Tailor Made: A Pilot Virtual Weight Loss Intervention Individually Tailored for African American Men

This study tests the acceptability and feasibility of the first virtual weight loss study individually tailored for middle-aged African American men. Tailor Made is a 3-month randomized controlled pilot of a weight loss intervention that included 58 overweight or obese African American men (mean age of 50.4; SD = 7.9). Control group participants received a Fitbit activity tracker and Bluetooth-enabled scale and copies of the self-led Tailor Made curriculum. Intervention group participants received the same Fitbit, Bluetooth-enabled scale, and curriculum and also participated in weekly, 45-minute virtual small group, professional-led education sessions using the Tailor Made curriculum and received three SMS text messages weekly: (a) a message individually tailored on African American Manhood that links men's values, goals, and motivation to health-promoting behavior; (b) a goal-tracking message to monitor physical activity, healthier eating, and lifestyle changes; and (c) a reminder 24 hours before their session. Participation rates in weekly small group sessions, randomization, and attendance at the assessments suggest that Tailor Made was feasible and acceptable. Only among intervention group participants, we found a small and significant decrease in BMI between baseline and final. In addition, active minutes of physical activity decreased for the control group while active minutes for the intervention group remained steady throughout the intervention. In sum, we demonstrated that a virtual, individually tailored weight loss intervention is feasible and acceptable to African American men. Participants valued the convenience of a virtual intervention, but there were a number of ways we may be able to enhance the potential benefits of this approach.

Individually Tailoring Messages to Promote African American Men's Health

In this paper, we describe our approach to individualizing messages to promote the health of middle-aged and older heterosexual, cisgender African American men. After arguing the importance of being population specific, we describe the process we use to increase the salience of health messages for this population by operationalizing the identity concepts of centrality and contextualization. We also present a measure of African American manhood and discuss how manhood is congruent with qualitative research that describes how African American men view their values, identities, goals, and aspirations in ways that can be utilized to create more meaningful and impactful messages to promote and maintain health behaviors. Our tailoring strategy uses an intersectional approach that considers how the centrality of racial identity and manhood and the salience of religiosity, spirituality, and role strains may help to increase the impact of health messages. We highlight the need to consider how the context of health behavior and the meaning ascribed to certain behaviors are gendered, not only from a man's perspective, but also how his social networks, behavioral context, and the dynamic sociopolitical climate may consider gendered ideals in ways that shape behavior. We close by discussing the need to apply this approach to other populations of men, women, and those who are non-gender binary because this strategy builds from the population of interest and incorporates factors that they deem central and salient to their identities and behaviors. These factors are important to consider in interventions using health messages to pursue health equity.

COVID-19 and MENtal Health: Addressing Men's Mental Health Needs in the Digital World

The COVID-19 pandemic continues to be a source of stress and have important mental health implications for all persons but may have unique implications for men. In addition to the risk of contracting and dying from COVID-19, the rising COVID-19 death toll, ongoing economic uncertainty, loneliness from social distancing, and other changes to our lifestyles make up the perfect recipe for a decline in mental health. In June 2020, men reported slightly lower rates of anxiety than women, but had higher rates of depressive symptoms and suicidal ideation. As of September 2020, men sought mental health care at a higher rate than women for family and relationships, with year-over-year visits up 5.5 times and total virtual mental health care visits monthly growth in 2020 was up 79% since January. Because men are not a homogeneous group, it is important to implement strategies for groups of men that may have particularly unique needs. In this paper, we discuss considerations for intervening in men’s mental health during and in response to the COVID-19 pandemic, including current technology-based cyberpsychology options.

Treatment-resistant depression and the collaborative treatment relationship

Many depressed patients experience only limited improvement despite provision of appropriate therapies within a collaborative treatment arrangement (the integrated provision of psychotherapy and pharmacotherapy). In the interest of enhancing these patients' partial responses, it is valuable to examine the treatments provided and also the collaborative framework in which they are offered. The authors use vignettes to illustrate how each of several factors-the adequacy of treatment with each modality, behavioral impediments to response, compliance with treatments, recognition and appropriate matching of treatments to relevant concurrent diagnoses, and appropriate communication between collaborating clinicians-may affect treatment outcome. Recommendations are offered for clinicians engaging in a collaborative relationship, including attending carefully to the patients' comments about a complementary modality of treatment and the clinician delivering it, communicating useful information to the collaborating therapist, and being receptive to information that is offered by the collaborating therapist.

