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Our tradition of making New Year’s resolutions is a good one, as we start the new year with hopefulness for improvements and growth for ourselves, humanity, and our planet. Unfortunately, all too often, by spring the resolutions are forgotten, as we fall into our usual routines and well-established habits. In psychiatry, our hope is often for a new treatment and ideally a cure for one of the many chronic and disabling conditions that are at the very center of our profession.

This past year, I read several articles as well as a book declaring that progress in psychiatric research is stagnant. These “glass half empty” opinions went so far as to claim that we have made no significant progress since the 1950s, when chlorpromazine and imipramine transformed psychopharmacology and were paradigm changes for our treatments for disorders such as schizophrenia and major depression. These writings went on to opine that all the research and drug development of the past 50 years have contributed very little to improved outcomes for our patients, and that all subsequent pharmacological agents developed are simply “me too” additions.

Working at a community mental health center, we serve a population that often has chronic symptoms, many of whom continue to decline in function over years and decades. Despite this, I hope to convince you that the glass is actually half full.

Psychiatry shares the challenges of all the other medical professions: many of the disease states that we treat have complex and multifactorial etiologies. These range from genetic vulnerabilities to intrauterine events to perinatal complications to environmental insults to results of suboptimal lifestyle behaviors to random accidents. Additionally, there is the simple fact that the great majority of us will die prior to the age of 100.

Yet it is quite remarkable that the average life expectancy in the United States was 48 years in 1900 and had increased to 79 years by 2020.

 Many factors have contributed to this striking increase in longevity, including a dramatic decrease in infant and child mortality rates, vaccinations, antibiotics, improved health care on many fronts, access to good nutrition for many, and the numerous advances in science and technology. And, although the life expectancy statistics look promising, they do not factor in the many possible acute and chronic diseases that can affect quality of life and virtually every organ system, including the brain.

Medicine continues to make great strides in technology, drugs, and treatments to minimize the impact of these diseases on quality of life and, in some cases, to cure them. However, virtually every medical specialty has disease states that persevere and, rather than being cured, are managed. Additionally, multiple factors—some modifiable and others unchangeable—will converge to accelerate or delay disease progression. Although the completion of the sequencing of all 3 billion base pairs in the human genome in 2003 was predicted to result in significant advances in diagnosing and treating all diseases, for the most part those advances did not happen.

According to the Centers for Disease Control and Prevention, the most common cause of death in the United States in 2019 continued to be heart disease.

 Despite the heart being a very straightforward and extensively studied organ—basically a pump—diseases of the heart continue to result in significant morbidity and functional impairment for many individuals. Does this mean that cardiology has failed as a specialty and no progress has been made? Of course not.

The human brain, the most complex organ known in the universe as of today, has many secrets awaiting our discovery. Over the past 100 years, we have merely begun our journey toward understanding the brain, and I posit that we have made great strides in treating psychiatric disorders, despite the likelihood that cures for many of these disorders, as for the heart, are far off in the future.

As I begin my 31st year as a practicing psychiatrist, I would like to welcome 2022 with reflections and hope for where we currently are as well as where we are heading in psychiatry.

I look forward to the time when the term 

 disappears from our nosology. First named 

 in 1886 by German psychiatrist Heinrich Schüle, this descriptor was popularized in 1893 by Emil Kraepelin, MD, who famously divided psychotic disorders into 2 subtypes: (1) dementia praecox for what now is named schizophrenia and (2) manic depression, which we now call bipolar disorder. In 1908, Eugen Bleuler, MD, introduced the term 

, which translates from 2 Greek words as a split in the mind; this is the name that persists today.

A genetic vulnerability is well established, as well as effects from developmental challenges and environmental exposures. The savvy clinician will aggressively rule out many potential medical etiologies before settling on the diagnosis of schizophrenia, which will likely be a permanent label once etched into the patient’s medical record. A sampling of medical conditions that can mimic schizophrenia includes tertiary syphilis, seizure disorders, hyperthyroidism, Wilson disease, substance intoxication, medication toxicity, brain lesions, and anti-NMDA glutamate receptor autoimmune encephalitis, first reported in 2005.

