bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychiatric Consultations at an Academic Medical Center in the Initial Weeks of the COVID-19 Pandemic: A Clinical and Sociodemographic Comparison of COVID-Positive and COVID-Negative Consultations
Authors: Groenendaal Emily , Lynch Sean , Shahar Sivan , Dornbush Rhea , Klepacz Lidia , Ferrando Stephen J. 
Published: January 2025

BackgroundDuring the initial weeks of the COVID-19 pandemic, the overall number of psychiatric consultations decreased; however, the consultations that were placed appeared to be heavily related to either COVID-19 infection or a stressor secondary to the pandemic. New onset neuropsychiatric symptoms have been seen and described in prior reports among patients with acute COVID-19 infection. This study aimed to examine the sociodemographic and clinical characteristics of psychiatric consultations in the early portion of the pandemic, and compare patients who were COVID-19-positive with those who were negative.MethodsThis IRB-approved retrospective chart review involved all psychiatric consultations for COVID-19-positive patients admitted to a medical floor at an academic medical center from March 1 2020 until May 31 2020. Sociodemographic, medical (including diagnoses and laboratory values), and psychiatric information was collected from all consultations, and patients who were COVID-19 positive were matched with a COVID-negative comparison group by age (+/- 3 years) and gender. Statistical analyses to compare these groups were performed.ResultsThere were 80 consultations for COVID-positive patients identified in the given time period. These were matched with a comparison group of 80 patients who had been listed as COVID-negative; however on review of medical records only 64 were truly negative, so 16 were excluded. Significant differences existed between groups in terms of reason for psychiatric consultation (p=0.04) and billing diagnosis (p<0.01), with COVID-positive patients appearing to have a greater likelihood of presenting with psychosis or delirium, and less likelihood for mood, anxiety, or substance use. D-dimer levels were higher in COVID-positive patients, and patients with COVID had a higher mortality rate. COVID-positive patients were more likely to receive a “second-generation antipsychotic”. Differences between groups in terms of specific psychiatric symptoms were explored. No other sociodemographic or medical differences were found between groups.Discussion/Conclusion: Patients with COVID-19 infection may be at an increased rate for delirium and for symptoms of psychosis. Multiple studies have speculated on mechanisms for such symptoms, though findings are inconclusive. This study suggests that simply increased stress during the pandemic is not the driving factor for these symptoms. Patients admitted to medical floors with COVID-19 infection should be screened for delirium and for new-onset neuropsychiatric symptoms.FundingNo Funding
Comparison of the Literature Regarding Weight Gain Between Olanzapine/Metformin and Olanzapine/Samidorphan Combinations
Authors: Loghavi Hameed , Imtiaz Ayyub , Kalfe Riju , Zaidi Muhammad 
Published: January 2025

IntroductionMany potent antipsychotics, such as olanzapine (OLZ), can cause significant and rapid weight gain as a potential side effect. This can lead to medication non-adherence and recurrence of psychiatric outcomes, or developing cardiometabolic risk factors that increase the risk of heart disease. The olanzapine-samidorphan (OLZ/SAM) drug combination has demonstrated ability to mitigate the weight gain caused by OLZ. However, olanzapine-metformin (OLZ/MET) combinations have also been studied for weight gain problems before the introduction of OLZ/SAM. The authors will review the similarities and differences between OLZ/SAM and OLZ/MET combinations regarding weight gain.MethodsIn this literature review, we conducted a non-systematic search in PubMed and Google Scholar, utilizing specific key words, such as “Olanzapine”, “Metformin”, “Samidorphan”, and “Weight Gain.” Case reports/series and narrative reviews were excluded, and only English-language studies reporting weight change or rate of weight change outcomes were included. Data extraction and qualitative synthesis were performed