Mike Hennessy Sr

The classic song by the Sherman Brothers makes a good point: “It’s a world of laughter, a world of tears/It’s a world of hopes and a world of fears/There’s so much that we share/That it’s time we’re aware/It’s a small world after all.” Certainly, the events of 2021—including the continued struggles with the COVID-19 pandemic, climate change, and political unrest in various countries—made us acutely aware of the ripple effects of events across the globe. In this issue of 

, we take this notion a bit further and explore global psychiatry.

Chaired by Editorial Board member Renato D. Alarcón, MD, MPH, emeritus professor of psychiatry at Mayo Clinic College of Medicine in Rochester, Minnesota, our special report dips into the deep waters of global psychiatry as the world marches forward into a new year. Milton L. Wainberg, MD, founding chair of the 

American Psychiatric Association’s Caucus of Global Mental Health

, sets the stage by exploring the challenges and opportunities facing global psychiatry in a postpandemic world. Similarly, Richard F. Mollica, MD, MAR, director of the 

 and a professor of psychiatry at Harvard Medical School in Boston, Massachusetts, tackles the growing refugee crisis resulting from continued political unrest, violence, and disruptions due to climate change and related catastrophes.

Meanwhile, here in the United States and abroad, we continue to experience a mental health epidemic, with long waits for care, issues in treatment resistance, and untold unnecessary suffering. This issue’s clinical articles aim to provide you with the insights and tools required to address your patients’ needs and improve care. For instance, “TMS: A Useful Clinical Tool for Treatment-Resistant Depression,” by Abhijit Ramanujam, MD, explores the promising treatment of transcranial magnetic stimulation (TMS). According to data, two-thirds of patients who receive TMS experience either full remission of or noticeable improvements in their depression symptoms. Not only is TMS garnering attention from clinicians and researchers but, thanks to a report in a recent episode of CBS Sunday Morning, patients with depression have heard about 

Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT)

 and the program’s success—notably, that 80% of the study’s participants saw their severe depression go into remission.

As we move into the holiday season and look forward to a new year, it is exciting to think of promising new treatment strategies and protocols for the millions of individuals across the globe who struggle with psychiatric illness. As always, cover to cover, 

 is committed to providing you with clinical insights, engaging commentaries and columns, and the tools and support you need to provide the best care to your patients.

Chairman and Founder, MJH Life SciencesTM

Articles

Now more than ever, we recognize the importance of our global community. 

 It’s a Small World, After All

Hippocrates is quoted as saying, “As to diseases, make a habit of 2 things—to help, or at least to do no harm.” In this issue of 

, we aim to help you do just that. Our coverage of the Annual 

 brings you the highlights and clinical pearls to help you better understand psychiatric illnesses and develop effective treatments for your patients. From the psychopharmacological wisdom of 

, our Educator of the Year, to guidance in caring for members of special populations—and even yourself—the esteemed faculty shared their tips for providing top quality care.

That theme resonates in this issue, as experts share cautions and concerns to prevent negative outcomes. For example, Steve Adelman, MD, shares his thoughts on prescribing caution in the case of benzodiazepines. According to the Centers for Disease Control and Prevention, there were almost 70,000 deaths attributable to opioids in 2020. Adelman further notes that concurrent use of benzodiazepine and opioids may occur in as many as 50% of opioid overdose deaths. In exploring the relationship between benzodiazepines and opioid use, he shares his concern and cautions for prescribing this class of medication.

Similarly, caution may be warranted in some cases when prescribing other psychotropic medications. Because some agents may trigger torsades de pointes, Margo C. Funk, MD, MA, and Junyang Lou, MD, PhD, share tips for understanding the 

. With this knowledge and guidance, you will be better prepared to identify potential pitfalls and prevent problems.

Care, concern, and cautions are also discussed throughout our Geriatric Psychiatry Special Report. Chaired by Rajesh Tampi, MD, MS, DFAPA, the section discusses issues in sleep, posttraumatic stress disorder, and issues surrounding COVID-19. As the US population ages, it becomes more important to be aware of the unique concerns impacting older adults, and this Special Report aims to support those endeavors.

From cover to cover, we hope this issue of 

 provides you with the tools, tips, and insights to follow in Hippocrates’ footsteps and help you help patients. ❒

This issue highlights the care, concern, and cautions in providing effective and thoughtful treatment to patients. 

