Highlights from 2023 NEI Congress: Scientific Poster Session
Friday, November 10, 2023
The 2023 NEI Congress Scientific Poster Session was held on Friday, November 10th and featured 128 posters 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. Presented below are the winners of the 2023 NEI Congress Young Investigator Poster Competition.
Improved Mood and Weight Gain Mitigation Following Switch from Aripiprazole to Cariprazine
Maxwell Zachary Price, Richard Louis Price
Introduction: Oral aripiprazole is FDA-approved for bipolar I maintenance but has not demonstrated efficacy in bipolar depression, the most commonly reported phase of bipolar disorder. Cariprazine is FDA-approved for bipolar I manic, mixed, and depressive episodes. Aripiprazole has been associated with >7% increase in body weight in 21.4% of bipolar patients in long-term trials versus 1-3% of bipolar patients on cariprazine in short-term trials. Although both agents are partial dopamine receptor agonists, cariprazine has greater affinity for D3 (Ki = 0.085nM) compared to that of aripiprazole (Ki = 0.8nM), which may account for improved efficacy in bipolar I depression. Furthermore, cariprazine has lower antagonism for the 5-HT2C receptor (Ki = 134nM) compared to that of aripiprazole (Ki = 15nM), which may explain lower rates of weight gain. We wanted to know whether patients taking oral aripiprazole for bipolar I disorder who had subsequently entered the depressive phase and reported weight gain would experience improved mood and weight mitigation following direct switch from aripiprazole to cariprazine. To minimize polypharmacy, this switch strategy could potentially obviate the need for additional antidepressant medication and antipsychotic-associated weight loss agents we have previously utilized, such as melatonin, topiramate, naltrexone, and metformin.
Method: We conducted a retrospective chart review on 37 patients (23 females, 14 males) who directly switched from oral aripiprazole to cariprazine. 2 mg-10 mg aripiprazole switched to 1.5 mg cariprazine; ≥15 mg aripiprazole switched to 3 mg cariprazine. Statistical analysis was performed using a within-subject, 2-tailed t test with significance level p < 0.05.
Results: Mean age was 35.4±13.8 years; mean aripiprazole dose was 11.3 mg/day (range 2-30 mg/day) for a mean duration of 94.9 weeks (range 1-728 weeks); mean body weight increase on aripiprazole was 16.1±12.3%. After a mean duration of 36.7 weeks (range 1-127 weeks) on a mean cariprazine dose 2.0 mg/day (range 1.5-4.5 mg/day), Clinical Global Impression-Bipolar Severity of Illness Scale score improved from a mean of 5.0±0.9 on aripiprazole to a mean of 2.8±0.7 on cariprazine (t=-12.75, p <0.00001). Mean weight on aripiprazole 90.3±21.5 kg decreased to a mean of 83.9±19.2 kg on cariprazine (t=-4.22, p < 0.001). Switch was well tolerated and no patients discontinued cariprazine for self-limited nausea (2 patients), restlessess (1), and insomnia (1).
Conclusion: This study found that bipolar I depressed patients, who had gained weight on aripiprazole, experienced significantly improved mood and desired weight gain mitigation following direct switch to low doses of cariprazine, which was well tolerated and without additional untoward side effects that warranted discontinuation. Our findings also lend support to the utility of cariprazine in helping bipolar depressed patients maintain stability beyond the resolution of the depressed phase.
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Psychiatric Consultations at an Academic Medical Center in the Initial Weeks of the COVID-19 Pandemic: A Clinical and Sociodemographic Comparison of COVID-Positive and COVID-Negative Consultations
Emily Groenendaal, MD1,2, Sean Lynch, MD2,3, Sivan Shahar, MD1,4, Rhea Dornbush, PhD, MPH1,2, Lidia Klepacz, MD1,2, Stephen J. Ferrando, MD1,2Affiliations:  New York Medical College;  Westchester Medical Center;  Mount Sinai Beth Israel;  Mount Sinai Hospital
Background: During the initial weeks of the COVID-19 pandemic, the overall number of psychiatric consultations decreased; however, the consultations that were placed appeared to be heavily related to either COVID-19 infection or a stressor secondary to the pandemic. New onset neuropsychiatric symptoms have been seen and described in prior reports among patients with acute COVID-19 infection. This study aimed to examine the sociodemographic and clinical characteristics of psychiatric consultations in the early portion of the pandemic, and compare patients who were COVID-19-positive with those who were negative.
