American Psychiatric Association Research Articles

Competing Models of Personality Disorder: Relations With Psychosocial Functioning.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5; American Psychiatric Association, 2013), includes 10 categorical personality disorders (PD) in Section II (Section II PD) and a dimensional alternative model of PD (AMPD) in Section III. We compared the two models in explaining concurrent psychosocial functioning levels in psychiatric outpatients and community residents screened as at risk for PD pathology (N = 600). The AMPD's fully dimensional form showed stronger associations with psychosocial difficulties and explained more of their variance compared with the categorical Section II PD. AMPD Criterion A (personality functioning impairment) and Criterion B (pathological traits) incrementally predicted psychosocial functioning about equally with some unique predictions. Finally, AMPD's six categorical PD diagnoses did not show stronger associations with psychosocial functioning than the corresponding Section II PD diagnoses. Findings directly comparing the two models remain important and timely for informing future conceptualizations of PD in the diagnostic system.

Teens with classmates with MI more likely to be diagnosed

Teens who have one or more classmates with a mental disorder are more likely to be diagnosed with one themselves later in life than those who do not have any classmates with a mental disorder, according to a report in JAMA Psychiatry. The risk of a mental illness diagnosis was greatest in the first year following the diagnosis of a classmate, according to an APA (American Psychiatric Association) Psychiatric News Alert.

Ramaswamy Viswanathan, M.D., Dr.Med.Sc., takes office as APA president

Ramaswamy Viswanathan, M.D., Dr.Med.Sc., a longtime advocate for mental health, a medical educator and clinician‐researcher, began his term as president of the American Psychiatric Association (APA) at the conclusion of the organization's 2024 Annual Meeting in New York City. Viswanathan currently serves as interim chair of psychiatry at the State University of New York Downstate Health Sciences University, where he also directs the Consultation‐Liaison Psychiatry Service and its Fellowship Program. He is board‐certified in psychiatry, internal medicine, consultation‐liaison psychiatry, addiction psychiatry, geriatric psychiatry, and forensic psychiatry. One of his research priorities for 2024–25 is to focus on lifestyle interventions for positive mental and physical health through a holistic approach to wellness including exercise, nutrition, sleep, social connectedness, stress reduction and avoidance of risky behaviors. They will be promoted in conjunction with other treatment modalities such as psychotherapy, pharmacotherapy and neural stimulation.

APA says methadone should be more widely prescribed an OTP

It's news, and it's worth restating, even though many have said it: he National Institute on Drug Abuse Director, Nora D. Volkow, M.D., said that even primary care physicians should be able to prescribe methadone for opioid use disorder (OUD). She made this remarkable statement in response to ADAW's question during a press briefing at the American Psychiatric Association (APA) annual meeting last week in New York City.

APA theme for annual meeting and current journal: Addiction

Last week's annual meeting of the American Psychiatric Association (APA) featured much more than the usual addiction‐focused programming, which has been growing year by year. It was, under the direction of outgoing president Petros Levounis, M.D., himself an addiction psychiatrist, based on addiction. So is the current issue of the APA's flagship journal, the American Journal of Psychiatry, which featured three major articles on addiction. Two were presented last week; one, a commentary by Keith Humphreys, Ph.D., and colleagues, focused on the barriers to Medicaid reimbursement for treatment, mainly erected by a few states (ADAW will cover that in depth next week).

Arizona legislator Amish Shah, M.D., M.P.H., receives APA's Javits Award for Public Service

Amish Shah, M.D., M.P.H., an emergency medicine physician and former member of the Arizona House of Representatives, was awarded the 2024 APA Jacob K. Javits Public Service Award for his dedication to improving access to quality care, and his advocacy for mental health reform. The Javits Award is the American Psychiatric Association's (APA) highest honor for contributions to the field of mental health by a federal or state public official. “Not only in hospitals, but also in the Arizona House of Representatives, Dr. Shah has left his mark as a distinctly skilled and dedicated voice for mental health,” said APA President Petros Levounis, M.D., M.A., in a statement. “His tireless efforts include working across the aisle to pass legislation like ‘Jake's Law,’ promoting important mental health interventions such as the Collaborative Care Model and advocating for youth to more easily access mental health care services.” APA established the award in 1986 in honor of Sen. Jacob K. Javits, who represented New York state in the U.S. Senate from 1957 to 1981.

