is a psychiatrist at the Nathan Kline Institute and at the New York State Psychiatric Institute. He also serves as assistant professor of Clinical Psychiatry, Columbia University College of Physicians and Surgeons and is Director of the Lieber Research Clinic, New York State Psychiatric Institute.

Significant cognitive impairments often accompany schizophrenia. In this Mental Health Minute, Dr Kantrowitz discusses a recent trial of CVN058, a drug that may reduce cognitive impairments in individuals with schizophrenia.

The trial recruited 19 men and women with schizophrenia, giving them a single dose of either CVN058 or a placebo at each study visit. In this video, Dr Kantrowitz reveals the statistically significant results. 

Videos

Listen to discussion on results from a recent Phase 1b clinical trial.  

A New Drug for Schizophrenia-Related Cognitive Impairments? 

Susan Noonan, MD, MPH gives the 6 basics of mental health. 

1) Patients must take all medications as prescribed and avoid alcohol, tobacco, and illegal substances.

2) They must maintain a consistent sleep pattern.

3) They must eat a healthy, colorful diet.

4) Patients must keep up with regular physical exercise.

5) Social interaction is important, and they should avoid isolating themselves.

6) Routine and structure to the day will help keep them happy and healthy.

is a physician consultant and Certified Peer Specialist in the Department of Psychiatry at McLean Hospital and the Massachusetts General Hospital. She is the author of four books and a blog on managing depression, most recently 

Helping Others With Depression: Words to Say, Things to Do (December 2020)

. Dr Noonan offers peer counseling to fellow patients, including physicians and other professionals, and can be confidentially reached through her website at 

Brains need continuous and consistent care. 

The Basics of Mental Health

by Robert T. Carver, PhD, and Alex L. Pieterse, PhD; Columbia University Press, 2020

Reviewed by H. Steven Moffic, MD, Jessica Isom, MD, MPH, and Rahn Bailey, MD

If you think that striving for cultural competence and humility makes you ready and able to address racism in your work, this book may tell you that is not quite so. If you think that we still need a scholarly way to classify and describe the harm from racism, this book provides it. If you think posttraumatic stress disorder is an inadequate and even misleading way to describe the ongoing trauma of systemic racism, because it is not truly post, then this book provides a different perspective. If you are unsure of how to consider racism in our clinical evaluations, a structured interview is provided in 1 of the Appendices. And if you need a way to measure racism, this book also provides that in another Appendix.

This well-researched book is written by 2 psychologists with a long history of scholarly work on racism. Beyond psychology per se, mental healthcare professionals of any discipline can benefit from this tour de force.

There are 3 main parts, though the Introduction should not be ignored. Part I, “What We Know About Racism and Stress,” lays out a new concept of trauma as applied to racism. Because race has been relatively ignored in prior studies of stress and trauma, despite the relatively greater experience of stress and trauma in those subjected to racism, the authors make a strong case that we need an appreciation of race-based traumatic stress (RBTS). The reader will note that RBTS eliminates the word “post” from the destructive trauma, as does a related conception from the psychologist Kevin Washington, called Persistent Enslavement Systemic Trauma, which refers back to the original systemic trauma of slavery.

Part II, “What We Need to Know about Racial Trauma,” seems to be the meat of the book. Here the authors offer an overview and critique of race and racism within mental health professional training, guidelines, and policy documents. Euphemistic considerations are discussed, including the erasure of race and racism within terms such as cultural difference, multiculturalism, and cultural diversity. While the authors acknowledge the overlap between PTSD and RBTS, they rely heavily on the literature base and carefully crafted empirical research to distinguish RBTS as a separate and valid phenomenon. The development of the Race Based Traumatic Stress Symptom Scale is detailed, including a focus on its construction and validity.

Part III covers “What to Do With What We Know: Practice Applications.” Racism at home, in everyday life, in mental healthcare, and in particular, in forensic assessments, is presented. The various types of interpersonal and institutional racial discrimination are associated with higher levels of negative mental health outcomes for many racial group members. It is pointed out, importantly, that clinicians, especially those from the white majority, typically believed that race did not matter, but at the same time feared that it did. Actual treatment is not covered in as much depth as the subtitle implies, though it recommends that RBTS treatment should be divided into 3 parts: containment, symptom reduction, and recovery. Recovery means that the clinician sometimes has to go beyond the traditional dyadic relationship to engage in advocacy, activism, or accessing resources for the patient. Group interventions with racially homogenous members can be particularly supportive and educational.

In conclusion, the self-knowledge of clinicians has to include their own experiences and identity as racial and cultural beings within a racialized society. At the same time, clinicians still have to remember that each patient is an individual who may or may not fit these general racial concepts. We—the public, patients, and ourselves—still face the challenge of a society with structural racism that produces an ongoing source of trauma and undue stress. We still have much work to do, and this volume provides a sound new conceptual base and some unique tools to do so successfully.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of

is a clinical instructor in psychiatry at Yale School of Medicine, psychiatrist, and racial health equity champion.

is assistant dean, Clinical Education, Charles Drew University School of Medicine; Chief Medical Officer, Kedren Community Health Systems, Los Angeles.

