highlights from the issue.

Serotonin or Not, Antidepressants Work

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Imagine that you, as a physician, just saw this headline splashed all over the internet: “Depression Probably Not Caused by Excessive Black Bile.” It was followed by a long discourse on how an imbalance in the 4 bodily humors is not responsible for mood disorders. You might scratch your head and wonder why anyone in 2022 would be bothering to refute the Galenic-medieval humoral theory.

As senior academic psychiatrists and psychopharmacologists, we reacted with similar puzzlement to a recent umbrella review and follow-up article by researchers in the United Kingdom. The review, by Moncrieff et al and published in Molecular Psychiatry (henceforth, “the review”), argued that there is “no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations” and that “the serotonin theory of depression is not empirically substantiated.” Continue Reading

Contingency Management is a Powerful Clinical Tool for Treating Substance Use Research Evidence and New Practice Guidelines for Use

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Contingency management (CM) is an effective behavior change technique commonly used to treat substance use disorders (SUDs). CM is one of the most effective behavioral interventions for initiating and maintaining abstinence from most types of commonly used drugs and alcohol.

Background and Rationale

CM-based treatments for SUD originate in basic behavioral science, namely the operant conditioning literature. Operant conditioning is a type of learning in which behavior is modified or maintained through the consequences it produces. In the context of SUD treatment, CM typically modifies substance use by delivering tangible, positive reinforcers (eg, prizes, vouchers, or monetary reinforcement) in exchange for evidence of the performance of the targeted behavior, such as the submission of a drug-negative urine sample. Continue Reading

Just the Tip of the Iceberg: Psychiatric Implications of Overturning Roe v Wade

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The US Supreme Court defied the court’s tradition and the expressed intentions of some of its members during their confirmation hearings by overturning the 50-year-old precedent, Roe v Wade, which had established abortion as a right. Immediately after the Dobbs v Jackson Women’s Health Organization decision was rendered on June 22, 2022, many states applied or enacted laws either severely limiting or banning abortion.

A week after the decision, a 10-year-old girl, pregnant by rape, was taken to Indiana, having been denied an abortion in her home state of Ohio. She was at high risk, not only for exacerbations of the trauma she had already experienced but for complications of pregnancy and childbirth, not to mention those of motherhood. It is notable, and relevant, that the first responses of Mike DeWine (Ohio’s governor), The Wall Street Journal, and other media was to declare that the story was untrue or could not be confirmed. No apologies were offered when the rapist was arrested and confessed. Next, the physician who performed the abortion was accused of not recording the procedure as required by law. Continue Reading

8 Tips for Psychiatrists to Prevent Burnout

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In 2018, the American Psychiatric Association found that burnout among psychiatrists was nearly 50%. This number may be even higher as we persist through a global endemic disease, social and political unrest, and increasing economic stressors. In many states, the collateral impact on health care will only be exacerbated by the recent Supreme Court decision to reverse Roe v Wade. This has led to increased burden on psychiatrists, our patients, and our colleagues in the medical field who turn to us for assistance.

It is important to note that the term burnout in itself can be polarizing and create stigma. It can place blame on the individual and does not take into account systemic or structural barriers that lead to untoward distress. At its core, burnout is an imbalance of empathy and self-compassion. Continue Reading

See the full September 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.