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OBJECTIVE: Catatonia is a neuropsychiatric disorder that can occur in the setting of many illnesses, but the frequency of catatonia diagnosis among hospitalized patients is poorly characterized. This study reports the occurrence of catatonia diagnosis among acute care hospital discharges in the United States and the cooccurring diagnoses of these patients. METHOD: The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients older than 18 discharged with a diagnosis of catatonia in 2019. RESULTS: 13,630 encounters among the 30,080,038 adult hospitalizations in the NIS during the study year included a diagnosis of catatonia. Total hospital charges for these admissions were $1.15 billion, with 215,165 cumulative hospital days. In this sample, approximately 60% of admissions had a primary psychiatric discharge diagnosis, while 40% had a primary neurologic or medical discharge diagnosis. Procedures were performed in 36.7% of hospitalizations involving catatonia, of which electroconvulsive therapy was most common. CONCLUSIONS: Catatonia is a rare but costly discharge diagnosis among patients in acute care hospitals. It occurs across the age spectrum and is associated with a range of medical and psychiatric comorbidities. Further research is needed to better characterize the occurrence of catatonia and its optimal treatment.

Mind-body programs can improve mental health and well-being in military populations. This pilot study of a virtual synchronous resilience intervention was conducted from 2018 to 2020 among 26 military personnel. Participants completed self-report psychosocial questionnaires before and after the 6-week program, including measures of posttraumatic stress disorder, depression, stress, resilience, and mindfulness. The intervention included eliciting the relaxation response, adaptive coping strategies, and healthy behaviors. Pre-post changes were calculated using paired t tests and effect sizes ( d ). Significant improvements were found for depression (Patient Health Questionnaire-8), stress reactivity (Measure of Current Status-Abbreviated Scale), and mindfulness (Cognitive Affective Mindfulness Scale-Revised). A 6-week resilience intervention can help military personnel improve mental health, coping, and stress management. [ Psychiatr Ann . 2022;52(5):186–190.]

The British Association for Psychopharmacology developed an evidence-based consensus guideline on the management of catatonia. A group of international experts from a wide range of disciplines was assembled. Evidence was gathered from existing systematic reviews and the primary literature. Recommendations were made on the basis of this evidence and were graded in terms of their strength. The guideline initially covers the diagnosis, aetiology, clinical features and descriptive epidemiology of catatonia. Clinical assessments, including history, physical examination and investigations are then considered. Treatment with benzodiazepines, electroconvulsive therapy and other pharmacological and neuromodulatory therapies is covered. Special regard is given to periodic catatonia, malignant catatonia, neuroleptic malignant syndrome and antipsychotic-induced catatonia. There is attention to the needs of particular groups, namely children and adolescents, older adults, women in the perinatal period, people with autism spectrum disorder and those with certain medical conditions. Clinical trials were uncommon, and the recommendations in this guideline are mainly informed by small observational studies, case series and case reports, which highlights the need for randomised controlled trials and prospective cohort studies in this area.

COVID-19 is associated with a range of neuropsychiatric manifestations. While case reports and case series have reported catatonia in the setting of COVID-19 infection, its rate has been poorly characterized. This study reports the co-occurrence of catatonia and COVID-19 diagnoses among acute care hospital discharges in the United States in 2020.The National Inpatient Sample, an all-payors database of acute care hospital discharges, was queried for patients of any age discharged with a diagnoses of catatonia and COVID-19 in 2020.Among 32,355,827 hospitalizations in the 2020 NIS, an estimated 15,965 (95% CI: 14,992 to 16,938) involved a diagnosis of catatonia without COVID-19 infection, 1,678,385 (95% CI: 1,644,738 to 1,712,022) involved a diagnosis of COVID-19 without a co-occurring catatonia diagnosis, and 610 (95% CI: 578 to 642) involved both catatonia and COVID-19 infection. In an adjusted model, a diagnosis of COVID-19, but not a diagnosis of catatonia or the combination of catatonia and COVID-19, was associated with increased mortality. Patients with catatonia and COVID-19 were frequently diagnosed with encephalopathy and delirium codes.Catatonia and COVID-19 were rarely co-diagnosed in 2020, and catatonia diagnosis was not associated with increased mortality in patients with COVID-19. Further research is needed to better characterize the phenomenology of catatonia in the setting of COVID-19 infection and its optimal treatment.

Love, compassion and related constructs have drawn to much attention from the general public due to the increased need of a better and more humanistic medical care. However, those constructs have been constantly neglected in academic benches and high impact research journals due to the 'abstract' and 'non-measurable' nature of these constructs. At the same time, medicine is claiming for a more patient-oriented and empathetic care, as care has been more disease-oriented and less life- and health-oriented, as initially proposed. This piece tries to discuss and claim for a more compassionate and altruistic care, despite technical pressure from most healthcare systems. We aim, thus, to incentive more research and clinical practice toward this very important subject.