It is thought-provoking that back in 1908 when Bleuler first described schizophrenia, most of these medical diagnoses had not been identified. Hence, these individuals would likely have received an incorrect diagnosis. A disturbing autobiography by a young 

 journalist who, in 2009, developed an abrupt onset of manic, psychotic, delusional, and paranoid symptoms and was deteriorating with no response to usual treatment, revealed that she eventually received a diagnosis of anti-NMDA glutamate receptor autoimmune encephalitis, the 217th person diagnosed with this condition. She recovered completely following treatment with steroids, plasmapheresis, and intravenous immunoglobulin.

What other as-yet undiscovered medical conditions are now lumped into the outdated diagnosis of schizophrenia? The half-full glass predicts that there are quite a few, but it may take years, decades, or even centuries to differentiate them.

More disturbing to me is our lack of treatments for the negative and cognitive symptoms of schizophrenia. We have no pharmacological treatments for these common symptoms, which are ultimately the cause of disability and progressive functional impairment of individuals with schizophrenia. Why do we focus on searching for pharmacological solutions to these core symptoms? What if cardiologists treated patients with heart disease with only pharmacology? Individuals with heart disease maximize their functional improvement when they aggressively participate in cardiac rehabilitation, dietary modification, smoking cessation, daily exercise, and quality management of other comorbidities, and have increased social support.

Drawing upon this analogy, a major step forward has been the growing implementation of first-episode psychosis (FEP) programs in psychiatric clinics across the country. In 2009, the National Institute of Mental Health funded a study to investigate the benefits of aggressive and comprehensive treatment of individuals in their first psychotic episode. The study, Recovery After an Initial Schizophrenia Episode (RAISE), demonstrated that comprehensive early intervention for FEP improves symptoms and functioning superior to the usual standard-of-care models using 4 pillars of treatment (

 We can call this half-full glass psychosis rehabilitation.

Finally, improved treatments with improved outcomes will happen as we further our understanding of the human brain, which will likely be a slow and arduous process. Our future treatment armamentarium for schizophrenia will likely include interventions about which we currently know nothing. As our learning progresses, our responsibility is to utilize all the tools that are available, and to give all patients full access to these treatments.

It is well established that one-third of patients being treated for a major depressive episode will ultimately fall into the category of treatment resistant.

 Currently, when a patient’s initial presenting depression score improves by 50% or more with treatment, we classify this as a “response.” For patients whose depression score improves by 75% or more, we classify them as “in remission.” For an individual who is severely depressed, a 50% improvement translates to continued significant depressive symptoms. Once a patient has completed and not responded to 2 adequate antidepressant trials of adequate dose and duration, the current consensus in psychiatry in the United States is that their depression is treatment resistant. This definition is arbitrary.

Depression is a complex emotional state, and the range of available treatments beyond pharmacology is immense.

 During my 30 years of practice, I have seen a steady decline in the use of nonpharmacological treatments, and a growing momentum that depression will improve once the right medication or combination of medications has been prescribed. The devolution toward this paradigm has been accelerated and supported by the policies of insurance companies reimbursing psychiatric providers for what they expect will be a 15- to 20-minute medication management visit. This is barely enough time to ask a few questions, continue or modify the medication regimen, order a lab or 2, review risks/benefits/adverse effects, and decide on follow-up. Oh, I almost forgot: This time theoretically also includes the extensive template-driven electronic medical record documentation. Realistically, there is no time to explore significant stressors or events, ask open-ended questions, or discuss nonpharmacological treatments that are viable and, at times, more appropriate options.

Our goal should always be full remission of depressive symptoms—as with the cardiologist, who ideally would treat heart disease back to an optimum cardiac output with no arrhythmias, normal blood pressure, and complete absence of any atherosclerotic plaques. However, just as many patients with cardiology issues continue to have significant heart disease even in the presence of optimal management, many patients with depression may have significant depressive symptoms once they are on an optimal medication regimen. In these settings, our goal is to maximize function and collaborate with the patient to educate them about and assist them in accessing all nonpharmacological treatments.

