Month: September 2024

FDA Approves Antipsychotic with New Mechanism of Action for Treatment of Schizophrenia

I just noticed the FDA announcment of the approval of an antipsychotic with a new mechanism of action for the treatment of schizophrenia.

The drug is Cobenfy and it interacts with cholinergic rather than dopaminergic receptors. It has a number of side effects which are anticholinergic. This could lead to psychotic symptoms that consultation-liaison psychiatrists might get called to evaluate due to the anticholinergic delirium that could occur, which can mimic psychosis.

It’s easy to get alarmed about the Cobenfy side effects. I just remember all of the side effects of the one antipsychotic that has sometimes been the only effective treatment for patients with treatment resistant schizophrenia-clozapine.

Clozapine has been associated with agranulocytosis, seizures, bowel obstruction, prolonged cardiac conduction time leading to arrhythmias, liver toxicity and more. In fact, clinicians are required to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program to prescribe it.

Patients who have schizophrenia and take clozapine are often admitted to general hospitals for treatment of medical problems which may or may not be directly related to clozapine itself. This requires close collaboration of internists and surgeons with consultation-liaison psychiatrists.

What do you do for patients who don’t respond to clozapine but are willing to take oral medication? There are augmenting strategies, some of which can be helpful although they could add to the side effect burden.

What do you do for a patient with treatment-resistant schizophrenia who refuses to take oral psychotropic medication? In some cases, it may be necessary to use injections of medications which also can have uncomfortable and even potentially life-threatening side effects. This difficult situation is complicated further by the lack of insight some patients have about their illness and the need for court orders to administer antipsychotics against their wishes.

I hope Cobenfy is a step forward for patients and their families.

Notes on the Blues and Rivers of Whiskey

I listened to the Big Mo Blues Show last night on KCCK radio (88.3 on your dial) as I usually do on Friday nights. It runs from 6:00 pm to 9:00 pm and you can learn a lot from Big Mo (aka John Heim) about the blues.

He also has a podcast called the Big Mo Pod Show, which is based on his blues show. He gets quizzed about some of the songs he played on Friday night by Producer Noah (as Big Mo calls him). Last night he was on target for all 5 of the songs he played and why he played them.

One of the songs I’ve never heard before but it was done by Taj Mahal and Keb Mo, artists I’m familiar with just from listening to Big Mo’s show. The title was “Diving Duck Blues. The chorus goes “If the river was whiskey and I was a diving duck, I’d dive to the bottom and I’d never come up.”

That led to a discussion of how alcoholism was sometimes (maybe more than sometimes) a part of the life of blues musicians. In fact, the lead off song last night was “Big Road Blues,” sung by Tommy Johnson. His last name just happens to be the same as Robert Johnson who made the song “Crossroads” famous because he claimed he sold his soul to the devil in order to become a great blues musician. Several blues artists made the claim, which Big Mo debunked as a ruse to get fans to pay more money to hear them perform.

But Tommy Johnson struggled with alcoholism and, according to Big Mo, was driven to the point of drinking Sterno, which was poisonous because it contained methyl alcohol.

This can lead you to think that maybe all blues music is gritty, played by alcoholics, and even depressing as declared by the lead character, Navin Johnson, played by Steve Martin in the movie “The Jerk” (a white guy raised by a black family).

Incidentally, this reminds me that a recent study showing that digital cognitive behavioral therapy is effective for those suffering from alcohol use disorder.

Anyway, blues musicians don’t always play sad, gritty music and die from drinking Sterno. One that is actually funny is “You Left the Water Running” by Otis Redding. You can look up the lyrics or listen to anyone who covers the song and it would be difficult not to laugh out loud.

And speaking of covering a song, Bill Withers originally wrote and sang “Lean on Me” back in 1972 which Keb Mo covered recently. I think it’s one of those uplifting examples of blues music which won’t send you diving to the bottom of any whiskey rivers.

University of Iowa Writing Programs Get High Ranking from U.S. News & World Report

The University of Iowa ranks No. 9 across all universities in the country for its power in the writing disciplines., according to the 2024 U.S. News & World Report.

