Dr. Sriram Raghavendran, MD’s Post

Clinical trial compared Behavioral Activation (BA) psychotherapy with #antidepressants #medicationmanagement in patients with #heartfailure and #depression. 50% of individuals with heart failure experience depressive symptoms. There is increased medication burden with both comorbidities. Due to concerns about the effectiveness of #psychotherapy and the adverse effects of antidepressants, clinicians and patients lack evidence on which intervention to use. Unlike complex CBT, BA therapy focuses mostly on improvement of patient mood, sense of control, and activity level through increased engagement in pleasurable and rewarding tasks, has comparable efficacy to CBT but "more feasible in patients with HF”. Study results: - BA was comparable to antidepressant medication in relieving symptoms of depression. - BA demonstrated slightly more improvement in physical health-related quality of life (HRQOL), and had fewer emergency department (ED) visits and days of hospitalization. Researchers concluded: BA stimulated patient activation, increased enjoyable physical activity, motivation, self care, and absence of antidepressant medication burden might be contributing factors. #cardiology #psychotherapy #psychiatry #pharmacy #pharmacists #polypharmacy

Join us in celebrating Dr. Kevin Rosi as he approaches his nine-year anniversary with Mindful Health Solutions! Dr. Rosi has played a pivotal role in the evolution of our interventional treatments, particularly in the advancement and application of Transcranial Magnetic Stimulation (TMS). Here's his reflection on the journey and the incredible impact TMS has had on the lives of treatment-resistant patients: "As I approach my nine-year anniversary with Mindful Health Solutions, I have been reflecting upon the evolution of our interventional treatments and how they improve the lives of treatment-resistant patients. When I joined MHS in 2015, I was immediately educated and trained in Transcranial Magnetic Stimulation (TMS), having only a cursory understanding of the treatment. In my first year of treating patients using TMS, I quickly understood how safe and effective the treatment was, even in the most chronically depressed patients. I have seen hundreds of depressed patients improve from TMS and feel grateful that I can offer patients hope when other treatments have failed. In the past five years, the field of TMS has advanced beyond depression and received FDA clearance for other conditions, including Obsessive Compulsive Disorder and smoking cessation. Research also strongly supports prescribing TMS for Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, as well as conditions outside of Psychiatry, specifically Neuropathic Pain. With the support of MHS leadership, myself and Dr. Ben Williamson have developed our Pain Protocol, employing TMS to treat Neuropathic Pain based on the latest cutting-edge research. It is extremely rewarding to see the improvement in both mental and physical health symptoms with TMS, and I am looking forward to future advances in the field of Interventional Psychiatry. This is truly an exciting time to be working in mental health. The annual Clinical TMS SocietyMeeting in London last month brought together leading clinicians and researchers in the field, offering the opportunity to enhance our knowledge and practice of TMS. Nine years ago, I had no idea I was entering into a field that would grow into what we now call Interventional Psychiatry, but I am forever grateful. I have witnessed TMS change the lives of so many patients in need, and I realize how offering this treatment has changed my life as well." #TMS #InnovativePsychiatry #MindfulHealthSolutions

Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence Abstract Garoosi, K., Yoon, Y., Hale, E., Kahan, R., Kalia, N., Higuchi, T., Mathes, D., Hudish, T., & Kaoutzanis, C. (2024). Association between genital gender-affirming surgery and psychiatric comorbidities in individuals with gender incongruence. The journal of sexual medicine, qdae077. Advance online publication. https://lnkd.in/gpGkX8pW Background: Previous studies present mixed evidence on the relationship between psychiatric comorbidities and genital gender-affirming surgery (GGAS) in individuals with gender incongruence (GI). Aim: This research aims to investigate the psychiatric comorbidity rates post-GGAS in the GI population-namely, depressive disorders, anxiety disorders, posttraumatic stress disorders, substance abuse disorder, and suicidality. Methods: Based on the TriNetX health care database, an international database with >250 million patients, a cross-sectional study was executed comparing psychiatric comorbidity rates among cases of GI with and without GGAS. Individuals were matched for demographic and health-related variables, which included history of cardiovascular disease, diabetes, and obesity. Outcomes: The main focus was to establish the rates and changes in psychiatric comorbidities following GGAS. Results: Among individuals with GI, the study identified 4061 with GGAS and 100 097 without. At 1 year post-GGAS, there was a significant decrease in depression (odds ratio [OR], 0.748; 95% CI, 0.672-0.833; P < .0001), anxiety (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), substance use disorder (OR, 0.730; 95% CI, 0.658-0.810; P < .0001), and suicidality (OR, 0.530; 95% CI, 0.425-0.661; P < .0001), and these reductions were maintained or improved on at 5 years, including posttraumatic stress disorder (OR, 0.831; 95% CI, 0.704-0.981; P = .028). Clinical implications: The findings indicate that GGAS may play a crucial role in diminishing psychiatric comorbidities among individuals with GI. Strengths and limitations: This is the largest known study to evaluate the effect of GGAS on psychiatric comorbidities in the GI population, offering robust evidence. The reliance on the precision of CPT and ICD-10 codes for data extraction poses a limitation due to potential coding inaccuracies. Conclusion: The evidence suggests a significant association between GGAS and reduced psychiatric comorbidities in individuals with GI. Keywords: TriNetX; gender reassignment surgery; genital reconstruction; psychiatric comorbidities.