I treat a woman in her 40s who has had treatment-resistant depression for 9 years and has failed a long list of aggressive pharmacological trials. Recently, her daughter and only child informed her that she was pregnant and that my patient was going to be a grandmother. This news improved my patient’s chronic depressive symptoms significantly more than my 9 years of pharmacological trials. If our patients’ treatment-resistant depression coexists with significant psychosocial stressors, recent unpleasant major life changes, or a history of chronic abuse and trauma that began in childhood, rethinking the treatment plan to include a broader array of interventions than medications may provide substantial benefit, or at the very least affirm the patient’s residual symptoms in the context of their life experiences.

Much excitement followed the complete sequencing of the human genome in 2003. It was a remarkable accomplishment resulting from the convergence of scientific understanding, technological advances in sequencing DNA, generous funding, worldwide cooperation, and a heroic commitment by all the individuals who contributed to the Human Genome Project’s completion.

Initially, the hope was that this treasure trove of information containing the blueprint of the human organism would accelerate our research and treatment of many diseases. Although much has been learned, 18 years later there have been few actionable clinical advances. One shocking discovery early on was that only 2% of the entire human genome coded for proteins—the remaining 98% was initially referred to as “junk DNA.”

 Our limited understanding at the time was that the purpose of DNA was to preserve the information required to construct the many proteins necessary for human life. Since that time, the term 

, and it is likely that much of this DNA has functions that we are just beginning to understand.

We now know that a significant percentage of noncoding DNA is evolutionarily preserved just like essential proteins, which strongly suggests that these sequences play a necessary role in the preservation of our species. It is likely that our future understanding of noncoding DNA will contain novel approaches to treat the wide range of human disease and disorders. That glass keeps filling up with more water.

Epigenetics is a rapidly advancing field that nicely complements genetics and allows for the turning on and off of genes depending on developmental or environmental factors. Genetics and epigenetics are the embodiment of the beauty and necessity of nature and nurture in understanding the inherent plasticity of our genome. Epigenetic modification of the human genome is yet another fertile area that will likely greatly contribute to our understanding of the complex human disorders schizophrenia and major depression. For the interested reader, 2 articles I authored in 2021 issues of 

Epigenetics Collides with Pharmacogenomics

Our growing understanding of the circuits of the human brain provides yet another opportunity to appreciate that, rather than being a prewired organ at birth, which I was taught in the early 1980s, the brain has inherent neuroplasticity, allowing it to change to its environment. A drug-receptor interaction, a memory-activated neuron, or a meaningful psychotherapeutic insight may trigger a cascade of neurochemical processes that ultimately can result in elevated levels of brain-derived neurotrophic factor, which then directs a target protein such as the mammalian target of rapamycin to facilitate synaptogenesis. For drugs such as ketamine and esketamine, this process is one putative mechanism that may contribute to their rapidly acting antidepressant effect.

 Abdallah et al demonstrated that patients who responded to ketamine showed an increase in global brain connectivity in the caudate, insula, and lateral prefrontal cortex.

As the new year begins, taking a moment to reflect on where we have been, where we are, and where we are going is a useful exercise. In our young field of psychiatry, much has happened since Bleuler introduced the term 

 in 1908. Clinical psychiatry today is very different than the field I trained in during the late 1980s—with a potpourri of advances, frustrations, external intrusions, and setbacks. But alas, such is the history of science, medicine, and psychiatry. Our challenge is to keep that flame of hope and optimism burning brightly, and to continue our journey together toward greater understanding, increased global citizenship and cooperation, and a strong dose of humility.

 is medical director, Brain Health, Exeter, New Hampshire; Editor in Chief, 

; staff psychiatrist, Seacoast Mental Health Center, Exeter; Consulting Psychiatrist, Exeter Hospital, Exeter; Consulting Psychiatrist, Insight Meditation Society, Barre, Massachusetts.

Life expectancy (from birth) in the United States, from 1860 to 2020

. Statista. February 3, 2021. Accessed December 1, 2021.

. NCHS Data Brief No. 395. December 2020.

Evidence-based treatments for first episode psychosis: components of coordinated specialty care

. National Institute of Mental Health. April 14, 2014. Accessed December 1, 2021.

