Mike Hennessy Sr

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! ❒

Articles

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. 

Walking on Sunshine

Pride is often what drives people to their successes in life. The feeling is associated with a job well done and has been considered an important part of preventing burnout, especially in difficult situations. Since March 2020, headlines around the world have conveyed the sense of pride frontline health care workers, although tired and weary, have felt as they tackled 

. It helped motivate them day in and day out, despite the challenges, to bravely help so many who were affected by the virus.

Psychiatrists, too, have much to be proud about. The field was among the first to 

 visits, ensuring the mental and physical well-being their patients. Similarly, clinicians shed light on the need for interactions to combat loneliness associated with quarantining as well as the importance of self-care for all health care professionals, as evidenced by many articles on our website and in the pages of 

In addition, psychiatry is stepping in to address the chronic pain epidemic. Almost half of the adult US population experienced pain on some days, and about one-fifth had pain most days or every day, 

 by the Centers for Disease Control and Prevention. The number is staggering, and research indicates pain has played a role in the country’s devastating opioid epidemic.

 has addressed pain to keep readers up to date. In this issue, Paul Noufi, MD, and Maryland Pao, MD, further explore the role of consultation-liaison psychiatry and how it can be used to benefit patients who have pain. With this important integrative approach, the authors conclude that, overall, the future looks bright.

Also within these pages, John J. Miller, MD, delves into a discussion on 

. In his monthly editorial, Miller lays the foundation and history of the field and how it affects psychiatry. From there, Harold J. Bursztajn, MD, and colleagues explore the role of epigenetics in resilience and examine the transgenerational transmission of resilience following trauma in this month’s continuing education article. Psychiatry can take pride in these efforts to leverage genetics and epigenetics as a means to prevent and treat psychiatric disorders.

June is also LGBTQ Pride Month, which commemorates the 

 in Manhattan, New York. Along with celebrations, the month presents an opportunity to address the wider social implications. 

 features the second part of our Special Report on sexual and gender minorities (SGM). The collection wraps up this month with an important discussion on the mental health implications of fertility options and trauma-focused cognitive-behavioral therapy for SGM youth.

Much more can be found in this issue, including thought-provoking commentaries and clinical insights from new and regular contributors. We hope you find these articles interesting, entertaining, and informative. As always, we take pride in providing the top-quality information you need to support you, your practice, and your patients. ❒

Pride: A Driving Force

As this issue went to press, the Centers for Disease Control and Prevention reported that about 

 had received at least 1 dose of the COVID-19 vaccine. Despite new variants and continued behavioral challenges worldwide, the progress made in addressing the pandemic is enormous, reminding us that we can—and should—do better in other areas of medicine, health care, and societal issues.

. While the opioid epidemic raged through the country and caught the attention of doctors, lawmakers, and others, the methamphetamine epidemic lurked in the shadows. This problem received less consideration even though, as 

, discusses in the lead article, the 2 drugs are often used concurrently. Great strides have been made toward understanding and addressing the opioid epidemic; hopefully, in the future, we will report the same for methamphetamine.

Cynthia M. A. Geppert, MD, MA, MPH, MSBE, DPS, MSJ

, reflects on the progress of the COVID-19 vaccine distribution but asks, “What about us?” In her commentary, Geppert ponders parity and whether patients with serious mental illness and substance use disorders (as well as the psychiatrists caring for them) were properly prioritized in the receipt of the vaccines. In doing so, she renews the call for advocacy for patients with mental illness to improve care now and in the future.

 on sexual and gender minority youth, a population facing increased challenges and at risk of mental health issues. With thanks to Special Report Chair Jack Turban, MD, this collection of articles shines a light on a population for whom the health care system can do better. As Turban explains, psychiatrists are in a unique position to foster positive affirmations for youth, both as a part of clinical care and as educators in the community.

™ features clinical pieces with practical guidance for supporting the patients in your care. This month’s Research Update looks at the pharmacotherapies that are most effective for schizoaffective disorder. Meanwhile, 2 articles explore the impact of psychiatric illness on the whole patient and provide suggestions to protect their well-being. 

