The 166th American Psychiatric Association Annual Meeting
The annual meeting of the American Psychiatric Association was held from May 18 to 22 in San Francisco and attracted approximately 10,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in psychiatry. The conference highlighted recent advances in the prevention, detection, and treatment of psychiatric conditions, with presentations focusing on mental illnesses, including posttraumatic stress disorder, Alzheimer's disease, and schizophrenia.
In one study, Lisa Cohen, Ph.D., of the Beth Israel Medical Center and the Albert Einstein College of Medicine in New York City, and colleagues found that psychiatric patients who report greater levels of neglectful parenting during childhood also report greater difficulty with interpersonal relationships in adulthood.
"This held true for the four different types of neglect studied (supervisory, cognitive, emotional, and physical) as well as the three aspects of interpersonal functioning assessed (intimacy, feeling recognized, and enduring relationships)," said Cohen. "From these results, we can infer that childhood neglect impedes general interpersonal functioning in adulthood but most strongly impacts the capacity to sustain close relationships over time as opposed to the capacity to enter into these relationships in the first place."
Based on these findings, Cohen recommends clinicians pay attention to their patients' histories of neglect in childhood as this seems to have far reaching effects.
"Secondly, the capacity to sustain relationships over time may be a more sensitive measure of interpersonal difficulties than the capacity to enter into such relationships at all. Therefore, clinicians should attend to their patients' ability to sustain relationships and try to enhance this capacity if it is lacking," Cohen added.
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In another study, Dinesh Mittal, M.D., of the Central Arkansas Veterans Healthcare System and the University of Arkansas in Fayetteville, and colleagues conducted a vignette-based study to find out if mental health and primary care providers' treatment decisions and expectations from their patients differed for the vignette with schizophrenia compared to the nearly identical vignette without a history of schizophrenia. The vignette describing the person with schizophrenia was intended to depict a person who had been clinically stable for several years.
The investigators found that all providers expected persons with schizophrenia to be less adherent to treatment, to have poorer vocational and social functioning, and to be less competent to manage their own health and lives. All providers were less likely to refer persons with schizophrenia compared with those without schizophrenia to weight management programs and more likely to involve their family members in their care.
"For patients' ability to understand educational material, the presence of schizophrenia influenced psychiatrists and primary care nurses in that they expected patients with schizophrenia to be significantly less likely to read or understand educational material than patients without schizophrenia," said Mittal. "For this variable, we also found some difference based on type of provider. For example, when comparing nurses to physicians, mental health nurses were significantly more likely than psychiatrists to expect patients with schizophrenia to read or understand educational material; when comparing specialty, mental health nurses were significantly more likely than primary care nurses to expect patients with schizophrenia to read or understand educational material."
Although the investigators hypothesized that mental health providers would be more positive in their views of persons with schizophrenia, this was only partly true.
"No single provider group was consistently negatively or positively influenced by the diagnosis of schizophrenia," Mittal noted. "This is one of the few studies to link serious mental illness with clinical expectations and behaviors rather than simply with attitudes. The findings suggest that more education of providers about serious mental illness is warranted."
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Jonghun Lee, M.D., of the Catholic University of Daegu School of Medicine in South Korea, and colleagues found that more and more adolescents are overusing smartphones, which is associated with more severe psychopathologies. The findings were in line with effects of Internet and computer overuse.
The investigators evaluated 195 adolescents and divided them into four groups based on their level of smartphone and computer overuse, evaluating 11 different symptoms associated with smartphone overuse, including withdrawal, somatic symptoms, depression/anxiety, thought problems, attention problems, delinquency, and aggression.
"It is evident that the higher the addiction rose, the more severe the psychopathologies were, regardless of addictive patterns," the authors write. "The effects of smartphone addiction are not different from those of Internet/computer addiction. The number of adolescents who are addicted to smartphone use is likely to increase as the popularization of smartphone is an inevitable social trend. We should try to screen smartphone addiction as well as Internet/computer addiction in adolescents."
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Nazanin Alavi, M.D., of Queen's University in Kingston, Canada, and colleagues found that a cognitive behavioral therapy (CBT) approach using e-mail as the mode of communication was effective in treating general anxiety disorder (GAD).
The investigators evaluated 61 individuals with GAD, with half of the individuals receiving 12 e-mail-based CBT sessions and the other half serving as the control group.
"Our study showed that CBT by e-mail is an alternative method of delivering CBT in GAD when in-person interaction is not possible due to barriers," the authors write.
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In patients with treatment-resistant major depression, James Murrough, M.D., of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues found that intravenous (IV) ketamine was effective in rapidly relieving the symptoms associated with depression.
The investigators evaluated 73 patients with treatment-resistant major depression, providing half of the patients with IV ketamine and the other half with midazolam. The investigators found that all the patients given ketamine showed sustained improvement up to seven days after drug administration.
"In the largest clinical trial testing the efficacy of IV ketamine in mood disorders conducted to date, ketamine was associated with a rapid and large antidepressant effect at 24 hours, significantly superior to midazolam, and this superior efficacy was maintained seven days post-infusion," the authors write. "Ketamine appears to possess rapid antidepressant effects independent of its transient psychoactive effects -- a conclusion validated by the novel use of midazolam as an active control condition in this study."
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