2 Minute Medicine ® - Psychiatry

1. This retrospective cohort study found that poor sleep quality and increased light exposure at night were associated with more symptoms of stress and depression during the 3rd trimester of pregnancy. 2. However, poor sleep quality, but not light exposure, was associated with worsening anxiety and depression levels during the 2nd trimester. Evidence Rating Level: 2 (Good) Psychological wellbeing is essential during pregnancy for optimal birth outcomes. However, pregnant women are particularly susceptible to stress, anxiety, and depression, which can negatively impact pregnancy outcomes...

1. In this longitudinal cohort study, in midlife women with high adverse childhood experiences and high current life stressors, there was an association between C-reactive protein (CRP) and higher odds of having clinically significant depression symptoms. 2. However, this interaction was not significant for other inflammatory markers, including interleukin-6 (IL-6), interleukin-1-beta (IL-1β), or tumor necrosis factor-alpha (TNF-α). Evidence Rating Level: 2 (Good) Inflammatory markers, such as C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-1-beta (IL-1β), and tumor necrosis factor-alpha (TNF-α) demonstrate variable relationships with depression...

1. In this retrospective cohort study, patients with a history of depression, anxiety, or both did not have a significant increase in emergency department visits following bariatric surgery compared to those without. 2. Furthermore, patients with a history of depression and/or anxiety also did not have an increase in hospital readmissions in the first year post-bariatric surgery compared to those without. Evidence Rating Level: 2 (Good) Patients who undergo bariatric surgery have a high prevalence of preoperative mental illness...

1. This umbrella systematic review and meta-analysis found that depression rating scale scores were significantly improved across medical diseases in patients with comorbid depression compared to placebo. 2. However, antidepressants showed the greatest effect for treating depression comorbid with myocardial infarction, functional chest pain, and coronary artery disease. They demonstrated the least effect for low back pain and traumatic brain injury. Evidence Rating Level: 1 (Excellent) Major depression disorder (MDD) is highly prevalent among individuals with other medical conditions...

1. In this randomized controlled trial, adjunctive treatment with escitalopram or bupropion XL for 52 weeks was not superior to eight weeks in preventing relapse of mood episodes among patients with bipolar I depression. 2. The rates of adverse events were comparable across both approaches. Evidence Rating Level: 2 (Good) Study Rundown: Bipolar I disorder is characterized by episodes of mania and depressive symptoms. Depression often afflicts bipolar I patients more frequently than mania and is associated with a significantly elevated risk of suicidality...

1. In this randomized controlled trial, seniors with disabilities in long-term care facilities who participated in an eight-week mindfulness-based elder care (MBEC) program experienced significant improvements in their mental health following the intervention. 2. Furthermore, those in the MBEC group also experienced significant improvements in spiritual well-being compared to the control group. Evidence Rating Level: 1 (Excellent) Seniors with disabilities often live in restrictive environments, negatively impacting their mental health and spiritual well-being...

1. In a survey study, transgender and gender-diverse adolescents reported barriers, inadequate psychosocial support, and discrimination when receiving gender-affirming care through primary care.  2. They also highlighted benefits, such as convenience, and called for greater care coordination between primary care providers and gender care specialists to improve their experiences. Evidence Rating Level:  4 (Below average) Study Rundown: While gender-affirming care is recommended as the standard of care by the American Academy of Pediatrics, transgender and gender diverse (TGD) adolescents still face many barriers to accessing it...

1. In this meta-analysis of randomized controlled trials, religion and spirituality-based (R/S) therapies were found to be moderately more efficacious at post-treatment and follow-up compared to non-R/S treatments. 2. R/S treatments were also associated with improvements in symptoms and functioning compared to non-R/S treatments. Evidence Rating Level: 1 (Excellent) Person-centered approaches are becoming increasingly important in mental health care. Many people worldwide identify as having a religious/spiritual affiliation; therefore, including religion and spirituality-based (R/S) therapies may help provide person-centered mental health care...

1. Mean MADRS change at week 6 was -8.2 in the active tDCS group versus -8.0 in the sham tDCS group. 2. There were significantly more adverse events in the active tDCS group. Evidence Rating Level: 1 (Excellent) Study Rundown: Transcranial direct current stimulation (tDCS) has been proposed as a feasible treatment for major depressive disorder (MDD), but heterogeneous meta-analytic evidence and limited multicentre trial data exist. This randomized controlled trial aimed to assess the efficacy of active tDCS as an add-on treatment to a stable dose of selective serotonin reuptake inhibitors (SSRIs) in adults with MDD...

1. In this systematic review and meta-analysis, virtual reality (VR) treatments were associated with lower anxiety symptoms when compared to passive control groups. 2. However, in comparison to active controls, VR treatments were not statistically superior. Evidence Rating Level: 1 (Excellent) Virtual reality (VR) is a potential treatment option for mental health disorders which may be desirable given the high prevalence of anxiety disorders and the lack of mental health resources. Current meta-analyses on VR applications have not been updated for several years and were limited in the anxiety disorders investigated...