, explores lithium dosing in renal patients, and Lawson Wulsin, MD, and Juliana Zambrano, MD, discuss treatment dilemmas in patients with comorbid depression and coronary heart disease.

As we have learned from our tango with COVID-19, there is no challenge we cannot overcome when we work together to find and implement solutions. Our country and the field of psychiatry continue to face these and other difficult issues. Yet, with continued dedication on behalf of all of you, we are sure to realize more successes and positive outcomes in the days, months, and years to come! ❒

Chairman and Founder, MJH Life Sciences™

An introduction to the May issue of Psychiatric Times.

Tackling the Big Issues

A penny for your thoughts, reader? This issue of 

 encourages psychiatrists to consider their convictions and assumptions on some tough issues as experts examine both sides of the coin.

 (ECT). Around for more than 80 years, ECT is one of the most hotly contested treatments in modern psychiatry. Although early iterations were not ideal, progress and research made way for improvements—but are these advances good enough? It depends on whom you ask, as passionate advocates continue to debate the risks vs benefits on both sides of the equation. As with good research, the back-and-forth is a positive: A healthy dialogue encourages clinicians to consider the 

 at their disposal and find the most appropriate treatment(s) for each patient.

This issue’s contributors remind us that when it comes to diagnosis and treatment of psychiatric disorders, finding the best tool can be the toughest part of a task. It is important to consider and balance the pros and cons, especially in psychopharmacology. Clinicians must consider availability, cost and insurance coverage, interactions with other medications, and potential side effects associated with each drug in question.

, selected several common challenging effects to help readers better choose appropriate medications and manage the “extra” effects they may cause. The good news in all this: Sometimes clinicians flip the coin and find that an unintended effect (like sedation) actually works in the patient’s favor.

What happens when the 2 sides mirror each other? In his conversation with Nev Jones, PhD, 

, toys with this notion while exploring how schizophrenia experiences and clinical relationships change when a person plays both roles. According to Aftab, Jones’ insights and unique perspectives have not only advanced the conversation but also empowered and helped countless patients.

We hope these and the other articles in this issue inspire you to look at both sides of the coin as you strive to provide the best care to your patients, and we want to know what you think. Share your two cents by emailing us at 

Mike Hennessy Sr
Chairman and Founder, MJH Life Sciences

Two Sides to Every Coin

It is hard to believe a year has passed since 

 first explored the coronavirus disease 2019 (

) and potential impacts in March 2020. When the article was written, we thought the virus was mostly contained in China, potentially affecting some of Europe. Naïvely, we felt safe in our country. By the time the issue was delivered to readers, the world had been turned upside down. We were on lockdowns, facing a new reality that loved ones, schools, and other outings and gatherings were not just dangerous but potentially lethal. Overnight, a new world befell us.

Fortunately, since then much has been learned about the virus, human nature, as well as our fractured health care infrastructure. Amilcar Arnaldo Tirado, MD, MBA, who 

 about his own experience as a patient with COVID-19, now reflects on how this pandemic has played out. His unique perspective as a health care worker who faced down the virus provides insight into the small steps we continue to take toward recovery and engenders hope. We have stared down the virus and become stronger and better, having faced the greatest health challenge in a century. We have demonstrated we can and will triumph.

Every new piece of information has, in turn, created new questions and challenges, and the field of psychiatry has risen to the occasion. As it became necessary to stay home, psychiatry took the lead in providing telehealth. Mental health experts also emphasized the importance of staying connected, even if it means in a different format—online or phone instead of in-person visits with family and friends. With limited resources, the question has now turned to the issue of deciding who should get the vaccine and when? And whether vaccines should be mandatory, especially for health care workers? Cynthia Geppert, MD, MA, MPH, 

 ethicist and editorial board member, explores these tough questions in this issue. As resistance to the vaccine has increased, even by frontline workers and health care workers, advisory board member Nidal Moukaddam, MD, PhD, and colleagues debunk many of the myths that have added stress to the successful rollout of the vaccine. The article in this issue provides tips for talking with patients and colleagues.

 also sheds light on the clinical topics that continue to cause confusion and controversy. Although research shows 

 can have a positive impact on care, lack of open dialogue and proper oversight has triggered a new Wild West. The pieces in this month’s Cannabis Conundrum Special Report dissect the claims and problems associated with cannabis to provide you with the clinical insights to successfully navigate this new and uncharted territory.