5. Kane JM, Robinson DG, Schooler NR, et al. 

Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE Early Treatment Program

6. Rush AJ, Trivedi MH, Wisniewski SR, et al. 

Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report

Antidepressants, part 1: 100 years and counting

Junk DNA: A Journey Through the Dark Matter of the Genome

Epigenetics collide with pharmacogenetics

Ketamine/esketamine: putative mechanisms of action

12. Abdallah CG, Averill LA, Collins KA, et al. 

Ketamine treatment and global brain connectivity in major depression

The glass is half full: reflections on where we are and hope for where we are heading in psychiatry.

Hope for the New Year

worked with experts from multiple areas in psychiatry to bring you discussions of important topics, such as identifying and treating victims of human trafficking; diagnosing and managing fibromyalgia; and ethically evaluating dangerousness in individuals with personality disorders. Here are some highlights from our selection of this year’s Continuing Medication Education (CME) articles:

Psilocybin Revisited: The Science Behind the Drug and Its Surprising Therapeutic Potential

Psilocybin and psilocin are the main psychedelic agents of the psychoactive mushroom genus Psilocybe.

 Historical and cultural use of these psychoactive mushrooms dates back 3000 years in Mexico and the Southwestern regional areas of the present-day United States. Scientifically, psilocybin was isolated and identified in 1958, synthesized in 1959, and used in various experimental research studies in the early 1960s. During that time, psilocybin and other psychedelic agents such as lysergic acid diethylamide (LSD) generated considerable controversy. Outside of recreational use, could they be used safely as therapeutic interventions? 

Fibromyalgia: What It Is and How to Treat It

Fibromyalgia (FM) is one of the most controversial diagnoses in the field of pain management. Some experts believe that it does not exist and actually represents an accidental or purposeful misdiagnosis of other conditions, while others believe that it is badly underdiagnosed.

 The truth likely falls somewhere between these 2 extremes. FM is a real syndrome, but it is also perhaps overdiagnosed, both because many physicians are unaware of the actual diagnostic criteria, and because there may be a desire to avoid diagnosing patients with other conditions that could explain the symptoms of FM—most notably mental disorders. 

Psychiatric Evaluation of the Peripartum Patient

The peripartum period is not necessarily a time of emotional well-being,

 highlighted by the fact that about 1 in 13 women develop new-onset major depressive disorder (MDD) while pregnant.

 (The term “peripartum” in this article refers to pregnant women and women who are up to 1 year postpartum.) In the postpartum period, 1 in 7 women will develop MDD and are at high risk for psychiatric hospitalization.

 Thus, comprehensive psychiatric evaluation of the peripartum patient is an essential skill. The mainstay of assessment remains the clinical interview; as such, careful and systematic psychiatric evaluation during these periods is crucial for diagnosis, risk assessment, and treatment. The general psychiatric evaluation, however, must be expanded and tailored to the needs of the peripartum patient. 

Psychiatrists’ Response to Human Trafficking

Human trafficking is a public health issue that involves exploiting individuals for forced sex or labor. Traffickers perpetuate the cycle of exploitation by utilizing methods such as emotional, economic, or physical abuse; isolation; and threats. Physical, mental, legal, and social sequelae of human trafficking can persist for years after individuals survive their trafficking situations. Individuals with a preexisting history of psychiatric illnesses, including substance use disorders, are especially vulnerable to being trafficked. 

Here is a full list of our CMEs from 2021:

Microglial Involvement With Psychiatric Diseases

Neuropsychiatric Symptoms of Multiple Sclerosis

Opportunities in Managing Treatment-Resistant Depression and Tardive Dyskinesia

Psychological and Cognitive Insight: How to Tell Them Apart and Assess for Each

Different Strokes: How to Spot and Treat Poststroke Depression

Transgenerational Transmission of Resilience After Catastrophic Trauma

Prognostic Considerations in Anti-NMDA Receptor Encephalopathy With Psychiatric Manifestations

Cognitive/Neuropsychological Functioning and Suicidal Behavior: A Review of Research and Implications for Clinical Practice

Be sure to stay up-to-date by subscribing to the 

Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at 

Psychiatric Times featured a wide variety of psychiatric issues in this year’s CMEs.

CMEs 2021: A Year in Review

Previous studies have found links between migraine and other psychiatric disorders, including bipolar disorder, peripartum depression, and attention-deficit/hyperactivity disorder.

 Now, research points to a common genetic basis for both migraine and 

 The results further suggest shared risk factors, thus partially explaining the comorbidity of these conditions.

