Authors: Jagdish Khubchandani, professor of public health, New Mexico State University, et al.

Abstract: Many people with type 2 diabetes also struggle with depression, and this combination can lead to premature death, researchers say. More than 35 million Americans have diabetes, and more than 95 million have prediabetes, making diabetes one of the leading causes of death in the US.

Researchers used data on nearly 15,000 people from the 2005 to 2010 National Health and Nutrition Examination Survey to explore this association. They found that more than 10% of American adults suffer from depression or diabetes. Participants with diabetes were 1.7 times more likely to die prematurely than those without diabetes.

The risk of death more than quadrupled for participants with both diabetes and depression compared to those without diabetes or depression.

Many demographic, psychosocial and biological mechanisms could be responsible for the co-occurrence of depression and diabetes, the authors suggest. They include lower income and education, racial/ethnic minority status, unhealthy lifestyles, and having other chronic diseases.

About 75% of people with diabetes receive treatment to manage their disorder in developed countries like the US. But more than 50% of diabetics with behavioral health issues do not get adequate mental health care, the authors say.

They recommend that physicians integrate treatment of mental health issues into primary and specialist care for diabetes.

“Given the high burden of depression, T2D, and their comorbid occurrence, extensive surveillance, and collaborative team management via interdisciplinary care teams for these two disorders, are highly recommended,” say the authors.

Importance: A plethora of recent reviews have reported the prevalence of depression among individuals living with T2D. A review of 26 comparative and epidemiological studies in 2019 found that the point prevalence of major depressive disorder among people with T2D was 14.5%, and people with T2D were 1.73 times more likely to have major depressive disorder. T2D and depression are leading global public health problems associated with profound disability and lower quality of life. Extensive evidence suggests that the two disorders are frequently comorbid. However, long-term effects such as the risk of mortality due to depression among people living with T2D are not well explored.

Availability: Published by Diabetes & Metabolic Syndrome: Clinical Research & Reviews.

Authors: Yelizaveta Sher, MD, FACLP, et al.

Abstract: C-L psychiatrists frequently address dyspnea in intensive care unit (ICU) patients. Dyspnea is common in this patient population, but is frequently misunderstood and underappreciated in non-communicative ICU patients, say the authors.

This paper provides an updated review on dyspnea specifically in the ICU population, including its pathophysiology and pharmacological and non-pharmacological management, aimed at C-L psychiatrists consulting in ICU. A reference guide has been created to help C-L psychiatrists and intensivists in the screening and treatment of dyspnea and Dyspnea-Associated Anxiety (DAA) in critically ill patients.

Dyspnea is frequently associated with anxiety, prolonged days on mechanical ventilation, and worse quality of life after discharge, say the authors. It can also increase the risk of posttraumatic stress disorder post ICU discharge. However, dyspnea is not routinely screened for, identified, or addressed in the ICU.

“C-L psychiatrists have been increasingly asked to manage delirium, anxiety, and agitation experienced by patients in the ICU,” say the authors. “What C-L psychiatrists inadvertently but frequently address in these consults is dyspneas as well as DAA. Dyspnea causes a lot of distress for patients, heightens anxiety, complicates medical management, and leads to post-ICU psychological consequences, such as PTSD. However, it is rarely screened for in clinical practice or studied.”

A recent study of lung transplant recipients found that clinician evaluation reported 63% of patients had dyspnea during their admission to the ICU after lung transplant surgery. “Dyspnea can increase duration of mechanical ventilation, worsen rehabilitation efforts, and prolong ICU stays. There is established data in the outpatient setting demonstrating dyspnea as a predictor of hospitalization and mortality in patients with chronic lung disease.

“Dyspnea is frequently confused with psychological anxiety preventing patients’ cooperation in weaning from ventilation. Hence, dyspnea should be a symptom that is recognized and actively managed by ICU physicians and C-L psychiatrists. Several excellent reviews over the last decade have discussed dyspnea and its proposed management.”

Importance: Dyspnea is common, distressing, and detrimental in ICU patients. Unfortunately, it is not screened for and is often misunderstood and underappreciated. C-L psychiatrists are frequently asked to manage anxiety in the ICU, but a frequent precipitant of this anxiety is dyspnea. Hence, while ICU clinicians treat underlying pathology and respiratory therapists manage ventilatory settings to address dyspnea, C-L psychiatrists can further educate their colleagues on the interplay between dyspnea and DAA.

Availability: To be published by the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Authors: Margaret Paschen-Wolff, DrPH, et al.