We present the case of a 65-year-old female with a past psychiatric history of obsessive compulsive disorder (OCD) and anxiety who recently underwent diagnostic laparoscopy in the setting of a recent computerized tomography (CT) scan revealing a peritoneal mass. Post-operatively she was delirious and soon found to be malignantly catatonic. This patient's treatment was complicated by an acute stroke which was a relative contraindication for electroconvulsive therapy (ECT). Top experts in the consultation-liaison psychiatry and ECT fields provide guidance for this clinical scenario based on their experience and a review of the available literature. Key teaching points include a review of diagnosing and treating catatonia, a review of ECT for the treatment of catatonia, as well as a review of the role of the CL psychiatrist in medically complex cases. Specifically, we offer guidance in treating patients that have malignant catatonia when ECT is unavailable.

BackgroundsExercise is an attractive, widely accessible intervention to promote cardiovascular health; however, evidence that exercise improves brain health is sparse. Here, we hypothesized that aerobic exercise would improve brain health of sedentary older adults, as reflected by cognition health, sleep macro- and micro-architecture, and brain age index (BAI), a biomarker of brain health derived from the overnight sleep electroencephalogram (EEG).MethodsSedentary older adults were recruited to complete a 12-week aerobic exercise. Home wearable devices were used to monitor heart rate and overnight sleep EEG over the period. NIH Toolbox Cognition Battery, in-lab overnight polysomnography, cardiopulmonary exercise testing and multiplex cytokine assay were employed to determine pre- and post-exercise brain health, exercise capacity and plasma proteins.Results26 participants completed the initial assessment and exercise program, and 24 completed all procedures. Participants significantly increased maximal oxygen consumption (VO2max) and decreased resting and sleeping heart rate after the exercise regimen. Cognition performances were significantly improved following the exercise program while no significant differences were seen in BAI and sleep macro- and micro-architecture. Plasma IL-4 was elevated while IL-8 was reduced after the exercise regimen. Home sleep data revealed a 3.59% increase in the percentage of N3 sleep over a 12-week.ConclusionsWe conclude that cognitive function and N3 sleep were improved by a 12-week moderate-intensity exercise program in sedentary older adults, associated with improvements in VO2max and plasma cytokine profiles. Our data show the value of integrating multi-modal assessments to study the effect of brain health targeted approaches.FundingDr. Westover received support during this work from the McCance Center for Brain Health, the Glenn Foundation for Medical Research and the American Federation for Aging Research through a Breakthroughs in Gerontology Grant; through the American Academy of Sleep Medicine through an AASM Foundation Strategic Research Award; by the Football Players Health Study (FPHS) at Harvard University; from the Department of Defense through a subcontract from Moberg ICU Solutions, Inc, and by grants from the NIH (R01NS102190, R01NS102574, R01NS107291, RF1AG064312, R01AG062989, R01AG073410), and NSF (2014431). Dr. Wrann was supported by a SPARC Award from the McCance Center for Brain Health. Dr. Tanzi and Dr. Zhang were supported by the Cure Alzheimer’s Fund.Clinical trial numberNational Clinical Trial: NCT04210882One Sentence SummaryWe observed that exercise improved slow wave sleep, increased circulating neuroprotective cytokines and improved cognition health in older adults.

The investigators aimed to describe the clinical experience of a single center reporting on neuropsychiatric findings among patients experiencing persistent symptoms as part of post-acute sequelae of SARS-CoV-2 (PASC) infection.Data were collected retrospectively (between February 2020 and May 2021) from a cohort (N=100) within a COVID-19 survivors study of patients with persistent symptoms enrolled after a short inpatient stay or who had been outpatients never hospitalized. Patients without confirmatory positive PCR or antibody diagnostic test results were grouped separately as presumptive cases (N=13).Of the 87 patients with confirmed SARS-CoV-2, 63 (72.4%) were female, and 65 (74.7%) were White. The mean age was 49.2 years (SD=14.9). The most prevalent symptoms after COVID-19 infection were fatigue, "brain fog," headache, anxiety, and sleep issues. Attention and executive function were frequently impaired. The mean Montreal Cognitive Assessment score was 26.0 (SD=2.8). Concentration and attention as well as memory issues were both significantly correlated with the complaint of brain fog.These preliminary findings suggest that post-acute sequelae of SARS-CoV-2 vary in frequency and duration with relation to premorbid history and that these conditions affect functional domains and patients' ability to return to work. Longitudinal research with larger cohorts is needed to characterize PASC and to optimize care, especially for vulnerable populations.