All 3 doctors are members of SPAR (Seven Psychiatrists Against Racism). To read more from them, see 

Articles

This book provides key tools to help combat racism in the mental health profession. 

Measuring the Effects of Racism: Guidelines for the Assessment and Treatment of Race-Based Traumatic Stress Injury 

Dr Okun is considered a world's authority on Parkinson's disease treatment and research. He is currently Executive Director of the Fixel Institute for Neurological Diseases, Chair of Neurology at the University of Florida, a Parkinson’s Foundation Center of Excellence and the National Medical Director for the Parkinson's Foundation.

Many people may assume patients with Parkinson disease have depression because of their diagnosis with Parkinson disease. What needs to be focused on further is the possibility of demoralization, which 1 in 5 patients with Parkinson disease deal with.

 is considered a world's authority on Parkinson's disease treatment and research. He is currently Executive Director of the Fixel Institute for Neurological Diseases, Chair of Neurology at the University of Florida, a 

Parkinson’s Foundation Center of Excellence

 and the National Medical Director for the Parkinson's Foundation. 

The largest unmet hurdle in dealing with Parkinson disease is the treatment of depression. 

Mental Health Tips for Living with Parkinson Disease

As the number of coronavirus disease 2019 (COVID-19) cases continues to rise, schools around the country begin to question the pros and cons of in-person hybrid schooling versus online-only education. To address these issues, my school devised protocol emphasizing the use of face masks and shortened, in-person school days. The school also forbids any physical contact, including high-fives and hugs. Any violation results in the student being restricted to remote learning for a specified period of time.

I feel safe at school. Since the start of school in September, I have not seen anyone without a face mask. There have only been 5 cases of 

 among the 500 students, and those cases did not result in further infections in other students, demonstrating the rules’ effectiveness.

We only have 4 hours of in-person learning per day. Yet, my school extended advisory and club meeting times from 20 minutes to an hour. This extra time has afforded opportunities for underclassmen like myself to seek advice from upperclassmen.

Advisory groups allow students in different grade levels to connect and share on a meaningful level. During the election, we discussed civil discourse in response to the presidential debates. We discussed the process of truly listening to each other, instead of forming an argument while the other talks.

Listening and sharing became common themes this school year. For example, the Black Student Union created an educational Instagram account. In addition, the school’s Gender and Sexuality Alliance club suggested ways to support our peers on Coming Out Day. Another 18 student-led clubs provided opportunities for students of all grade levels to interact. Some clubs shared service opportunities or means to take much-needed mental health breaks, like the Walking Club. This year the emphasis on building community has increased club involvement, which has helped so many of us. The clubs follow the school’s COVID-19 guidelines while strengthening our school community.

The strict safety regimen and efforts to bring the student body together have made this year less

. Although these guidelines physically separate us, being at school with friends and teachers unites our community. I believe schools mirror the society we live in. Let us work to protect and bring together the people in our own communities during the pandemic to truly improve our well-being.

is from Evanston, IL. She is 15 years old and has contributed several reflective pieces as a young adult for the Coronavirus Chronicles series.

An insider’s look at how balancing COVID-19 safety protocols and affording teens a safe space to interact and bond has made this challenging year less daunting.

How 4 Hours Can Make a Big Difference: A Successful High School During the Pandemic

The 2020 Race Between the Psychiatric Turtle and the Climate Hare

Slideshows

Although our 2020 Presidential race is apparently over, our climate race has no end in sight. Can this race be like the parable where the turtle caught the hare? 

Dr White is a physician, speaker, consultant, and author. He travels the world conducting seminars, consulting and speaking to public and private organizations. He is the author of two books: Why Normal Isn’t Healthy and with John MacDougal, A Clinician’s Guide to Spirituality. In addition he created two audio series: The Cry of the Heart and Dr. White’s Complete Stress Management Kit.

Bowen F. White, MD, discusses this piece by John Donne first:

No man is an island entire of itself; every man is a piece of the continent, a part of the main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as any manner of thy friends or of thine own were; any man's death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.

God, grant me the serenity to accept the things I cannot change,
courage to change the things I can,
and wisdom to know the difference.

is a physician, speaker, consultant, and author. He travels the world conducting seminars, consulting and speaking to public and private organizations. He is the author of two books: 

. In addition he created two audio series: The Cry of the Heart and Dr. White’s Complete Stress Management Kit.

One doctor shares 3 interconnected pieces relating to the 3 Ps: prose, poetry, and prayer.

Prose, Poetry, Prayer

In this Mental Health Minute video, John J. Miller, MD, explains how you can integrate this system into your practice and why it works. 

The steps include asking yourself the following questions:

1. What are the pharmacodynamics of drug A (the drug the patient is currently taking) and drug B (the drug you wish the patient to take)?