for the selected studies.ResultsOLZ/SAM has shown the ability to effectively reduce weight gain in non-obese populations, however, OLZ/MET has shown the ability to decrease weight gain in both obese and non-obese populations. Both drug combinations displayed these benefits after approximately 7 weeks. OLZ/MET’s weight mitigation was largely commensurate with increases in both dosage and duration of treatment. OLZ/SAM’s most efficacious dosage was not readily apparent. The maximum reduction in weight gain was achieved when MET was titrated to a daily dose of 2000 mg, although significant prevention of weight gain has been reported with lower doses as well. The mean weight change for OLZ/MET over 24 weeks was +5.5 lbs on 2000 mg per day. The mean weight change for OLZ/SAM over 24 weeks was +7.0 lbs., however, the average dose of OLZ/SAM was not reported. These results were seen in both adult and non-adult populations. OLZ/MET is considerably more affordable in comparison to OLZ/SAM. Other notable differences included dosage flexibility and scheduling, contraindications in select populations, and common side effects, among others.ConclusionsWeight gain is a serious side effect of many antipsychotics and can greatly impair a patient’s quality of health and life. Drug combinations such as OLZ/SAM and OLZ/MET are crucial to help minimize the morbidity caused by medication-induced obesity. Both combinations showed effectiveness in reducing rates of weight gain but these effects were delayed until approximately 7 weeks. OLZ/MET’s effectiveness was positively correlated with increased dosages and duration, unlike OLZ/SAM in which no such relation could be convincingly established. OLZ/SAM’s relatively high cost is likely prohibitive for many persons, especially considering mental illness’ often devastating socioeconomic impact.FundingNo Funding
Do Images in Jackson Pollock’s Paintings - Polloglyphs – Arise From His Conscious and Unconscious, Or Are They All in The Viewer’s Mind?
Authors: Morrissette Debbi Ann , Stahl Stephen M. , Gates Jon A. 
Published: January 2025

Was Jackson Pollock “Jack the dripper” with paintings “that a dog or cat could have done better,” or did Pollock insert Polloglyphs – images that are encrypted that tell a story about Pollock’s inner being - into his paintings and then disguise them with drippings? On the one hand, some - especially art critics - have emphasized the formal elements of Pollock’s work, arguing that no images are present and the viewer can find whatever they are looking for because such images are artefacts of the “fractal” fuzzy edges to the drippings and are just fooling the eyes. Thus, maybe Pollock’s paintings are just a massive set of new Rorschach inkblots to provoke the viewer to project their own emotions onto the painting, whereas there is actually nothing at all in the painting from the artist. On the other hand, from a psychiatric point of view, given that Pollock had bipolar disorder, painted when he was euthymic or manic and not intoxicated nor depressed, had extensive exposure to Rorschach ink blots during his own psychiatric treatment, had visual images and hallucinations of images, clearly incorporated images into his pre-drip paintings (e.g., see Troubled Queen), and used repeatedly the same images in multiple drip paintings (e.g., booze bottles, images of himself, monkeys, clowns, elephants and more), the alternate point of view is that Pollock either consciously or unconsciously encrypted images in his drip paintings. His remarkable ability to do this with Polloglyphs hiding in plain sight may be part of Pollock’s creative genius and could have been enhanced by the endowment of extraordinary visual spatial skills that have been described in some bipolar patients. If so, painting could have been Pollock’s way to rapidly unspool his images and to do this onto canvas. Pollock himself stated that consciously “I try to stay away from any recognizable image; if it creeps in, I try to do away with it.” However, he also admitted “recognizable images are always there in the end.” If coming from his deep unconscious creativity and genius, such images may have appeared in spite of himself. Pollock thus may indeed not have been mindful of creating Polloglyphs as he stated “When I am in my painting, I’m not aware of what I am doing.” He painted in air, letting gravity make the picture, and dripping became not just another way of obscuring images but as well a new way of creating them. Ultimately, we may never know if there are Polloglyphs present in Jackson Pollock’s famous drip paintings, nor can we know for sure whether they are merely in the mind of the beholder or put there consciously or unconsciously by the artist. In the meantime, it can be fun and enlightening to view Pollock’s works and decide for yourself.FundingNo Funding
