Neuropsychiatry

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Managing Negative Symptoms of Schizophrenia: Can Prescription Digital Therapeutics Make an Impact?

Michael Asbach, DMSc, PA-C; Erin Crown, MHS, PA-C, Psych-CAQ

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Optimizing Care for Patients With Tardive Dyskinesia

Amber Hoberg, MSN, APRN, PMHNP-BC; Erin Crown, PA-C, Psych-CAQ

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Stabilize and Thrive: Prioritizing Patient Success Through Novel Therapeutic Management in Schizophrenia

Jonathan Meyer, MD; Jacob Hanaie, PharmD, APh, BCPP; Sanjai Rao, MD, DFAPA

A transdisciplinary team summarizes key points and reflections after 18 months of activity.Global society is faced with interrelated challenges that are complex, systemic, and dynamic from climate change, population displacement, famine, productivity slowdown, and mis- and dis-information to cyber exploitation, mental health crisis epidemics, aging and dementia, COVID-19-related losses, and fraying trust in social and political institutions. In the midst of these crises, a group of neuroscientists, medical doctors, and economists came together to develop new concepts, ideas, and tools to use brain science to tackle some of society’s most pressing problems. A seminal paper outlining their preliminary thinking on brain capital was published in January 2021.1 The agenda has significantly advanced since through deeper, transdisciplinary research and narratives; broader academic, business, and policy networks; and refined measurement to guide all stakeholders and monitor progress. The Brain Capital Alliance takes this to the next level. Each of us possesses a complex system—the brain—which is implicated in the emergence, propagation, aggravation, and potential resolution of these challenges. To address these issues, a neuropolitical approach that considers brain capacity as a crucial asset is needed. The insights can be translated into policy, business practices, and civil society advocacy. In response to the urgent needs, a group of researchers and policymakers developed the concept of brain capital. Brain capital is based on the position that brains are the world’s most important resource and the means by which all problems will be solved, ameliorated, or worsened. The brain capital framework acknowledges the importance of every brain and the corresponding need for brain diversity to achieve equity in solving global issues. Brain capital is a framework incorporating brain health and brain skills in the knowledge economy. In an era that is dependent on intellectual capacity, our brains are our greatest asset. Brain capital provides an approach to define brain issues, quantify them, and track them. Brain preservation and enhancement is critical to advancing brain capital, which can be driven into local, national, and international policies and investments.1 Despite the fundamental importance of brain health and brain skills, these factors are often overlooked in policy-making and are not well-reflected in measures of human capital.2 Brain capital differs from human capital in its recognition of the unique role that brain health and brain skills play in human civilization. Unlike human capital measures, which look at broad educational and health metrics, brain capital encompasses and measures brain health as well as society- and-economy-critical variables such as collective confidence, social trust, and shared values and goals. These key social processes in turn depend on critical aspects of individual human functioning such as perceived control, confidence, ability to work collectively, problem-solving capacity, and values-driven goals. It also differs from human capital in its encompassing and measurement of economy-shaping brain health measures such as addiction, depression, anxiety, brain fog, loneliness, and dementia. There are a range of notable achievements of brain capital in the past 18 months, including new initiatives, expanded partnerships, and more outreach and influence. These are interlocking and mutually reinforcing. The Organisation of Economic Collaboration and Development (OECD) established the Neuroscience-inspired Policy Initiative in collaboration with the PRODEO Institute.3 Consultations have been held with the United National Development Programme and the World Health Organization (WHO). The OECD NIPI supported the European Brain Initiative in collaboration with EBRAINS, French EU Presidency, the European Commission, the WHO, scientific societies, patient organizations, and health professionals.4 The Meadows Mental Health Policy Institute appointed a senior fellow for brain capital.5 A new chair of excellence in brain capital will be established as part of the recently funded PEPR ProPsy, a project to develop precision psychiatry in France.6 The Global Brain Health Institute7 and the Latin American Brain Health Institute (BrainLat)8 both launched brain capital summer courses, respectively.9 Brain capital also received notable mentions in 2 US Congressional presentations in front of the Congressional Neuroscience Caucus10 and the US House Select Committee on Economic Disparity and Fairness in Growth.11 There has been engagement with major think tanks including the Center for European Policy Studies12 and The Brookings Institution.13 Two working groups were also established. The Brain Health Diplomacy Working Group aims to formalize the field of brain health diplomacy14 and to develop a brain health diplomat toolkit. Working group members include former US State Department official Virginia Bennett and former US Representative Patrick J. Kennedy (D-RI). The Brain Capital Dashboard working group aims to quantify and track brain capital and is constituted by economists, neuroscientists, and physicians. This is seen as a