American Psychiatrists Research Articles

Personal and social connection to psychedelics is associated with lower drug use stigma among psychiatrists in the United States

AbstractBackground and AimsThis study sought to identify patterns of psychedelic use among American psychiatrists, to compare the demographic variables across categories of social proximity and personal use, and to determine how these categories influenced psychiatrists' attitudes towards drugs and people who use drugs.MethodsRespondents (N = 180; mean age = 48.4 [SD = 16.2]; male = 65.5%; trainees = 24.1%) were recruited via email lists/listservs and personal networks (snowball sampling).ResultsApproximately one-third (32.8%) of psychiatrists reported Personal Connection (i.e., history of personal use and social connection) to psychedelics. Psychiatrists with Personal Connection to psychedelics were more likely to be younger (p = 0.006, ηp2 = 0.057) and have fewer years of practice (p = 0.008, ηp2 = 0.058). Almost all (92%) of those with No Connection to psychedelics were out of training, compared with only 8% of those in training. Those with Personal and Social Connection to psychedelics were more likely to disagree: that using illegal drugs is morally wrong (p < 0.001, ηp2 = 0.28), that illegal drug users should go to prison (p < 0.001, ηp2 = 0.15), are weak minded (p < 0.001, ηp2 = 0.10), have no future (p < 0.001, ηp2 = 0.12), are not well educated (F(2.0, 170) = 7.38. p < 0.001, ηp2 = 0.08), are dishonest (p < 0.001, ηp2 = 0.10), and that illegal drug users ‘make me angry’ (p < 0.001, ηp2 = 0.10).ConclusionsPersonal and social connection to psychedelics is associated with decreased stigma towards drug use and people who use drugs. Future research should examine whether proximity to psychedelic use impacts other factors (e.g., empathy, therapeutic alliance) involved in psychiatry training and practice.

American Psychiatrists' Opinions About Classic Hallucinogens and Their Potential Therapeutic Applications: A 7-Year Follow-Up Survey

American Psychiatrists' Opinions About Classic Hallucinogens and Their Potential Therapeutic Applications: A 7-Year Follow-Up Survey

How the Food and Drug Administration Drug Approval Process Relates to the Potential Approval of Intravenous Racemic Ketamine for Treatment-resistant Major Depression.

This column focuses on the status of intravenous racemic ketamine for the treatment of patients suffering from a form of major depressive disorder that does not respond to trials of currently available biogenic amine antidepressants. To provide context, the column reviews the 3 pivotal elements of the usual Food and Drug Administration (FDA) drug approval process: (1) the unmet medical need (ie, the indication) for which the drug is being developed, (2) the efficacy of the drug for that condition, and (3) the safety/tolerability of the drug. This column is based on the author's 45-year history of drug development work and is not a statement of the FDA. There are typically 3 phases in the drug development process: (1) studies done in normal volunteers, (2) typically small-scale proof of concept studies, and (3) large-scale registration trials. This third phase is critical in determining the efficacy, safety, and tolerability of the drug in a manner that most closely follows the clinical use of the drug. This column focuses specifically on whether generally small-scale studies done in academic centers are sufficient for drug approval, and it briefly reviews lithium and clozapine as examples of psychiatric medications that had such academic research in the literature, as well as clinical use in other countries. Those data supported the unique value of these medications in patients with bipolar disorder and treatment-resistant schizophrenia (ie, the unmet medical need), respectively, and the findings led American psychiatrists to advocate for FDA approval of these medications. Their efforts led to the needed registration trials for FDA approval of these medications. This column reviews the key features of registration trials and the reason that they are critical for FDA approval, and it discusses 2 special considerations related to the intravenous administration of racemic ketamine. First, racemic ketamine is not esketamine but, instead, it contains R-ketamine in addition to S-ketamine (ie, esketamine). The second consideration is that differences between intravenous and intranasal administration may affect the safety of the drug. While safety concerns were specifically addressed in the registration trials for esketamine, comparable research remains to be done for intravenous racemic ketamine. Understanding how the FDA's drug approval process works is important for prescribers, their patients, and the public.

The Protest Psychosis & the Future of Equity & Diversity Efforts in American Psychiatry

Abstract This essay chronicles the history of medical associations between schizophrenia and Blackness that emerged during the tumultuous decades of the 1960s and 1970s, when American psychiatrists overdiagnosed schizophrenia in Black men in ways that undermined brain science of the era. I provide data to show how racially disparate diagnostic outcomes resulted not solely from the attitudes or biases of clinicians, but from a series of larger political and social determinants, most notably changing frameworks surrounding mental illness and political protest. I conclude by highlighting how training clinicians to examine their own cultural biases also needs to include training in how structures and institutions produce symptoms and diseases, and how we can only build better structures to support health if we can individually and then communally imagine them.

