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The Special Reports of 2024
Author(s):
Key Takeaways
- Clinician wellness is crucial, with travel and resilience-building as key strategies to combat burnout and enhance therapeutic effectiveness.
- Personality disorders are prevalent in medical settings, with significant comorbidities and management challenges, particularly in narcissistic personality disorder.
Let's review the Special Reports of 2024!
In case you missed any of the clinical pearls and treatment updates found across our 12 Special Reports this year, we are happy to share this brief recap, bringing you highlights from each of these important topics.
January Special Report: Clinician Wellness
This Special Report gathered a range of wellness perspectives from our contributors. How can you as a clinician maintain your mental health while providing the best possible care for your patients?
Travel Builds Your Brain Capital
Harris A. Eyre, MD, PhD
Travel can boost your brain health, cultural intelligence, and creativity, as well as make you more effective at caring for your patients via combatting burnout.
Nurturing Resilience in the Wounded Healer
Darshan H. Mehta, MD, MPH
Resilience is necessary to navigate the challenging terrain of your profession. Building resilience involves embracing vulnerability. It is essential to understand that vulnerability is not a weakness but a source of strength that enhances therapeutic effectiveness. Check out the 10 dimensions of resilience in this article.
Jane B. Sofair, MD
The basic importance of taking a lunch break as a way of recharging during the workday is seriously underrated according to this month’s Special Report chair.
Wellness in Physician Colleagues
Susan J. Noonan, MD, MPH
Learn more about the 6 dimensions from the Ryff Scales of Psychological Well-Being model and the Substance Abuse and Mental Health Services Administration’s 8 dimensions of wellness to improve your own sense of wellness.
February Special Report: Personality Disorders
This month’s Special Report focused on comorbidities and management of personality disorders across the spectrum, using case examples to illuminate best practices.
An Update on Personality Disorders and Common Comorbidities
In patients seen in the medical setting, as many as 20% have personality disorders. The most common are borderline (28.5% of patients), avoidant (24.6%), dependent (15%), and obsessive-compulsive (10.5%) personality disorders. Individuals with personality disorders are at risk for self-induced harm as well as injuries resultant from impulsive behaviors. They also have shortened life spans.
Yaakov S. Green, MD, MBA; Claire C. Holderness, MD, DFAPA
Narcissistic personality disorder is a common condition, with prevalence estimates in clinical samples ranging from 1% to 17%. Individuals with narcissistic personality disorder can experience significant impairments in psychosocial and interpersonal functioning. Despite its prevalence and consequences, narcissistic personality disorder remains poorly understood. It is one of the least studied personality disorders.
March Special Report: Treatment-Resistant Depression
To address the problem of treatment-resistant depression, this month’s Special Report took a closer look at patient needs, augmentation strategies, and management options for clinicians.
Attuned to the Needs of Patients
Gustavo Alva, MD, DFAPA
Current guidelines espouse the use of pharmacotherapy and psychotherapy for those with moderate to severe MDD, but up to 50% of patients may not respond to treatment and may require changes to their intervention, leading to delayed improvement and increased likelihood of decline and suffering. This disastrous condition erodes well-being and demoralizes the patient.
Augmentation Strategies for Treatment-Resistant Depression
Rohit Madan, MD; Hanadi Ajam Oughli, MD; Marie Anne Gebara, MD
Augmentation strategies can improve treatment response in those who have had a partial response to an initial antidepressant trial. Psychotherapy, neuromodulation, electroconvulsive therapy, repetitive transcranial magnetic stimulation, and ketamine may also be options to explore.
Managing Treatment-Resistant Depression: Tips for the Outpatient Psychiatrist
Lisa Harding, MD
Embracing a comprehensive, patient-centered approach and staying informed about emerging treatments can help mental health professionals make a difference in the lives of patients with TRD. Learn more about steps clinicians can take to help with tools they have in the outpatient setting, tips for assessing and addressing exacerbating factors in depression, and more in this article.