Antidepressant-induced sexual dysfunction: review, classification, and suggestions for treatment

Sexual function, an important component of quality of life, is often affected by antidepressant treatment. Reports associate antidepressant medications with a wide range of sexual disorders of desire, arousal, and orgasm, and with the occurrence of sexual pain. Fewer sexual dysfunctions have been reported with bupropion, nefazodone, and mirtazapine than with the monoamine-oxidase inhibitors, tricyclic antidepressants, selective serotonin-reuptake inhibitors, and venlafaxine. Sexual dysfunctions may occur in more than half of patients treated with selective serotonin-reuptake inhibitors, but patients may not readily divulge sexual information unless a clinician is knowledgeable and proactive in assessment. Once an antidepressant-induced sexual dysfunction is detected and its nature is characterized, an appropriate treatment intervention can be chosen in order to alleviate the sexual disorder and enhance treatment compliance. This review classifies antidepressant-induced sexual dysfunctions, discusses assessment and differential diagnosis, and describes currently reported treatment approaches.

Description of antipanic therapy in a prospective longitudinal study

The authors present a summary scale for assessing the percentage of patients in a large longitudinal study of panic disorder who received proven effective psychopharmacologic treatment. Such a scale provides a means for assessing and comparing somatic treatments of panic disorder across medication classes. The antipanic therapy levels were applied to data on medication treatment received by 492 patients participating in a naturalistic study and reflect psychopharmacologic treatment prescribed in 11 academic centers. Results show that among patients treated by psychiatrists at major teaching hospitals only 54% of the most symptomatic groups received optimal pharmacologic treatment. Among less symptomatic patients, who nonetheless met full criteria for panic disorder with or without agoraphobia, only 43% received maximal therapy.

Schizophrenia and the life cycle

We reframe the longitudinal treatment of persons with schizophrenia from the perspective of phases in adult development. This approach articulates the need for different interventions of varying intensities over the person's lifetime. The paper discusses the implications of an adult developmental perspective in managing pharmacologic treatment and psychosocial interventions, and in reallocating financial resources for improved long-term outcomes. This perspective is especially useful in the context of a comprehensive community mental health program permitting access to a continuum of services throughout the lifecycle.

SSRI-associated nocturnal bruxism in four patients

BACKGROUND

Nocturnal bruxism (tooth clenching and/or grinding during sleep) affects a significant proportion of the population. Its etiology remains uncertain, and no entirely satisfactory treatment is available.

METHOD

This is an observational report of four depressed individuals selected from one psychiatrist's practice within an urban hospital's psychopharmacology clinic. Psychiatric diagnoses were made according to DSM-III-R criteria. Nocturnal bruxism was determined on the basis of dental examination and/or self-reported nocturnal tooth clenching and/or grinding.

RESULTS

Four patients developed nocturnal bruxism within 2 to 4 weeks after initiation of treatment with fluoxetine or sertraline. Bruxism remitted in all patients after a decrease in antidepressant dosage (N = 1) or addition of buspirone (N = 3).

CONCLUSION

These observations, which should be confirmed by a controlled study, suggest an association between serotonin selective reuptake inhibitor (SSRI) treatment and the onset or exacerbation of nocturnal bruxism. In addition, they suggest that a decrease in SSRI dosage or the addition of buspirone may relieve SSRI-associated nocturnal bruxism.

The case for a services-based approach to payment for mental illness under national health care reform

In this position paper drafted by the committee on psychopathology of the Group for the Advancement of Psychiatry, the authors discuss merits and disadvantages of three different approaches to equitable coverage of mental illness: coverage for selected psychiatric diagnoses, coverage based on severity of impairment, and coverage of services. They believe that coverage of selected disorders has political appeal but is discriminatory and arbitrary; it is also impractical because clinicians may overdiagnose conditions covered by insurance and underdiagnose excluded conditions. Coverage based on severity of impairment, or disability, has similar limitations. The authors believe services should be the principal basis for coverage, as under general medical insurance. The approach is nondiscriminatory, and costs can be controlled through such means as managed care, changes in the payment system, or benefit design.

Fluoxetine-induced bradycardia and syncope in two patients

Fluoxetine appears to cause a low incidence of adverse cardiac effects. An uncommon but potentially hazardous effect of fluoxetine therapy, however, is bradycardia accompanied by faintness or syncope. The authors report two cases in which this adverse effect occurred. They hypothesize that the mechanism of bradycardia in these cases represents a direct central nervous system effect of increased serotonin on medullary cardiovascular regulation.

Comorbidity of personality disorders: two for the price of three

Clinicians who treat individuals with personality disorders must remain alert to the presence of concurrent mood disorders, anxiety disorders; or schizophrenia. Comorbid disorders can significantly affect a patient's presentation, treatment, and prognosis.