Diagnosis and Treatment of Tardive Dyskinesia: Online Medical Education Improves Psychiatrists Knowledge, Competence, and Confidence
Authors: Guevara Natalie , Lubarda Jovana , Wright Clinton 
Published: January 2025

ObjectivesThis study examined whether online continuing medical education (CME) could improve the knowledge, competence, confidence of psychiatrists regarding the diagnosis and management of tardive dyskinesia (TD).MethodsPsychiatrists participated in a 30-minute online video-based lecture presented by an expert faculty. Educational effect was assessed using a repeated-pair design with pre-/post-assessment. 3 multiple choice questions assessed knowledge, and 1 question rated on a Likert-type scale assessed confidence. A paired samples t-test was conducted for significance testing on overall average number of correct responses and for confidence rating, and a McNemar’s test was conducted at the question level (5% significance level, P <.05). Data were collected from 4/14/2022 to 7/8/2022.ResultsPsychiatrists (n=579) showed significant improvements in overall knowledge and competence (P<.001) as well as confidence.•There was a 9% relative improvement in knowledge among psychiatrists regarding the factors that differentiate TD from other motor symptoms associated with antipsychotic use•There was a 18% relative improvement in competence among psychiatrists regarding the selection of appropriate pharmacotherapy for TD•38% of psychiatrists had measurable increases in confidence to diagnose and treat TDConclusionsThis study demonstrated the success of online, video-based lecture CME on improving knowledge, competence, and confidence related to the diagnosis and management of TD. These findings suggest the benefits of education that addresses clinicians’ individual needs across the continuum of their professional development.FundingMedscape Education, Neurocrine Biosciences
Cariprazine as Adjunctive Treatment for Major Depressive Disorder: Benefit and Risk Assessment Using Number Needed to Treat and Number Needed to Harm
Authors: Citrome Leslie , Reda Ivonna , Kerolous Majid 
Published: January 2025

PurposeThis post hoc analysis investigated efficacy and tolerability of adjunctive cariprazine (CAR) in patients with major depressive disorder (MDD) using evidence-based medicine metrics of number needed to treat (NNT), number needed to harm (NNH), and likelihood to be helped or harmed (LHH).MethodsData sources were five completed Phase II/III, 6-8 week, randomized, double-blind, placebo-controlled studies. Efficacy outcomes included acute response (≥50% decrease from baseline on the Montgomery-Åsberg Depression Rating Scale [MADRS] total score). Tolerability outcomes included commonly occurring adverse events (AEs) and rates of discontinuation because of an AE, with data pooled across all studies for the CAR 1-2 mg/day plus 1.5 mg/day dose groups, 2-4.5 mg/day plus 3 mg/day dose groups, and for all groups where CAR dose was ≥1 mg/day. NNT and NNH were calculated for adjunctive CAR vs. adjunctive placebo.ResultsMADRS response rates at Week 8 for CAR 2-4.5 mg/day vs. placebo were 134/271 (49.4%) vs. 101/264 (38.3%), resulting in a NNT of 9 (95% CI 6-36). In study NCT03738215, MADRS response rates at Week 6 for CAR 1.5 mg/day vs. placebo were 110/250 (44.0%) vs. 87/249 (34.9%), resulting in a NNT of 11 (95% CI 6-193). For the pooled CAR ≥1 mg/day group, MADRS response rates at Week 6 were 765/1887 (40.5%) for CAR vs. 354/1101 (32.2%) for placebo, resulting in a NNT of 12 (95% CI 9-21). For the pooled CAR ≥1 mg/day group, rates of akathisia vs. placebo were 209/1893 (11.0%) vs. 25/1108 (2.3%) for placebo, resulting in a NNH of 12 (95% CI 10-14). This appears