A&E Abstracts and Extracts

Authors: Chuntana Reangsing, School of Nursing, St Louis University, et al.

Abstract: The authors found that Mindfulness-Based Interventions (MBIs) improved psychotic symptoms, patients’ functioning, insight and mindfulness in patients with schizophrenia spectrum disorders.

Although antipsychotic medicine, and electroconvulsive therapy may be effective for the treatment of patients with schizophrenia spectrum disorders, some researchers have found that these treatments have a negative impact on cognition and memory.

MBIs might be used as alternative to conventional treatment, but they have significantly moderate effects to reduce psychotic symptoms, increase global functioning and insight, compared to controls.

This review examined 24 in which 796 schizophrenia patients participated in mindfulness interventions. Most were males with a mean age ranged from 24.4 to 59.5 years. With every one-year‘s increase in mean age, psychotic symptom worsened. Also, providing MBIs with a home assignment had a greater effect on improving patients’ insight than providing MBIs without a home assignment.

Importance: Approximately 24 million, or one in 300 people worldwide, have been diagnosed with schizophrenia (World Health Organization, 2022). Schizophrenia is characterized by a range of symptoms including delusions, hallucinations, sensory abnormalities, and cognitive and behavioral impairments. This multifaceted illness causes deficits in social cognition, including emotional control and awareness, in addition to these obvious symptoms, which can have a significant negative influence on the psychosocial function of those who are afflicted.

The estimated excess economic burden of schizophrenia in the US in 2019 was approximately $343.2 billion, which is about twice the cost of the burden compared to 2013.

Availability: Published by Psychiatry Research.

Authors: Gretchen Diefenbach, PhD, et al.

Abstract: Does adding an inpatient version of brief cognitive behavioral therapy for suicide prevention to treatment as usual reduce suicide attempts, suicidal ideation, and psychiatric readmissions over six months post-discharge?

In this randomized clinical trial at a private psychiatric unit in Connecticut, 200 suicidal inpatients were analysed—and adding brief cognitive behavioral therapy significantly reduced the odds of post-discharge suicide attempts. In addition, the rate of psychiatric readmissions was reduced in participants without substance use disorders. Effects on suicidal ideation were less clear, although post-hoc analyses indicated less severe suicidal ideation following brief cognitive behavioral therapy at one and two months post-discharge.

Importance: Suicide rates have increased over the past two decades and reached an estimated all-time high in 2022 when nearly 50,000 individuals in the US died by suicide. Suicidal crisis is a common reason for admission to psychiatric inpatient settings.

Optimizing suicide prevention care during inpatient stays is crucial, given that the post-discharge period is one of the highest risk times for suicide attempt and death.

“The inpatient setting presents opportunities for delivering suicide-specific psychosocial interventions given the secure environment, continuous access to treatment professionals, and reduction in daily stressors and responsibilities,” say the authors. “It is also important to leverage the inpatient stay to provide access to suicide prevention treatment, given high variability in treatment engagement post-discharge.”

To the authors’ knowledge, this study is the largest randomized clinical trial to date for inpatient suicide prevention.

Availability: Published by: JAMA Psychiatry.

Authors: Michael Dinh, MD, et al.

Abstract: The End of Life Option Act (EOLOA) legalized medical aid in dying (MAID) in California in 2015. University of California, San Francisco Health initially implemented a policy requiring a mandatory mental health assessment of all patients seeking MAID, though this was not required by the EOLOA.

State-level statistics on EOLOA are available, but less is known about outcomes at individual institutions and how institutional policy affects outcomes for patients seeking MAID.

The authors examined factors contributing to patients' decisions to request MAID, and how the mandatory mental health assessment impacted determinations of decisional capacity and access to MAID.

A sample of patients who had pursued MAID, or been prescribed MAID medications, between June 2016 and May 2020 was reviewed—demographic factors, neuropsychiatric diagnoses and rating scales, factors contributing to patients' decision to request MAID, and outcomes of the psychiatric evaluation process.

Of the 78 patients who had initiated EOLOA requests, 67% had MAID medications prescribed. No patients were found to have lacked decisional capacity due to a current psychiatric condition. Neuropsychiatric rating scale scores and diagnoses did not suggest a high prevalence of severe psychiatric illness in the sample.

“Findings suggest that mandatory mental health assessments for all patients requesting MAID (at a single academic medical center) did not identify patients who lacked decisional capacity to pursue MAID, and potentially created access barriers to seriously ill patients seeking this intervention,” say the authors.

Results from the study contributed to changes in EOLOA institutional policy, including elimination of the mandatory mental health assessment for EOLOA candidates in favor of a conditional mental health assessment based on clinical criteria.

Importance: The study demonstrates how institutional research can help change policy—in this instance, by removing access barriers for seriously ill patients.

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

Authors: Laura Mann, PhD, MPH, et al.

Abstract: Preexposure prophylaxis (PrEP) with antiretroviral medications is effective in preventing HIV acquisition. Multiple PrEP medications have recently become available in the US, including three oral options with comparable safety and efficacy: branded tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) (July 2012), branded tenofovir alafenamide fumarate/emtricitabine (TAF/FTC) (October 2019), and generic TDF/FTC (October 2020).

A long-acting injectable option (cabotegravir) became available in December 2021. TDF/FTC and cabotegravir have been approved for use by men and women; TAF/FTC has not been approved for females. The costs of branded medications are substantially higher than those of generic PrEP.

This study examines trends in PrEP medication prescriptions in the US from 2013 to 2023. New PrEP medications are heavily marketed, yet, generic PrEP dominate the market despite the availability of three branded medications. “This could be attributed to a 2021 federal guidance directing insurers to cover the cost of generic PrEP medication without patient cost-sharing, suggesting that effective health policy can result in lower health care expenditures,” say the authors.

Importance: Studying PrEP prescribing patterns is necessary to monitor progress in efforts to increase PrEP use and end HIV spread.

Availability: Published by JAMA.

Authors: Francisco Estupina, PhD, et al.

Abstract: Problematic video game use is a source of concern. In addictions, difficulties with emotional regulation have become an important variable of interest. However, their study in relation to problematic video game use remains insufficient.

The authors reviewed 322 studies, resulting in a focused sample of 18 studies. They found evidence of the relationship between different facets of emotional regulation and the presence of problematic video game use.

“Particularly, video games serve as escape strategy for suppressing emotional expression,” say the authors.

Emotional dysregulation plays a role in problematic video game use, especially through strategies as emotional suppression, and lack of abilities to understand and control emotions, they say.

Importance: Video games have become a thriving leisure activity, particularly among adolescents and young people. Their rapid growth is facilitated by a wide variety of increasingly appealing video games, greater accessibility to these video games through various devices, and widespread social acceptance. 

“Currently, video games are likely the primary leisure activity among adolescents,” say the authors. Globally, approximately 3 billion people spend about eight hours per week playing video games.

“While the majority of people who play video games demonstrate responsible use, an increasing number of studies indicate that a certain percentage of people exhibit problematic use of video games,” say the authors. In addition to the inherent dangers, numerous studies have associated it with the presence of psychopathological, familial, and social problems.

Taking this situation into consideration, Internet Gaming Disorder was included as a diagnostic category for research purposes in Section III of the DSM-5. Furthermore, the World Health Organization included Gaming Disorder in the eleventh revision of the International Classification of Diseases.

Availability: Published by The American Journal on Addictions.