Method: This IRB-approved retrospective chart review involved all psychiatric consultations for COVID-19-positive patients admitted to a medical floor at an academic medical center from March 1 2020 until May 31 2020. Sociodemographic, medical (including diagnoses and laboratory values), and psychiatric information was collected from all consultations, and patients who were COVID-19 positive were matched with a COVID-negative comparison group by age (+/- 3 years) and gender. Statistical analyses to compare these groups were performed.?
Results: There were 80 consultations for COVID-positive patients identified in the given time period. These were matched with a comparison group of 80 patients who had been listed as COVID-negative; however on review of medical records only 64 were truly negative, so 16 were excluded. Significant differences existed between groups in terms of reason for psychiatric consultation (p=0.04) and billing diagnosis (p<0.01), with COVID-positive patients appearing to have a greater likelihood of presenting with psychosis or delirium, and less likelihood for mood, anxiety, or substance use. D-dimer levels were higher in COVID-positive patients, and patients with COVID had a higher mortality rate. COVID-positive patients were more likely to receive a “second-generation antipsychotic”. Differences between groups in terms of specific psychiatric symptoms were explored. No other sociodemographic or medical differences were found between groups.
Discussion/Conclusion: Patients with COVID-19 infection may be at an increased rate for delirium and for symptoms of psychosis. Multiple studies have speculated on mechanisms for such symptoms, though findings are inconclusive. This study suggests that simply increased stress during the pandemic is not the driving factor for these symptoms. Patients admitted to medical floors with COVID-19 infection should be screened for delirium and for new-onset neuropsychiatric symptoms.
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Dexmedetomidine: A review of its use for the treatment and prevention of hyperactive delirium in intensive care units (ICU)
Brittany Booker, MS4 1, Ayyub Imtiaz, MD 2, Muhammad Zaidi, MD 2 Affiliations:  Ross University School of Medicine, Bridgetown, Barbados;  Saint Elizabeths Hospital - Department of Behavioral Health, Washington, DC
Introduction: The incidence of delirium in the ICU occurs upwards of 80% and is associated with increased length of stay in hospitals and mortality. The effects of previously recommended antipsychotics and benzodiazepines for management of ICU delirium have come into question as they have been associated with no change in or even exacerbation of delirium. This has led to unclear pharmacological treatment recommendations and the need to seek explicit treatment of ICU delirium. Dexmedetomidine, an adrenergic alpha 2 receptor agonist, has been shown to reduce the development of delirium and improve the resolution of delirium. The aim of this review is to explore the evidence that supports the use of dexmedetomidine for treatment and prevention of hyperactive delirium in ICU patients.
Method: A literature review using articles from databases such as PubMed and Google Scholar was conducted to gather supporting evidence on the use of dexmedetomidine in ICU delirium. The articles included in this review were randomized controlled trials (RCT), observational studies, systematic reviews and meta-analyses, and literature review articles. The main outcomes measured included a decrease in scales used to measure delirium and agitation, time spent in delirium, duration of mechanical ventilation, and incidence of delirium.
Results: A RCT comparing the use of lorazepam and dexmedetomidine in 106 adult mechanically ventilated ICU patients demonstrated that dexmedetomidine at 0.15- 1.5 µg/kg/h resulted in more days without delirium. Another study done to compare the efficacy and safety of prolonged sedation in 375 mechanically ventilated patients found that individuals receiving dexmedetomidine at a rate of 0.2-1.4 µg/kg/h spent less time on the ventilator, developed delirium 20% less often, and were off mechanical ventilation almost 2 days sooner compared to midazolam. The Dexmedetomidine to Lessen ICU Agitation RCT, which involved 74 adults treated at rate of 0.5-1.5 µg/kg/h in whom extubation was not done due to delirium severity, demonstrated that dexmedetomidine increased ventilator free hours by 17 hours compared to placebo. Another RCT of 100 delirium-free ICU adults demonstrated a greater proportion of patients who remained delirium-free during the ICU stay after administration of nocturnal dexmedetomidine at rate of 0.2-0.7 µg/kg/h. A case series done to explore the use of dexmedetomidine in post-traumatic brain injury (TBI) showed dexmedetomidine at a rate of 0.49 µg/kg/h in 85 patients with severe TBI did not worsen neurological function.
Conclusion: Delirium in ICU patients occur at exceptionally high rates and there is a need for clear pharmacologic treatment. Current literature supports the use of dexmedetomidine for reduction of delirium in ICU patients with potential to eliminate risk associated with previously used antipsychotics and benefits of safe use in TBI, decreased risk of polypharmacy and overall mortality associated with ICU delirium.
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