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Work completed since the pandemic began has repeatedly demonstrated elevated mortality rates in people with schizophrenia hospitalized with COVID. They are a vulnerable group due to multiple issues-for example high co-morbidity rates of medical illness, often impaired insight and judgment, barriers to obtaining health care, and trouble understanding and implementing preventive measures. The objective of this study was to evaluate if a diagnosis of schizophrenia in the context of COVID-19 requiring hospitalization increased the risk for people with a diagnosis of schizophrenia to be intubated, admitted to the ICU or die when compared to people hospitalized with COVID-19 who did not have schizophrenia. This was accomplished by doing a retrospective chart review of 123 people with schizophrenia and matched controls. Although we found elevated rates of these outcomes in the patients with schizophrenia, our analysis attributed these differences to congregate living, rather than the illness itself.

Background: The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented shift in health care toward telepsychiatry. This worldwide phenomenon was necessary to meet community health needs while prioritizing patient and provider safety. This study explored the impact of changes in delivery of mental health care services during the pandemic on patient and provider satisfaction with care. Methods: Providers and patients at an academic outpatient psychiatric clinic completed an electronic, cross-sectional, anonymous survey. Items probed perceived convenience and comfort with in-person and telehealth visits, COVID-19–related depression and anxiety, and visit modality preferences. Results: The response rate was 80.0% for providers and 21.0% for patients. Providers found telehealth more convenient than in-person visits during the pandemic, t(11)=1.66, P=0.024. Patients reported no differences in convenience (P=0.497) or comfort (P=0.535) ratings. As the pandemic continues, 83.3% of providers and 50.0% of patients indicated they would prefer telehealth visits. Only 16.7% of providers and 25.0% of patients would prefer telehealth visits continue after the pandemic. Preferred appointment type during the pandemic was not significantly correlated with pandemic-related anxiety or depression. Conclusion: Providers showed a strong preference for telehealth visits during the pandemic, whereas patients felt equal convenience and comfort with care in both telehealth and in-person visits. Fewer participants preferred to use the telehealth modality after the pandemic ends. Higher COVID-19–related depression or anxiety did not impact preference toward visit type. These results suggest that telepsychiatry is an acceptable, although not always preferred, modality for psychiatric care during the global pandemic.

The current paper presents a biopsychosocial model of cannabis use and anxiety that focuses explicitly on aspects of anxiety that may contribute to cannabis use and use-related problems among individuals with elevated anxiety. Elevated anxiety and anxiety disorders are common among individuals who use cannabis and those with cannabis use disorder (CUD). One possible explanation for this co-occurrence may be that symptoms associated with anxiety disorders (i.e., physiological arousal, subjective anxiety, and avoidance) may place anxious individuals at risk of using cannabis to cope with these symptoms. A review of the literature on the relationships between facets of anxiety and cannabis use and related problems partially supports the utility of this model and informs future directions for research and treatment in this area.

R Hammarlund,1 KA Crapanzano,2 L Luce,2 L Mulligan,2 KM Ward2 1Our Lady of the Lake Division of Academic Affairs, Baton Rouge, LA, USA; 2Department of Psychiatry, Louisiana State University Health Sciences Center, Baton Rouge, LA, USA Abstract: Substance-use disorders are a public health crisis globally and carry with them significant morbidity and mortality. Stigma toward people who abuse these substances, as well as the internalization of that stigma by substance users, is widespread. In this review, we synthesized the available evidence for the role of perceived social stigma and self-stigma in people’s willingness to seek treatment. While stigma may be frequently cited as a barrier to treatment in some samples, the degree of its impact on decision-making regarding treatment varied widely. More research needs to be done to standardize the definition and measurement of self- and perceived social stigma to fully determine the magnitude of their effect on treatment-seeking decisions. Keywords: self-stigma, perceived social stigma, substance-use disorders, treatment seeking

Implicit attitudes are outside of conscious awareness and are thought to affect automatic responses outside of one’s deliberate control, with the potential to impact physician-patient relationships. To measure the nature and extent of implicit biases towards depression in internal medicine and psychiatry residents. Descriptive and comparative study. Fifty-one residents from three internal medicine programs and 35 residents from three psychiatry programs located in two states. Participants were sent a link to voluntarily participate in four online implicit association tests. Residents’ identities were anonymous. Four implicit association tests to measure the association of (1) attitude (good/bad), (2) permanence, (3) controllability, and (4) etiology with depression/physical illness. Internal medicine residents demonstrated a significant association between depression and negative attitudes (t(38) = 6.01, p

My story illustrates how a power dynamic altered my own behaviors, how gender biases about sexual misconduct contribute to inequities within academia, and the importance of providing safety and validation to victims of sexual misconduct. As faculty now, I pay attention to power dynamics with trainees, colleagues and patients, recognizing that even voicing differences of opinions can be difficult from a disempowered position. The powerlessness I experienced, freezing then yielding, can occur in any setting that does not provide safety and support for the expression of diverse and contrasting perspectives. Changing cultural norms related to power within academia requires all of us to think differently about ourselves and others continuously as we all carry implicit biases [11]. From a women’s mental health perspective, all physicians should recognize that emotional pain often derives as much from sociocultural narratives that invalidate lived experiences as from the actual traumatic events. Sexual aggression from my supervisor rendered me powerless as a trainee; this common experience limits both professional successes and damages the health of women in our society.