The school is well known for its writing programs of which the The Writers Workshop is the best known.

The University of Iowa also gives medical students a leg up on writing in its Writing and Humanities Program, which offers courses such as writing and medicine and editorial writing.

This reminds me of a couple of things, one of which was the University of Iowa medical school note service. Many medical schools have note services so that not all students have to write their own lecture notes. It’s ironic in a way that one of the best known public medical schools didn’t encourage all the medical students to labor over their own class notes. I volunteered once to write notes for the class. It was hard work.

The other thing writing education at the University of Iowa reminds me of is the Iowa Avenue Literary Walk. There are several plaques along Iowa Avenue which honor famous authors who had Iowa connections, often through the Iowa Writers Workshop. My favorite is one by Kurt Vonnegut, a former teacher at the workshop.

Thoughts on X-Files Episode “Sunshine Days”

I saw the X-Files episode “Sunshine Days” again last night. It’s the second time I’ve seen it. It’s about a guy who calls himself Oliver who has telekinetic power and who yearns for a father-son relationship with a paranormal researcher (Dr. Reitz) who studied him when he was a kid named Anthony.  

The set of an old 1970s TV show “The Brady Bunch” was used. It was something Oliver created using the power of his mind. As a child, he used to insist that he and Dr. Reitz watch the show regularly. In his mind, it was the perfect family he always wanted but never had.

Anyway, Oliver (Anthony) endangers his life when he uses his telekinetic powers as an adult. He can’t control them and nearly dies from using them. He ends up near death in the hospital after showing the FBI agents including Scully and Doggett (who replaced Mulder) his miraculous ability. The agents and Dr. Reitz are ecstatic because they think it will change the world and humanity.

But after they realize the life-threatening nature of Oliver’s powers, they all agree, including Dr. Reitz, that Oliver should never use them again. Dr. Reitz even tells Oliver (who now wants to be called Anthony) firmly that he can’t use his power, to which Oliver replies that he can’t be alone. Then, Dr. Reitz tells Oliver that he’ll never have to be alone because he’ll always be with him.

A lot of fans hated it because it was the penultimate episode before the final show of the 9th and final season of the X-Files. It was one of the many Monster-of-the-Week (MOTW) shows that had nothing to do with the extraterrestrial mythology.

I liked the MOTW episodes better the ET/conspiracy shows, and Sunshine Days is one of my favorites. However, I never watched The Brady Bunch and the whole perfectly happy and well-adjusted family idea was ridiculously implausible in my opinion.

I doubt there is such a thing as a perfect family. Mine certainly was not and look how well I turned out. Even in nature, there are examples of savagery that can make you doubt the ultimate wisdom of whoever or whatever is in charge of evolution.

For example, birds can be exquisitely cruel. Cowbirds lay their eggs in the nests of completely different species of birds, where the cowbird chicks bully their weaker nestlings. And surely just about everyone has seen the pitiless pecking of the larger of the two shoebill chicks in which the parents calmly watch as the smaller chick gets stepped on, pushed out of the next and essentially murdered by the bigger chick. This is because the parents know there is not enough water for both.

Even the song “A Boy Named Sue” is based on the natural law of survival of the fittest, which has nothing to do with kindness. Incidentally, that song came out in 1969, the same year that The Brady Bunch show began.

On the other hand, the reconciliation of Anthony with Dr. Rietz always fills me with joy.

The Incredible Shrinking Headshrinker

Last week we saw the 1957 movie “The Incredible Shrinking Man” on the Svengoolie show on the MeTV channel. We’ve never seen it before and it actually got pretty good reviews back in the day. The main character, Scott Carey, was played by Grant Williams. You can watch the movie for free on the Internet Archive.

According to some interpretations, the story uses the metaphor of diminishing size to highlight the diminishing role of masculinity in American society in the 1950s or human notions in general about one’s self-worth in society.

It got me thinking about how the challenges of adjusting to retirement as a process has been (and still is to some degree) for me. I started out with gradual reduction of my work schedule in the form of a phased retirement contract. It was difficult.