Thus, as we reflect on this past year with COVID-19, there are also many reasons to look forward. Armed with lessons learned and new research on the horizon, 

 is ready help you tackle the latest challenges and find positive solutions for your patients. ❒

There are many reasons to look forward, armed with lessons learned and new research on the horizon.

An Affair to Remember

In March 2020, the United States was in the early stages of the coronavirus disease 2019 (COVID-19) pandemic. The country shut down, and the economy ground to a halt to slow the spread of the virus. Think back to March and the uncertainties it held for us all.

 approved 2 COVID-19 vaccines under emergency authorization. Before New Year’s Day, millions of Americans—including frontline physicians, health care providers, and our vulnerable populations in nursing homes—had received the vaccine.

Overall, the media has crafted a rather negative narrative about the COVID-19 pandemic. They described the US response to the pandemic as blundering from one mistake to the next.

Yet, a more accurate and underappreciated way to tell the story of the past 9 months revolves around heroism, innovation, and precise science, performed under unbelievable pressure.

Let’s not mince words: The United States and the world must appreciate the role of the pharmaceutical industry—the investigators, physicians, and business leaders—who are rescuing the world from COVID-19. It is the medical breakthrough of our lifetime. Consider these facts:

In this short time, scientists have identified a novel virus; unlocked and sequenced its genetic code; created new therapies to save lives; and developed multiple safe and effective vaccines using messenger RNA technology—a technology hopefully applicable to future vaccine development. Margaret Liu, MD, a biomedical scientist and member of the 

, called it a breakthrough for mRNA vaccines.

The United States has 2 vaccines approved for emergency use: 1 from Pfizer/BioNTech and another from Moderna. Additionally, the 

 is approved for emergency use in the UK. There are 64 additional vaccines currently undergoing clinical trials, including 20 in phase 3 trials. Worldwide, the pharmaceutical industry has answered the call and invested heavily in this effort to prevent morbidity and mortality.

This was the fastest vaccine development in history, and by a long shot. 

, a microbiologist at the University of California, San Diego, estimates that vaccines typically take 10 to 15 years to develop. Until the COVID-19 pandemic, the fastest development timeline was 4 years, which was for the mumps vaccine.

Many government systems moved to lessen the burden of onerous regulations and provided funding so vaccines could be developed quickly but with rigorous standards. Perhaps it should be a lesson that regulation and innovation can be calibrated more effectively during normal times as industry aims to develop new therapies for other diseases—cancer, diabetes, heart disease, and even psychiatric disorders.

Distribution of the vaccine, the next step in the process, will be as challenging as the development phase, if not more so. Again, the pharmaceutical industry is rising to the occasion, as factories worldwide are on overdrive to produce hundreds of millions of vaccine doses.

 was approved, more than 15.4 million doses of vaccine have been distributed throughout the country, and more than 4.6 million individuals have received their first dose, according to CDC data. Many patients are already receiving their second dose. All of this is incredible, considering 6 months ago many observers did not think a vaccine would be available until 2021.

Every day, more people will be vaccinated. After health care workers and our most vulnerable citizens, other frontline workers will be protected. Teachers will be vaccinated so our children can return to school. Soon, all Americans will be able to receive the vaccine at their doctor’s office or at a CVS or Walgreens.

Remember, we accomplished this in only 9 months—with the help, dedication, and expertise of our pharmaceutical industry heroes. Next time you turn on the TV and see negativity, turn it off and imagine instead where we will be in 9 months. ❒

Over the last 9 months, we have seen heroism, innovation, and precise science, performed under unbelievable pressure. The result is no short of miraculous.

How Pharmaceutical Innovation Is Saving the World

The beauty of a new year is the blank slate it presents. We close the book on the previous year, hopefully wiser from lessons learned, and charge forward expectantly. After last year, such a gift is particularly appreciated.

 is poised to jump into 2021 with great excitement. 