critical project and will subserve future policy innovations. Additional notable achievements for the brain capital agenda are outlined in the Table. Most recently, the Brain Capital Alliance, a public-private-people partnership, was launched via a series of events in Europe.6 The alliance aims to advance approaches to measurement, investment, and policy and will further integrate brain capital into policy agendas including productivity, climate change, political stability, gender equality, and neurotechnology. The alliance will raise awareness among public and private leaders for neuroscience-related issues across the life span, from early childhood development to youth resilience and brain reserve, to reduce the risk of cognitive decline in older adults. The Brain Capital Dashboard will be refined and leveraged in policy discussions. Specific research labs will be developed to experiment at different scales and will be applied to real world problems such as micro-plastic pollution, the youth mental health crisis, caregiver distress, and disinformation. These platforms will improve the statistical bases and analytical foundation to guide decisions and assess progress. Novel financial instruments will also be explored to unlock additional funding for building brain capital such as bonds, venture capital, and exchange traded funds. The alliance is seeking interested supporters, collaborators, and partners to accelerate this work. As we look toward the future, it is imperative that brain capital continues to be developed and integrated into policy, business, and society. To sustainably solve the most pressing global challenges, we must place brain capital at the heart of solutions. We must develop ways to use brain science to overcome the most difficult, seemingly intractable global problems. Dr Eyre is the lead of the Brain Capital Alliance, co-lead of the OECD NIPI and Senior Fellow with the Meadows Mental Health Policy Institute. Eyre maintains advisory or adjunct roles with IMPACT at Deakin University, the Heka Fund, Brain Health Nexus at Cohen Veterans Bioscience, GBHI, Baylor College of Medicine, BrainLat, University of Texas Health Sciences Center at Houston, the Davos Alzheimer’s Collaborative, and the Euro-Mediterranean Economists Association (EMEA). Dr Hynes is an associate fellow at the Johns Hopkins School of Advanced International Studies. Dr Berk is the director of the IMPACT institute at Deakin University. Ms Smith is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute, a Thiel Fellow at Stanford University, and a Steering Committee member for the OECD Neuroscience-inspired Policy Initiative. Dr Cummings is the Joy Chambers-Grundy Professor of Brain Science; director of the Chambers-Grundy Center for Transformative Neuroscience; and co-director of the Pam Quirk Brain Health and Biomarker Laboratory, Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV). References 1. Smith E, Ali D, Wilkerson B, et al. A brain capital grand strategy: toward economic reimagination. Mol Psychiatry. 2021;26(1):3-22. 2. Angrist N, Djankov S, Goldberg PK, Patrinos HA. Measuring human capital using global learning data. Nature. 2021;592(7854):403-408. 3. Neuroscience-inspired Policy Initiative. Organisation for Economic Co-operation and Development. Accessed August 22, 2022. https://www.oecd.org/naec/brain-capital/ 4. Towards a European brain initiative. EBRAINS. Accessed August 22, 2022. https://www.ebrains.eu/news/Towards-a-European-Brain-Initiative/ 5. Harris Eyre, MBBS, PhD: senior fellow for brain capital. Meadows Mental Health Policy Institute. Accessed August 22, 2022. https://mmhpi.org/staff/harris-eyre-phd/ 6. Brain Capital Alliance launches to accelerate agenda for change. Newsmatics Inc. News release. July 17, 2022. Accessed August 22, 2022. https://www.einnews.com/pr_news/581691203/brain-capital-alliance-launches-to-accelerate-agenda-for-change 7. Brain capital continues to advance. Global Brain Health Institute. September 7, 2022. Accessed September 8, 2022. https://www.gbhi.org/news-publications/brain-capital-continues-advance 8. Bär N. Políticas públicas y neurociencia, la deuda con la salud cerebral. El Destape. September 1, 2022. Accessed September 7, 2022. https://www.eldestapeweb.com/sociedad/salud/politicas-publicas-y-neurociencia-la-deuda-con-la-salud-cerebral-2022910526?utm_medium=Social&utm_source=Twitter#Echobox=1662030318 9. Improving brain health and reducing the scale and impact of dementia worldwide. Global Brain Health Institute. Accessed August 22, 2022. https://www.gbhi.org/ 10. Congressional Neuroscience Caucus Briefing long haul neurological & psychological impacts of COVID19. American Brain Coalition on YouTube. May 18, 2022. Accessed August 22, 2022. https://www.youtube.com/watch?v=sdUwKIHccFE 11. Graham C. Addressing America’s crisis of despair and economic recovery: a call for a coordinated effort. Testimony to the House Select Committee on Economic Disparity and Fairness in Growth. September 28, 2021. Accessed August 22, 2022. https://www.brookings.edu/wp-content/uploads/2021/10/Carol-Graham-Testimony-Sept-28-2021.pdf 12. Launch event of the Brain Capital Alliance: towards a person-centered approach to brain health. CEPS Think Tank on YouTube. July 4, 2022. Accessed August 22, 2022. https://www.youtube.com/watch?v=Mo2dASiMrd4 13. Dawson WD, Graham C, Smith E, et al. Build brains better: a proposal for a White House brain capital council to accelerate post-COVID recovery and resilience. The Brookings Institute. December 22, 2021. Accessed August 22, 2022. https://www.brookings.edu/research/build-brains-better-a-proposal-for-a-white-house-brain-capital-council-to-accelerate-post-covid-recovery-and-resilience/ 14. Dawson WD, Bobrow K, Ibanez A, et al. The necessity of diplomacy in brain health. Lancet Neurol. 2020;19(12):972-974.