Check out the peer-reviewed version of my recent first-author publication on Bipolar Disorders journal! In this study we demonstrate that deep brain stimulation of the dopaminergic system corrects manic-like behaviour and abnormal brain signalling in an animal model. These findings shed lights on new non-pharmacological and more effective approaches for treatment-resistant bipolar disorder. It was a great honour to work with the renowned researchers from University of Queensland, Mayo Clinic (USA), Deakin University (AUS), The University of Texas (US) and University of Southern Santa Catarina (Brazil) in this study. #BipolarDisorder #DeepBrainStimuation #BiologicalPsychiatry #PreclinicalResearch

New Dual Brain Stimulation Technique for Treating Resistant Depression: Combining High-Frequency Stimulation and Theta Burst Therapy A study led by Dr. Sabrina Segal has unveiled a promising new therapy for patients with treatment-resistant major depressive disorder (TR-MDD). Published in the November issue of Brain Stimulation, this research explores a novel sequential bilateral neurostimulation approach. The protocol combines high-frequency repetitive transcranial magnetic stimulation (rTMS) to the left dorsolateral prefrontal cortex with intermittent theta burst stimulation to the right dorsolateral prefrontal cortex. Involving 38 patients across 28 TMS sessions, the study observed a significant decrease in depression severity, as measured by the Patient Health Questionnaire-9 scores. Results showed a 66% response rate and a 24% remission rate, highlighting the potential of this approach to reshape rTMS treatment strategies for depression. https://lnkd.in/etpmhBxu #tms #tmstherapy #brainstimulation #brainhealth #psychiatry #psychiatrist

Will I see you at ECNP in Milan? I am invited (and honored) to speak about "What is really different in Older Age Bipolar Disorder" in the Highlights in old age psychiatry Top paper session. see also www.gage-bd.org for more #ECNP #ECNP2024 European College of Neuropsychopharmacology (ECNP) https://lnkd.in/eGFfCYKf Older Age Bipolar Disorder (OABD) refers to individuals aged 50 and over with bipolar disorder (BD). By 2030, it is projected that 50% of BD patients will be in this age group. The longevity gap in BD is influenced by both unnatural and natural causes, with suicide, accidents, and endocrine and metabolic diseases being the primary contributors to potential years of life lost. Despite the increasing prevalence of OABD, research has been limited, hindering the development of evidence-based guidelines tailored to their specific needs. OABD patients accumulate physical comorbidities more rapidly than the general population, partly due to baseline differences in psychosocial, lifestyle, and health behavior factors. The Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) project revealed that OABD patients exhibit more physical morbidities compared to matched controls, with women bearing a significantly higher health burden. Additionally, lower functioning in OABD was linked to higher depressive and manic symptoms, rather than the elevated somatic burden observed. These findings underscore the urgent need for integrated care approaches in BD. Cognitive impairment in OABD is particularly pronounced in the domains of verbal learning and delayed memory, occurring more frequently than in major depression or healthy controls. The severity of BD and medication use are key determinants of cognitive dysfunction. Follow-up studies have identified three cognitive trajectory classes: normal aging, selective impairment, and a progressive course leading to dementia. Aging is generally associated with declines in cognitive functioning and physical health. For individuals with BD, these somatic and cognitive comorbidities further impede daily functioning and limit treatment options. It remains unclear whether these comorbidities are intrinsic to BD or a consequence of lifestyle choices and medication. Future follow-up studies comparing health peers or BD patients not on maintenance medications are essential to provide new insights.

First in our series of three papers on GLP1 receptor agonists and dementia: in a study on US based electronic health records we show that semaglutide associates with lower risk of cognitive deficits. Also of interest is the effect on nicotine dependence which ties in with an effect on craving. Stay turned for papers 2 (what mechanism mediates the effect on neurodegenerstion ) and 3 (what are doing to directly test the semaglutide effects on Alzheimer’s pathology in people at risk)