“Our results suggest that common genes and signaling pathways are involved in PTSD and migraine, and this might explain why PTSD and migraine can co-occur frequently,” said senior author on the study, Divya Mehta, PhD, of the Queensland University of Technology. “This might further imply that common environmental risk factors for both PTSD and migraine might be acting on these genes.”

The study observed 6 pairs of monozygotic (MZ) twins discordant for PTSD and 15 pairs of MZ twins discordant for migraine. PTSD was assessed via phone interviews conducted by an experienced interviewer using structured questions and DSM-IV criteria. All 6 pairs of twins were identified as having experienced a PTSD-qualifying potentially traumatic event as per the 

 criteria. Migraine was assessed using International Headache Society diagnostic criteria (

International Classification of Headache Disorders, Third Edition

) together with a diagnosis of migraine with or without aura. Pairs of twins discordant for migraine with aura were chosen for the study.

Blood samples were taken from all participants. Association between DNA methylation and PTSD status was tested using linear mixed effects models with age, sex, and cell counts as covariates. Using the same study design as the PTSD sample of twins, the 15 pairs of MZ twins discordant for migraine were tested for association of methylation at genetic loci that overlap between PTSD and migraine using varied analyses.

At the epigenome-wide level, researchers assessed how many of the 1036 genes associated with PTSD overlapped with those significantly associated with migraine in the discordant migraine MZ twins.

“We identified DAPK2 and TM6SF2 as two of the top overlapping genes between the two disorders. DAPK2 is a calmodulin-regulated protein kinase; it has been implicated in the intracellular degradation process essential for adaptation to metabolic stress (autophagy). TM6SF2 is associated with cardiovascular disease and plays a role in oxidative stress. These findings suggest that epigenetic changes in response to different types of stress may ‘mediate’ stress phenotypes,” the study authors explained.

“To the best of our knowledge, this is the first study to examine overlapping genes and biological processes in PTSD and migraine comorbidity using the monozygotic co-twin design,” the authors reported. “These results are important and suggest that common genes and pathways might be associated with PTSD and migraine, with implications for diagnosis of comorbidities in PTSD and common treatments for these comorbid disorders.”

“These results may have implications for treatments, as one medicine or therapy might only be effective for a single disorder,” Mehta added. “For co-occurring disorders such as PTSD and migraine, once we know which common genes are implicated in both disorders, we can develop new therapeutics to target these, thereby reducing symptoms and curing both.”

Comorbid bipolar disorder and migraine: from mechanisms to treatment

. 2021;11:560138. Accessed October 27, 2021.

2. Welander NZ, Mwinyi J, Asif S, et al. 

Migraine as a risk factor for mixed symptoms of peripartum depression and anxiety in late pregnancy: a prospective cohort study

3. Folkmann Hansen T, Hoeffding LK, Kogelman L, et al. 

Comorbidity of migraine with ADHD in adults

. 2018;18(1):147. Accessed October 27, 2021.

4. Bainomugisa CK, Sutherland H, Parker R, et al. 

Using monozygotic twins to dissect common genes in posttraumatic stress disorder and migraine

. June 22, 2021. Accessed October 27, 2021.

Twin study is first to reveal common genetic risk factors for PTSD and migraine

. June 22, 2021. Accessed October 27, 2021. ❒

Are common genes and signaling pathways involved in PTSD and migraine?

Exploring the Link Between Migraine and PTSD

From preparing for the holiday season to clinical updates and psychiatric perspectives on social issues and contemporary events, 

 covered important topics this week. Top articles included:

Holidays are joyous for some, but not for everyone. How can you help patients with mood disorders navigate the difficulties of the holidays?

COVID-19, Cognition, and Dementias: What Role Has the Pandemic Played?

How does COVID-19 contribute to cognitive impairment in older adults and future cases of dementia?

Shedding Light on the Shadow Brain Pandemic: The Devastating Effects of Gendered Violence-Related Acquired Brain Injury

In honor of the International Day for the Elimination of Violence against Women, let’s consider the impact of IPV on the neuropsychiatric health of women.

A Humanity Lesson From the Mouths of Babes

A child’s perspective, innocent and honest, serves as a good reminder of our biases.