I was reminded of how difficult it was to slow down, especially as a teacher of residents and other health care trainees, when I was going through some old papers after the recent move to our new house. They included teaching awards I’d received over the years.

I was struck by how small my self-perceived role in psychiatry and medicine has gradually become in the last few years. I’ve been shrinking, similar to Scott Carey. In fact, I’m a shrinking headshrinker.

I don’t want to spend too much time ruminating about what retirement means to me. I think it’s a very common response to perceive the world gets smaller when you retire.

It doesn’t help much to intellectualize about shrinking in this way. Scott Carey eventually accepted his diminishing stature, even to the point of disappearance. Grief about this kind of loss is normal, although I’m realizing that grief might never completely disappear.

Back to the Roller Window Shades?

I just heard about the new regulation banning cords on window shades. I didn’t know that window cords were so dangerous.

We recently moved into our new house and need window coverings. We’ve had corded window coverings (mostly blinds) for years wherever we moved. I guess we’ll have to consider other options.

This reminds me of the old roller shades we used to have. I couldn’t find a free picture of them on pixabay, no matter how I worded the search term. The ones I remember were white and had a mechanism in the roller which retracted the shade—if you had just the right wrist motion.

Many times, the shade ended up in a heap at your feet. You could injure yourself by tripping over the shade, or sometimes by the shade suddenly snapping upwards and smacking you in the face.

There are newer versions of roller shades and they’re all expensive. You can still get old-fashioned roller shades, but I think they cost a lot more.

There’s an old photograph of a room with several roller shades on this web page.

Can Artificial Intelligence Learn from My Book?

Recently the publisher of a book co-edited by me and my former psychiatry chair Dr. Robert G. Robinson asked me to sign off on a proposal to involve Artificial Intelligence (AI) in using the work.

The book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” is 14 years old now, but is still a practical tool for learners, at least in my opinion.

Interestingly, it looks like the publisher is also trying to contact Dr. Robinson about the proposal through me. I wonder if that means they’re having as much trouble finding him as I have.

I’ve made it clear that I have misgivings about AI, as I’ve indicated in at least one blog post about Google’s AI, which used to be called, Bard which I think has been renamed Gemini. I think AI is prone to spreading misinformation, which has been called “hallucinations” by some writers.

The publisher makes it clear that this proposal regarding AI involvement in our book is an “opt in” choice. I gather that means if I don’t opt in, they’ll continue to bug me about it until I do.

That’s unlikely to happen.

Bathroom Fan Timers are Now Required by Code!

OK, so maybe you already knew that bathroom exhaust fan timers for reducing moisture are required by code.

But we didn’t, which is why we were both a little spooked when the hallway bathroom fan came on all by itself on our first evening in our new house. It has done that a few times, even though we barely use that bathroom. It’s the only bathroom in the house which has a fan timer. I don’t think it’s supposed to come on by itself, so it’s probably haunted.

It’s made by Intermatic and Sena finally flagged down an electrician working in another house under construction on our street who found an instruction manual for our model. He told her it was installed because it’s code.

Imagine if every bathroom in your house had a bathroom fan timer in it. I’m sure some people love the idea. I also realize some people might think it’s crass of me to admit I would love to disable it.

I don’t think I can disable it. The initial setup instructions alone contain 28 steps. Then you get to actually program it, which gets you to 41 steps. If you ever have to edit the programming, you’ll need to develop a serious drinking problem. You have to scan a QR code to get your latitude and longitude. That’s not a joke.

The unit runs partly on batteries. I think the model we have is the ST01 and it takes a single CR2 battery. A newer model takes a different kind of battery and you need two of them. They control the clicking noise and the time and date. You also need strong fingernails or a tiny flat head screw driver to open the battery compartment. See the video below.

If you figure out how to disable it, please comment. Otherwise, I guess you could call the 800 number in the manual to access what might be an automated recorded answering algorithm which ends up recommending mayonnaise or Miracle Whip for your Braunschweiger sandwich.

ADDENDUM 9/10/2024: I pressed the MODE button once and the timer went from AUTO to MAN (manual). We haven’t had it turn on automatically so far after that.