dose related as the NNH for akathisia vs. placebo was 24 (95% CI 17-43) for the 1-2 mg/day plus 1.5 mg/day dose groups, and 9 (95% CI 7-11) for the 2-4.5 mg/day plus 3 mg/day dose groups. For the pooled CAR ≥1 mg/day group, rates of discontinuation because of an AE vs. placebo were 122/1893 (6.4%) vs. 26/1108 (2.3%) for placebo, resulting in a NNH of 25 (95% CI 19-38). This appears dose related as the NNH for discontinuation because of an AE vs. placebo was 94 (ns) for the 1-2 mg/day plus 1.5 mg/day dose groups, and 17 (95% CI 13-28) for the 2-4.5 mg/day plus 3 mg/day dose groups. For the pooled CAR ≥1 mg/d group, rates of weight gain ≥7% from baseline vs. placebo were 35/1893 (1.8%) vs. 12/1108 (1.1%) for placebo, resulting in a NNH of 131 (ns). LHH comparing MADRS response vs. discontinuation because of an AE is >1, and >>1 for the lower dose range. Indirect comparisons of the above results with that of the effect sizes seen in positive studies of other adjunctive antipsychotic treatments vs. adjunctive placebo in MDD demonstrate similar values for NNT for response, and when the lower dose range of CAR is used, a more favorable NNH regarding discontinuation because of an AE.ImportanceThe benefit-risk profile of CAR is favorable for adjunctive treatment of MDD.FundingAbbVie
Mental Health-Related Healthcare Resource Use and Costs of Medicaid Beneficiaries with Treatment Resistant Depression Receiving Interventional Therapy
Authors: Clemens Kristin , Zhdanava Maryia , Teeple Amanda , Voegel Arthur , Shah Aditi , Bowrey Hannah , Tardif-Samson Anabelle , Pilon Dominic , Joshi Kruti 
Published: January 2025

IntroductionEsketamine (ESK) nasal spray and interventional therapies including electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) are indicated for patients with treatment resistant depression (TRD). Little is known about healthcare resource use and associated costs of Medicaid beneficiaries, a population with a high burden of mental health disorders, initiating ESK, ECT or TMS. This study aimed to bridge this gap in knowledge.MethodsMedicaid-insured adults with evidence of TRD (≥2 unique antidepressants of adequate dose and duration) were selected from Merative™ MarketScan® Multi-State Medicaid Database (01/2016-06/2022). Based on therapy initiated on or after 03/05/2019 (ESK approval date for TRD), patients were classified into three cohorts: ESK, ECT, and TMS. Before treatment initiation (index date), patients had ≥12 months of continuous insurance eligibility (baseline period). Mental health (MH)-related resource use and payer costs (USD 2022) were reported per-patient-per-month (PPPM) during the follow-up period, which spanned the index date until the earliest continuous insurance eligibility or data end.ResultsESK cohort included 151 patients (mean age: 40.6 years; female: 70.2%), ECT cohort included 198 patients (mean age: 43.0 years; female: 60.6%), and TMS cohort included 140 patients (mean age: 39.5 years; female: 65.0%).During the follow-up period, the mean number of MH-related inpatient (IP) days trended lower in ESK cohort (0.09) relative to the ECT (3.72) and TMS (0.31) cohorts. Similarly, the mean number of MH-related emergency department (ED) visits trended lower in ESK cohort (0.07) relative to ECT (0.12) and TMS (0.26) cohorts. The mean number of MH-related outpatient (OP) visits in ESK cohort (4.83) trended higher than in ECT cohort (4.37) but lower than in TMS cohort (6.41). Mean MH-related acute care costs during the follow-up period trended lower in ESK cohort (IP: $76; ED: $29) relative to ECT (IP: $1,547; ED: $45) and TMS cohorts (IP: $238; ED: $123). Outpatient costs in ESK cohort ($1,632) exceeded OP costs in ECT ($1,023) and TMS ($1,051) cohorts.ConclusionIn this descriptive analysis, a trend towards lower use and costs of acute MH-related care was observed after the initiation of ESK relative to the initiation of ECT and TMS. This finding should be interpreted with caution, given potential differences in patient profiles, clinical history and setting of administration.FundingJanssen Scientific Affairs, LLC. Analysis Group is a consulting company that has provided paid consulting services to Janssen Scientific Affairs, LLC, which funded the development and conduct of this study.
