Authors: Ying Li Tan, assistant professor, Yong Loo Lin School of Medicine, National University of Singapore, et al.

Abstract: Frontotemporal dementia (FTD) may impose substantial psychological and social burdens on caregivers and family members that are unique from other forms of dementia due to its distinctive clinical characteristics. This systematic review investigates these impacts on caregivers and family members.

This systematic review included 36 papers with a total of 5129 subjects included in the studies. Like other forms of dementia, FTD caregivers had significant caregiver burden levels and psychological impacts. However, the financial costs of caring for a patient with FTD were found to be higher than those for Alzheimer’s disease.

“FTD patients often face challenges in obtaining a correct diagnosis and experience significant delays and multiple misdiagnoses,” say the authors. “Health care professionals may also be less familiar with FTD than with Alzheimer’s, leading to delayed diagnosis. This can cause considerable stress and deprive patients and caregivers of early intervention.”

While there are many studies on Alzheimer’s and its effects on caregivers and family members, “to our knowledge, there has not been a systematic review on FTD,” say the authors. “We believe that due to the earlier onset of FTD and the significant behavioral changes it involves, its effects on caregivers and family members can be different from those of other forms of dementia and can pose considerable challenges.”

Better education about FTD for family members and health care professionals is required to improve the quality of life for both patients and caregivers, they say, and more support needs to be provided at all stages of the disease.

“Identifying and understanding the various psychological and social impacts of FTD on caregivers and family members may facilitate increased quality of life for caregivers and patients with FTD by allowing more interventions and measures to be designed specifically for them.“

Importance: This study highlights that the psychosocial and financial impacts of FTD are different and unique compared to those of Alzheimer’s and other early-onset dementias.

Availability: Published by General Hospital Psychiatry.

Authors: Usue De la Barrera Marzal, assistant professor, University of Valencia, et al.

Abstract: The objective was to predict the level of depressive symptoms in emerging adults (aged 18-29) by analyzing sociodemographic variables, affect, and emotion. Thirty-three participants were asked to assess their current emotional state (positive or negative), recent events that may relate to that state, and emotion regulation strategies through ecological momentary assessment. Participants were prompted randomly by an app six times per day between 10:00 AM and 10:00 PM for a seven-day period.

Analysis of their answers using machine learning techniques showed that the Random Forest algorithm, a machine learning algorithm that combines the results of multiple decision trees, yields significantly better predictions than other models. By selecting predictors and utilizing sorting techniques, findings may provide valuable supplementary information to traditional diagnostic methods and psychological assessments, say the authors.

‘Emerging adults’ are considered to be at the period between the end of adolescence and the assumption of adult responsibilities, such as securing a stable job, getting married, or becoming a parent—a time of identity exploration, instability, self-focus, possibilities, and ‘feeling in-between.’

Stress may impact on the psychological status of this group and increase the incidence of mental disorders, say the authors. “The transition from adolescence to adulthood has seen a significant increase in depression, making it a major public health concern.”

They add: “To the best of our knowledge, there is limited research that combines sociodemographic and emotional variables that has been assessed ecologically and momentarily to predict depressive symptoms in emerging adulthood. Furthermore, there is even less research that applies machine learning techniques to analyze such data.”

Importance: The authors present a tool capable of predicting the level of depressive symptoms.

Availability: Pre-publication in Psychiatry Research.

Authors: Anastasia Evanoff, MD, et al.

Abstract: Ketamine is often used for sedation and management of acute agitation in general hospitals. Many hospitals now include ketamine as part of their standard agitation protocol, and C-L psychiatrists frequently find themselves treating patients who have received ketamine despite a lack of clear recommendations for management, say the authors.

This review includes benefits and adverse psychiatric effects, compares ketamine to more traditional agents of agitation control, and provides C-L psychiatrists with a summary of available knowledge and recommendations for managing patients receiving ketamine.

From the review of 37 articles, ketamine was found to have multiple benefits, including shorter time to adequate sedation for agitated patients when compared to haloperidol ± benzodiazepines and unique advantages for continuous sedation.

