Authors: Writing Committee for the REMAP-CAP investigators.

Abstract: What is the effect of treatment for critically ill patients with COVID-19 on longer-term mortality, disability, and health-related quality of life?

In this clinical trial that included 4,869 critically ill patients with COVID-19, the probability was high that IL-6 receptor antagonists and antiplatelet agents improved survival at six months. Long-term outcomes were not improved with therapeutic anticoagulation (11.5%), convalescent plasma (54.7%), or lopinavir-ritonavir (31.9%) and were worsened with hydroxychloroquine. Corticosteroids did not improve long-term outcomes, although enrollment had been terminated early in response to external evidence.

In a bid to determine the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes, the research team enrolled the patients between March 9, 2020, and June 22, 2021, from 197 sites in 14 countries. The final 180-day follow-up was completed on March 2, 2022.

Among critically ill patients with COVID-19 randomized to receive one or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with patients randomized to the control; and treatment with an antiplatelet had a 95% probability of improved 180-day mortality compared with patients randomized to the control.

Importance: Randomized clinical trials in critically ill patients, including those with COVID-19, typically assess short-term outcomes, such as organ failure or 28-day mortality; fewer published trials assess whether treatments affect long-term survival and patient-centered outcomes, such as disability and health-related quality of life (HRQoL).

Longer-term effects of therapies for the treatment of critically ill patients with COVID-19 are, of course, unknown.

But longer-term survival free of major disability with an acceptable HRQoL may be more important to patients than short-term survival—which has caused The World Health Organization and others to call for additional research on the effect of initial therapeutic interventions on longer-term outcomes.

The Randomized Embedded Multifactorial Adaptive Platform for Community Acquired Pneumonia (REMAP-CAP) trial is an ongoing international, multicenter, randomized platform trial evaluating multiple treatments for patients with severe pneumonia in both pandemic and non-pandemic settings.

Availability: Published by JAMA Network.

Authors: Scott Beach, MD, FACLP, et al.

Abstract: In 2010, ACLP surveyed US residency programs to understand training in C-L Psychiatry, leading to recommendations in 2014. Since then, residency training in C-L Psychiatry has evolved through competing training demands, increased prioritization of electives, and reactions to COVID-19.

So, the Academy’s Residency Education Subcommittee set out to determine the current state of C-L Psychiatry residency training across the US, including the structure of core and elective resident rotations, attending physician staffing, presence of fellows and other trainees, didactic curriculum, and impact of COVID-19.

They designed and piloted an 81-question survey tool that was sent to program directors of 269 US general psychiatry training programs—resulting in 103 responses. Responding programs were larger and more likely to have a C-L Psychiatry fellowship than non-responding programs.

Among those responding, the amount of time spent on core C-L Psychiatry rotations has increased in the past decade, but programs have also shifted C-L Psychiatry training earlier during residency. Programs are increasingly challenged to provide an optimal C-L Psychiatry experience, and updated ACLP guidance may be appreciated, say the authors.

The nature of C-L Psychiatry work has also changed significantly in the past decade, with the expansion of outpatient C-L Psychiatry services, the introduction of proactive consultation models, and the broad use of telepsychiatry during the pandemic.

Importance: “Understanding the details of residency training in C-L Psychiatry is essential to improving the experience of trainees in our subspecialty and recruiting future trainees into our fellowships,” say the authors.

Availability: Pre-publication in the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Authors: Anthony Quinn, PhD, et al.

Abstract: Previous research has examined how the age at which an individual first gambles (age of gambling onset) correlates with problematic behavior later in life, such as problematic alcohol or substance use. Much less is known about how age of gambling onset, particularly as a child or as a young adult, might influence future gambling.

The research team examined three age groups (under 18, 18-20, 21 and over) and found no statistically significant associations between age of gambling onset and severity of recent pathological gambling, nor gambling expenditure, in the past year, nor gambling frequency in the past week.

“Future longitudinal study should discern the causality of these findings and ascertain whether these findings can be extended to older and clinical populations,” say the authors. “Future work should explore other variables, such as ethnicity and socioeconomic background, that may be relevant to understanding variations in age of gambling onset and its repercussions.”

Importance: Gambling has become pervasive among males and females of all ages, especially with the introduction of online gambling. Literature highlights the prevalence of underage gambling in the US as an ongoing concern despite all forms of gambling being illegal under the age of 18 in all states and some forms of gambling being illegal under the age of 21 in others. As the authors say, gambling can precede problematic gambling, both during adolescence and adulthood, and there is a need for an improved understanding of underlying risks and protective factors.

Research involving children, adolescents, and young adults should be cognizant of comorbidities between gambling and other forms of addiction and maladaptive behavior during childhood and beyond. Correlations have been noted between early age of gambling onset and (co-occurring) problematic alcohol use, drug or substance use, smoking, depression, poor physical health, bankruptcy, and attention-deficit hyperactivity disorder.

In light of negative outcomes of continued gambling over the life course, particularly from a young age, there are opportunities to identify characteristics of gambling behavior that might serve as conduits towards these outcomes. More specifically, there is an opening for research to examine whether age of gambling onset correlates with an individual’s gambling frequency, incurred gambling losses, and performance in a neurocognitive gambling task.

“This is important so that prevention efforts can be put in place to limit these detrimental behaviors where they are found to be significant indicators of gambling disorder and a possible antecedent to co-occurring risks,” say the authors.

Conflicting studies have found both that gambling later in life is shaped by gambling as a child or adolescent^, and that it is not. “However, scholarly work is consistent in its call for closer investigation of how childhood upbringing can shape gambling in later life so that precursors to the adult clinical presentation of pathological gambling are better understood,” say the authors.

Availability: Published in The American Journal on Addictions.

Authors: Bin Gao, PhD, MD, Zhejiang University School of Medicine, et al.

Abstract: This study aims to examine association of Life’s Simple 7 (LS7), an estimation of cardiovascular health status, with depression and the modification by genetic risk.

Participants aged 50 years and older in the English Longitudinal Study of Ageing (ELSA) were analyzed. (ELSA study is an ongoing, community-based, longitudinal study performed in a nationally representative sample of residents aged 50 years and older in England.) Cardiovascular health status was assessed by the LS7 which contains four health behaviors and three biological metrics.

Findings indicate that ideal cardiovascular health is associated with decreased depression. Improved levels of behavioral metrics (BMI, smoking, and physical activity) and blood glucose were protective against depression. But a better cholesterol status was associated with an increased risk of depression.

Importance: Examining the prospective association between LS7 and depression may help provide evidence in determining the role of adherence to a combination of healthy behaviors in preventing depression.

Availability: Published in Psychiatry Research.

Authors: Isabella Channell, BS, et al.

Abstract: Hazardous substance use is a major public health concern among individuals with a history of sexual victimization. Although increased religiosity has been known to serve as a protective factor against hazardous substance use, religious individuals with a history of sexual victimization may be at a greater risk for hazardous substance use due to difficulties reconciling sexual victimization with their religious beliefs. Individuals with greater trauma-related shame may engage in hazardous substance use as a means of coping with the traumatic event.

The authors’ study of 614 participants suggests that organizational, non-organizational, and intrinsic religiosity are positively associated with hazardous alcohol use at higher, but not lower, levels of trauma-related shame. Organizational and intrinsic religiosity are positively associated with hazardous drug use at higher, but not lower, levels of trauma-related shame.

Importance: This is the first study to examine the role of trauma-related shame in the relationship between religiosity and hazardous substance use. Findings underline the importance of targeting trauma-related shame in religious individuals with a history of sexual victimization.

Availability: Published in The American Journal on Addictions.