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Howell, PhD</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Neuroplasticity After Brain Injury: Principles and Methods for Postinjury Improvement " aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="Neuroplasticity After Brain Injury: Principles and Methods for Postinjury Improvement " aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">Improving cognitive function is a primary goal of brain injury rehabilitation and is made possible through the process of neuroplasticity.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class=""><div style="width:50%;float:left;max-width:525px;margin:0 1.5rem 1.5rem 0;clear:both;cursor:pointer" class=" figure"><div class="flex-none relative text-center"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%276001%27%20height=%274000%27/%3e"/></span><img alt="brain" title="brain" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="brain" title="brain" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F7045e608baaea1cc2ea6cbe3927d7e31b102b4fa-6001x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 1x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F7045e608baaea1cc2ea6cbe3927d7e31b102b4fa-6001x4000.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div id="image-caption" class="text-gray-500 italic"><div class="blockText_blockContent__TbCXh"><p class="pb-2">Lindsay Citraro/AdobeStock</p></div></div><div class="top-[-100%] block w-[1px] transition-opacity duration-500 ease-in-out opacity-0 overflow-hidden"><img class="m-auto absolute inset-0 max-w-[0%] max-h-[0%] border-[3px] border-solid border-white shadow-[0px_0px_8px_rgba(0,0,0,0.3)] box-border transition ease-in-out duration-500" src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/7045e608baaea1cc2ea6cbe3927d7e31b102b4fa-6001x4000.jpg?fit=crop&auto=format"/></div></div><style> #image-caption p{ font-size: 12px; max-width: 525px; margin: 0 auto; text-align: center; } </style></div><p class="pb-2">Brain injury survivors experience a wide range of secondary physical, cognitive, and behavioral consequences that may significantly impact daily life. Ranging from seizures, paralysis, and pain to learning and memory impairment, disorientation, aggression, impulsivity, and noncompliance. Cognitive function postinjury is considered the most impacted and is also cited as the most important predictor for returning to work or prior living status. Improving these symptoms/functions is a primary goal of brain injury rehabilitation and is made possible through the process of neuroplasticity.</p><p class="pb-2"></p><p class="pb-2"><strong>What Is Neuroplasticity?</strong></p><p class="pb-2">Neuroplasticity is the science of how the brain changes its structure and function in response to input. These changes include creation of new blood vessels, creation of new synapses, dendritic arborization, and creation of new neurons. These changes may occur in response to positive, as well as negative stimuli (maladaptive vs adaptive plasticity). Examples of maladaptive plasticity include neuronal structure/function changes in response to addictive substances, as well as the strengthening of connections and reinforcement of compensatory mechanisms that impede recovery. <a target="_blank" href="https://www.psychiatrictimes.com/view/neuroplasticity-and-smart-phones">Neuroplasticity</a> can occur at multiple levels, from the molecular and synaptic level to higher order levels of cortical maps and large-scale neuronal networks. Data indicates that the brain continuously restructures neural circuitry, in fact, this is the foundation for encoding new experiences and enabling changes in behavior. Channeling this innate ability of the brain to change is essential to maximizing the benefits of rehabilitation.<sup class="text-inherit">1</sup> Change requires structure, repetition, and consistency by trained and experienced staff. This need for structure, repetition, and consistency is illustrated in a set of principles of neuroplasticity.</p><p class="pb-2"></p><p class="pb-2"><strong>Principles of Neuroplasticity<sup class="text-inherit">2</sup></strong></p><ol class="my-2"><li class="list-decimal ml-8"><strong>Use it or lose it: </strong>This principle describes the degradation of neural circuits not actively engaged in task performance for long periods of time. For example, individuals with left side strokes may lose some function on the right side of their bodies. Since tasks with the right side become more difficult, they default to use of the unaffected (left) side. The brain reorganizes and dedicates more “space” to the left motor area, thus limiting recovery potential of the right side.</li><li class="list-decimal ml-8"><strong>Use it and improve it: </strong>Plasticity can be induced through extended training. In other words, training that drives a specific brain function can lead to enhancement of that function. For example, under the guidance of trained staff, a technique known as constraint-induced movement therapy can be used to restrain the arm on the nonaffected side, so that the patient is compelled to use their affected limb as much as possible, thereby improving its function.