Managing power and psychiatric training in the United States, 1945–1990

In the wake of their heightened role in addressing the emotional challenges of United States soldiers during World War II, American psychiatrists increasingly argued that their knowledge of human nature, based on interpretation of unconscious processes, was a powerful tool in effecting changes in society. As they turned to training an adequate supply of psychiatrists to meet expanding demand, educators in psychiatry residency programs faced questions about whom to entrust with the power of psychiatric interpretation, how educators’ knowledge about trainees’ own unconscious processes should be harnessed, and how much to adhere to strict psychoanalytic doctrine in training. During the 1970s, social and cultural upheavals outside and inside psychiatry began to dismantle the grand claims of the postwar generation of psychiatrists, while shifts in the 1980s led educators to focus more on seemingly objective educational measures. Trainees’ and critics’ serious questioning of authority and structures in American society, and within psychiatry training programs, was perhaps as much of a factor – if not more – in the shift away from an emphasis on the interpretive power of psychoanalysis in favor of more eclectic and ultimately biological approaches in academic psychiatry.

Sexual violence, deviance, and the paraphilias in American psychiatry, 1952–2013

ABSTRACT This article explores arguments within American psychiatry from the 1950s around whether rapists were mentally ill. It analyses debates in the lead-up to the various editions of the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM) from 1952 to the latest version in 2013, focussing particularly on a diagnostic category called ‘Paraphilic Coercive Disorder’ (PCD). Since the first DSM, American psychiatrists had routinely considered people who committed certain forms of sexual violence to be suffering from mental disorders. For example, ‘Paedophilia’ and ‘Sexual Sadism’ had always been considered valid diagnoses. However, the APA refused to pathologise non-sadistic sexual violence committed against adults. Opposition can be classified into four overlapping arguments: uncertainty about ‘normal’ male sexual aggression, feminist worries about ‘excusing’ harmful sexual behaviours, concerns about the misuse of psychiatry in courts, and the need to defend the psychiatric profession from encroachments on their ‘territory’ by non-medically trained psychologists, social workers, and anti-psychiatric activists.

APA Library Exhibit Recognizes Asian American Psychiatrists

APA Library Exhibit Recognizes Asian American Psychiatrists

Mental health research in South America: Psychiatrists and psychiatry trainees' perceived resources and barriers.

As mental health issues continue to rise in Latin America, the need for research in this field becomes increasingly pressing. This study aimed to explore the perceived barriers and resources for research and publications among psychiatrists and psychiatry trainees from nine Spanish-speaking countries in South America. Data was collected through an anonymous online survey and analyzed using descriptive methods and the SPSS Statistical package. In total, 214 responses were analyzed. Among the participating psychiatrists, 61.8% reported having led a research project and 74.7% of them reported having led an academic publication. As for the psychiatry trainees, 26% reported having conducted research and 41.5% reported having published or attempted to publish an academic paper. When available, having access to research training, protected research time and mentorship opportunities were significant resources for research. Further support is needed in terms of funding, training, protected research time and mentorship opportunities. However, despite their efforts to participate in the global mental health discussion, Latin American psychiatrists and psychiatry trainees remain largely underrepresented in the literature.

Inconsistencies between national drug policy and professional beliefs about psychoactive drugs among psychiatrists in the United States.

Evidence points to an incongruence between international drug policy and expert opinion about safety, abuse potential, and therapeutic potential of specific drugs. However, no prior studies have directly explored psychiatrists' attitudes about the current drug schedule. Therefore, we examined whether American psychiatrists' perceptions of four psychoactive drugs differed from those indicated by their schedules. A quasi-experimental online survey of a convenience sample of psychiatrists in the United States (N=181; Mean age=48.7; Female=35%). Participants were randomized to receive 1-of-4 vignettes, each depicting a depressed patient reporting relief from symptoms after non-prescribed psychoactive drug use (i.e., psilocybin [Schedule I], methamphetamine [SchedII], ketamine [SchedIII], or alprazolam [SchedIV]). Participants responded to questions related to this clinical scenario and then rated the safety, therapeutic, and abuse potentials of these four drugs and alcohol. There were significant differences by vignette condition in mean likelihood ratings of: warning against engaging in drug use again (p<.01), being concerned about developing a new psychiatric problem (p<.001), being concerned about increased suicide risk (p<.01) and being supportive of further use of this drug as part of the treatment plan (p<.001). Overall, non-prescribed use of methamphetamine and alprazolam was rated more concerning and less acceptable than non-prescribed use of psilocybin and ketamine. Compared to psilocybin and ketamine, participants rated methamphetamine and alprazolam as less safe (p<.001), having less therapeutic potential (p<.001), and having more abuse potential (p<.001). Mean ratings of safety and abuse/therapeutic potential of alprazolam and methamphetamine were equivalent to that of alcohol, and all three were rated more harmful than psilocybin and ketamine. American psychiatrists' perceptions about safety and abuse/therapeutic potentials associated with certain psychoactive drugs were inconsistent with those indicated by their placement in drug schedules. These findings add to a growing consensus amongst experts that the current drug policy is not scientifically coherent.