, our editor in chief, explores the psychiatric treatments in the pipeline. Some of these agents leverage innovative psychopharmacology, and all offer the hope of improved outcomes for patients.

, a long-time contributor, now joins us as the Psychopharmacology Section Editor. Dr Preskorn is a professor in the Department of Psychiatry and Behavioral Sciences at the University of Kansas School of Medicine in Wichita. Also familiar to readers, 

, chairman of the Department of Psychiatry & Behavioral Sciences at Cleveland Clinic Akron General in Akron, and chief of the Section for Geriatric Psychiatry at Cleveland Clinic, is now serving as our Geriatric Psychiatry Section Editor. As part of our commitment to diversity, Advisory Board member 

, is our new Diversity and Inclusion Section Editor. Dr Clark is a clinical assistant professor at the University of South Carolina School of Medicine Greenville, and the medical director and division chief for Adult Inpatient and Consult-Liaison Services for the Department of Psychiatry and Behavioral Medicine at Prisma Health. We also welcome 

 chair of psychiatry and neurobehavioral sciences and the David C. Wilson Professor of Psychiaty and Neurobehavioral Sciences at the University of Virgina School of Medicine, as our Women’s Issues Section Edior. 

 medical director of the Division of Neuropsychiatry at Dent Neurologic Institute and medical director of addiction services at BryLin Hospital, in Buffalo, New York, will serve as our Neuropsychiatry Section Editor. In our continued effort to address collaboration, we are pleased to have 

as Nurse Practitioner Liaison. Ms Robinson is a psychiatric-mental health nurse practitioner in Portsmouth, New Hampshire, and a clinical assistant professor in the Department of Nursing at the University of New Hampshire College of Health and Human Services in Durham.

This year we are excited to highlight contributions from our partner organizations and associations. In this issue, 

 and colleagues from the Committee on Work & Organizations of the 

 share their thoughts on job loss. Previous

 articles have elucidated the direct neuropsychiatric implications of coronavirus disease 2019 (COVID-19). In this piece, these authors discuss how COVID-19 affects employment and how psychiatrists can assist their patients who are struggling with job loss.

There is much reason for optimism as we step into 2021: potential new treatments, a COVID-19 vaccine, and renewed hope and enthusiasm. Through it all, 

 is committed to keeping you up-to-date with the latest information and providing you with the resources you need to help your patients. If you have suggestions or requests to better assist you and your colleagues, let us know by emailing 

As we close the door to the past, the promise of tomorrow is yet to come.

New Beginnings, New Promises

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair.” – Charles Dickens, 

The year 2020 will go down in the history books as a period of unusual and challenging times. Nevertheless, as H. Steven Moffic, MD, and our editor in chief, 

, point out in their respective articles in this issue, it was a year of opportunities, growth, bravery, and renewed commitment.

, Special Report chair, notes that despite much progress in treating the core symptoms of serious mental illness, cognitive issues sometimes get overlooked. Addressing these lingering problems improves patients’ quality of life, he adds. After all, everyone is trying to make sense of the world, even (or especially) in the year 2020. To better support you and your patients, Hartej Gill; 

, explore ways to assess and address the cognitive deficits that often accompany psychiatric illnesses.

Throughout this troubled year, we have learned so much that will allow us to improve ourselves and our world, as well as patients with psychiatric disorders. To that end, 

, shares lessons gleaned from the pandemic in hopes of helping her colleagues better assist patients as the pandemic evolves. Similarly, the Schizophrenia in the News feature offers a reminder that moving the research agenda forward has remained a priority, with a better understanding of psychiatric illnesses and novel agents to treat psychiatric disorders in the works.

Dickens’ sentiments seem to ring true, but perhaps he understood only part of it. It is not that the glass is half empty or even that it is 

. Instead, the glass is vast—and that requires us to work harder to find ways to keep it filled. At 

, our goal is to keep filling your cup of knowledge with a plethora of important, interesting, and useful clinical information to best enlighten you as you care for your patients.

With that, we wish you and yours a joyous holiday season and hopes for a happy, healthy, and fulfilling 2021! ❒

Throughout this troubled year, we have learned much that will allow us to make the world a better place. 