Category: Psychiatry

Thoughts About Psychedelic Assisted Psychotherapy

I read the Psychiatric Times article “FDA Issues CRL to Lykos for MDMA-Assisted Therapy.” The short story is that the FDA essentially told the drug company Lykos that their study of the efficacy of MDMA-assisted treatment of PTSD needs more work.

I tried to wade through the on-line documents of the FDA’s meeting on June 4, 2024. There are hundreds of pages and I didn’t go through every page of the transcript. The minutes were succinct and much easier to digest.

I’m going to simply admit that I’m biased against using psychedelics in psychiatry for personal and professional reasons. I’m not a research scientist. I’m a retired consultation-liaison psychiatrist. I saw many patients with a variety of psychiatric diagnoses including PTSD and substance use disorders. I’m not opposed to clinical research in this area, but I’m aware of the difficulty of conducting it.

In that regard, I want to also admit that I’m very susceptible to being influenced by a former colleague’s remarks about the quality of the research in question in the Lykos study. Dr. Jess G. Fiedorowicz, MD, PhD formerly was formerly on staff at University of Iowa Health Care. He’s now the Chief of Mental Health at The Ottawa Hospital where he’s also Professor and Senior Research Chair in Adult Psychiatry, Department of Psychiatry, University of Ottawa, Ontario. His remarks in the transcript are typical for his erudition and expertise as a clinician scientist.

It’s difficult to wade through the pages of the FDA transcript and I couldn’t digest all of it, by any means. But if you’re interested in reading both sides of this issue, it’s a good place to get the best idea of the committee members’ thinking about it. The minutes are much easier to read and provide a succinct summary.

I realize the Psychiatric Times article editor doesn’t agree with the FDA recommendations for further study of psychedelic-assisted psychotherapy for PTSD. It may or may not influence the University of Iowa’s study of psilocybin. In my opinion, the FDA did the right thing.

Verbal De-escalation: University of Colorado School of Medicine Video Series cont. Chapter 5

Simpson, Scott & Sakai, Joseph & Rylander, Melanie. (2019). A Free Online Video Series Teaching Verbal De-escalation for Agitated Patients. Academic Psychiatry. 44. 10.1007/s40596-019-01155-2.

Verbal De-escalation: University of Colorado School of Medicine Video Series cont. Chapter 4

Simpson, Scott & Sakai, Joseph & Rylander, Melanie. (2019). A Free Online Video Series Teaching Verbal De-escalation for Agitated Patients. Academic Psychiatry. 44. 10.1007/s40596-019-01155-2.

Verbal De-escalation: University of Colorado School of Medicine Video Series cont. Chapter 3

Simpson, Scott & Sakai, Joseph & Rylander, Melanie. (2019). A Free Online Video Series Teaching Verbal De-escalation for Agitated Patients. Academic Psychiatry. 44. 10.1007/s40596-019-01155-2.

Verbal De-escalation: University of Colorado School of Medicine Video Series cont. Chapter 2

This is Chapter 2 of the free verbal de-escalation video series. This one is “Basic elements of verbal de-escalation.”

Simpson, Scott & Sakai, Joseph & Rylander, Melanie. (2019). A Free Online Video Series Teaching Verbal De-escalation for Agitated Patients. Academic Psychiatry. 44. 10.1007/s40596-019-01155-2.

Verbal De-escalation Education Videos

I was looking at the Academy of Consultation-Liaison Psychiatry (ACLP) and discovered a free online video educational series on verbal de-escalation of agitated patients. It reminded me of my own early attempts to educate trainees about this very important topic (see my post “A Little Too Exuberant”).

The Simpson et al presentation includes 5 free online videos. The first one is below.

Simpson, Scott & Sakai, Joseph & Rylander, Melanie. (2019). A Free Online Video Series Teaching Verbal De-escalation for Agitated Patients. Academic Psychiatry. 44. 10.1007/s40596-019-01155-2.

Rounding at Iowa: New Treatments for Alzheimer’s Disease

This is one of the latest Rounding@Iowa podcasts and it’s about new treatments for Azheimer’s Disease, with one specific agent called Lecanemab.

I’m an old psychiatrist, and I remember my clinical impresson of the previous medications for Alzheimer’s Disease, one of which was Donepezil. The scientific literature seemed to suggest that patients and families were more impressed with Donepezil than clinicians were.

According to Dr. Shim, one of the participants in the podcast, it’s been 20 years since there has been a new treatment for Alzheimer’s Disease-and the long term effectiveness of Lecanemab is uncertain.

In addition, there are significant risks associated with the agent as well. As you can guess, it’s very expensive, and while Medicare pays for some of the cost, the podcast participants mentioned that it was difficult to get some treatment monitoring imaging studies covered.

Patients and their physicians need to have a full discussion of the risks and benefits of treatments for Alzheimer’s Disease. It’s just as important to avoid the use of certain drugs that are known to worsen cognitive function, such as benzodiazepines and anticholinergics.

Great Rounding@Iowa Podcast on Preventing & Managing Heat-Related Illness

The Rounding@Iowa podcast has many fascinating and helpful episodes, not the least of which is this one on heat-related illness. The days are getting hotter and we need to pay close attention to what happens in our bodies when exposed to excessive heat.

About That Artificial Intelligence…

I’ve got a couple of things to get off my chest about Artificial Intelligence (AI). By now, everyone knows about AI telling people to put hot glue on pizza and whatnot. Sena and I talked to a guy at an electronics store who had nothing but good things to say about AI. I mentioned the hot glue thing and pizza and it didn’t faze him.

I noticed the Psychiatric Times article, “AI in Psychiatry: Things Are Moving Fast.” They mention the tendency for AI to hallucinate and expressed appropriate reservations about its limitations.

And then I found something very interesting about AI and Cribbage. How much does AI know about the game? Turns out not much. Any questions? Don’t expect AI to answer them accurately.

In Memory of L. Jay Stein

I was thinking of one of the Johnson County judicial mental health referees I often worked with years ago. L. Jay Stein died in 2014. I looked up his obituary the other day and was a little surprised to find I had written a remembrance for him. I’d forgotten it.

“I will always remember my first encounters with Judge Stein. I was a first-year resident in psychiatry at The University of Iowa Hospitals & Clinics. He often presided at mental health commitment hearings at which I was often the nervous trainee providing “expert testimony” as the treating physician. Jay taught me and countless other psychiatry residents about the importance of procedure. His knowledge was prodigious. But it was his compassion, his fairness, and his inimitable sense of humor I will always treasure.”

Judge Stein’s vocabulary was impressive. Even his recorded telephone automatic replies sounded amusingly erudite. Occasionally, when I had a question about legal procedures in mental health I would call him but get his answering machine. These out of office replies were entertaining and sounded very much like the way he did during commitment hearings. I can’t remember all of it, but it began with something like, “Once again, your request has been denied…” It made me think of what I might hear at a parole hearing—not mine of course.

L. Jay Stein was wise and funny.