New Insights into Endocannabinoid System Dysregulation in Stress-Related Neuropsychiatric Disorders 🧠 Dysregulation of the endocannabinoid (eCB) system is linked to various stress-related neuropsychiatric disorders (SRDs) such as anxiety, depression, and PTSD. A new systematic review and meta-analysis screening 1072, 1341, and 400 articles for inclusion in Aims 1, 2, and 3, respectively, aimed to explore circulating anandamide (AEA) and 2-arachidonoylglycerol (2-AG) concentrations at rest and in response to acute psychosocial stress in individuals with SRDs compared to controls. Results: 🔸 Aim 1: Out of seven studies in controls, most reported stress-related increases in AEA (86%) and 2-AG (83%), though meta-analyses did not support these patterns statistically. 🔸 Aim 2: From twenty studies, higher baseline concentrations of both AEA (63%) and 2-AG (60%) were observed in individuals with SRDs compared to controls, confirmed by meta-analyses (p's < 0.05). 🔸 Aim 3: In three studies, one reported a statistically significant difference in stress-related 2-AG changes between PTSD patients (decrease) and controls (increase), supported by meta-analysis (p < 0.001). Despite significant heterogeneity in study designs, consistent patterns were identified, including elevated baseline AEA and 2-AG in individuals with SRDs and smaller stress-related increases in 2-AG in these individuals compared to controls. Standardised research methods are crucial to clarify the complex relationships between eCBs, SRDs, and psychosocial stress, positioning eCBs as potential biomarkers and intervention targets for SRDs. 🔗 Read the complete study here: https://lnkd.in/d6f24Ser #Neuropsychiatry #EndocannabinoidSystem #MentalHealthResearch

Researchers at Dalhousie University, led by Nelofar Kureshi, have explored the connection between traumatic brain injury (TBI) and the development of new-onset psychiatric disorders (NPDs). Using a dataset of 3,453 TBI patients and 13,112 controls from a provincial trauma registry, they applied latent class analysis to uncover distinct phenotypes within the TBI population. The results showed that TBI patients are significantly more likely to develop NPDs compared to non-TBI individuals, with odds ratios of 2.78 for those without pre-injury psychiatric history and 2.36 for those with prior psychiatric conditions. Eight different phenotypes were identified, each showing varying risks for NPD development, influenced by factors like age, injury severity, length of hospital stay, and discharge destination. For example, older adults requiring extended recovery and supportive care showed a 53% higher risk of developing NPDs compared to younger individuals with shorter recovery times. This research emphasizes the need for tailored psychiatric care, particularly early intervention based on individual risk profiles. By identifying specific patient clusters, this study offers a framework for improving mental health outcomes in TBI patients through targeted, phenotype-driven care strategies. The findings highlight the importance of integrating psychiatric risk assessments into TBI patient care, particularly at discharge, to better manage long-term psychiatric effects and improve patient recovery. #TBI #Psychiatry #Neuroscience #MentalHealth #HealthcareInnovation #PublicHealth #TraumaCare

Although COVID-19 was first described as a disease of the lungs, as its relentless march has continued we’ve realised that it has a far wider reach within the human body. COVID-19 has been related to skin rashes, bleeding disorders and structural damage to the center and kidneys. It has also been implicated in disorders of each the brain and the mind. Early studies prompted fears that healthcare services would collapse under a crushing wave of strokes, brain inflammation and muscular disorders. Moreover, reviews of previous coronavirus outbreaks warned that those recovering from COVID-19 may face an increased burden of psychiatric disorders like depression and PTSD. But despite research on COVID-19 and the brain being produced at unprecedented scale and speed through the pandemic – with a whole bunch of latest articles appearing every week – it was hard initially to search out reliable data to substantiate or disprove these fears. So, as a team of doctors, students and researchers from disciplines including psychiatry, psychology and neurology, we joined forces to analyse all of the available research on the results of COVID-19 on the brain. By doing so, we aimed to chop through numerous the speculation surrounding COVID-19’s neurological and psychiatric effects. Here’s what we found. Different conditions, different frequencies Our team soon realised that lots of the associations between COVID-19 and the brain were being drawn from small, highly chosen groups of patients, which risks bias. So to combat this, we whittled down the vast number of probably relevant papers on the neurology and psychiatry of COVID-19 (greater than 13,000) to 215 that were robust enough to be analysed. Collectively, these covered 105,000 people from 30 countries. We found that in these studies essentially the most common neuropsychiatric symptoms were lack of smell (anosmia), weakness, fatigue and a change in taste (dysgeusia), which all occur quite ceaselessly. Anosmia and weakness appeared in greater than 30% of the patients the studies we checked out, for instance. It’s subsequently very likely that neuropsychiatric symptoms in COVID-19 are the rule and never the exception. But reassuringly, initial fears about more serious brain-related conditions – reminiscent of widespread inflammation of the brain (encephalitis) and Guillain-Barré syndromewhere the immune system attacks the nerves – appeared to be based only on very rare events. Concerns about vast waves of such conditions seem unfounded. Guillain-Barré syndrome is a serious condition that mainly affects the feet, hands and limbs, causing numbness, weakness and pain. aijiro/Shutterstock However, we did find that some essential mental illnesses, reminiscent of depression and anxiety, were each occurring in as many as 25% of individuals with COVID-19. These may represent an enormous burden to patients in years to come back. Even neurological