2. What is the half life of drug A and drug B?

3. What are the metabolic pathways drugs A and B?

4. What is the patient’s current dose in comparison to the usual effective dose?

5. How long has the patient been on drug A?

6. What is the current acuity of the target symptoms?

7. What are the withdrawal adverse effects of drug A that is not compensated for by drug B?

8. What is the patient’s motivation for changing medications?

9. What education can be shared with the patient and their guardians and caregivers?

10. What are the delivery systems for each of the drugs?

Over the years, Psychiatric Times’ editor in chief has developed “Miller’s Formula,” his 10-step system to ensure a successful cross-titration for his patients. The strategies are straight-forward and can be used for any drug and in any specialty. 

10 Things To Consider When Cross Titrating Drugs

 led by The Jackson Laboratory and University of Maine has discovered that the gene Dlgap2 is associated with Alzheimer disease, dementia, and cognitive decline. Researchers found post-mortem human brain tissues of individuals experiencing “poorer cognitive health” and “faster cognitive decline” had low levels of Dlgap2.

“The reason why this is so important is because a lot of research around cognitive aging and Alzheimer’s has been hyper-focused on well-known risk genes like APOE and brain pathologies,” Catherine Kaczorowski, associate professor and Evnin family chair in Alzheimer disease research at The Jackson Laboratory (JAX), and adjunct professor with the University of Maine Graduate School of Biomedical Science and Engineering (GSBSE), said to the press. “We wanted to give ourselves the option of looking at new things people keep ignoring because they've never heard about a gene before.”

Located in the synapses of neurons, Dlgap2 anchors critical receptors for signals between learning and memory neurons. The research team examined the memory and brain tissue from a large group of genetically diverse mice, relying on diversity outbred mice. The population came from 8 parents created by JAX, as they thought a diversified group would better reflect genetic diversity in humans. About 437 mice, each either 6, 12, or 18 months old were used.

“It’s great because you can harness the best parts of a mouse study and human society,” Andrew Ouellette, a PhD student at JAX and a GSBSE NIH T32 predoctoral awardee, said to the press. “Historically, research has been done with inbred mice with similar genetic makeups; same, similar genetic models. But clinically, humans don't work like that because they're not genetically identical.”

Quantitative trait loci mapping was performed on the mouse population. Study of entire genome sequences allowed for identification of the genes responsible for varying cognitive function and where they occurred. Researchers pinpointed the connection between Dlgap2 and memory decline in mice, and were then able to evaluate its significance to humans.

They found Dlgap2 is associated with the degree of memory loss in mice and risk for Alzheimer dementia in humans. Further research will be needed to determine how the gene influences dementia and brain functioning.

1. Ouellette AR, Neuner SM, Dumitrescu L, Hadad N, et al. Cross-species analyses identify Dlgap2 as a regulator of age-related cognitive decline and alzheimer’s dementia. 

2. University of Maine. New connection between Alzheimer's dementia and Dlgap2. News release. 

https://www.sciencedaily.com/releases/2020/11/201123161040.htm

A new study associates a gene that facilitates neuron communication in the nervous system with memory loss. 

Dlgap2: The Gene Associated With Memory Loss

Researchers at Yale University have found that prazosin, a drug developed to treat high blood pressure, can also reduce alcohol use in patients with 

“There has been no treatment readily available for people who experience severe withdrawal symptoms,” 

, an author on the study and director of the Yale Stress Center. “These are the people at the highest risk of relapse and are most likely to end up in hospital emergency rooms.”

Alcohol withdrawal symptoms include shakes, heightened cravings, anxiety, and difficulty sleeping, which can easily lead to poor treatment outcomes.

In order to study the possible effects of prazosin on alcohol use, Sinha and her co-authors designed a 12-week, double-blind trial, recruiting 100 patients with alcohol dependence. The researchers collected information on the participants’ self-reported drinking habits (including average drinks per day) and their moods, levels of anxiety, alcohol cravings, and sleep quality ratings.

At the end of the 12-week study, researchers found that participants with high alcohol withdrawal symptoms who received prazosin reported fewer “drinking” and “heavy drinking” days than patients who received a placebo.

 Patients with high withdrawal symptoms also reported decreased anxiety, depression, and alcohol cravings. Patients with no or low withdrawal symptoms did not receive a similar benefit from prazosin.

Originally developed to treat high blood pressure, prazosin has also been shown to affect stress centers in the brain, improving memory while reducing anxiety and cravings.

 Sinha’s lab has previously found that the recovery process disrupts stress centers in the brain, especially in patients with severe withdrawal symptoms.

Fortunately, these disruptions decrease over time. The hope, Sinha said, is that prazosin could bridge the gap between patients’ initial withdrawal symptoms and long-term recovery.

Share comments with your colleagues by emailing 

. Comments may be shared online pending review and editing for style.

1. Sinha R, Wemm S, Fogelman N, et al. Moderation of prazosin’s efficacy by alcohol withdrawal symptoms. 

2. Drug eases recover for those with severe alcohol withdrawal. 

. November 19, 2020. Accessed November 25, 2020. 

https://www.sciencedaily.com/releases/2020/11/201119124716.htm

A drug developed to treat high blood pressure has unexpected benefits for patients with severe withdrawal symptoms.