</li><li class="list-decimal ml-8"><strong>Specificity: </strong>From a treatment standpoint, specificity highlights the importance of tailoring an activity or exercise to produce a result in specific circuitry. Research in this area has shown that specific skill acquisition produces greater changes in the brain than unskilled repetitive movements. While physical exercises aimed at strengthening leg muscles will ultimately help patients improve their sit-to-stand from a chair or bed, more significant changes will occur when that specific sit-to-stand skill is practiced.</li><li class="list-decimal ml-8"><strong>Repetition matters: </strong>Patients may often ask, “how long is this going to take?” While it is difficult to give a precise answer, research shows that thousands and even tens of thousands of repetitions are required to generate change. Utilization of combination therapies can be particularly beneficial for increasing repetitions without necessarily increasing time. For example, physical therapists may increase a patient’s steps outside of their therapy session by having them walk between therapy sessions or stand during their other therapy sessions. Likewise, speech therapists could have patients working on memory or pathfinding activities during their PT session.</li><li class="list-decimal ml-8"><strong>Intensity matters: </strong>This principle can be thought of as the dosage required to induce change. The intensity, or dosage, is highly dependent upon the therapy goals; however, data shows that the more intense a therapy program, the more likely it is that the program will result in substantial change and the more sustainable those changes will be.</li><li class="list-decimal ml-8"><strong>Time matters:</strong> “Plasticity occurs at different times during recovery.” This is particularly relevant in the context of brain injury recovery, as in the acute phase especially, the brain is actively looking for new ways to rewire to regain function (making the training much easier). Without access to the appropriate training during this phase, the brain will instead develop less desirable compensatory mechanisms (like a stroke patient not using their affected limb to do daily tasks). Early access to treatment helps avoid development of maladaptive behaviors.</li><li class="list-decimal ml-8"><strong>Salience matters:</strong> Research suggests that emotions play a role in neuroplasticity. It is easier for us to learn things that we are interested in or that excite us. It is important for therapists to know what really matters to their patients in order to improve skill acquisition by targeting relevant and salient tasks.</li><li class="list-decimal ml-8"><strong>Age matters:</strong> Our brains are much more adaptable when we are younger, which makes change in structure and function easier to achieve. An aging brain is very capable of neuroplasticity, it simply may take more time and be more difficult, requiring more repetitions and higher intensity.</li><li class="list-decimal ml-8"><strong>Transference or generalization:</strong> “Plasticity in response to one training experience can enhance acquisition of similar behaviors.” This principle is best explained in the context of rehabilitation. During therapy, the goal is to get the patient to a level where they can function as independently as possible, meaning that it is important to utilize techniques that can be applied outside of the therapy environment. For example, having a patient reach out to grab an object during PT or OT knowing that they will be able to utilize that same technique to reach for objects at home.</li><li class="list-decimal ml-8"><strong>Interference:</strong> This principle is referencing the development of maladaptive behaviors. When therapy is delayed and maladaptive behaviors surface, therapy is made more challenging by needing to unlearn the maladaptive compensatory mechanisms before real positive change can occur.</li></ol><p class="pb-2"></p><p class="pb-2"><strong>Methods for Improving Neuroplasticity After Brain Injury</strong></p><p class="pb-2"><strong><em>Structured Rehabilitation</em></strong></p><p class="pb-2">Structured rehabilitation is the most direct way to improve neuroplasticity postinjury, especially multidisciplinary programs. Multidisciplinary programs including all therapeutic disciplines (cognitive, physical, occupational, educational, and counseling) allow for the most efficient use of time and the highest amount of carry over by creating well-balanced and coordinated treatment plans that are supported by each department. Progress can then be reassessed across time, and therapy goals redirected as appropriate.</p><p class="pb-2"></p><p class="pb-2"><strong><em>Physical Exercise and Cognitive Activity</em></strong></p><p class="pb-2">A large body of evidence tells us that exercise is neuroprotective. Its mechanisms include anti-inflammatory effects, neuro- and angiogenesis, decreasing oxidative stress, promoting long-term strengthening of synapses [long-term potentiation (LTP)], and increasing transcription of genes associated with plasticity.<sup class="text-inherit">3</sup> Functionally, this leads to improvements in depressive symptoms, cognitive function, balance, and sleep. By combining the effects of exercise with cognitive training, we are likely to see a substantial impact on neural structure and function.