Persistent symptoms following COVID-19 infection have been termed postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. Many of these symptoms are neuropsychiatric, such as inattention, impaired memory, and executive dysfunction; these are often colloquially termed "brain fog". These symptoms are common and often persist long after the acute phase. The pattern of these deficits combined with laboratory, neuroimaging, electroencephalographic, and neuropsychological data suggest that these symptoms may be driven by direct and indirect damage to the frontal-subcortical neural networks. Here, we review this evidence, share our clinical experience at an academic medical center, and discuss potential treatment implications. While the exact etiology remains unknown, a neurocircuit-informed understanding of postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection can help guide pharmacology, neuromodulation, and physical and psychological therapeutic approaches.

Objective The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors of moderate or severe forms of COVID-19. Method 425 adults were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview, psychometric tests and a cognitive battery. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the ‘Least Absolute Shrinkage and Selection Operator’ (LASSO) method. Results Diagnoses of ‘depression’, ‘generalized anxiety disorder’ and ‘post-traumatic stress disorder’ were established respectively in 8%, 15.5% and 13.6% of the sample. After pandemic onset (i.e., within the previous year), the prevalence of ‘depression’ and ‘generalized anxiety disorder’ were 2.56% and 8.14%, respectively. Memory decline was subjectively reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not associated with any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors. Conclusions This is the first study to access rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe forms of COVID-19 using standardized measures. As a key finding, there was no significant association between clinical severity in the acute-phase of SARS-CoV-2 infection and the neuropsychiatric impairment 6 to 9 months thereafter.

BACKGROUND Loneliness is a growing public health problem that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Social support interventions have been shown to reduce loneliness, including when delivered through technology. Digital humans are a new type of computer agent that show promise as supportive peers in health care. For digital humans to be effective and engaging support persons, it is important that they develop closeness with people. Closeness can be increased by emotional expressiveness, particularly in female relationships. However, it is unknown whether emotional expressiveness improves relationships with digital humans and affects physiological responses. OBJECTIVE The aim of this study is to investigate whether emotional expression by a digital human can affect psychological and physiological outcomes and whether the effects are moderated by the user’s gender. METHODS A community sample of 198 adults (101 women, 95 men, and 2 gender-diverse individuals) was block-randomized by gender to complete a 15-minute self-disclosure conversation with a female digital human in 1 of 6 conditions. In these conditions, the digital human varied in modality richness and emotional expression on the face and in the voice (emotional, neutral, or no face; emotional or neutral voice). Perceived loneliness, closeness, social support, caring perceptions, and stress were measured after each interaction. Heart rate, skin temperature, and electrodermal activity were assessed during each interaction. 3-way factorial analyses of variance with post hoc tests were conducted. RESULTS Emotional expression in the voice was associated with greater perceptions of caring and physiological arousal during the interaction, and unexpectedly, with lower feelings of support. User gender moderated the effect of emotional expressiveness on several outcomes. For women, an emotional voice was associated with increased closeness, social support, and caring perceptions, whereas for men, a neutral voice increased these outcomes. For women, interacting with a neutral face was associated with lower loneliness and subjective stress compared with no face. Interacting with no face (ie, a voice-only black screen) resulted in lower loneliness and subjective stress for men, compared with a neutral or emotional face. No significant results were found for heart rate or skin temperature. However, average electrodermal activity was significantly higher for men while interacting with an emotional voice. CONCLUSIONS Emotional expressiveness in a female digital human has different effects on loneliness, social, and physiological outcomes for men and women. The results inform the design of digital human support persons and have theoretical implications. Further research is needed to evaluate how more pronounced emotional facial expressions in a digital human might affect the results. CLINICALTRIAL Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000865819; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381816&isReview

The catatonic syndrome is an example of a multifactorial neurobehavioral disorder that causes much morbidity and mortality but also has the potential to unlock the mystery of how motivation and movement interact to produce behavior. In this chapter, an attempt is made to understand better the catatonic syndrome through the lens of neurobiology and neuropathophysiology updated by recent studies in molecular biology, genomics, inflammasomics, neuroimaging, neural network theory, and neuropsychopathology. This will result in a neurostructural model for the catatonic syndrome that centers on paralimbic regions including the anterior and midcingulate cortices, as they interface with striatal and thalamic nodes in the salience decision-making network. Examination of neurologic disorders like the abulic syndrome, which includes in its extreme catatonic form, akinetic mutism, will identify the cingulate cortex and paralimbic neighbors as regions of interest. This exploration has the potential to unlock mysteries of the brain cascade from motivation to movement and to clarify catatonia therapeutics. Such a synthesis may also help us discern meaning inherent in this complex neurobehavioral syndrome.