Group-Based Interventions for Adolescents with Gaming Disorder or Problematic Gaming Behavior: A Systematic Review

Abstract Purpose of Review Although gaming disorder (GD) is prevalent during adolescence and group-based interventions (GBIs) prove highly beneficial for substance use disorders, much remains unknown regarding their utility for addressing problematic gaming (PG) and GD. This systematic review thus explores the potential value of GBIs for adolescents with PG/GD. Recent Findings With the inclusion of PG/GD as a potential diagnosis by the American Psychiatric Association in 2013 and the acceptance of GD as a psychological disorder by the World Health Organization in 2019, research on this topic has proliferated. Although reviews to date have accorded attention to cognitive behavioral therapy, technology-based interventions, or focused on broader conditions such as “Internet addiction,” none has exclusively focused on GBIs or adolescent populations. Summary The findings from the eight retained studies suggest a positive impact of GBIs on adolescent PG/GD. Nonetheless, the particular benefits of “the group” as a modality remained largely unaddressed. Future research should adopt more rigorous designs to understand its underlying mechanisms.

In Case You Haven't Heard…

Rapid induction with naltrexone, and children who lost parents to drug overdoses, are two important studies that were released last week in the midst of the American Psychiatric Association's (APA) annual meeting. Both studies were funded by the National Institute on Drug Abuse and will be covered in next week's issue. Meanwhile, reflecting at the APA's addiction‐themed conference covered in this issue, ADAW was reminded of another APA conference years ago, in which we were in the audience surrounded by psychiatrists who were listening, somewhat distractedly, to a presentation about addiction. “Why do we have to hear this addiction stuff,” we overheard one audience member say to another. So for those who think progress isn't taking place, it is. Kudos to outgoing APA president Petros Levounis, M.D., for his work on this and also to American Journal of Psychiatry editor Kathleen Brady for the current addiction‐themed issue. There are probably some psychiatrists who still wonder why they need to know about addiction. If they were at last week's conference, though, they don't have any more questions.

APA poll: U.S. adults anxious over election, current events

Many adults in this country are feeling increasingly anxious, particularly more so than they did the previous year — from 43% this year compared to 37% in 2023 and 32% in 2022, according to the results of the American Psychiatric Association's (APA's) 2024 mental health poll.

Coming Up…

The annual meeting of the American Psychiatric Association will be held May 4‐8 in New York City. For more information, go to https://www.psychiatry.org/psychiatrists/meetings/annual‐meeting

Pharmacogenomic Clinical Support Tools for the Treatment of Depression.

In this review, the authors update the 2018 position statement of the American Psychiatric Association Council of Research Workgroup on Biomarkers and Novel Treatments on pharmacogenomic (PGx) tools for treatment selection in depression. The literature was reviewed for new clinical trials and meta-analyses, published from 2017 to 2022, of studies using PGx tools for treatment selection in depression. The blinding and control conditions, as well as primary and secondary outcomes and post hoc analyses, were summarized. Eleven new clinical trials and five meta-analyses were identified; all studies had primary outcome measures related to speed or efficacy of treatment response. Three trials (27%) demonstrated efficacy on the primary outcome measure with statistical significance; the three studies used different PGx tools; one study was open-label and the other two were small single-blind trials. Five trials (45%) did not detect efficacy with statistical significance on either primary or secondary outcome measures. Only one trial (9%) used adverse events as a primary outcome measure. All studies had significant limitations; for example, none adopted a fully blinded study design, only two studies attempted to blind the treating clinician, and none incorporated measures to estimate the effectiveness of the blinds or the influence of lack of blinding on the study results. The addition of these new data do not alter the recommendations of the 2018 report, or the advice of the U.S. Food and Drug Administration, that the evidence does not support the use of currently available combinatorial PGx tools for treatment selection in major depressive disorder. Priority efforts for future studies and the development and testing of effective tools include fully blinded study designs, inclusion of promising genetic variants not currently included in any commercially available tests, and investigation of other uses of pharmacogenomics, such as estimating the likelihood of rare adverse drug effects, rather than increasing the speed or magnitude of drug response.

APA conference theme: Addiction

The theme of this year's annual meeting of the American Psychiatric Association (APA) is “Confronting Addiction from Prevention to Recovery.” This is appropriate considering the crisis facing America and the fact that outgoing president Petros Levounis, M.D., is an addiction psychiatrist. ADAW will of course be at the meeting, which is in New York City and starts May 4. Among the sessions are (links will take you to the APA meeting website with presenters and descriptions of presentations).

Coming Up…

The American Psychiatric Association is holding its Annual Meeting May 4–8 in New York. The meeting will be held in‐person and virtually. (Registration for the virtual meeting opens in February.) Visit https://www.psychiatry.org/psychiatrists/meetings/annual‐meeting/registration for more information.