</p><p class="pb-2"></p><p class="pb-2"><strong><em>Noninvasive Neurostimulation and Rehabilitation</em></strong></p><p class="pb-2">There are a number of different methods of noninvasive <a target="_blank" href="https://www.psychiatrictimes.com/view/spotlight-on-neurostimulation-research-innovation-award">neurostimulation</a> (ie, tDCS, TMS, tACS). While these methods of stimulation are not enough to generate action potentials on their own, they produce sub-threshold changes in the firing patterns of already active neurons. By producing these small subthreshold changes, the stimulation may be able to prime the neural circuits so that the brain is more responsive to rehabilitation.<sup class="text-inherit">4</sup></p><p class="pb-2"></p><p class="pb-2"><strong>Addressing Underrecognized Comorbidities</strong></p><p class="pb-2"><strong><em>Sleep</em></strong></p><p class="pb-2"><a target="_blank" href="https://www.psychiatrictimes.com/view/identifying-and-addressing-sleep-wake-disturbances-post-tbi">Sleep-wake disturbances</a> are common after brain injury, impacting up to 80% of brain injury survivors. These disturbances are often multiple and multifaceted ranging from sleep disordered breathing (sleep apnea) to REM sleep behavior disorders, circadian rhythm disorders, and disruptions in sleep architecture. Sleep has long been established as critical for learning and memory and is now also associated with the ability to suppress memories and unlearn, as well as decrease depressive symptoms. Sleep also impacts various aspects of synaptic strength and structure, including stabilization of dendritic spines and spine pruning, and decreases inflammation.<sup class="text-inherit">5</sup> By objectively addressing any sleep disturbances, we can weed out the impact of sleep on cognitive and behavioral function, as well as directly improve the capacity for neuroplastic change.</p><p class="pb-2"></p><p class="pb-2"><strong><em>Neuroendocrine Function</em></strong></p><p class="pb-2">Neuroendocrine dysfunction is not uncommon postinjury and may or may not be associated with sleep disturbances, since sleep impacts hormone function and vice versa. In general, the pituitary gland, which directs neuroendocrine function, is very susceptible to injury due to its size and location. Our neuroendocrine system relies on tightly regulated negative feedback loops to function properly. When the hypothalamus and/or pituitary is injured, these feedback loops breakdown and lead to widespread functional damage. One specific example is the impact of prolonged stress on neuroplasticity. If the brain is not receiving and sending stress signals appropriately, leading to a prolonged response, we can see atrophy and remodeling of neurons, impacts on gene expression, decreases in LTP, and increases in depression and anxiety.<sup class="text-inherit">6</sup></p><p class="pb-2"></p><p class="pb-2"><strong>Concluding Thoughts</strong></p><p class="pb-2">Understanding and utilizing neuroplasticity principles is crucial in neurorehabilitation. Early access to multidisciplinary therapy programs with experienced and trained staff will aid in improving a patient’s ability to engage in daily activities and participate in meaningful social roles. In fact, substantial recovery or restoration of function is unlikely in the absence of targeted intervention. In addition to targeted rehabilitation, we can bolster neuroplasticity by using combination therapies, noninvasive neurostimulation, and addressing underrecognized comorbidities such as sleep and neuroendocrine function.</p><p class="pb-2"></p><p class="pb-2"><strong>Dr Howell </strong><em>is a senior neuroscientist and Director of Research Integration at the Centre for Neuro Skills. She is a specialist in brain injury rehabilitation, neurodegenerative disease, and clinical research.</em></p><p class="pb-2"></p><p class="pb-2"><strong>References</strong></p><p class="pb-2">1. Kelly C, Foxe JJ, Garavan H. <a rel="nofollow noreferrer noopener" target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/17140876/">Patterns of normal human brain plasticity after practice and their implications for neurorehabilitation.</a> <em>Arch Phys Med Rehabil. </em>2006;87(12 Suppl 2):S20-29.</p><p class="pb-2">2. Kleim JA, Jones TA. <a rel="nofollow noreferrer noopener" target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/18230848/">Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.</a> <em>J Speech Lang Hear Res. </em>2008;51(1):S225-239.</p><p class="pb-2">3. Xing Y, Bai Y. <a rel="nofollow noreferrer noopener" target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/32691303/">A review of exercise-induced neuroplasticity in ischemic stroke: pathology and mechanisms.</a> <em>Mol Neurobiol. </em>2020;57(10):4218-4231.</p><p class="pb-2">4. Zaninotto AL, El-Hagrassy MM, Green JR, et al. <a rel="nofollow noreferrer noopener" target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/31285791/">Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: a systematic review.</a> <em>Dement Neuropsychol. </em>2019;13(2):172-179.</p><p class="pb-2">5. Sun L, Zhou H, Cichon J, Yang G. <a rel="nofollow noreferrer noopener" target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/32248786/">Experience and sleep-dependent synaptic plasticity: from structure to activity.