Provider Perspectives on the Current Use of Lithium Medications and Lithium Monitoring Practices for Psychiatric Conditions.

PurposeDespite lithium being a gold standard treatment for bipolar disorder, the percentage of patients with bipolar disorder who are prescribed lithium medication has declined in many parts of the world over the past two decades. The use of lithium is limited by its narrow therapeutic window and adverse side effects, which necessitates frequent serum lithium monitoring; hence, there is a critical need for improved ways to monitor lithium levels in psychiatric patients. We have recently shown that saliva lithium levels are highly correlated with those in blood, thereby presenting an alternative to venipuncture. Saliva sampling could open the door for at-home collections – potential that has been exemplified throughout the COVID-19 pandemic – thereby allowing samples to be collected remotely and delivered to a specific site for testing. In addition, prototype point-of-care devices have been developed by others for serum lithium monitoring, suggesting potential for a saliva lithium monitoring device. Our objective was to query the perspectives of American psychiatrists on lithium treatment practices and obstacles, the potential for at-home saliva collection and point-of-care devices, for lithium monitoring, as an alternative to pathology-based blood testing.MethodsData was collected through an online, anonymous survey, distributed to American psychiatric societies.ResultsSixty-five respondents from 21 American states completed the survey. The majority of respondents were female, over 65 years of age, and/or had practiced for 30 years or more. The most frequent obstacles encountered with regard to lithium monitoring were adverse drug effects, and the need for monitoring. Overall, respondents believed saliva lithium monitoring and point-of-care devices would be useful, however raised concerns regarding validity and time-delay.ConclusionPoint-of-care devices and saliva lithium monitoring are promising alternatives to blood testing that would be welcomed by psychiatric societies, however, require extensive development and validation before implementation into a clinical setting.

Assessing Alexithymia across Asian and Western Cultures: Psychometric Properties of the Perth Alexithymia Questionnaire and Toronto Alexithymia Scale-20 in Singaporean and Australian Samples

Alexithymia refers to difficulties identifying feelings (DIF), describing feelings (DDF), and externally orientated thinking (EOT). Originally conceptualized by American psychiatrists, some researchers have since questioned the validity and application of this construct in Asian cultures. However, to date, there is little empirical work formally assessing the invariance of alexithymia across Asian and Western cultures. The present study aimed to help address this gap, by examining the psychometric properties and measurement invariance of two alexithymia measures, the Perth Alexithymia Questionnaire (PAQ) and Toronto Alexithymia Scale-20 (TAS-20), across samples from Singapore (n = 434) or Australia (n = 489). The same theoretically congruent factor structure was supported across both samples; this structure was fully invariant across samples for the PAQ, and partially invariant for the TAS-20. Both measures had good internal consistency and concurrent validity across samples, except the TAS-20 EOT subscale which had low internal consistency and factor loadings in both samples. The Singaporean sample reported higher DIF and DDF for positive emotions than the Australian sample. Overall, our results support the cross-cultural validity and application of the alexithymia construct. The PAQ and TAS-20 both appear to have good utility in this respect, though the PAQ may provide a more detailed facet-level profile.

Classification in Psychiatry

Classification in psychiatry has ancient roots but mainly took form in the 19th and 20th centuries. European and American psychiatrists brought to the fore careful observation and description of clinical course. Formal attempts to classify patients took root after World War II based on the exigencies of the time. The DSM-I was published in 1952 and summarized all the diagnoses in psychiatry. Diagnostic criteria were introduced in the DSM-III in 1980 to introduce reliability to the diagnostic process, and a multiaxial system was introduced to aid in the comprehensive assessment of patients, later dropped in the DSM-5. Dimensional measures were introduced to aid with patient assessment, although many categories were reformulated based on research findings. In the DSM-5, the diagnoses are listed in order of clinical importance. Residual categories exist for those who do not meet the criteria for a more specific disorder. Although the DSM-5 has been criticized, criteria-based diagnoses will persist until a system can be created based on etiology. This review contains 2 tables, and 23 references Keywords: classification in psychiatry, diagnostic criteria, DSM-5, Feighner criteria, International Classification of Diseases, Kraepelin

Representation of women at American Psychiatric Association annual meetings over 10 years (between 2009 and 2019).