A strategy for the pharmacotherapy of personality disorders

Current research reveals that biological factors play an important role in shaping normal and disordered personality features. Judicious use of medications can facilitate the treatment of individuals with personality disorders.

An emergency psychiatry update

A review of trends in emergency psychiatry since 1981 indicates that the scope and complexity of the field have greatly increased. Clinicians have found it useful to identify patient groups with special assessment and treatment needs, including adolescents, the elderly, victims of rape and of domestic violence, and repeat visitors to the emergency service. The spread of AIDS requires greater medical attentiveness by psychiatric emergency clinicians, and two recreational substances of abuse, cocaine and inhalants, have become increasingly popular. The use of psychotropic drugs in the emergency room has received more attention, and new trends in rapid tranquilization are apparent. Also reviewed are current medicolegal controversies related to emergency room practice, findings on prediction and control of violence, and the use of the psychiatric emergency service as a training site.

Emergency psychopharmacology: a review and update

The emergency area is a difficult site for the practice of careful psychopharmacology. The detailed history taking and collaborative treatment relationship often found in the consultant's office is rarely present. Instead, rapid decisions are made under a variety of pressures, with patients who may be uncooperative and unwilling to be treated. Many emergency patients are concurrently in treatment with a psychotherapist or psychopharmacologist who is available for consultation to the emergency service. When this is possible it is of great potential value, both in arriving more quickly at an appropriate treatment and in preventing a harmful opposition of the patient's treatment resources. For patients who are not currently in another treatment, additional helpful information often may be obtained from friends or family members. This is especially useful in treating patients who are acutely psychotic, unable to communicate, or uncooperative with the emergency interview. Although psychopharmacological approaches properly chosen often yield rapid results, medications are only a part of most emergency treatment plans. Medications are ineffective in a variety of crises and cannot replace careful interviewing of patients and others aimed at understanding the exogenous stress, change in interpersonal relationships, intrapsychic conflict, or biological disorder that precipitated an emergency visit. Furthermore, the decision to treat with medications must include a consideration of the adverse effects that may occur. With these limitations in mind, the area of emergency psychopharmacology can provide powerful assistance to emergency clinicians.

Repeat visitors in the psychiatric emergency service: a critical review of the data

Repeat visitors to psychiatric emergency services constitute 7 to 18 percent of the total patients and account for up to a third of the visits. This frequently difficult-to-treat group has been described in six controlled and two uncontrolled studies. In a critical review of findings and methodology, the authors interpret and compare the available data about repeaters. Their major conclusions are that repeaters are more likely to lack social supports, to be currently in psychiatric treatment, and to have a chronic illness. Research approaches to further elucidate these patients' characteristics are suggested.

More than a gateway: the role of the emergency psychiatry service in the community mental health network

The authors describe how an emergency psychiatry service in an inner-city general hospital has been able to expand its functions and strengthen its ties to community mental health agencies. A major factor in helping the emergency unit build closer relationships with community agencies is its contract with the state to perform evaluations of all admissions to the state hospital psychiatric unit serving the catchment area. The emergency unit performs triage and provides backup for the agencies, coordinates the management of multi-agency cases, and holds weekly educational conferences for agency staff. Using case examples, the authors illustrate how unit and agency staff collaborate to ensure continuity of patient care.

DSM-III and the diagnosis of organic mental disorders

Among the many emergency patients who complain of behavioral symptoms, a significant proportion suffer from a physical illness manifesting as an organic mental disorder. Dementia and delirium should be considered in the presence of an impairment of orientation, alertness, or cognition. Effort is required to remain aware of the organic differential diagnoses of hallucinatory, delusional, amnestic, and affective disorders or of personality changes not associated with overt changes of sensorium or cognitive abilities. We review the DSM-III classification of organic mental disorders published by the American Psychiatric Association, and consider the usefulness of historical data, mental status examination, physical examination, laboratory investigations, and hospitalization in the differentiation of organic from functional disorders.

Methamphetamine abuse presenting as dysuria following urethral insertion of tablets

Foreign bodies are inserted into the male urogenital tract for a variety of motives, and patients may present with symptoms of dysuria, urinary retention, hematuria, discharge, or priapism. Concomitant psychopathology is seen frequently, necessitating a thorough psychiatric assessment with attention to other acts of self-mutilation, suicide attempts, psychosis, or substance abuse. We report the case of an abuser of methamphetamine who inserted a sustained-release form of medication into his urethra, with resulting mechanical and pharmacological trauma.