</a> <em>Philos Trans R Soc Lond B Biol Sci. </em>2020;375(1799):20190234.</p><p class="pb-2">6. Radley J, Morilak D, Viau V, Campeau S. <a rel="nofollow noreferrer noopener" target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/26116544/">Chronic stress and brain plasticity: mechanisms underlying adaptive and maladaptive changes and implications for stress-related CNS disorders.</a> <em>Neurosci Biobehav Rev. </em>2015;58:79-91.</p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" 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Ranging from seizures, paralysis, and pain to learning and memory impairment, disorientation, aggression, impulsivity, and noncompliance. Cognitive function postinjury is considered the most impacted and is also cited as the most important predictor for returning to work or prior living status. Improving these symptoms/functions is a primary goal of brain injury rehabilitation and is made possible through the process of neuroplasticity.\n\n\n\nWhat Is Neuroplasticity?\n\nNeuroplasticity is the science of how the brain changes its structure and function in response to input. These changes include creation of new blood vessels, creation of new synapses, dendritic arborization, and creation of new neurons. These changes may occur in response to positive, as well as negative stimuli (maladaptive vs adaptive plasticity). Examples of maladaptive plasticity include neuronal structure/function changes in response to addictive substances, as well as the strengthening of connections and reinforcement of compensatory mechanisms that impede recovery. Neuroplasticity can occur at multiple levels, from the molecular and synaptic level to higher order levels of cortical maps and large-scale neuronal networks. Data indicates that the brain continuously restructures neural circuitry, in fact, this is the foundation for encoding new experiences and enabling changes in behavior. Channeling this innate ability of the brain to change is essential to maximizing the benefits of rehabilitation.1 Change requires structure, repetition, and consistency by trained and experienced staff. This need for structure, repetition, and consistency is illustrated in a set of principles of neuroplasticity.\n\n\n\nPrinciples of Neuroplasticity2\n\nUse it or lose it: This principle describes the degradation of neural circuits not actively engaged in task performance for long periods of time. For example, individuals with left side strokes may lose some function on the right side of their bodies. Since tasks with the right side become more difficult, they default to use of the unaffected (left) side. The brain reorganizes and dedicates more “space” to the left motor area, thus limiting recovery potential of the right side.\n\nUse it and improve it: Plasticity can be induced through extended training. In other words, training that drives a specific brain function can lead to enhancement of that function. For example, under the guidance of trained staff, a technique known as constraint-induced movement therapy can be used to restrain the arm on the nonaffected side, so that the patient is compelled to use their affected limb as much as possible, thereby improving its function.\n\nSpecificity: From a treatment standpoint, specificity highlights the importance of tailoring an activity or exercise to produce a result in specific circuitry. Research in this area has shown that specific skill acquisition produces greater changes in the brain than unskilled repetitive movements. While physical exercises aimed at strengthening leg muscles will ultimately help patients improve their sit-to-stand from a chair or bed, more significant changes will occur when that specific sit-to-stand skill is practiced.\n\nRepetition matters: Patients may often ask, “how long is this going to take?” While it is difficult to give a precise answer, research shows that thousands and even tens of thousands of repetitions are required to generate change. Utilization of combination therapies can be particularly beneficial for increasing repetitions without necessarily increasing time. For example, physical therapists may increase a patient’s steps outside of their therapy session by having them walk between therapy sessions or stand during their other therapy sessions. Likewise, speech therapists could have patients working on memory or pathfinding activities during their PT session.\n\nIntensity matters: This principle can be thought of as the dosage required to induce change. The intensity, or dosage, is highly dependent upon the therapy goals; however, data shows that the more intense a therapy program, the more likely it is that the program will result in substantial change and the more sustainable those changes will be.\n\nTime matters: “Plasticity occurs at different times during recovery.” This is particularly relevant in the context of brain injury recovery, as in the acute phase especially, the brain is actively looking for new ways to rewire to regain function (making the training much easier). Without access to the appropriate training during this phase, the brain will instead develop less desirable compensatory mechanisms (like a stroke patient not using their affected limb to do daily tasks). Early access to treatment helps avoid development of maladaptive behaviors.