Mike Hennessy Sr

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

Articles

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. 

A Dickens of a Year

November is the start of the holiday season, with Thanksgiving’s merriment arriving at the end of the month. It is the time of year we usually gather with friends and family and enjoy a bounty of food, comradery, and laughter. There is no question that this year’s feasts and festivities will be different, but the opportunity to reflect and give thanks should still be at the forefront of our minds.

, does just that. Although the past 6-plus months have been challenging, he found silver linings amid the coronavirus disease 2019 (COVID-19) crisis. From teamwork and innovation to more fully appreciating the little things, his article reminds us of the magic that happens when people come together to help others. For those who have worked tirelessly to keep our health care system working, we give thanks.

Meanwhile, Carl I. Cohen, MD, and Jena Lee, MD, explore one of the mixed blessings of the COVID-19 pandemic—

 and the seemingly infinite number of virtual meetings. On the surface, “

” and the inability to see patients in-person seem like another hassle. Yet, technology has afforded us ways to communicate and connect from the safety of our homes for work and pleasure and it has allowed clinicians to “meet” with their patients without exposing the most vulnerable to undue risks. For all those virtual platforms, we give thanks.

Pain continues to be a hot topic in medicine, especially as the fight against the opioid epidemic continues. To that end, a number of articles in this issue investigate the strategies for managing pain in patients with psychiatric disorders. Steven King, MD, 

 a fascinating Special Report that examines the roles sleep and posttraumatic stress disorder play in addressing pain. Similarly, Ellen Lockard Edens, MD, MPE, and colleagues explore the vicious “catch-22” of pain and substance use, explaining how chronic pain drives substance use and how the cycle of addiction leads to greater pain interference and poorer outcomes. Although the complications and challenges are ever-present, the articles share solutions to help improve patients’ quality of life. For the increasing options and awareness, we give thanks.

To help address the need for continuing medical education, last month we held our 

Annual Psychiatric Times® World CME Conference™

. The virtual meeting was a huge success, as attendees had the opportunity to hear from leaders in the field and Psychiatric Times

 contributors and editorial board members. For those who attended and shared their positive feedback as well as for our first-class speakers and staff who ensured a meaningful meeting experience for all, we give thanks.

So, although this year has given us plenty of obstacles, frustrations, and disappointments, I cannot help but look around and think we are relatively fortunate. As we gather around our more intimate holiday table this year, I will be thankful for so much. And, among other things, I am thankful for you, dear reader, for giving Psychiatric Times

 the opportunity to provide you with the insights and information you need to best treat your patients. May you, too, continue to have a plethora of reasons to be thankful! ❒

Although this year has thrown us off, there is much to be thankful for.

Giving Thanks

Albert Einstein once said, “Intellectual growth should commence at birth and cease only at death.” Nowhere is that truer than in medicine. As research uncovers new mechanisms of action for pharmacology and etiologies of disorders, physicians must keep up with the latest and most effective ways to help their patients.

John J. Miller, MD, sets the stage with his editorial, a personal reflection on a lifetime of learning. Even after nearly 30 years of practice, he admits he has mastered only the first 5 letters of the “psychiatric alphabet.” He exhorts clinicians to join him as he seeks a deeper understanding of the psychiatric ABCs. And 

® is honored to support you in that endeavor.

Perhaps the most exciting learning happens at the frontiers of knowledge, where new discoveries are made. In this issue you will find clinical and commentary pieces that explore new research, outline novel strategies to overcome challenges, and share lessons from experiential learning. Our continuing medical education article, for example, discusses considerations surrounding medical cannabis. Although it is gaining medical acceptance and piquing patient interest, cannabis raises important medicolegal questions, and clinicians need to know what they are and how to answer.

At the same time, there is always something new to learn, even about the most familiar topics. Within these pages, we include articles that explore core clinical areas, including mood disorders, schizophrenia and psychosis, and neuropsychiatry. For example, Rajesh Tampi, MD, MS, FAPA, and colleagues take a close look at the variants of 

 (FTD). This disorder is the third most common type of dementia and the second most common among patients 65 years or younger, but it is often misdiagnosed as other psychiatric disorders. The authors provide the practical knowledge you need to better identify and manage FTD. Similarly, Kultaj Kaleka, RN, and Juliette M. Perzhinsky, MD, MSc, share insights into medication-assisted treatment, including the ethical dilemmas related to its use. They remind us that in learning the ABCs of psychiatry, it is important to reflect on the ethical implications for patients.

This month you have another exciting learning opportunity, as we proudly present the 

. This dynamic, online event will offer you practical clinical insights, from the comfort of your own home, as you learn from members of the Psychiatric Times’

 Editorial Board, regular contributors, and leaders in the field. As a bonus, attendees can earn 16.5 AMA PRA Category 1 credits. We hope to see you there!

In our continuing effort to support you and your practice, we encourage you to give us your thoughts, feedback, and ideas.You can reach the editorial staff at 

. We are partners on your educational journeys, and 

®is honored to be the publication you read cover-to-cover. ❒

The chairman of Psychiatric Times' parent company, MJH Life Sciences, introduces the October issue.

The Importance of Learning

Usually, summer is about vacations, new adventures and excursions, and time off to explore, learn, and recharge. This year, our summers were a bit different—in fact, they were like no other in recent history. Traditional travel was not an option, but there was still much to learn. New data poured in about the coronavirus disease-2019 (COVID-19). And, as regions began to re-open, we learned what happens when you do so too quickly or without enough caution.

, tackled new challenges associated with the COVID-19 virus. In this issue, he describes the neuropsychiatric sequelae seen on the consultation-liaison service in his hospital. Lessons learned from our frontline C-L psychiatrists will be helpful in the days, weeks, and months to come. Some have been hard lessons, but they can be enlightening and empowering as the next sets of patients arrive at their doorsteps.