Care, Concern, and Cautions

Children are the world’s most valuable resource and its best hope for the future.

Once you become a parent, this quote becomes even more poignant. You recognize how your voice, actions, and presence affect your children—both negatively and positively—and you desire to protect them, invest in them, and nurture them. Indeed, research repeatedly shows how environment and social issues affect their growth, starting at the earliest ages.

It is, therefore, why this issue addresses so many facets of child and adolescent psychiatry. During the pandemic, children’s mental health has taken center stage. The media continue to feature stories on the rising number of youth suicides, the impact of quarantining and subsequent reentry, substance use and misuse, and issues associated with social media.

In the Special Report, Martin P. Paulus, MD, and colleagues tackle the complicated issue of screen time, asking, “Is it friend or foe?” Screens were vital in our attempts to hold onto normalcy during the pandemic, allowing children and teenagers to attend school virtually and visit with family. It helped maintain connections. Yet, studies have demonstrated that too much screen time can be deleterious, and social media’s role in depression and drug use among teenagers has been called into question. Paulus et al attempt to make sense of the data and provide useful tips for working with your patients. Chaired by Karen Dineen Wagner, MD, PhD, the Special Report also sheds light on new research in depression, digital therapeutics for autism, integrating well-being into child and adolescent psychiatry, and special issues in caring for immigrant children.

This issue also features pieces on issues that affect all patients, regardless of age. For instance, our popular 

 series is back, this time discussing how psychotherapeutic, pharmacological, and comorbidity factors interplay. Similarly, Dustin DeMoss, DO, and colleagues explore psychiatric implications of vitamin B

 deficiency. And we look at the ABCs of vaping, as well as diagnostic challenges associated with bipolar disorder.

Hopefully the insights and clinical pearls you will find cover-to-cover in this issue of 

 will help you provide the best future possible for all of your patients—young and old alike. ❒

Supporting Our Future

In many ways, September is a time of changes and new beginnings. Children return to school, a little bit older and wiser and ready for new learning adventures. A new season arrives and promises comfort and coziness—apple picking and apple cider, beautiful autumn leaves and oversized blankets, and the hint of the holidays right around the corner. Similarly, there is the Jewish New Year, which also marks sweet new beginnings and opportunities.

September also marks some somber moments. The delta variant has increased the number of COVID-19 cases. Just as we were making progress, we seem to be fighting a new battle on that front. This month is also the 20th anniversary of the September 11th tragedies. As James Knoll IV, MD, reminds us in this issue, the anniversary both allows for reflections on the past and offers an opportunity to do better in the future. He eloquently speaks of the 3 antidotes to these tragedies: compassion, compromise, and creativity. By following these ideals, we can seize control, march forward, and make a positive impact in medicine and our communities.

Interestingly, that is exactly what Tony George, MD, and colleagues suggest in addressing the opioid crisis. Investigating harm-reduction programs that have been successful in Canada, the authors consider how these programs might be implemented in the United States. The second part of our Special Report on Minority Health similarly explores creative ways to connect with underserved populations. Throughout the issue, you will find articles sharing clinical advice and insights to support you as you aim to help your patients.

With that in mind, we hope you will continue to turn over a new leaf—and the pages of 

—as we look ahead to new adventures and new successes! ❒

As the seasons change and new possibilities open up, we also pause to remember the victims of September 11 and the ongoing opioid crisis. 

Turning Over a New Leaf

Was it a natural zoonotic spillover that catapulted SARS-CoV-2 from an emerging virus into a pandemic pathogen or was it something much more sinister? Did a lab leak in Wuhan, China, cast a spark that lit the fuse?

Debate and discussion about the origin of the virus that causes 

 have been at the forefront of the global consciousness since the first cases were reported in December 2019.

Early on, whispers of a potentially engineered virus quickly grew to a roar and fueled speculation that China was behind the pandemic. This narrative was so pervasive that, in February 2020, 27 public health scientists published a letter in 

disputing the lab leak theory and announcing their support of their counterparts in China: the scientists, public health officials, and medical professionals combating the pandemic.

The authors, who all declared no competing interests in their disclosures, wrote: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin.”

And although analyses of the genomic sequence of the virus subsequently pointed to natural origins, the questions regarding China’s role persisted, led by discrepancies and conflicting reports.