April Special Report: Psychiatry & The Environment
Our relationship with our environment has a strong influence on our mental health, as this Special Report demonstrates.
Exploring the Connections Between Mental Health and Our Environment
Elizabeth Haase, MD
Our awareness of the direct impacts of poor environment on the brain has only grown as global warming has advanced despite literally 150 years of awareness of the impacts of carbon-based fuels on the atmosphere.
Unraveling Minds: The Impact of Global Climate Change on Mental Health
Raman Marwaha, MD; Narpinder Kaur Malhi, MD
The health effects of climate change in the US include increased respiratory and cardiovascular disease, injuries and premature deaths related to extreme weather events, changes in the prevalence and geographical distribution of food- and waterborne illnesses and other infectious diseases, and threats to mental health.
Connections Between Food Additives and Psychiatric Disorders
Ruo-Gu Xiong; Jiahui Li; Hua-Bin Li, PhD
Recently, the connections between food additives and mental health disorders have gained increasing attention. Food additives are used to prevent food spoilage and/or to enhance food color and flavor. The results of several studies have indicated, however, that excessive use of certain food additives (eg, sweeteners, preservatives, and emulsifiers) may trigger mental disorders including anxiety, depression, and attention-deficit/hyperactivity disorder.
May Special Report: Polypharmacy
How can you best manage polypharmacy in your patients? The May Special Report sought to answer frequently asked questions.
Polypharmacy in Traumatic Brain Injury
Matthew Ashley, MD, JD
Some of the most problematic contributors to polypharmacy are the most common: sedating medications. Antipsychotics, typically used in acute settings to manage behavioral complications of traumatic brain injury, are generally detrimental to traumatic brain injury recovery in the long term.
Correlates of Antipsychotic Polypharmacy in Taiwanese Patients With Schizophrenia
Brian Miller, MD, PhD, MPH
Although treatment guidelines recommend antipsychotic monotherapy for patients with schizophrenia, at least 20% of patients have a partial response or nonresponse to this approach. However, antipsychotic polypharmacy may also be associated with an increased risk of adverse effects, drug-drug interactions, and adherence issues. Practice guidelines suggest using APP only for patients with treatment-resistant schizophrenia, after multiple antipsychotics trials, including clozapine.
Sarah A. Nguyen, MD; Hanadi Ajam Oughli, MD; Helen Lavretsky, MD, MS
Older adults, defined as individuals older than 65 years, are vulnerable to drug-induced adverse effects due to age-related physiological changes, such as decreased renal and hepatic function, increased body fat, lower total body water, and lower lean body mass, all of which can impact the pharmacodynamics and pharmacokinetics of medications and increase the elimination half-life. Clinicians should carefully weigh the risks and benefits of each prescribed medication for an older adult with neuropsychiatric diseases and periodically review all prescribed medications.
Tips for Managing Multiple Medication Use
Sheldon H. Preskorn, MD
These 7 guiding principles provide an introduction to the issues that should be considered as part of prescribing single as well as multiple medications for a patient.
June Special Report: Advances In Psychiatry
Following the 2024 American Psychiatric Association (APA) Annual Meeting, this Special Report sought to bring you the latest and greatest in psychiatric advancements.
John J. Miller, MD
Our Editor-in-Chief summarizes the highlights of our APA coverage in 2024, including his own 3 interviews with leaders in psychiatry.
New Baseline Data on Iclepertin for Schizophrenia
Erin O'Brien
The phase 3 CONNEX-X study explored the potential of glycine transporter-1 inhibitor iclepertin (BI 425809) to address cognitive impairment associated with schizophrenia. The primary objective of the CONNEX-X study was to monitor the occurrence of treatment-emergent adverse events. Secondary end points included changes from baseline in the Clinical Global Impressions-Severity scale and hemoglobin levels.