Advancing Brain Capital: Achievements, Lessons, and Next Steps

ByHarris A. Eyre, MD, PhD,William Hynes, DPhil,Michael Berk, MD, PhD,Erin Smith,Jeffrey L. Cummings, MD, ScD

September 13th 2022

A transdisciplinary team summarizes key points and reflections after 18 months of activity.

"It would be naïve to believe that targeting a single neurotransmitter, receptor, or circuit in the brain will cure any psychiatric or neurological disorder. However, we would be remiss if we did not try."

Serotonin: A Biography

ByJohn J. Miller, MD

September 12th 2022

"It would be naïve to believe that targeting a single neurotransmitter, receptor, or circuit in the brain will cure any psychiatric or neurological disorder. However, we would be remiss if we did not try."

The experts weighed in on a wide variety of psychiatric issues for the August 2022 issue of Psychiatric Times.

From the Pages of Psychiatric Times: August 2022

ByPsychiatric Times Editors

August 31st 2022

The experts weighed in on a wide variety of psychiatric issues for the August 2022 issue of Psychiatric Times.

Figures for Serotonin: A Biography

ByJohn J. Miller, MD

August 22nd 2022

These are the extra figures for John J. Miller, MD's article, "Serotonin: A Biography" from the 2022 September issue.

COVID-19: A Direct Viral Attack on the Brain

ByLeah Kuntz

August 19th 2022

What are the long term psychiatric and neuropsychiatric complications of COVID-19?

Is the term, "extrapyramidal symptoms," an example of a “4-letter word”?