However, ketamine carries significant medical risks, including high rates of intubation. It appears to induce a syndrome that mimics schizophrenia in healthy controls, and such effects are more pronounced and longer-lasting in patients with schizophrenia.

“Evidence regarding rates of delirium with ketamine for continuous sedation is mixed and requires further investigation before the agent is widely adopted for this purpose,” say the authors.

With emergency medicine staff at high risk for assault and violence from patients (48% report at least one incidence of physical assault by a patient), there has been an ongoing need for safe and effective ways to manage agitation in the emergency setting.

Given its proven sedative and analgesic properties, ketamine emerged as an attractive option for agitation in the mid-2000s in both prehospital and emergency department settings.  In the past several years, ketamine has also been used more commonly for continuous sedation in critical care settings, often in combination with other agents.

“C-L psychiatrists will encounter patients receiving ketamine for acute agitation and continuous sedation purposes, likely increasingly,” say the authors. “Ketamine carries many potential benefits and could be a safe and appropriate medication for patients with profound undifferentiated agitation to maintain safety and allow for further medical workup. It represents another potentially useful tool in the armamentarium of C-L psychiatrists for managing agitation. However, intubation rates remain high.”

Importance: C-L psychiatrists will want to understand the advantages, disadvantages, biased administration, and areas of limited knowledge regarding ketamine.

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

Authors: Seungwon Cho, Hanyang University Medical Center, Seoul, et al.

Abstract: This study examines the association between insurance type and suicidal ideation and attempts among US adults, incorporating a comparative analysis of the pre- and post-Affordable Care Act (ACA) periods.

The authors used a nationally representative, cross-sectional, population-based survey of individuals aged 18 years and older from the 2010-2019 National Survey on Drug Use and Health.

The rates of suicidal ideation and attempts among Medicaid and uninsured groups were compared with those with private insurance. After implementation of the ACA policy, analysis showed a significantly reduced risk of suicide in the Medicare group compared with the privately insured group, with no significant differences observed in other groups. “These findings highlight the importance of improving access to mental health services, particularly for those with lower levels of insurance coverage, such as Medicaid and Medicare,” say the authors.

Importance: The study revealed a decrease in the risk of suicide among Medicare beneficiaries in the elderly population following the implementation of the ACA. This decrease was thought to be influenced by the expansion of guaranteed Medicare benefits. Insurance coverage may improve access to clinical services and contribute to suicide prevention.

In this study, the prevalence of suicidal ideation and attempts was statistically significantly higher in the Medicaid and uninsured groups than in the private insurance group.

Availability: Pre-publication in Psychiatry Research.

 

Authors: Sean Lynch, MD, et al

Abstract: Post-acute sequelae of COVID-19 may include physical, psychiatric, and neurocognitive symptoms. Few studies of cognitive symptoms have been longitudinal, with many following participants briefly after infection, relying on subjective complaints, screening instruments, or computerized testing.

These authors previously reported diminished neuropsychological (NP) test performance in over half of 60 individuals tested in-person seven months post-COVID-19, particularly those seeking care for cognitive complaints. Their current study describes the initial and six-month follow-up results of an expanded cohort of 75 participants who were seeking post-COVID care, as well as those from the community.

“A substantial proportion of individuals recovered from acute COVID-19 infection have persistent neuropsychiatric symptoms over one year after infection,” say the authors. “While the overall sample in this study showed some improvement in NP test performance relative to norms, only fatigue and delayed memory improved significantly. Relatively few individuals made significant clinical improvement, indicating the need for serial neuropsychiatric assessment and treatment supports.”

Importance: Since the first case of COVID-19 in January 2020, SARS-CoV-2, the virus that causes the disease, has infected over 100 million people in the US and caused over one million deaths. Researchers and clinicians have described significant short- and long-term medical and neuropsychiatric sequelae. Acute symptoms range from cough, headache, and fatigue to encephalopathy/encephalitis, delirium, and psychosis. For some, symptoms persist months after recovery from the acute infection.

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