We have also learned the importance of tempering enthusiasm with the patience of doing what’s right not just for ourselves, but also for our community. A case in point is the coming school year. The debate over opening in-person versus online must weigh the benefits of protecting children and school officials from the virus against the mental and psychiatric challenges associated with quarantining. Unfortunately, nobody has a one-size-fits-all answer.

, sheds light on the debate, including what we know about the risks to children, what the expert organizations have to say, and the emotional impact of the pandemic and isolation. He also shares resources and guidance to work toward the best outcomes possible, regardless of how we move ahead, especially for children with preexisting psychiatric disorders. The hard-earned lessons of emergency online schooling in the spring and our new knowledge about the impact of the virus on younger patients will enable society and psychiatry to prepare and react better than before.

Although it has been a tough and unusual summer, perhaps it is best to focus on gratitude for what we have learned and what we can do with that information. Knowledge, after all, is power, and so we hope this issue of 

 will inspire you to continue to be successful, safe, and serve your patients well. ❒

It has been a tough and unusual summer, but perhaps it is best to focus on gratitude for what we have learned and what we can do with that information. 

What I Learned During My Summer Vacation 

It is hard to believe it is already August. Soon children will return to school, in 1 form or another; the days will grow shorter and colder, and the leaves will change color. To some it marks the end of summer, and to others it marks the beginning of the autumn holidays and cozier days. It depends on how you look at it.

Several of this month’s contributors share these sentiments, reminding us that both the half-full and half-empty views can serve as important wake-up calls. In our 

, the authors celebrate advances in cancer care, but they also recognize we can do more to help patients. For instance, Wendy G. Lichtenthal, PhD, and colleagues explore how meaning-centered psychotherapy (MCP) can serve as a buffer against the depression and hopelessness reported by patients with metastatic disease. According to the authors, this brief, structured, manualized intervention enhances patients’ sense of meaning and purpose by reflecting on what matters most to them and facilitating reconnection, even during the most challenging of times. Similarly, Lawrence E. Kaplan, DO, sheds light on the lingering neuropsychiatric sequalae, either due to the specific cancer or adverse effects of treatment. With improved screening and awareness, interdisciplinary approaches and interventions can address these issues to improve patients’ lives.

Similarly, in the front cover article discussing racism, 7 psychiatrists come together to challenge the status quo. We can—and should—do better, they say. Not only do the authors identify areas that need to be addressed, but they provide measures to help us ensure we are indeed moving forward.

Also in this issue, leaders in psychiatry discuss the need to push the envelope to do more for patients. Jerald Kay, MD, and Joel Yager, MD, lament the 

 often seen in psychiatric literature. After diagnosing the problem, they share potential cures, identify future steps to remedy the situation, and challenge the field to do better.

, agrees with many of those sentiments, he reminds us of the 

. From pharmacogenomics to neuroimaging and brain circuitry, ever-evolving research propels psychiatry into new areas to improve patient care and outcomes. His “glass half full” assessment reminds us that while progress has been made, we need to continue pushing for more.

With everything going on in the world, this lesson has become abundantly clear—our attitudes will help us ride the ups and downs and the slings and arrows that present themselves and propel us to better times. And, we hope, this issue of 

will provide you with the tools and knowledge to achieve successes for you and your patients. ❒

With everything going on in the world, this lesson has become abundantly clear—our attitudes will help us ride the ups and downs and the slings and arrows that present themselves and propel us to better times.

The Glass Is Half Full

FROM THE CHAIRMAN OF MJH LIFE SCIENCES, parent company of 

Our country’s founders embarked on a dream. They did not know what would happen, and they did not agree on how our new world should work. Nonetheless, they recognized a need for change.

Here we are at the birthday of our country, recognizing we are still a work in progress, and we still have some changes we need to make to live up to the ideals of the United States of America and our founding fathers. How do we do it? We do it one step at time, always keeping in mind those precious ideals, believing we can reach them.

Same is true in medicine and psychiatry. Awais Aftab, MD, starts us on this voyage in his discussion with Anne Harrington, DPhil. A critical historian, Harrington walks the fine line of “poking holes in the narrative without legitimizing the antipsychiatry story” in her efforts to push for positive changes. Her work helps to reinforce the notion that psychiatry may be a work in progress as well as the importance to regularly question and reevaluate the progress.

 pulls together great minds to consider how psychiatry and health care might morph to better meet the needs of patients. Erin Smith, William Ellsworth, Charles F. Reynolds III, MD, Michael Berk, MD, PhD, Harris A. Eyre, MBBS, PhD, and Helen Lavretsky, MD, MS, discuss the steps that should be considered, including recognizing the current challenges coupled with the pandemic’s impact. By leveraging experts from different fields—even those beyond medicine—convergence psychiatry may very well be the answer. Only time will tell how this work-in-progress unfolds.

In the clinical world, psychiatry looks for new ways to improve care. Jon E. Grant, JD, MD, MPH, and Samuel R. Chamberlain, MD, PhD, 

explore the neurobiology of obsessive-compulsive disorder

 and what it might mean for improving outcomes. Also in this issue, David N. Osser, MD, 

 to ask the tough questions and to re-evaluate old standby treatment strategies. He leverages data from recent studies to determine what role valproic acid should really play in treating bipolar disorder.

As we all take one step at a time to reach our ideals, our goal is that, one page at a time, 

 continues to provide you with the timely commentary and clinical guidance you need to reach the ideals you want in your practice.

Our country’s founders embarked on a dream. They did not know what would happen, and they did not agree on how our new world should work. Same is true in medicine and psychiatry. More in this introduction to the July issue.