Stigma towards people with substance use disorders is a common phenomenon with far reaching effects. This study evaluated the long-term effect of using an educational intervention on the attitudes of physician assistant students.Physician assistant students received a one-week educational intervention focused on substance abuse. Changes in student attitudes were measured one year later using the Attitude to Mental Health Questionnaire (AMIQ).Significant and sustained improvement was noted in attitudes in the AMIQ score for the opiate use disorder vignette; no significant change was noted in the alcohol use disorder vignette.The persistence of improved attitudes (although they remained negative) in study participants towards people with opiate use disorders is a cautiously encouraging finding. Educational interventions can have a sustained effect on stigma reduction, but much more work on the etiology of these implicit and explicit beliefs is needed to inform robust future interventions.

Background: Burnout is a major problem among physicians in the United States. Women physicians experience higher rates of both burnout and sexual harassment than their male counterparts. Some studies from Asia and Europe have shown a correlation between sexual harassment at work and burnout in women physicians, but no studies on this topic have been done in the United States. Methods: For this study, women physicians with active Louisiana licenses were invited to complete a cross-sectional self-report survey to assess burnout and sexual harassment. Burnout was assessed with the 2-item Maslach Burnout Inventory, and sexual harassment was assessed with a questionnaire adapted from the Sexual Experiences Questionnaire and a series of follow-up items. Results: The survey response rate was 13% (129 of 970 invitees). Of the 129 participants, 36% reported feeling burned out from their work at least once a week and 38% reported having experienced at least one inappropriate sexual incident in their career. Ninety-six percent of respondents reported having experienced gender harassment from their colleagues, while 69% had experienced unwanted sexual attention from the same. Additionally, 69 (53%) participants reported experiencing some form of sexual harassment from patients or their families. Colleague gender harassment was significantly correlated with burnout scores. Conclusion: This study found that reports of burnout and gender harassment from colleagues were significantly correlated. The results also align with previous findings of high rates of sexual harassment in medical school and residency. More research should be done in this area, especially focusing on women in training, women of color, and sexual and gender minority individuals.

Substance use disorders (SUDs) take a heavy toll on those who have them and on society more broadly. These disorders are often difficult to treat, and relapse is common. Perhaps, because of these factors, these disorders are highly stigmatized worldwide. The purpose of this study is to examine empirical work intended to determine the impact of perceived social stigma and self-stigma on the process of recovering from SUDs with the assistance of formal treatment services. Qualitative studies confirmed that stigma experiences are common among those with these disorders and that these experiences can negatively impact feelings and beliefs about treatment. One quantitative study provided good statistical support for a direct effect of stigma on outcomes, but this was contradicted by other longitudinal data. In general, quantitative articles suggested an indirect effect of stigma on treatment outcomes, via negative emotions and cognitive mechanisms such as feelings of self-efficacy. However, it was notable that there was little consistency in the literature as to definitions and measurement of the constructs of recovery, perceived social stigma, and self-stigma. Future work should focus on bringing clarity, and validated measures, to this problem in order to better determine the nature of these relationships.

Cannabis use disorder (CUD) is the most common illicit substance use disorder and individuals with CUD have high rates of comorbid anxiety disorders. Comorbidity between CUD and anxiety disorders is of public health relevance given that although motivation enhancement therapy (MET) combined with cognitive-behavioral therapy (CBT) is an efficacious intervention for CUD, outcomes are worse for patients with elevated anxiety. The current study tested the acceptability and efficacy of the integration of a transdiagnostic anxiety CBT (i.e., treatment of patients with any anxiety disorder) with MET-CBT (integrated cannabis and anxiety reduction treatment, or ICART) for CUD compared to MET-CBT alone. Treatment-seeking cannabis users (56.4% male, Mage = 23.2, 63.3% non-Hispanic White) with CUD and at least one comorbid anxiety disorder were randomly assigned to ICART (n = 27) or MET-CBT (n = 28). Patients in the ICART condition attended significantly more treatment sessions than those in the MET-CBT condition. Patients in the ICART condition were more likely to be abstinent post-treatment than those in MET-CBT. Further, treatment produced decreases in cannabis use and related problems. Notably, therapy type did not moderate the impact of treatment on frequency of use and related problems. Together, these data suggest that ICART may be at least as efficacious as a gold-standard psychosocial CUD treatment, MET-CBT, for a difficult-to-treat subpopulation of cannabis users.