How to Safely and Effectively Taper Benzodiazepines
Leah Kuntz
As benzodiazepines carry a considerable risk of abuse, it is important to frequently review benzodiazepine tapering practices, outpatient detoxification challenges, and potential barriers to discontinuation. One estimate suggested 25.3 million (10.4%) adults in the United States reported using benzodiazepines, and approximately 17.2% of these individuals admitted to misuse.
Disabilities: The Next Chapter in DEI
Heidi Anne Duerr, MPH
Approximately 60% of US adults have a chronic disease, and 40% have 2 or more. Additionally, 27% of US adults have reported they have a disability across a spectrum of areas. Individuals with disabilities tend to experience frequent mental distress (ie, 14 or more mentally unhealthy days in the past 30 days) at a higher level than those who do not have disabilities. Despite the high rates of disability, practical issues involving patients with disabilities are rarely discussed in medical school.
July Special Report: Anxiety & Stress Disorders
Current events may be exacerbating mental health disorders related to anxiety and stress. We provided updates across the spectrum of these disorders to help you
What Have We Learned About Trauma and Stress Over the Years?
Phebe Tucker, MD, DLFAPA
Our understanding of the role of trauma in mental health has evolved exponentially over time with clinical research. Research has identified neurobiological characteristics of PTSD and traumatic exposure as well as recovery and resilience. Among these, that epigenetic DNA changes after trauma has been shown to cause lasting illness and, on a more optimistic note, may even add to resilience.
Itamar Shapira, MD; and Charles B. Nemeroff, MD, PhD
An understanding of evolving risk factors and pathophysiology is vital to optimal clinical management of anxiety disorders and PTSD. Navigating appropriate expectations while sharing decision-making, conducting psychoeducation, and being discerning in diagnosis and treatment are essential to maintaining an effective alliance with the patient, preventing pathologizing, and maintaining a focus on resilience and recovery.
Jana Gutierrez, MD; and Phebe Tucker, MD, DLFAPA
Complex posttraumatic stress disorder (cPTSD) has been identified as a separate diagnosis from PTSD in the ICD-11. cPTSD is defined as the presence of symptoms synonymous with PTSD (including hyperarousal, avoidance, and reexperiencing), as well as emotional dysregulation, negative self-concept, and interpersonal difficulties. It is believed to occur after exposure to severe and repeated trauma typically during early life stages. In many patients, these diagnostic criteria seem to overlap with borderline personality disorder.
August Special Report: Addiction
In this month’s Special Report, we explored the relationships between substance use and social factors.
Increasing Our Knowledge of Addiction and Substance Use Disorders
Roueen Rafeyan, MD, DFAPA, FASAM
“We can always increase our knowledge regarding substance use disorders, clinical impacts, and potential differential diagnoses to be able to compose better treatment plans for our patients,” says our Special Report chair for this month. “It also falls on our shoulders to educate our patients regarding outcomes of SUDs or addictive behaviors.”
Social Media and Substance Use: What Clinicians Need to Know
Natalie Ceballos, PhD; and Cara Petrofes, MA
Social media is here to stay, and its use must be a consideration in the treatment of psychiatric conditions, particularly substance use disorder and alcohol use disorder. Not only can the platforms be addictive, but in many cases social media exposure can facilitate other addictive behaviors including substance misuse and alcohol abuse.
Not Your Average Hazard: Cannabis Use, Psychosis, and the Youthful Brain
Nancy Shenoi, MD; and Richa Vijayvargiya, MD
Cannabis use during adolescence can profoundly impact brain development. Substance use, including cannabis use, may lead to loss of gray matter in areas such as the medial prefrontal cortex, compromising decision-making skills and impulse control. Cannabis may negatively affect other cognitive domains, particularly learning, memory, attention, and working memory. Regular cannabis use is also associated with amotivational syndrome, defined by apathy and decreased goal-directed behavior.