Coming Up…

The annual meeting of the American Psychiatric Association will be held May 4‐8 in New York City. For more information, go to https://www.psychiatry.org/psychiatrists/meetings/annual‐meeting

Cognitive disorders in Parkinson's disease

Movement disorders undoubtedly form the core of the Parkinson's disease (PD) clinical picture. However, several other clinical manifestations can significantly complicate the course of the disease. These are the so-called non-motor symptoms, which include emotional, cognitive, autonomic, and sensory disorders, as well as psychotic [1, 2, 3]. According to DSM-IV criteria (American Psychiatric Association, 1994), dementia in PD can be presented as a progressive memory impairment syndrome in the absence of aphasia, apraxia, or agnosia. Keywords: Parkinson's disease; cognitive disorders; dementia; Alzheimer's disease; levodopa; acetylcholinesterase inhibitors

Coming Up…

The American Psychiatric Association is holding its Annual Meeting May 4–8 in New York. The meeting will be held in‐person and virtually. (Registration for the virtual meeting opens in February.) Visit https://www.psychiatry.org/psychiatrists/meetings/annual‐meeting/registration for more information.

APA poll: Americans' thoughts shift about social media harms

Americans in 2024 are somewhat split on the mental health benefits of social media according to the American Psychiatric Association's (APA's) new Healthy Minds Monthly poll, which was fielded by Morning Consult on behalf of the APA. The public annual opinion poll was released on April 2.

MENTAL DISORDER PROPORTION OF RECRUITED INPATIENTS IN THE DEPARTMENT OF PSYCHIATRY, MILITARY HOSPITAL 103 IN 2 YEARS (2022 - 2023)

Objectives: To investigate the proportion of mental disorders and military-related factors among recruited inpatients. Methods: A retrospective study on 296 recruits treated in the Department of Psychiatry, Military Hospital 103 from 2022 to 2023 compared to 126 military recruiting-naïve participants obtained from community patients treated at the same department and during the same period. Diagnostic criteria were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition of the American Psychiatric Association. Results: Most mental disorders had the onset within 6 months of recruitment (51.7%) and were more common in lower military rank (78.3%). Out of several main mental disorders, major depressive disorder and schizophrenia were prominent (22.6% and 17.9%, respectively). However, the proportion of schizophrenia in recruited inpatients was double lesser than in community inpatients (17.9% and 51.6%, respectively). Dissociative disorders and factitious disorders were unique in recruited inpatients compared with community inpatients with mental health disorders (13.5% and 13.9% vs 0.8% and 0%, respectively). Conclusion: In the military, the proportion of mental disorders of recruited inpatients compared with community control inpatients is different not only by a higher percentage of dissociative disorders and factitious disorders but also by a smaller percentage of schizophrenia.

Roles of Hospital Type and Community Setting in Rate of Screening for Metabolic Disorders Among Psychiatric Patients.

Globally, rates of metabolic disorders continue to climb, leading to significant disease morbidity and mortality. Individuals with mental illness are particularly prone to obesity, and some medications, such as antipsychotics, may increase the risk for metabolic disorders. The American Psychiatric Association and the American Diabetes Association recommend that patients taking antipsychotic medications receive regular screening for metabolic disorders. This study examined hospital and community factors associated with screening these patients for such disorders. The authors combined Centers for Medicare and Medicaid Services (CMS) hospital-level data on screening for metabolic disorders among patients with an antipsychotic prescription with community data, including urbanization classification, social vulnerability, and metabolic disease presence and risk factors. Data were merged at the county level and evaluated with a nonparametric multivariate regression model. The CMS data set included 1,497 U.S. hospitals with data on screening for metabolic disorders among patients with an antipsychotic prescription. Screening rates varied by type of facility; acute care and critical access hospitals outperformed freestanding psychiatric facilities (p<0.001). No other variables examined in the multivariate model were associated with screening for metabolic disorders. Despite common resource limitations, screening for metabolic disorders may be driven more by logistics and less by time, finances, or a community's primary care network. Identifying the specific logistical challenges of freestanding psychiatric facilities could aid in the development of targeted interventions to improve the rates of screening for and treatment of not only metabolic disorders but also other common comorbid conditions.

Caring for Patients With Body Dysmorphic Disorder Seeking to Undergo Plastic Surgery and/or Aesthetic Interventions.

In the field of medical aesthetics and plastic surgery, it is not uncommon to interact with clients who never seem to be satisfied, regardless of the success of an intervention. Medical professionals may attribute this to the patient having an overly critical nature; however, this continual dissatisfaction could also be the result of a mental health disorder known as body dysmorphic disorder (BDD) that is significantly underdiagnosed and prevalent within the plastic surgery and aesthetic patient population. According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; American Psychiatric Association, 2013), BDD is defined as, "a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others" (Substance Abuse and Mental Health Services Administration, 2016, Table 23). Having the ability to identify the signs of BDD, utilize appropriate communication skills with individuals who may have BDD, and understand the implications of providing additional aesthetic treatments for patients who present with BDD allows aesthetic practitioners to prioritize and promote patient safety, well-being, and satisfaction.