It’s been a full week of interesting stories, commentaries, and more on a variety of topics at psychiatrictimes.com.

In Case You Missed It: November 22 to 26

Insomnia Sleep Supplement

Violence against women, which often results in 

 (TBI) and other acquired brain injuries (ABIs), has intensified during the COVID pandemic. Violence against women is a clear violation of human rights and a legal and moral failure of society. It likewise contributes to the brain health gap as well as presents as a major economic problem. As the world struggles to emerge from COVID-induced health and economic decline, women are a major key to the economic recovery. A comprehensive and long-term strategy is required to shed light on and address this dire issue and to ensure the mental well-being women as well as unlock the power of women to drive the economic recovery.

During July 2021, social media influencer Gabby Petito, aged 22, and her fiancé Brian Laundrie, aged 23, embarked from New York on a cross-country road trip captured on Instagram and YouTube.

 In September, Brian returned early from the trip—and alone. Weeks later, Gabby’s remains were found. It was determined that Gabby died from strangulation, and her case opened a national conversation about 

Tragically, Gabby’s case is just one of many. There has been an increase in IPV, illuminating a shadow pandemic within the COVID-19 pandemic.

, 1 in 3 women (approximately 1.27 billion individuals out of the 3.82 billion women in the world) are estimated to have experienced IPV.

 Further, more than one-third (30,000) of the women killed in 2017 were killed by their current or former intimate partner.

 COVID-19 has escalated the rates of IPV. Calls to helplines have increased five-fold in some countries in 2020.4In numerous countries, there has been a 300% increase in police reports of IPV, likely fueled by COVID-19 mitigation strategies.

 UN Women had projected that an additional 15 million women would be affected by IPV for every 3 months of lockdown.

Although this increase in violence will have multipronged effects, the neurological effects and IPV-related acquired brain injury (ABI), including Traumatic Brain Injury (TBI), is particularly devastating. Despite the increasing attention in the last 10 years paid to sports-related TBI, little attention has been paid to TBI resulting from IPV.

 Up to 90% of survivors of IPV report head, neck, and face injuries, many of which result in TBI.

 One study examining brain injury in women who experienced IPV found that 74% of the women sustained at least one IPV-related TBI and 51% sustained repetitive IPV-related TBIs.11 Moreover, the study found a higher brain injury score from IPV was negatively associated with memory, learning, and cognitive flexibility and positively associated with a number of measures of psychological distress.

IPV-related ABI also includes nontraumatic brain injuries. Research has shown that 1 out of 10 women have been strangled by an intimate partner,

 which can cause a multitude of neurological problems, including hypoxic-anoxic brain injury, with long-term implications. As Gabby’s case emphasized, strangulation can result not just in hypoxic-anoxic brain injury but also in death. Indeed, prior non-fatal strangulation has been found to be associated with greater than 6-fold odds of becoming a victim of attempted homicide, and more than 7-fold odds of becoming a victim of completed homicide.

 The high-profile fatal strangulation murder of Gabby underscores femicide in IPV, which devastatingly remains commonplace.

In addition to TBI, hypoxic-anoxic brain injury, and other forms of acquired brain injury, women who experience IPV also are more likely to suffer from anxiety, depression, posttraumatic stress disorder, suicidal ideation, and many other health problems that can last even after the violence has ended, potentially detaching them from the labor market.

There is also a growing concern that women who experience repeated TBIs from IPV may develop chronic traumatic encephalopathy (CTE), a progressive and fatal neurodegenerative disease that cannot be diagnosed until postmortem.

 Unfortunately, the literature tells their tales. For instance, a report from 1990 identified a case of a women who apparently developed CTE from partner abuse.

 In 2021, during a postmortem examination of a woman aged 29 who died following a domestic violence incident, immunohistochemical staining for phosphor-tau revealed evidence of CTE-type pathology.

 This marked the first case of CTE pathology in a young woman who experienced IPV. However, there remains a lack of research investigating the long-term neurological consequences for women who have experienced IPV; research is needed to understand the potential for misdiagnosis, nondiagnosis, or the development of dementia and Alzheimer disease as a result of IPV.

 The latter is especially important since TBI has been identified as a modifiable risk factor for dementia.