Fast forward to June 2021, when new evidence breathed new life into the origin questions. 

 published an addendum with revised disclosure statements from virologist and investigator Peter Daszak, PhD, one of the 27 authors of the original letter; it noted that Daszak’s remuneration is paid solely in the form of a salary from EcoHealth Alliance, a New York-based nonprofit research foundation of which he is president. The company has reportedly worked directly with Wuhan laboratories and funded gain-of-function research at China’s Wuhan Institute of Virology.

Consider, too, other odd associations. Recent reports have uncovered financial ties between Google and EcoHealth Alliance. This comes after accusations that the tech giant censored lab leak conspiracy theory stories in its search results. Google has dismissed those reports, insisting the company is simply taking steps to protect users from unverified information.

Are these coincidences or is this a case of “where there’s smoke, there’s fire”? Although the answer is unclear, these questions add to the bank of other troublesome queries standing in the way of the truth about COVID-19.

The questions extend beyond origin theory. After the US Food and Drug Administration, approved the vaccine use for adolescents, a new concern arose over its long-term effects, especially on 

 and heart inflammation. Robert Malone, MD, the inventor of the mRNA technology, recently expressed strong concern over the risk-benefit analysis of vaccination for young adults. Similarly, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices met to discuss instances of myocarditis or pericarditis in individuals aged 30 and younger who have received an mRNA COVID-19 vaccine.

Of course, we may never know the answers to these and other questions. We may never know what triggered the global pandemic that has claimed more than 3.8 million lives. And we will not know the long-term effects for quite some time. What we do know is that the incredible strength and collaboration of health care professionals and the scientific community have allowed us to regain some semblance of normalcy, which is 

essential to the mental well-being of our country

And that, right now, is the only answer that matters. ❒

Will we ever know what triggered the global pandemic?

Questions Linger About COVID-19’s Origin

Who doesn’t love summer? The days are longer and more carefree. This year, there is also a resurgence of energy and hope as many people begin to gather with family and friends, travel, visit a baseball stadium, and even send their children off to summer camp—all of which were missed last year with COVID-19 throwing a wet blanket over many traditional summer pastimes.

The field of psychiatry has held an important and unique role during the pandemic, in monitoring and addressing the mental health sequelae of isolation, quarantining, and grief, as well as the neuropsychiatric issues associated with the virus. Although many people feel they have cleared one of the last hurdles of this marathon, some folks have not been so fortunate. This month we feature 2 articles looking at the consequences of long-haul COVID-19 or postacute sequelae of SARS-CoV-2 infection (PASC). Elizabeth LaSalvia, MD, Jason Maley, MD, and Matcheri Keshavan, MD, share their insights from working on the front lines at Beth Israel Deaconess Medical Center. Psychiatrists and clinicians like them are just beginning to understand the long-term consequences of this syndrome, including how to recognize it, how to treat it, and its prognosis. Similarly, Macy Bayern, MS, brings us into the world of 3 patients dealing with the neuropsychiatric sequela of COVID-19, serving as a reminder of the continued challenges presented by the virus, even as new infection rates continue to drop.

Fortunately, medicine and psychiatry continue to rally. In February, the National Institutes of Health launched an initiative to further study long COVID and, just as this issue was going to press, NYU Langone Health announced that it was selected as the clinical science core. An interdisciplinary team will lead the investigation as multiple diverse patient groups are followed over time to track symptoms in hopes of better understanding treatment issues and the underlying mechanisms of PASC.

Nonetheless, we remain resilient in the face of this ongoing crisis; indeed, the focus of this month’s Special Report is resiliency. Editorial Board member Phebe Tucker, MD, leads the charge in exploring this understudied area of psychiatry. In addressing the nurture versus nature debate, Ping Zheng, MD, PhD, and Andreas Maercker, MD, PhD, delve into the role of culture in determining and fostering resiliency. Meanwhile, Igor Linkov, PhD, MSc, and colleagues investigate the role of resiliency in healthy aging, which is a good goal for everyone.

Indeed, the future seems brighter than ever. Most of the country has reopened its stores, restaurants, and places of worship, restoring a sense of normalcy. Perhaps it is a good time to kick back on a lounge chair with a copy of 

As the country opens up this summer, it's time to enjoy friends and family—and to build resilience for the challenges that still lie ahead. 