The Week in Review: April 10-14

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This week, Psychiatric Times® covered a wide variety of psychiatric issues and industry updates, from co-occurring substance use and eating disorders to treatment options for OCD. Here are some highlights from the week.

ChatGPT: Artificial Intelligence & Mental Health

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Human-computer interaction (HCI) and artificial intelligence (AI) recently took another step into the future. OpenAI’s ChatGPT has swept headlines and captivated nearly 500 million users, since its November 2022 launch. Psychiatry is no stranger to HCI. ELIZA, a computer program created by Joseph Weizenbaum of MIT in the 1960s, introduced how simple communication patterns provided by artificial means can illicit very real human emotion.

Although our lifestyle has evolved drastically, the fundamental structure of our brains is quite like those of our ancestors 200,000 years ago. We are wired to seek patterns and to anthropomorphize. It is not surprising that when I was introduced to ChatGPT, my brain quickly recognized an opportunity to satisfy this curiosity by interviewing the AI. Continue Reading

Co-occurring Substance Use and Eating Disorders

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There have been many studies analyzing co-occurrences between substance use disorders (SUDs) and eating disorders (EDs). The DSM-5 describes different EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED).

AN is mainly characterized by a low body weight due to a persistent restriction of food intake, a fear of gaining weight, and a body image distortion. Two AN subtypes have been proposed: AN-restrictive (AN-R) and AN-binge/purge (AN-BP). BN is characterized by recurrent episodes of binge eating (the consumption, in a discrete period of time, of an objectively large amount food with a sense of loss of control during the episode). Continue Reading

Role of Lithium in 2023 in Bipolar I Mania and Depression

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Let’s start with the treatment of acute mania. Lithium is a good treatment for classic, nonmixed mania, but if there are depression symptoms mixed in (per DSM-5-TR, if 3 or more depressive symptoms are combined with meeting full criteria for mania, it is mania with mixed features), lithium does not work well. Instead, the first choice for mixed would be a second-generation antipsychotic (SGA).

Quetiapine may be favored because it also has evidence for efficacy in treating and preventing bipolar depressions, which is often what happens after mania. Cariprazine has efficacy as a treatment for bipolar depression as well as mania including mixed mania, so that is another SGA option, but it has not been studied as a maintenance treatment for mania or depression so at this point it is only a guess how it would do for that important function. Continue Reading

Achieving OCD Relief: Consideration of TMS Earlier in the Treatment Continuum

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Obsessive-compulsive disorder (OCD) is a chronic and debilitating condition that impacts over 2% of the global population. Characterized by uncontrollable, reoccurring thoughts (obsessions) and behaviors (compulsions) that the patient feels compelled to repeat over and over, OCD was previously ranked by the World Health Organization (WHO) to be one of the top 10 debilitating medical conditions associated with a decreased quality of life and loss of income. It is now listed among other anxiety-based disorders, which together rank as the sixth leading cause of worldwide disability.

The economic burden on the US health care system for OCD treatments is estimated to be over $10.6 billion per year. Unfortunately, treatment options are limited and often do not work. Psychotherapy, including exposure response therapy (ERP), can be very helpful to manage OCD, but durability is limited. The reason for this is that OCD, like diabetes, is a chronic illness with constant daily implications and periodic worsening or relief. Continue Reading

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