Everyone Please Stop (EPS)

ByJohn J. Miller, MD

August 11th 2022

Is the term, "extrapyramidal symptoms," an example of a “4-letter word”?

An estimated 5% to 10% of acute psychiatric inpatients have catatonia—yet catatonia remains widely underdiagnosed.

What Are Clinicians Missing About Catatonia?

ByMark A. Oldham, MD,Joshua R. Wortzel, MD, MPhil

August 9th 2022

An estimated 5% to 10% of acute psychiatric inpatients have catatonia—yet catatonia remains widely underdiagnosed.

Survey results addressed connections between migraine and mental health, stigma, and treatment preferences.

Migraine and Mental Health: Patients, Health Care Professionals Share Their Perspectives

ByErin O'Brien

July 28th 2022

Survey results addressed connections between migraine and mental health, stigma, and treatment preferences.

Buyers Beware in Alzheimer Disease Neuroscience

ByH. Steven Moffic, MD

July 28th 2022

Is our research about Alzheimer disease wrong?

How prioritizing brain health and brain skills could offer new solutions to this challenge.

Cybercriminal Exploitation of Cognitive Biases: A Brain Capital Perspective

ByIan MacRae, MSc,Rashi Ojha, MD,Erin Smith,Daniel Krawczyk, PhD,Michael Berk, MD, PhD,Harris A. Eyre, MD, PhD

July 27th 2022

How prioritizing brain health and brain skills could offer new solutions to this challenge.

"The young and exciting field of psychiatric pharmacogenomics is providing a third pillar of understanding to aid in our competent and informed prescribing of drugs, joining the more well-established pillars of pharmacokinetics and pharmacodynamics."

Psychiatric Pharmacogenomics: The Evidence Base

ByJohn J. Miller, MD

July 7th 2022

"The young and exciting field of psychiatric pharmacogenomics is providing a third pillar of understanding to aid in our competent and informed prescribing of drugs, joining the more well-established pillars of pharmacokinetics and pharmacodynamics."

Substance Misuse and Acquired Brain Injury

ByGary S. Seale, PhD, LPA, LCDC, CBIS-T

June 27th 2022

Understanding the intersection between substance misuse and acquired brain injury can assist clinicians in accurately diagnosing and treating these cooccurring conditions.

Over the past 6 months, Psychiatric Times has featured expert opinions on important psychiatric issues from psychosis to psychedelics.

From the Pages of Psychiatric Times: 6 Months of Cover Stories

ByPsychiatric Times Editors

June 22nd 2022

Over the past 6 months, Psychiatric Times has featured expert opinions on important psychiatric issues from psychosis to psychedelics.

Catch up on the latest research on ADHD, PTSD, and more with Psychiatric Times.

In Case You Missed It: Highlights From the 2022 APA Annual Meeting

ByPsychiatric Times Editors

June 21st 2022

Catch up on the latest research on ADHD, PTSD, and more with Psychiatric Times.

Despite its prevalence and clinical impact, catatonia remains widely underdiagnosed. What are clinicians missing?

So That’s What Catatonia Looks Like?

ByMark A. Oldham, MD,Joshua R. Wortzel, MD, MPhil

June 16th 2022

Despite its prevalence and clinical impact, catatonia remains widely underdiagnosed. What are clinicians missing?

An expert discusses the effects of long COVID on the brain at the 2022 APA Annual Meeting.

Neurological and Neuropsychiatric Complications of COVID-19

ByErin O'Brien

June 9th 2022

An expert discusses the effects of long COVID on the brain at the 2022 APA Annual Meeting.

Is it ADHD—or something else? The importance of careful assessment for the proper diagnosis and effective treatment of the third most common mental health disorder worldwide.

ADHD Update: Diagnosis, Assessment, and Treatment Issues

ByJonathan C. Blassingame III, PhD,Nathalie V. Buitrago, PsyD

June 8th 2022

Is it ADHD—or something else? The importance of careful assessment for the proper diagnosis and effective treatment of the third most common mental health disorder worldwide.