Abstract: Limited research has explored sex differences in opioid use disorder medication (MOUD) treatment outcomes. The purpose of this study was to examine MOUD initiation onto buprenorphine-naloxone (BUP-NX) versus extended-release naltrexone (XR-NTX) by sex, and sex differences in clinical and psychosocial outcomes.

Using data from a 24-week open-label comparative effectiveness trial of BUP-NX or XR-NTX, this study examined MOUD initiation (i.e., receiving a minimum one XR-NTX injection or first BUP-NX dose) and 24-week self-report outcomes. Regression models were used to estimate the probability of MOUD initiation failure among the intent-to-treat sample, and the main and interaction effects of sex on outcomes of interest among the subsample of participants who successfully initiated MOUD.

Importance: Results indicate that further research should explore how to integrate employment support into MOUD treatment to improve patient outcomes, particularly among women.

Availability: Published by The American Journal on Addictions.

Authors: John Patrick Janowski, MD, et al.

Abstract: Serotonin syndrome is an acute, life-threatening illness characterized by mental status changes, neuromuscular symptoms and autonomic instability. Some patients taking serotonergic antidepressants have been noted to have unexplained mental status changes and/or neuromuscular changes without autonomic instability, raising the possibility of a more chronic or attenuated form of serotonin syndrome.

At a tertiary psychiatric outpatient clinic, patients with unexplained mental status and/or neuromuscular changes without autonomic instability had antidepressant blood levels assessed.

Eleven patients were identified with signs and symptoms partially consistent with serotonin syndrome. Nine patients had cognitive changes, while four had motor changes and three had psychosis. All patients had elevated blood levels of a single serotonergic antidepressant. Limited follow up suggests that symptoms improve with reduction of antidepressant medication.

Importance: These cases suggest that a more chronic, attenuated form of serotonin syndrome exists. Diagnostic criteria are proposed for a distinct clinical entity—subacute serotonin syndrome (SSS). Clinicians should consider drawing antidepressant levels for patients with symptoms and signs suggestive of SSS—especially those at increased vulnerability for excessive serotonergic agonism. Given the high prevalence of antidepressant medication use, the awareness of SSS could lead to improved patient outcomes.

Availability: To be published by the Journal of the Academy of Consultation-Liaison Psychiatry (JACLP).

Authors: Joseph Cerimele, MD, FACLP, et al.

Abstract: The authors set out to determine the perceived acceptability and helpfulness of bipolar disorder symptom measures, and rank the measures in order of preference, among individuals with bipolar disorder.

They recruited 20 participants 18 years or older with any type of bipolar disorder from a primary care clinical site and a national advocacy organization.

Participants completed three symptom measures or combination of measures: 1) Affective Self-Rating Scale (ASRS); 2) combination Patient Mania Questionnaire-9 (PMQ-9) and Patient Health Questionnaire-9 (PHQ-9); and 3) combination Altman Self-Rating Mania Rating Scale (ASRM) and PHQ-9. A semi-structured interview was conducted, and participants ranked preference of measures. Interviews focused on participants’ rationale for measure preferences. Interviews were analyzed by two psychiatrist-investigators using content analysis, and themes were determined. The average rank of each measure was determined.

Individuals with bipolar disorder preferred the combination PMQ-9 and PHQ-9 for use in monitoring treatment due to perceived strengths such as format, ease of completion and interpretation, accurate description of experiences, and feasibility of use in practice.

This combination should be considered for use in monitoring treatment of bipolar disorder, say the authors.

Importance: C-L Psychiatry in primary care commonly includes use of patient-reported symptom measures to screen for and monitor treatment of psychiatric disorders. Additionally, psychiatrists working in collaborative care teams use symptom measure results to monitor individual patient outcomes (measurement-based care) and estimate population effects of clinical services (e.g.: proportion of patients receiving treatment with improvement).

Many clinicians regularly use the Patient Health Questionnaire-9 to detect and monitor treatment of individuals with major depressive disorder, and to monitor depression response and remission rates. This strategy is especially important in collaborative care and increasingly used in clinical settings such as primary care to increase the proportion of people receiving treatment.

Adopting a symptom measure in practice involves clinicians and patients who can inform which measure to use. The authors previously explored which measures clinicians might use in monitoring bipolar disorder and found respondents significantly preferred three specific symptom measures. In the current study, they sought to identify the preferred symptom measure(s) among individuals with bipolar disorder and associated rationale.

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