Sex disparity is a major societal issue. The aim of this paper was to describe changes in the representation of women among speakers of the American Psychiatric Association (APA) annual meeting over 10 years, between 2009 and 2019 and to compare them to changes in the proportion of women among American psychiatrists. Data were collected from the programs of the APA annual meetings of 2009 and 2019, and from the Association of American Medical Colleges. Descriptive and comparative statistical analyses were performed. There were 1,138 distinct speakers at the 2009 conference and 1,784 at the 2019 conference. The number of distinct female speakers increased from 413 (36.3%) to 813 (45.6%). The proportion of female speakers at the meetings was almost equivalent to the proportion of women in the American psychiatrists' workforce. The number of female chairs increased from 158 (39.6%) to 322 (46.4%). There were 38 female speakers in child and adolescent psychiatry in 2009 (51.4% of 74 speakers) and 74 in 2019 (51.0% of 155 speakers). The representation of women at the APA annual meetings increased between 2009 and 2019. At the same time, the growth in the percentage of women in the American psychiatrists' workforce was slower. The APA appears to promote female representation during its annual meetings.

Psychosis Without Meaning: Creating Modern Clinical Psychiatry, 1950 to 1980

Over the last fifty years, American psychiatrists have embraced psychotropic drugs as their primary treatment intervention. This has especially been the case in their treatment of patients suffering from psychotic disorders such as schizophrenia. This focus has led to an increasing disregard for patients’ subjective lived-experiences, life histories, and social contexts. This transformation of American psychiatry occurred abruptly beginning in the late 1960s and 1970s. My essay looks the ways these major transformations played themselves out in everyday clinical practices of state hospital psychiatrists from 1950 to 1980. Using clinical case records from California state hospitals, I chronicle the ways institutional and ideological forces shaped the clinical care of patients with psychotic disorders. I show there was an abrupt rupture in the late 1960s, where psychiatrists’ concerns about the subjective and social were replaced by a clinical vision focused on a narrow set of drug-responsive signs and symptoms. Major political, economic, and ideological shifts occurred in American life and social policy that provided the context for this increasingly pharmacocentric clinical psychiatry, a clinical perspective that has largely blinded psychiatrists to their patients’ social and psychological suffering.

Peripheral Nerve: Health and Medicine in Cold War Latin America

Peripheral Nerve: Health and Medicine in Cold War Latin America

Social Media Disinformation Bots May Harm Psychiatry

Social Media Disinformation Bots May Harm Psychiatry

"Missing in Action" in Psychiatric Nursing History: The Role of Chief Nurse Adele S. Poston and Her Band of Nurses During World War I.

This is the first nursing journal article to introduce the pioneering work of American psychiatric nurse leader, Adele S. Poston. Poston supervised a team of nurses as they cared for soldiers serving with the American Expeditionary Forces during World War I in France. Poston and her nurses worked in the first American specialized neuropsychiatric hospital in a war. The soldiers they treated primarily had functional nervous disorders described at that time as "shell shock" or "war neuroses." The traumatized officers and enlisted men were considered capable of being cured and returned to active duty based on research done by American psychiatrists among British troops during the first 3 years of the war. The story of Poston's career prior, during, and after the war and her work with other nurses during a global war are significant in psychiatric nursing history. Bringing this hitherto missing piece of psychiatric and nursing history into the light gives us a unique opportunity to recognize Poston and the nurses who served with her, even as today we recognize the nurses who serve during the global COVID-19 pandemic. [Journal of Psychosocial and Mental Health Services, 59(6), 37-47.].

"Insanity Is the Price of Modern Civilization": The Discourse of Civilization and the Asian Insane in Modern America.

Examining debates on the link between civilization and insanity in the late nineteenth and early twentieth-century United States, this essay engages the discourse of civilization to discuss the ways in which insanity among Asian immigrants, in particular Chinese and Japanese, was understood, defined and debated. During the period, insanity was regarded as a disease of civilization, which had been increasing due to the struggles of modern life. While Americans witnessed insanity among the "colored" and Asians, they argued that these groups had lower rates of insanity than white Americans and European immigrants because they belonged to lower positions on the civilization scale. Though not explicitly racialist or even racist, the discourse of civilization ordered the international world and drew a clear color line between white westerners and non-white others. At the same time, American missionaries and medical professionals stationed in China and Japan, who were there to see and learn about insanity in Asia, reaffirmed the existing medical understandings of insanity and offered a knowledge base for American psychiatrists who would encounter the Asian insane at their mental institutions. The alleged rarity of mental troubles for Chinese and Japanese was not considered an asset; the insanity debates confirmed the non-white, non-American status of Asian immigrants, rendering them forever foreign. Moreover, their very distance from western civilization explained why Asians in America seemed to have suffered less from mental disturbances and how they could resist the debilitating effects of civilization and migration.

Call for Action to Address MH Disparities Impacting Asian Americans and Pacific Islanders

Call for Action to Address MH Disparities Impacting Asian Americans and Pacific Islanders

Rep. Grace Meng Addresses APA Caucus of Asian American Psychiatrists

Rep. Grace Meng Addresses APA Caucus of Asian American Psychiatrists