September Special Report: Death & Dying
How can you best support a patient who is dying and their families? It is a profound challenge, one we help you address in this month’s Special Report.
Treating Prolonged Grief Disorder: Innovations and Future Directions
Daniella Spencer-Laitt, MA; Henry A. Willis, PhD; Natalia Skritskaya, PhD; M. Katherine Shear, MD
Sidney Zisook, MD
Conversations about death and dying are often confined to recognizing suicide risk and preventing suicide. Far less attention is paid to other aspects of death and dying. For many clinicians, 1 or 2 hours in medical school and perhaps another few hours during residency are all the training they receive in the complex and challenging clinical issues of dealing with loss, dying, death, and bereavement.
Suffering Revisited: Tenets of Intensive Caring
Harvey Max Chochinov, MD, PhD, FRCPC
Intensive caring offers a way of addressing suffering designed to better meet the needs of patients and families. Tenets include nonabandonment, taking an interest in the patient as a person, holding hope, maintaining a dignity-affirming tone or therapeutic presence, and therapeutic humility.
Guidelines for Supporting the Dying and Their Families
Ken Druck, PhD
Meeting the needs of the dying and their families requires a deep and clear understanding of competent and compassionate care. Check out these top 7 guidelines to share with patients and their families.
October Special Report: Schizophrenia/Psychosis
Schizophrenia affects only 1% of the population yet it is among the top 20 causes of disability in the US. Learn more about best practices for care in this month’s Special Report.
First Episode Schizophrenia: Intervening Early and Well
Abigail L. Donovan, MD
The first episode of schizophrenia is a critical period of illness. Although long-term recovery in schizophrenia remains suboptimal, the best opportunity for recovery lies in early intervention with comprehensive treatment of the first episode, including CSC and the use of clozapine for treatment-resistant patients. Prevention of morbidity and mortality is an integral aspect of psychopharmacology.
Postpartum Psychosis: Complicated but Treatable Psychiatric Emergency
Ramanpreet Toor, MD
Postpartum psychosis is a rare psychiatric emergency with an incidence of 0.89 to 2.6 per 1000 births, requiring prompt identification and treatment. Symptoms include mood disorder, psychosis, and delirium, often misdiagnosed as primary psychosis or bipolar disorder. Treatment involves psychoeducation, pharmacotherapy, and inpatient care, with atypical antipsychotics and lithium commonly used. Early identification and treatment are crucial to prevent severe outcomes, with a good long-term prognosis if managed appropriately.
Bridging Gaps: The Symbiosis of Case Managers and Patients With Psychosis
Taylor Spradley; and Michaela Gris
Early intervention in psychosis is vital for enhancing recovery outcomes and reducing stigma associated with diagnoses like schizophrenia. Building trust through community engagement and everyday language helps minimize stigma and fosters positive client relationships. A collaborative team approach, including case managers, therapists, and psychiatric providers, ensures comprehensive support and improved client outcomes.
November Special Report: Forensic Psychiatry Part 1
You asked, we listened: Many readers were interested in a focus on forensic psychiatry, so we brought you a double Special Report on the most pressing issues in this area.
Leveraging and Balancing Skills in a Big Data Era
James L. Knoll IV, MD
Forensic psychiatry faces challenges from the rapid expansion of big data, requiring adaptation through teamwork and technology. The field continues to evolve, balancing roles in court assistance, psychiatric care in carceral settings, and research for future advancements.
Issues in Civil Commitment: The Cases of Incarcerated Patients
Esther Schoenfeld, MD; Raina Aggarwal, MD; Danielle B. Kushner, MD
A significant percentage of incarcerated individuals have serious mental illnesses, exceeding the homeless population and mental health treatment capacity. Legal entitlements exist for adequate medical care, yet biases and misdiagnoses often hinder appropriate treatment for justice-involved individuals. The complex journey through legal and mental health systems disrupts continuity of care, emphasizing the need for improved mental health treatment access.
