On August 22, 2024, the FDA authorized new Covid-19 vaccines (2024-2025) “to include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. The mRNA COVID-19 vaccines have been updated with this formula to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. Today’s actions relate to updated mRNA COVID-19 vaccines manufactured by ModernaTX Inc. and Pfizer Inc.”
Category: science
Thoughts on the Homeless Mentally Ill
The homeless man who lives on the sidewalk outside our hotel reminds me of a couple of things. One is Dr. Gerard Clancy, MD who is University of Iowa Health Care Professor of Psychiatry, Professor of Emergency Medicine, and Senior Associate Dean of External Affairs.
I remember Gerry, who was in the department of psychiatry when I was a resident. I saw his picture in the newspaper and hearing about him riding a bicycle around Iowa City doing a sort of outreach to the homeless mentally ill.
I found an archived article mentioning him published in 1995 in the Daily Iowan. The story starts on the bottom of the front page, entitled “I.C. opens new doors for area’s mentally ill.” It continues on page 9A.
The story mentions Dr. Clancy and what was called then the Clinical Outreach Services and the Emergency Housing Program (EHP). The challenges then sound a lot like what they are now: long waiting lists for psychiatric evaluation and treatment, a lack of funding for the treatment of mental illness, and a lack of preventive care. The most common mental illnesses in the homeless mentally ill are chronic schizophrenia, schizoaffective disorder, and bipolar disorder. The idea of reaching out to them “on their own turf” as Clancy was quoted, was to help them feel more comfortable talking about their mental illness.
The housing situation for this population of those struggling with mental illness was dismal then and it’s still dismal.
The homeless guy I’ve been calling Bob lives on the sidewalk next to a busy street. It’s just my opinion that he’s mentally ill based on my observations of his behavior. I’ve never tried to talk to him. However, Bob gets visits from people who obviously have differing views about the way he lives.
Some of them do talk to him and, although I can’t hear their conversations, the actions tell me important things. Some bring him what I call “care packages,” often food, water, and other items. They may start by acting kind, although may get impatient with him. Others try to clean up his sidewalk, and may criticize him. The police occasionally visit and have so far not taken him into custody.
It looks like things have not changed much since 1995 regarding the homeless mentally ill based on what I write here about my observations. In fact, it’s easy to find current news stories that say things are getting worse.
At the beginning of this post, I said I found a couple of things. The other thing was a very thorough teaching presentation about the current state of formal outreach to this population. It’s available on the web as a power point presentation by another University of Iowa faculty, Dr. Victoria Tann, MD, entitled “Assertive Community Treatment 101.”
Dr. Tann is currently an IMPACT Team psychiatrist. It’s an excellent source of background on the history of this effort at outreach to the homeless mentally ill. It also summarizes what’s happening with the program now.
Alcohol is Bad for Old Guys
I took a quick peek at the study published recently in the Journal of the American Medical Association (JAMA) that a few news agencies are reporting on which says alcohol in moderation is bad for older persons. So much for moderation.
Actually, the full abstract is:
Ortolá R, Sotos-Prieto M, García-Esquinas E, Galán I, Rodríguez-Artalejo F. Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors. JAMA Netw Open. 2024;7(8):e2424495. doi:10.1001/jamanetworkopen.2024.24495
“Conclusions and Relevance: In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.”
Conclusions: “This cohort study among older drinkers from the UK did not find evidence of a beneficial association between low-risk alcohol consumption and mortality; however, we observed a detrimental association of even low-risk drinking in individuals with socioeconomic or health-related risk factors, especially for cancer deaths. The attenuation of the excess mortality associated with alcohol among individuals who preferred to drink wine or drink only during meals requires further investigation to elucidate the factors that may explain it. Finally, these results have important public health implications because they identify inequalities in the detrimental health outcomes associated with alcohol that should be addressed to reduce the high burden of disease of alcohol use.”
The news stories play a little fast and loose with the headlines, which tend to gloss over the effect of health-related and socioeconomic risk factors. But, there’s no doubt in my mind that most people could do without alcohol.
Personally, I would have a couple of 12-ounce bottles of beers while watching football games or listening to the Big Mo Blues Show on KCCK Blues and Jazz Radio station on Friday nights. I hardly drank at all in terms of the grams per day metric.
But I’ve not imbibed since we got so busy selling our old house and camping out in a hotel while waiting for our new house to be built. Not surprisingly, I don’t miss it. When I was a young guy, I drank more and even smoked cigarettes. That was a long time ago.
In fact, when I look back on those days, I remember the factors that tended to limit my use of those substances. Take cigarettes—to the landfill if you don’t mind. I was what you would call a “sometimey smoker” because after a few days I suffered a sore throat, blunted taste for food, stuffy nose, lower appetite (bad for a baseline skinny guy) and fatigue. I just couldn’t stick with smoking long enough to make it a habit.
I’m going to pick on wine a little because the article alludes to the idea that it might have some health benefit. When I was a kid, I once had a lot too much wine which led to a longstanding inability to even stand the smell of it for years. I still never drink wine.
There are many things that can be habit forming. I’m beginning to wonder if watching Men in Black movies might be one of my weaknesses. I don’t watch any other movies as often as I do the MIB trilogy films. I’ve watched them dozens of times and I don’t have a good explanation for it. I think they’re funny and I can always use a good laugh.
Agent K: After neuralyzing Officer James Edwards, he and Agent K are finishing a meal in a café while K is delivering the punchline to a joke, “Honey, this one’s eating my popcorn! Get it?” Agent K laughs uproariously.
Officer James Edwards: Looking dazed from the recent neuralyzer blast, asks “Who are you?”
Agent K: “You see, James, you are a nice young man, but you—need to lay off the sauce.”
The quote is probably not word for word. I didn’t look it up on the web. It’s just as I remember from seeing the movie so often. And that’s partly because, for the most part, I lay off the sauce.
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.
CDC Covid Information
Often, I see news agency headlines claiming to have insider information about what’s going on with the Centers for Disease Control (CDC), FDA, etc. I respect the opinions of others about government agencies. On the other hand, I like to get information straight from the horse’s mouth.
With that in mind, here’s what the CDC says is important to know about the Covid-19 situation.
Are These Compass Flowers?
I have misidentified plenty of plants and the compass flower is one of them. We were walking the Clear Creek trail the other day and saw what I thought was a patch of compass flowers. See what you think, judging from the featured image.
Anyway, I thought the flower itself pointed in a particular direction, but it’s actually the leaves as I rediscovered after looking it up.
As a real expert points out, it’s the edges of the leaves that point North/South.
Go Retire Psychiatrist 