 Thus, more research is needed to evaluate IPV as a potential risk factor for dementia.

The neurological effects of IPV extend to the entire family and remain under researched. A recent Brain Injury Australia report of the country’s first research into domestic and family violence (DFV) and ABI found that, out of the 16,000 survivors of family violence attending Victoria hospitals over a decade’s time, 2 in every 5 survivors had sustained brain injury.

 Further, nearly 1 in 3 of the survivors of family violence were children and, of those, 1 in every 4 had sustained a brain injury. Because this was not a study of IPV but instead a study of hospitalizations, it likely represents the tip of the iceberg. Similarly, a study of more than 100 clients of 5 domestic abuse shelters in Arizona found 9 in every 10 individuals reported a head injury with loss of consciousness from family violence in the preceding 12 months.24 Of those, 9 in every 10 reported “too many head injuries to quantify.” Yet only 1 in every 5 ever sought medical attention. Thus, community rates of IPV ABI remain radically under researched.

Currently, most domestic violence shelters and emergency department settings do not assess for TBI, non-fatal strangulation, or other brain injuries from IPV, despite the significant number of studies that demonstrate brain trauma among IPV survivors as well as those that show non-fatal strangulation as an important risk factor for homicide of women.

 Additionally, many women do not seek medical care for their IPV-related ABI.

 However, even when women do interact with social workers, physicians, or domestic violence advocates and shelter staff, there is a lack of training in these professions to adequately screen for and address IPV-related ABI.

Further, when developing criminal justice policy, histories of abuse and brain injury should be addressed. A study of women in prison found that 78% had significant head injury; 84% of these women had experienced repeated head injury largely as a result of domestic abuse that had occurred over many years.

 Yet screening and care for brain injury is not adequately accounted for in criminal justice. The staggering statistics of the number of women who have experienced abuse and are now in prison also further necessitates the development of a trauma-informed criminal justice system.

IPV-related ABI add yet another injustice to the Brain Health Gap, which highlights and frames the sex and gender gap in outcomes for brain health disorders across the lifespan, with strikingly negative outcomes for women.

 To address the Brain Health Gap, research institutions are calling for more women participants in preclinical development of medications, clinical trials, and clinical practice, as well as the expansion of research designed to focus on culturally relevant experiences specific to individuals who identify as female. This will enable more robust and representative data to be collected. Big data, real world evidence, and precision medicine approaches should be the tools used to respond to the call to action above. Furthermore, investing in leaders in health care and public health efforts is imperative to translate these data and perspectives into action. Women remain underrepresented in health care leadership, underlining the lack of gendered consideration in care. These efforts and initiatives are especially important for research, clinical care, and training related to IPV. The Brain Health Gap must address issues related to IPV-related ABIs.

Likewise, we have previously noted that the world is suffering a global brain capital collapse.

Brain Capital is a novel econometric asset that puts a premium on brain health and brain skills in our brain economy.

form of capital relevant to a complex, interconnected, and fragile global economy. Brain Capital needs to be integral to a new narrative of growth and progress that puts people and their well-being, health, interaction with others, and psychological resilience at the center of our economic system. Female empowerment—which includes preventing and addressing violence against women and better identifying and caring for the neurological effects in survivors—is a public and brain health imperative as well as the most effective way to build Brain Capital globally.

Addressing gendered violence and related ABIs can be remedied by integrating the social, medical, political, policy, and diplomatic levels. Taking sex and gender into account—including structural and social determinants—is critical for equality in brain health and precision medicine. The 

Organisation for Economic Co-Operation and Development 

Unit’s Neuroscience-inspired Policy Initiative

 We aim to find new ways to reconceptualize and revitalize the economy and how it works, laying the groundwork to identify relevant metrics while building a transdisciplinary network of stakeholders. The effort draws on experts from medicine, neuroscience, gender analysis, economic policy, philanthropy, and business. The Initiative will rapidly refine and advance women’s brain health via a series of research projects, seminars, and clear policy analyses and recommendations. In doing so, we hope to address the Brain Health Gap, leading to greater health justice for all people and a new era of innovation and progress. We hope to help build a future where both men and women are equipped with the support, resources, and care they need to thrive and in turn build more a resilient society and world.

