This Month in Psychopharmacology

2021 NEI Congress Young Investigator Poster Competition Winners

2021 NEI Congress | Colorado Springs, CO & Virtual
November 5, 2021

The 2021 NEI Congress Scientific Poster Session and Reception was held on Friday, November 5th and featured 67 posters, with an additional 48 posters presented virtually, covering the full spectrum of mental health research and clinical data. Among them, three particularly stood out for the quality of their data and contributions to the field, and one (Poster Winner #3) also stands out due to the age of the first author/presenter—14 years old! Presented below are the winners of the 2021 NEI Congress Young Investigator Poster Competition.

Comparative Effectiveness Of Intravenous Ketamine And Intranasal Esketamine In Real-World Setting Among Patients With Treatment Refractory Depression
Balwinder Singh MD, MS, Simon Kung, MD, Kathryn M. Schak, MD, William V. Bobo, MD, MPH, Mark A. Frye, MD, Jennifer L. Vande Voort, MD

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Background: Ketamine, an N-methyl-D-aspartate receptor antagonist, has been repurposed as a rapid-acting antidepressant for treatment-resistant depression (TRD). The s-enantiomer of ketamine, esketamine, was FDA approved for TRD and depressive symptoms in adults with major depressive disorder with suicidal ideations/behaviors. Intravenous (IV) ketamine, although financially less expensive, is often not covered by insurance and intranasal (IN) esketamine, although covered by insurance can be expensive. There is a paucity of literature on efficacy data comparing subanesthetic IV ketamine and IN esketamine for TRD in real-world scenario. Thus, we conducted this study comparing the efficacy and the number of treatments required to achieve remission/response with repeated use of subanesthetic IV ketamine/IN esketamine among TRD patients.

Methods: This was an observational study where we included adults (=18 years) with TRD who provided consent and had received up to 6 IV ketamine infusions (0.5 mg/kg, infused over 40 minutes) or up to 8 intranasal (IN) esketamine (56/84 mg) treatments for TRD at the Mayo Clinic Depression Center. Depression symptoms were measured utilizing the self-report 16-Item Quick Inventory of Depressive Symptomatology (QIDS-SR) scale before and 24 hours after ketamine/esketamine treatment. Remission and response were defined as QIDS-SR 16 score =5 and =50% change in QIDS-SR 16, respectively. Continuous variables are reported as means ± SD and categorical variables as counts and percentages. The Wilcoxon rank-sum test was used to compare continuous variables. Chi-square and Fisher’s exact tests were used to compare categorical variables. Number of treatments to remission/response were calculated.

Results: Sixty-three adults with TRD, middle-aged (47.0 ± 12.1 years), predominantly female (65%), of which 75% (n=47) and 25% (n=16) received IV ketamine and IN esketamine, respectively. Mean (SE) change in QIDS-SR 16 score was -8.7 ± 0.7 (p<0.001), a significant reduction (improvement) from baseline (mean ± SD = 17.6 ± 3.7). Overall remission and response rates were 36.5% and 55.6% respectively in the acute phase. Response (55.3 vs 56.3%) and remission rates (40.4 vs 25.0%) were similar among patients who received IV ketamine or IN esketamine, respectively (p>0.05). The mean number of treatments received to achieve response (2.5 ± 1.6 vs 4.4 ± 2.1) and remission (2.4 ± 1.3 vs 6.3 ± 2.4) were significantly lower among patients who received IV ketamine compared to IN esketamine (p=0.008). Most patients tolerated both the treatments well.

Conclusion: Intravenous ketamine and intranasal esketamine showed similar response/remission in TRD patients but the number of treatments required to achieve response/remission was significantly lower with IV ketamine compared to IN esketamine. These findings need to be investigated in a randomized control trial comparing these two treatment interventions.

Improving Cultural Competency of Health Care Providers When Caring for the LGBTQ Community
Susana Nwosu, CRNP-PMH

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Background: The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is at an increased risk of experiencing health disparities, poor health outcomes, stigma, and discrimination when seeking medical care.

Purpose: This project aimed to improve nurse practitioners’ competence level, knowledge, and awareness when providing care to the LGBTQ community. Raising the cultural competence level is anticipated to improve and build a therapeutic alliance and bond with the LGBTQ community, which is expected to improve patient outcomes on a long-term basis.

Design: A quantitative study with a pre-test/post-test design.

Methods: A pre- and post-intervention study design was conducted, and participants comprised a convenience sample of nurse practitioners from throughout the United States (N = 50). Three subscales were calculated using the Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Descriptive statistics were calculated using means and standard deviations for continuous variables and frequencies for categorical variables. To compare responses pre- and post-training, paired-samples t-tests were conducted on the Clinical Preparedness, Attitudinal Awareness, Basic Knowledge subscales, and the total LGBT-DOCSS score.

Results: 98% of study participants desired additional cultural competency training. When investigating changes from pre- to post-training, it was found that the three subscales and the total score all significantly increased (all ps = .02).

Conclusion: There is a significant gap in the knowledge of providers when caring for the LGBTQ community. The results of this study highlight the need for LGBTQ awareness and educational training for health care providers.

Error-Related Brain Activity in ADHD: A Systematic Review and Meta-Analysis of Electroencephalography Markers of Cognitive Control Performance
Pranjali Awasthi, George Buzzell, Ph.D.

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Background: Deviant cognitive control performance is implicated in attention-deficit hyperactivity disorder (ADHD). It is also conjectured to be a potential diagnoser and differentiator between the Inattentive and Hyperactive-Impulsive ADHD types. Reliable measures have not been established due to the variation in published results.

Methods: We performed a systematic review and meta-analysis of the literature published up to May 2021 with data on electrophysiological correlates i.e., EEG correlates of cognitive control monitoring (error-related negativity, ERN; error positivity, Pe; correct-response negativity, CRN) in ADHD patients and the efficiency of EEG recordings in differentiating between ADHD types. Multiple databases including PubMed, Scopus, Google Scholar, bioRxiv, medRxiv were searched for eligible literature. Meta-analyses were performed through statistical tools provided by the open-source metafor package and separately using the Hedges’ g standardized mean differences.

Results: Meta-analyses were performed on a shortlisted set of 125 studies involving 7248 participants. To avoid extraneous variables, the sex ratio was maintained at 50:50, and the age groups of participants were equally varied between early teenagers (12-15 years), late teenagers (15-18 years), young adults (21-25), and middle-aged adults (29-37). The ADHD-afflicted group showed reduced ERN (Hedges’ g=-0.58 [CIs: -0.76, -0.35]) and reduced Pe (Hedges’ g=-0.65 [CIs: -0.79, -0.44]). The Hyperactive-Impulsive ADHD types (2574/7248 participants) showed an increased CRN (Hedges’ g=0.68 [CIs: 0.71, 0.29]), while the Inattentive ADHD types (4674/7248 participants) showed a slightly reduced CRN (Hedges’ g=-0.25 [CIs: -0.31, -0.28]). The prevalence of counted task-errors was higher in the teenagers' group (12-18 years) than the adults' group (21-37 years).

Conclusion: Results suggest that EEG Pattern Markers (especially Pe and CRN) can act as strong differentiators/diagnosers between the Hyperactive-Impulsive and Inattentive ADHD types. In further development, deep learning classifiers can be built for ADHD types using EEG Markers as Features and statistical values as weights.

2021 NEI Congress Young Investigator Poster Competition Winner, Balwinder Singh MD, MS (center) with NEI's Chief Medical Officer, Andrew J. Cutler, MD (left) and NEI Congress Chairman, Stephen M. Stahl, MD, PhD, DSc (Hon.) (right)