1. In this systematic review and meta-analysis, it was found that individuals with social anxiety disorder (SAD) had more difficulty recognizing facial expressions. 2. Individuals with SAD were also found to have a slower reaction time for recognizing happy facial expressions than controls. Evidence Rating Level: 1 (Excellent) Social anxiety disorder (SAD) is a highly prevalent disorder that may be further complicated by difficulties with emotional expression recognition (EER). To date, the data investigating whether individuals with SAD have impaired performance in categorizing facial expressions of emotion has been mixed...

1. In this systematic review, results demonstrated that moral injury was associated with professional and personal wellbeing and mental health outcomes, such as depression and anxiety. 2. Moral injury was also associated with burnout, compassion fatigue, and stress in healthcare workers. Evidence Rating Level: 1 (Excellent) Achieving a work-life balance may be difficult for healthcare workers due to significant work stressors. Moral injury — the experience of a moral transgression, either by yourself or those around you, and the resulting consequences — is a topic that is becoming more relevant in healthcare following the fast-paced and highly intense environment of the COVID-19 pandemic...

1. Anxiety and depression were more prevalent among individuals with eczema or psoriasis, and those with these inflammatory conditions were more likely to report poor sleep.  Evidence Rating Level: 2 (Good) Anxiety and depression are known to be more prevalent among those with inflammatory skin diseases, such as eczema and psoriasis. In this population-based match cohort study, researchers aimed to establish whether known risk factors for mental illness, such as poor sleep quality, disproportionately impact people with eczema or psoriasis...

1. Compared to healthy controls, participants with a first episode of schizophrenia had reduced expression of a microglia-associated protein, CSF1R.  2. CSF1R inhibition worsened anxiety behaviors in mice exposed to chronic unpredictable stress.  Evidence-rating level: 3 (Average) Psychosocial stress is thought to contribute to the development of schizophrenia, mainly for those with underlying genetic susceptibility. Though microglia are important regulators of stress in the brain, the role of microglia in the development of schizophrenia has not previously been thoroughly investigated...

1. In this systematic review and meta-analysis, there was a positive association between general perfectionism and binge eating. 2. There was also an association between Perfectionistic Concerns and binge eating, but not Perfectionistic Strivings. Evidence Rating Level: 1 (Excellent) Perfectionism has long been considered a risk factor for developing eating disorders. However, there has been a lack of evidence regarding the association between perfectionism and binge eating disorders. Furthermore, many studies have failed to consider different forms of perfectionism related to binge eating, such as Perfectionistic Concerns and Perfectionistic Strivings...

1. Important components of the endocannabinoid system (ECS) were isolated in the developing human fetal testis, implying that the development of this organ could be impacted by cannabinoid consumption.  2. Early testis exposure to phytocannabinoids directly and negatively impacted male gonadal development and physiology ex vivo.  Evidence Rating Level: 1 (Excellent) Study Rundown:  Cannabis is the most commonly consumed recreational drug by women in pregnancy, and the presence of THC (Δ9-trans-tetrahydrocannabinol) and cannabidiol (CBD) in the fetal blood and/or meconium suggest that this substance crosses the placenta...

1. For patients newly initiated on lithium or valproate, the absolute risks of chronic kidney disease (CKD) progression or acute kidney injury (AKI) were low and similar. 2. Higher cumulative exposure to lithium was associated with greater risk of CKD progression compared to valproate. 3. Higher median lithium levels were associated with increased risk of AKI in a dose-response relationship. EvidEnce Rating Level: 2 (Good) Study Rundown:  Lithium is used in the treatment of bipolar disorder, but has always been associated with concerns of nephrotoxicity, although the pathophysiology is not well understood...

1. For patients with schizophrenia, symptomatic response to antipsychotic medication at 2 and 4 weeks after initiation can appropriately predict non-response at 8 weeks, varying by baseline severity and specific antipsychotic trialed. Evidence Rating Level: 1 (Excellent) For patients with schizophrenia trialed on antipsychotic medication, it is unclear when to switch medication for failed responses, with guidelines ranging from 2-8 weeks. Though a meta-analysis suggested that non-improvement after 2 weeks of an antipsychotic trial was predictive of future non-improvement, baseline severity of schizophrenia was not accounted for...

1. Patients with mild cognitive impairment (MCI) randomized to a combined intervention of aerobic-resistance exercise and computerized cognitive training, had significantly improved cognitive scores compared to control. 2. There was no significant difference in cognitive improvement when comparing interventions with and without Vitamin D supplementation. Evidence Rating Level: 1 (Excellent) For individuals with mild cognitive impairment (MCI), interventions that have improved cognition include Vitamin D supplementation, aerobic exercise, resistance training, and computer-based cognitive training...

1. Patients with a history of treated delirium tremens (DT) are at higher risk for all-cause mortality and alcohol-related morbidities compared to patients with just alcohol dependence (AD) or other alcohol withdrawal states (AWS), during a mean follow-up period of less than 1 year. Evidence Rating Level: 2 (Good) An estimated 3 to 15% of patients with alcohol use disorder (AUD) experience delirium tremens (DT), a potentially fatal form of alcohol withdrawal characterized by confusion, hallucinations, hypertension, tachycardia, and seizures...