Mike Hennessy Jr

Spring is universally celebrated as a time of rebirth and renewal. As we emerge from the dark days of winter and look to brighter—literally and figuratively—days, we also are reminded of the hopes of remission, recovery, or at least improved quality of life for patients with mental illness. Perhaps that’s why May was chosen as Mental Health Month.

Established in 1949, the monthlong observance was meant to highlight the importance of mental health and wellness and as a means to support those with mental illness. For the general public, the month serves as a good reminder of the resources available, and needed, to support vulnerable individuals. Of course, within the field of psychiatry, every day is Mental Health Month.

™ is filled with clinical insights and pearls, research reviews, and thoughtful commentaries, all pushing the field forward. For instance, Holly Betterly, MD, and Ruby Barghini, MD, shed light on the global misuse of 

, a supplement that has gained attention on social media and is being sold illegally to enhance body figures. Apetamin contains the first-generation antihistamine cyproheptadine, which, because of its anticholinergic and sedative properties, has been investigated as an off-label treatment for a wide range of psychiatric conditions. Nonetheless, these supplements are associated with safety concerns that you as a psychiatrist should know about, and Drs Betterly and Barghini detail those issues.

Meanwhile, there is abundant awareness of 

(TRD), which continues to be a problem for many patients. In this month’s continuing education article, Lawrence T. Park, MD; Sarah H. Lisanby, MD; and Carlos A. Zarate Jr, MD, explore promising strategies for TRD, from novel psychopharmacologic agents to neurostimulation. They discuss the safety and efficacy of these options to help you make the best treatment decisions for your patients.

In fact, from cover to cover, you will find some of your favorite contributors and sections as well as new authors and new ways of looking at clinical dilemmas. We hope the articles in this issue of 

™ put a little spring in your step and in your practice. ❒

Articles

Spring Awakenings and Awareness

Of all the fields in medicine, psychiatry is most attuned to the importance of conversations. Through dialogue, it is possible to share information, which in turn can help diagnose and treat patients. And, at the end of the day, improving patient care and outcomes is of utmost importance.

Perhaps that is why “Conversations in Critical Psychiatry” continues to be one of the most-read series in Psychiatric Times™. In this issue, Awais Aftab, MD, talks with child and adolescent psychiatrist 

. Together they explore the “McDonaldization” of child development and other challenges in the field. Never has this discussion been more critical, as we face what has been called a mental health epidemic in youth.

Conversations are likewise important in the one-on-one clinical encounters. Judith S. Beck, PhD, explains how cognitive behavioral therapy techniques can be useful in developing and maintaining strong therapeutic alliances. Similarly, in this installment of “Tales From the Clinic: The Art of Psychiatry,” Hai Le, MD, and colleagues illustrate the importance of conversations with patients to better understand their struggles and challenges, especially for patients with chronic psychosis.

As the voice of psychiatry, Psychiatric Times™ aims to foster those conversations that challenge and help propel the field to its finest. Cover to cover, our goal is to support you, our readers, in providing top-quality care for your patients. ❒

Challenging and Critical Conversations

Nobody wants to reinvent the wheel, but sometimes we recognize the wheel can be improved. Maybe changing the treading will prevent skidding on a wet surface. Or maybe altering its composition will help it last longer. The same seems to be true in psychiatry, where, according to your colleagues, some systems are not performing as well as they could.

. In this month’s Letter From the Editor, 

, looks ahead to the release of the latest editition of the DSM. Although he was disappointed with DSM-5, he anticipates some positive changes in this new release. Nevertheless, he argues there are still issues with the classification and diagnostic system.

Similar issues can be found in consultation-liaison psychiatry, as Jacob M. Appel, MD, JD, MPH, shares frustrations over inappropriate consults. He notes that as many as 30% of patients in medical units have psychiatric disorders, so it makes sense that psychiatrists are in-demand— and nobody disagrees that psychiatric expertise can lead to better outcomes for the patient. Yet, inappropriate consultants—regardless of their cause or reason—can be disruptive and wasteful. Dr Appel shares tips for managing and navigating these situations to refine the process for all.

The potential for improvement also can be found in psychopharmacology. 

, examines new research that looks at dose response of antipsychotics to determine how to optimize antipsychotic dosing during acute illness exacerbations. Similarly, Editorial Board Member 

, synthesizes research to help make sense of prescribing lithium while monitoring its nephrotoxicity.

The cover stories also share insights into improving status quo. 

J.J. Rasimas, PhD, MD, and Courtney S. Rasimas, MPH

, discuss the complexities surrounding excited delirium as well as the controversies that surround it. As they succinctly put it, “The path forward will need to address the many forms of systemic bias embedded in society and the structures of service professions in order to refine the work in a just way.”

, pokes holes in the culture of silence and the myth of the superhero clinician in hopes to improve lives for current and future health care professionals. His brave story shines a light on what needs to happen to improve the fields of psychiatry and medicine.

™. We are always looking for more ways to share the stories and clinical pearls that matter most to you, our reader. As the voice of psychiatry, we remain steadfast in providing top quality content from cover to cover. If you have ideas or suggestions to help us refine our wheel, please email us at PTEditor@mmhgroup.com. ❒

Sometimes it is important to take another look at things to see what can be improved.

Refining the Wheel

As we continue this new year, there are still many uncertainties. At press time, the omicron variant was

, adding to the stress of already taxed clinicians like yourself. In addition, this new wave continues to add to anxiety and disruptions in patients’ lives. Although we all wished we had turned the corner of the pandemic, the reality is we will continue to feel its effects for some time.

 shares valuable clinical pearls to support you and your patients. For instance, Teofilo Matos Santana, MD, and colleagues found the pandemic has led to a new variety of malingering. They draw from their clinical experience to shine a light on unique behavioral maladaptations to crises as well as the 

that arise from such. Their clinical pearls are great reminders of the importance of listening to patients and really understanding their circumstances.

Meanwhile, the usual clinical challenges still arise, like finding the best treatment strategies for patients with schizophrenia. Often, there is a need to switch antipsychotics, and doing so can be complicated. To support you in this endeavor, 

, shares 10 factors to consider when cross-titrating these medications in this month’s continuing education article. His thoughtful explanations provide a roadmap to successful outcomes.

Of course, you also will find many of the usual clinical articles, features, and commentaries that have you reading

 from cover to cover. As we look to the future, our goal continues to be to support you, our readers, in all things psychiatry related. ❒

Despite uncertainties and stresses, the field of psychiatry is poised to have a better year.  

Mike Hennessy Jr

Articles

Spring Awakenings and Awareness

Challenging and Critical Conversations

Refining the Wheel

Looking to the Future