Tinnitus is the sensation of hearing a sound with no external auditory stimulus present. It is a public health issue correlated with multiple comorbidities and precipitating factors such as noise exposure, military service, and traumatic brain injury, migraine, insomnia, small vessel disease, smoking history, stress exposure, anxiety, depression, and socioeconomic status. Clinical experience and a recent literature review point at tinnitus as a neuropsychiatric condition involving both auditory and nonauditory cortical areas of the brain and affecting brain-auditory circuitry. In fact, brain-ear connections have been highlighted in different models. Forward management of this disorder should take this body of research into consideration as tinnitus remains a challenging condition to evaluate and treat with current management protocols still symptomatic at best. With a better understanding of the etiologic factors and comorbidities of tinnitus, additional research trials and new therapeutic approaches could see the light to tackle this public health disability bringing hope to patients and doctors.

In an important book titled Health Wars: On the Global Front Lines of Modern Medicine, Richard Horton, physician editor of the Lancet, focuses on the crisis in clinical medicine and the patient–doctor relationship today [1]. Horton makes the point that modern medicine, while continuing to push its scientific frontiers, must remain true to its roots in the relationship of trust between the patient and the doctor.

Neuroleptic malignant syndrome (NMS) represents an iatrogenic form of malignant catatonia, and simple catatonia has been shown to predispose to NMS.The authors present the case of a bipolar patient with catatonic features who developed NMS after receiving haloperidol.Supportive therapy, including rehydration, electrolyte restoration, and blood pressure aids were given, together with antipyretics, antibiotics, and anticoagulants. The patient was also started on bromocriptine and diazepam.Supportive care, diazepam, and dopamine agonists yielded only partial benefit. However, switching from diazepam to lorazepam, in combination with electroconvulsive therapy (ECT) and a long-acting dopamine agonist led to the resolution of NMS.This case sheds further light on the relationship between catatonia and NMS. As noted in the literature, ECT in combination with lorazepam proved to be safe and effective for NMS.

Even though viral management of HIV infection is now more effective, clinical observations suggest that fatigue remains a problem for a substantial proportion of patients.The authors delineated prevalence and severity of fatigue in HIV patients with psychiatric comorbidities and examined psychological correlates of fatigue.The authors comprehensively assessed fatigue in 38 consecutive HIV patients referred for psychiatric treatment with the Identity-Consequence Fatigue Scale.About 80% of patients reported at least moderate feelings of fatigue, and about 25% judged that fatigue was severely affecting their daily functioning. Depression, anxiety, and perceived stress explained between 20% and 75% of the variance in fatigue ratings.The results suggest that fatigue in the era of effective antiretroviral treatment is prevalent, relevant, and related to psychological morbidities. Recognition and treatment of these comorbidities may be important in reducing this fatigue.

This chapter reflects on the relationships between attachment, resiliency, altruism, and health within the background of brain evolution and allostasis. It begins by discussing the disconnected relationships between doctors and patients that have arisen in our culture due to our preoccupation with evidence-based medicine and the doctor's disregard of the important psychological and social concerns that accompany human disease. It uses the separation-attachment dialectic to advocate an attachment solution to this separation challenge in which the doctor and patient are reconnected through the healing power of compassionate love. The chapter concludes by advocating resiliency-building techniques to prevent disease and to encourage altruistic behaviour in the human population.

Evidence suggests that the placebo response is related to the tonic effects of constitutive nitric oxide in neural, vascular and immune tissues. Constitutive nitric oxide levels play a role in the modulation of dopamine outflow in the nigrostriatal movement and the mesolimbic and mesocortical reward and motivation circuitries. Endogenous morphine, which stimulates constitutive nitric oxide, may be an important signal molecule working at mu receptors on gamma aminobutyric acid B interneurons to disinhibit nigral and tegmental dopamine output. We surmise that placebo induced belief will activate the prefrontal cortex with downstream stimulatory effects on these dopamine systems as well as on periaqueductal grey opioid output neurons. Placebo responses in Parkinson's disease, depression and pain disorder may result. In addition, mesolimbic/mesocortical control of the stress response systems may provide a way for the placebo response to benefit other medical conditions.

This review is an attempt to explore the relationship between two complex areas of behavioral research, namely that of religion and crime and delinquency. We will also examine supporting research from the area of physiological belief and relaxation systems as a means of understanding the posited negative correlation between religiosity and crime. Our central thesis is that ones level of participation in religious activities is negatively correlated to participation in criminal activity. While this central tenant seems straightforward there are a number of methodological issues that need to be addressed. In particular we need to operationally define the terms religiosity and delinquency. By reviewing archival research we hope to help substantiate the negative correlation between religion and crime, as well as explain a possible mechanism for this relationship.

Georg Northoff employs a comparison with Parkinson's disease in an effort to tease apart the underlying pathophysiology of psychogenic catatonia. Northoff's extensive treatment of the subject is abetted by his own research as well as the research of others. Nevertheless, a number of points concerning basal ganglia/thalamocortical processing need to be raised, some adding support to his hypothesis and others detracting from it.