‍Introduction

We are back again this month with some of our thought leaders in psychiatry talking shop in a rapid-fire format— this month touching on the most promising new treatment, preference on meeting/conference—live or virtual, and best recent publication. Read on for candid insights from Dr. Christoph Correll, Dr. Margaret Sibley, Dr. Ann Childers, Dr. Holly Swartz, and Dr. Donald Black.

Our last issue featured Part 1 of this two-part series, in which these thought leaders discussed what they look forward to in 2023, the most significant advances and treatments of 2022, recent most memorable case, and biggest challenge. 

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Psychiatry Update Spring June 8-10, 2023; Marriott Marquis Chicago, Chicago, Illinois

• Full 2.5-day meeting with interactive presentations, discussion and networking opportunities, and in addition to the scientific sessions, there will be informative Bonus Presentations and an exciting Keynote speaker.
• Major Depressive Disorder, ADHD, Schizophrenia, and Bipolar Disorder, plus other clinically relevant hot topics: healthcare resilience, updates and innovations in fast-acting antidepressants, newly emerging digital therapeutics and updates in neuropsychiatry.
• Register here: https://events.medscapelive.org/ereg/newreg.php?eventid=720766

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Also, don’t miss our upcoming Psychiatry Update Journal Club on Tuesday March 21 at 10AM. During this live event, Dr. Leslie Citrome will talk with Dr. Stanley Caroff about tardive dyskinesia. Recent progress has led to the development of highly efficacious and well-tolerated novel VMAT2 inhibitors that have transformed the clinical management of TD. These treatments, the remaining unanswered research questions, and the challenge to rekindle interest in this area will be the focus of this episode of the journal club. We hope you can join us.

There will be questions and interaction. Click here to register! 

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This month’s Psych Resource section will keep you updated with articles from Clinical Psychiatry News, Current Psychiatry, MDedge Psychiatry, New England Journal of Medicine, and JAMA Psychiatry—check them out below. 

Thank you to our participants for their perspectives this month. Please contact me at colleen@cmhadvisors.com with any comments and/or suggestions. –Colleen Hutchinson

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Thought Leader Rapid Fire

• Christoph Correll, MD, is Professor of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; and Investigator, Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York.
• Margaret H. Sibley, Ph.D. is Associate Professor of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Licensed Clinical Psychologist at Seattle Children’s Hospital and a researcher who specializes in the diagnosis and treatment of ADHD in adolescence and adulthood, having published over 100 scientific works on this topic, as well as a book on the psychosocial treatment of adolescent ADHD.
• Ann Childress, MD, is President of the Center for Psychiatry and Behavioral Medicine, Clinical Associate Professor, Kirk Kerkorian School of Medicine, University of Nevada Las Vegas and Adjunct Associate Professor, Touro University Nevada College of Osteopathic Medicine.
• Holly A. Swartz, MD, is Professor of Psychiatry at the University of Pittsburgh; Editor-in-Chief, American Journal of Psychotherapy; and Treasurer of the International Society for Bipolar Disorders, Pittsburgh, PA.
• Donald W. Black is Past-President of the American Academy of Clinical Psychiatrists (AACP) and Professor of Psychiatry at University of Iowa Carver College of Medicine in Iowa City, Iowa.

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Most promising new treatment on the horizon:

Dr. Correll: Muscarinic agonists for patients diagnosed with schizophrenia.

Dr. Sibley: There is a well-designed RCT for trigeminal nerve stimulation for pediatric ADHD that was conducted at UCLA. It needs replication, but it was a good trial with respectable effect sizes. I look forward to learning more about this approach.

Dr. Black: What’s exciting is the potential to treat negative symptoms. Cariprazine, which is a dopamine D3/D2 receptor partial agonist, and serotonin 5-HT1A receptor partial agonist, is showing promise, and is paving the way for newer antipsychotics. The next generation of antipsychotics may well be a game changer for schizophrenia treatment.

Dr. Childress: Non-invasive brain stimulation for negative symptoms of schizophrenia.

Dr. Swartz: Like everyone else, I am cautiously optimistic that psychedelic-assisted psychotherapy may help many with PTSD.

Best recent medical journal article I read:

Dr. Correll:  Yohn SE, Weiden PJ, Felder CC, Stahl SM. Muscarinic acetylcholine receptors

for psychotic disorders: bench-side to clinic. Trends Pharmacol Sci. 2022

Dec;43(12):1098-1112.

Find it here: https://pubmed.ncbi.nlm.nih.gov/36273943/

Dr. Sibley: Yeung A, Ng E, Abi-Jaoude E. TikTok and attention-deficit/hyperactivity disorder: a cross-sectional study of social media content quality. The Canadian Journal of Psychiatry. 2022 Dec;67(12):899-906.

This article on TikTok and ADHD is really important for people to read. It shows that a lot of misinformation sharing about ADHD is happening. This impacts patients who may self-identify as having ADHD, but could be misdiagnosing themselves based on relatable but inaccurate information they saw online.

Find it here: https://pubmed.ncbi.nlm.nih.gov/35196157/

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Dr. Black: Moncrieff J, Cooper RE, Stockmann T, et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry 2022 Jul 20.

This is an important article that casts doubt on a popular theory of the etiology of depression. While I believe there are problems with their interpretation of some of the studies that were cited, their conclusions force psychiatrists to rethink their cherished beliefs about the “chemical imbalance” theory. I’ve always thought that psychiatric illnesses were too complex to explain as an imbalance of one or more neurotransmitters, though undoubtedly they are involved. I tell patients that if I understood what caused depression, I’d get a Nobel prize. And, further, not understanding how a medication works does not mean that it is ineffective.

Find it here: https://www.nature.com/articles/s41380-022-01661-0

Dr. Childress: Epstein J, Garner A, Kiefer A, et al. Trial of Training to Reduce Driver Inattention in Teens with ADHD. Engl J Med. 2022 Dec 1;387(22):2056-2066. Driver simulation training targeting inattention can help reduce collisions and near collisions.

Find it here: https://pubmed.ncbi.nlm.nih.gov/36449421/

Dr. Swartz: Calkin V, Chengappa K, Cairns K, et al. Treating Insulin Resistance With Metformin as a Strategy to Improve Clinical Outcomes in Treatment-Resistant Bipolar Depression (the TRIO-BD Study): A Randomized, Quadruple-Masked, Placebo-Controlled Clinical Trial. J Clin Psychiatry. 2022 Feb 1;83(2):21m14022.

I am a big fan of the TRIO-BD study that showed that successful reversal of insulin resistance by metformin in patients with treatment-resistant bipolar disorder resulted in significant reductions in symptoms and improvements in functioning.

Find it here: https://pubmed.ncbi.nlm.nih.gov/35120288/

Live conferences or hybrid/online virtual attendance?

Dr. Correll: Both, as it depends. For some I like not having to travel, or being able to attend when being tied up otherwise, and for others I really like the human factor and interaction.

Dr. Sibley: The APSARD (www.apsard.org) live conference in January was a really fantastic event where I learned new science on ADHD and met a lot of key thought leaders in the field.

Dr. Black: Medscape’s Psychiatry Update December 2022. A lively hybrid meeting that emphasized new developments and treatments in psychiatry, held in beautiful Carlsbad, CA.

Dr. Childress: Live conferences!! Just attended the American Professional Society for ADHD and Related Disorders annual conference. It was live for the first time since 2020 and the experience was amazing.

Dr. Swartz: A combination of both. Sometimes it’s easier (and less destructive to the environment) to learn from home, but it’s also important to connect in person.

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