Curriculum Based CME Improves Healthcare Provider Knowledge and Competence in the Assessment and Management of Major Depressive Disorder
Authors: Guevara Natalie , Lubarda Jovana , Aboulsaoud Pakinam 
Published: January 2025

ObjectiveThis study examined whether curriculum based continuing medical education (CME) interventions can improve provider knowledge, competence, and confidence related to the assessment and treatment of patients with major depressive disorder (MDD).MethodsThe online CME curriculum consisted of 2 online activities, which used repeated pairs pre-/post-assessment study design and McNemar’s test (P <.05 is considered significant) to assess educational effect. Clinicians who completed questions both pre- and post-assessment were aggregated across activities, stratified by 2 learning themes.ResultsSignificant improvements (n=31-756, P<0.05-0.001) were seen for knowledge/competence across all providers (psychiatrists, psychiatry NPs, psychiatry PAs, PCPs, primary care NPs, and primary care PAs) for both learning themes – “Appropriate depression medication selection and modification” and “Evaluating residual symptoms in patients with MDD”. Notable improvements:•There was a 48% relative improvement among PCPs, 26% relative improvement among primary care NPs, 42% relative improvement among primary care PAs, 19% relative improvement among psychiatrists, 23% relative improvement among psychiatry NPs, and 24% relative improvement among psychiatry PAs (P<0.001) related to appropriate depression medication selection and modification.•There was a 47% relative improvement among PCPs (P<0.01), 41% relative improvement among NPs (P<0.01), 18% relative improvement among psychiatrists, 33% relative improvement among psychiatry NPs, and 52% among psychiatry PAs (P<0.001) related to evaluating residual symptoms in patients with MDD.ConclusionParticipation in CME interventions significantly improved knowledge/competence and confidence among psychiatric and primary care providers. This study identified persistent gaps in clinician knowledge and competence related to MDD care that may guide future education.FundingMedscape Education, Takeda Pharmaceuticals
A Review and Comparison of FDA-Approved Transcranial Magnetic Stimulation (TMS) Protocols for Depression
Authors: Gomes Paula , Imtiaz Ayyub , Groden Menachem , Zaidi Muhammad 
Published: January 2025

IntroductionTranscranial Magnetic Stimulation (TMS) is a Food and Drug Administration (FDA) approved treatment that induces neuronal activity in the left dorsolateral prefrontal cortex. TMS was initially developed to treat major depression after studies of patients with depression revealed hypometabolism in this brain region. Since it was first FDA approved in 2008, several types of TMS have been developed and its clinical indications expanded. Given the dearth of literature guiding clinicians in understanding different forms of TMS and their protocols, this poster will review the common and unique aspects of several forms of TMS in an effort to aid clinicians in appropriately utilizing this safe and effective neuromodulatory treatment.MethodsSpecific keywords were used to conduct a thorough but nonsystematic review of multiple databases, including PubMed, Google Scholar, and PsychInfo. Articles describing protocols rather than direct comparisons were selected. The outcomes regarding protocol guidelines, advantages, disadvantages, safety, and side effects were included in the review.ResultsThe FDA approved types of TMS include repetitive TMS (rTMS), deep TMS (dTMS), intermittent theta burst stimulation (iTBS), and accelerated TMS (aTMS). While rTMS is limited to cortical tissue, other forms of TMS reach subcortical neurons with aTMS using functional magnetic resonance imaging (fMRI) to specifically locate the target area. dTMS was approved in 2013 and its session time is half that of rTMS. Subsequently developed TMS types have even shorter sessions; iTBS sessions are only 3 minutes and aTMS is 9 minutes per session. Most TMS protocols require 8-9 weeks for full treatment, but aTMS only needs 5 days. All TMS protocols stimulate at 120% of resting motor thresholds except for aTMS which adjusts based on the patient using fMRI results. Efficacy is mostly similar with rTMS, dTMS, and iTBS demonstrating remission rates up to 30%, but aTMS had remission rates up to 90.5%. aTMS can also be used for suicidality, patients with severe or refractory depression, as well as those with comorbid anxiety, which have historically shown lower rates of success with other treatments. Overall, all forms of TMS produce minimal and temporary side effects with patients being able to return to normal activities the same day as treatment, although aTMS may cause side effects of greater intensity resulting in sleep dysregulation. Cost remains a barrier, with many insurances covering rTMS but not iTBS or aTMS.ConclusionTMS is an evidence based, efficacious, and safe treatment for depression. Most FDA-approved TMS protocols for depression have similar number of sessions, duration of treatment, common side effects, and remission rates, besides aTMS, which has dramatically greater remission rates and shorter treatment duration, making it a potentially rapid and effective treatment modality for acute and more severe cases of depression.FundingNo Funding