 is an Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI) (at the University of California, San Francisco (UCSF) and Trinity College Dublin), a Thiel Fellow at Stanford University and Steering Committee member for NIPI ( OECD, Meadows Mental Health Policy Institute (MMHPI) and the PRODEO Institute).

is an associate professor in psychiatry at Harvard Medical School and a research scientist at Massachusetts General Hospital. 

is head stakeholder, Engagement Alzheimer's disease at Biogen and Pro Bono CEO and Co-founder of the Women's Brain Project.

is head of the OECD New Approaches to Economic Challenges Unit, Senior Advisor to the OECD Secretary General and co-lead of OECD NIPI.

is advisor to the chief of staff and gender advisor at OECD.

 is a Senior Clinical Advisor for Cohen Veterans Bioscience’s Trauma Research Programs. She serves as Strategic Advisor co-leading CVB’s Suicide Strategy Initiative. 

 is co-lead of OECD NIPI, strategic advisor to the HEKA Fund (Newfund Capital and Fondation FondaMental), steering committee member for the Brain Health Nexus at Cohen Veterans Bioscience, and holds adjuncts roles with IMPACT at Deakin University, GBHI and Baylor College of Medicine.

How the case of Gabrielle Petito galvanized the internet

October 20, 2021. Accessed November 20, 2021. https://www.nytimes.com/2021/09/20/style/gabby-petito-case-tiktok-social-media.html

Gabby Petito was strangled. Experts say such an assault is a red flag for intimate partner homicides

 October 12, 2021. Accessed November 20, 2021. https://www.usatoday.com/story/news/nation/2021/10/12/gabby-petito-strangled-experts-say-its-common-intimate-partner-violence/8426282002/

A Pandemic within a Pandemic - Intimate Partner Violence during Covid-19

When pandemics clash: Gendered violence-related traumatic brain injuries in women since COVID-19.

5. Breiding MJ, Smith SG, Basile KC, et al. 

Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization--national intimate partner and sexual violence survey

6.United Nations Office on Drugs and Crime. 

Global study on homicide: Gender-related killing of women and girls

. 2018. Accessed November 20, 2021. https://www.unodc.org/documents/data-and-analysis/GSH2018/GSH18_Gender-related_killing_of_women_and_girls.pdf

Gender-based violence: We must flatten the curve of this shadow pandemic

. November-December 2020. Accessed November 20, 2021. https://www.un.org/africarenewal/magazine/november-december-2020/gender-based-violence-we-must-flatten-curve-shadow-pandemic

Concussion in sport: Domestic violence victims show same brain injury trauma as athletes with CTE

Intimate Partner Violence and Traumatic Brain Injury: State of the Science and Next Steps

10.Liu LY, Bush WS, Koyutürk M, Karakurt G. 

Interplay between traumatic brain injury and intimate partner violence: data driven analysis utilizing electronic health records.

12.Monahan, K., A. Purushotham, and A. Biegon, 

Neurological implications of nonfatal strangulation and intimate partner violence

13. Glass N, Laughon K, Campbell J, et al. 

Non-fatal strangulation is an important risk factor for homicide of women

Adult experience of mental health outcomes as a result of intimate partner violence victimisation: a systematic review

. 2014;5:10.3402/ejpt.v5.24794. Published 2014 Sep 12.

Intimate Partner Violence, Traumatic Brain Injury, and Social Work: Moving Forward

Intimate partner violence and traumatic brain injury: a public health issue

In honor of the International Day for the Elimination of Violence against Women on November 25, 2021, let’s consider the impact of IPV on the neuropsychiatric health of women. 

Neuropsychiatry

Hope for the New Year

CMEs 2021: A Year in Review

Exploring the Link Between Migraine and PTSD

In Case You Missed It: November 22 to 26

Insomnia Sleep Supplement

Shedding Light on the Shadow Brain Pandemic: The Devastating Effects of Gendered Violence-Related Acquired Brain Injury

Brain Science Must Be on COP 26 Agenda

A Brain-Based Approach to Psychotherapy

Exploring Vital Amines: The Who, What, When, Where, Why, and How of B12 Deficiency

Pioneering Psychopharmacology: Educator of the Year Award