BACKGROUND: Physician biases toward mental conditions such as depression have been shown to adversely affect medical outcomes. OBJECTIVE: To explore the relationship between residents’ explicit bias toward depressed patients and their clinical skills on a cardiac case during an objective structured clinical exam (OSCE). DESIGN: Prospective parallel randomized controlled study. PARTICIPANTS: One hundred eighty-five internal medicine residents from three residency programs in two states. INTERVENTION: During October–November 2015, residents were randomized to either a depressed or non-depressed standardized patient (SP) presenting with acute chest pain. MAIN MEASURES: The Medical Condition Regard Scale (MCRS) assessed residents’ explicit bias toward patients with depression. Their clinical skills (history-taking, physical examination, patient counseling, patient–physician interaction (PPI), differential diagnosis, and workup plan) and facial expressions were rated during an OSCE. KEY RESULTS: No significant relationships were found between resident explicit bias and clinical skill measurements. Residents who examined the depressed SP scored lower, on average, on history-taking (t [183] = −2.77, p

Psychotherapy competence is a core skill for psychiatry residents, and psychotherapy supervision is a time-honored approach to teaching this skill. To explore the current supervision practices of psychiatry training programs, a 24-item questionnaire was sent to all program directors of Accreditation Council for Graduate Medical Education (ACGME)-approved adult psychiatry programs. The questionnaire included items regarding adherence to recently proposed therapy supervision practices aimed at reducing potential liability risk. The results suggested that current therapy supervision practices do not include sufficient management of the potential liability involved in therapy supervision. Better protections for patients, residents, supervisors and the institutions would be possible with improved credentialing practices and better documentation of informed consent and supervision policies and procedures.

Stigma towards people with substance use disorders is pervasive and imbedded in our US culture. Prejudicial attitudes that are part of a health care practitioner’s value system are a barrier to people accessing health care and substance use treatment. This study aimed to reduce stigmatizing attitudes of graduate health care professional students by implementing an innovative curriculum combining multiple teaching methods. Physician assistant students received a 3-h educational intervention that consisted of lecture and discussion sessions, direct interaction with a recovering substance user, viewing a film portrayal of addiction and addiction treatment, and written self-reflection. Changes in student attitudes were measured using a subscale of the Attitudes to Mental Illness Questionnaire (AMIQ) instrument and analysis of coded written reflections. A follow-up focus group resulted in additional qualitative insight into attitudes. Post-intervention scores for the “heroin” AMIQ vignette significantly improved compared to pre-test scores (p

Dextromethorphan, an antitussive (cough suppressant) drug of the morphinan class with sedative and dissociative properties found in cough syrup and other over-the-counter products, is also a substance of abuse, seen primarily in young adults all over the world. A case of dextromethorphan use disorder is presented in a 45-year-old women. Her repeated attempts at abstinence were unsuccessful secondary to continued intense cravings. Treatment with topiramate resulted in complete resolution of her cravings. Topiramate was chosen empirically because of a common action with dextromethorphan in the NMDA system. Genetic testing was obtained and the patient was found to be a carrier of the GRIK1 rs2832407(C:C) allele. The (C:C) allele has been associated with an increased risk of alcohol use disorder and a treatment response of patients with heavy drinking to topiramate. This case provides an opportunity to discuss personalized medicine (treatment options aided by the use of genetic testing) and the possible shared genetic susceptibility for dependence in 2 substances of abuse.

Medical professionals' negative attitudes toward patients with mental illness and substance abuse disorders can have negative consequences, and these attitudes are not rare. In surveys, patients have reported discrimination in mental health settings in the 16% to 44% range and 17% to 31% in physical health settings.1 More concerning than the perceived stigma experienced by patients is the potential for bias in medical decision making. For example, health care providers are less likely to refer people with mental illnesses for a mammogram, less likely to admit them for hospitalization after a diabetic crisis, and less likely to perform a cardiac catheterization.2 Stigmatizing beliefs also affect clinical decisions through diagnostic overshadowing, attributing physical symptoms to the mental condition and consequently not investigating or treating them.3 Although evidence suggests that patients with mental illnesses are no less likely to be adherent to treatment recommendations than others, health care professionals who endorsed more stigmatizing attitudes about mental illness were more likely to be pessimistic about the likelihood of patients adhering to treatment, and this contributed to impaired decision making.4

Engagement in treatment for a person having a behavioral health crisis is critical to fully address the concerns of the individual as well as to prevent future crises. This study explored the benefits of establishing outreach visits from a local community mental health provider to psychiatric patients in an emergency department. Using retrospective analysis of data collected by a local mental health agency, the effect of receiving face to face contact in the emergency room with a community mental health worker (and/or telephone follow up) was compared to no outreach interaction. The effect of this intervention was a significant increase in initial appointment attendance at the local mental health clinic in the aftermath of a psychiatric crisis. Community mental health services provided in partnership with community emergency departments may improve patient engagement in aftercare and consequently help alleviate future behavioral health crises as well as return visits to the emergency department.

Th e syndrome qf inappropriate secretion qf antidiuretic hormone (S IADH) is a common medical illness which has many etiologies-some ofwhich are particular to psychiatric pat ients. Th is review will discuss the diagnosis qfSIADH and then the various etiologiesfor its development wi th emphasis on those which are more relevant to psychiat ric patients. Future research will be directed to afu rther understanding qf this disorder, as well as to treatment opt ions to decrease the significant morbidity associated with this condition. " Is it only the mouth and th e belly whic h are inju red by hunger and thirst ? Men 's minds are also injured by th em ." Mencius , Works, Book VII 372-289 Be