Violence Risk Assessment: Using the Oxford Mental Illness and Violence Tool
Seena Fazel, MBChB, MD, FRCPsych; Giulio Scola
Clinical prediction models offer individual-level risk estimates for adverse mental health outcomes, aiding evidence-based decision-making. Traditional risk assessment tools are being replaced by novel tools like OxMIV, which provide probability scores for better clinical assessments. Integrating these tools into practice enhances patient care, safety, and well-being through personalized, data-driven decisions.
Understanding and Evaluating Conspiracy Theories: A Primer for the General and Forensic Psychiatrist
Brian Holoyda, MD, MPH, MBA
Conspiracy theories are widespread, often involving unverifiable claims and malevolent intentions, and can lead to criminal behavior. Distinguishing between delusion-like beliefs and delusions is crucial for forensic psychiatrists, considering community support and adaptability of beliefs. Evaluating the etiology of beliefs is essential for appropriate treatment and legal assessments, focusing on the origin and development of beliefs. Understanding conspiracy theories' appeal, similar to religious or cult beliefs, aids in assessing their impact on individuals' legal competencies and mental health.
Malingering in the Forensic and Correctional Settings
Vikram Kumar, MD
Malingering in forensic settings is driven by motives like avoiding incarceration and obtaining medications, necessitating careful psychiatric assessments to avoid misdiagnosis and stigma. Malingering can be categorized into pure, partial, and false imputation, with psychosis being the most commonly feigned condition due to its overt nature. Ethical considerations in diagnosing malingering are crucial, requiring comprehensive assessments and adherence to forensic psychiatry guidelines to ensure justice and objectivity.
December Special Report: Forensic Psychiatry Part 2
The discussion on forensic psychiatry continues in the final Special Report of the year.
Mothers and Child Murder: How Psychiatrists Can Help in Prevention
Susan Hatters Friedman, MD, MSt; Joshua Friedman, MD, PhD
In some cases of child murder by the mother, psychiatrists may have a critical role in prevention. Diagnostically, it is also important to discern the difference between an obsession in postpartum obsessive-compulsive disorder and the delusions of postpartum psychosis. In considering prevention, psychiatrists should feel comfortable inquiring about maternal filicidal thoughts, though many do not.
Study Finds ERPOs Can Prevent Suicide by Firearms
Heidi Anne Duerr, MPH
ERPOs, or "red flag laws," temporarily restrict firearm access for individuals deemed a risk, aiming to prevent harm. A study across 4 states found ERPOs can save one life for every 13 orders issued, despite not being 100% effective. ERPOs are most often initiated by law enforcement, but some states allow clinicians and family members to petition. The study suggests ERPOs are a crucial part of gun violence prevention, advocating for increased awareness and use by frontline responders.
Criminal Sanctions, Psychosis, and Mortality
Megan McSweeney
In a recent study, a significant portion of participants experienced criminal sanctions or mental health court diversions, with 10.85% imprisoned and 9.7% receiving court diversion. Disease-related deaths were prevalent in older participants, while suicide and accidental drug overdose were leading causes in specific subgroups. Mortality rates increased with age and were higher in men, with recent criminal sanctions linked to higher mortality in non-imprisoned patients.
Antipsychotic Prescriptions and Rehospitalizations in a Forensic Psychiatry Sample
Leah Kuntz
A recent longitudinal, retrospective study aimed to examine antipsychotic prescribing and rehospitalization rates in a forensic psychiatric sample. Atypical antipsychotics were the most prescribed, with a 75.9% rate, and 39.9% of patients experienced antipsychotic polypharmacy. Clozapine, prescribed to 19% of patients, showed potential in reducing rehospitalization duration but was not statistically significant. Long-acting injectable antipsychotics did not reduce rehospitalization rates compared with oral antipsychotics.
If you'd like to suggest a Special Report for 2025, email us at PTEditor@mmhgroup.com!