\n\nSalience matters: Research suggests that emotions play a role in neuroplasticity. It is easier for us to learn things that we are interested in or that excite us. It is important for therapists to know what really matters to their patients in order to improve skill acquisition by targeting relevant and salient tasks.\n\nAge matters: Our brains are much more adaptable when we are younger, which makes change in structure and function easier to achieve. An aging brain is very capable of neuroplasticity, it simply may take more time and be more difficult, requiring more repetitions and higher intensity.\n\nTransference or generalization: “Plasticity in response to one training experience can enhance acquisition of similar behaviors.” This principle is best explained in the context of rehabilitation. During therapy, the goal is to get the patient to a level where they can function as independently as possible, meaning that it is important to utilize techniques that can be applied outside of the therapy environment. For example, having a patient reach out to grab an object during PT or OT knowing that they will be able to utilize that same technique to reach for objects at home.\n\nInterference: This principle is referencing the development of maladaptive behaviors. When therapy is delayed and maladaptive behaviors surface, therapy is made more challenging by needing to unlearn the maladaptive compensatory mechanisms before real positive change can occur.\n\n\n\nMethods for Improving Neuroplasticity After Brain Injury\n\nStructured Rehabilitation\n\nStructured rehabilitation is the most direct way to improve neuroplasticity postinjury, especially multidisciplinary programs. Multidisciplinary programs including all therapeutic disciplines (cognitive, physical, occupational, educational, and counseling) allow for the most efficient use of time and the highest amount of carry over by creating well-balanced and coordinated treatment plans that are supported by each department. Progress can then be reassessed across time, and therapy goals redirected as appropriate.\n\n\n\nPhysical Exercise and Cognitive Activity\n\nA large body of evidence tells us that exercise is neuroprotective. Its mechanisms include anti-inflammatory effects, neuro- and angiogenesis, decreasing oxidative stress, promoting long-term strengthening of synapses [long-term potentiation (LTP)], and increasing transcription of genes associated with plasticity.3 Functionally, this leads to improvements in depressive symptoms, cognitive function, balance, and sleep. By combining the effects of exercise with cognitive training, we are likely to see a substantial impact on neural structure and function.\n\n\n\nNoninvasive Neurostimulation and Rehabilitation\n\nThere are a number of different methods of noninvasive neurostimulation (ie, tDCS, TMS, tACS). While these methods of stimulation are not enough to generate action potentials on their own, they produce sub-threshold changes in the firing patterns of already active neurons. By producing these small subthreshold changes, the stimulation may be able to prime the neural circuits so that the brain is more responsive to rehabilitation.4\n\n\n\nAddressing Underrecognized Comorbidities\n\nSleep\n\nSleep-wake disturbances are common after brain injury, impacting up to 80% of brain injury survivors. These disturbances are often multiple and multifaceted ranging from sleep disordered breathing (sleep apnea) to REM sleep behavior disorders, circadian rhythm disorders, and disruptions in sleep architecture. Sleep has long been established as critical for learning and memory and is now also associated with the ability to suppress memories and unlearn, as well as decrease depressive symptoms. Sleep also impacts various aspects of synaptic strength and structure, including stabilization of dendritic spines and spine pruning, and decreases inflammation.5 By objectively addressing any sleep disturbances, we can weed out the impact of sleep on cognitive and behavioral function, as well as directly improve the capacity for neuroplastic change.\n\n\n\nNeuroendocrine Function\n\nNeuroendocrine dysfunction is not uncommon postinjury and may or may not be associated with sleep disturbances, since sleep impacts hormone function and vice versa. In general, the pituitary gland, which directs neuroendocrine function, is very susceptible to injury due to its size and location. Our neuroendocrine system relies on tightly regulated negative feedback loops to function properly. When the hypothalamus and/or pituitary is injured, these feedback loops breakdown and lead to widespread functional damage. One specific example is the impact of prolonged stress on neuroplasticity. If the brain is not receiving and sending stress signals appropriately, leading to a prolonged response, we can see atrophy and remodeling of neurons, impacts on gene expression, decreases in LTP, and increases in depression and anxiety.6\n\n\n\nConcluding Thoughts\n\nUnderstanding and utilizing neuroplasticity principles is crucial in neurorehabilitation. Early access to multidisciplinary therapy programs with experienced and trained staff will aid in improving a patient’s ability to engage in daily activities and participate in meaningful social roles. In fact, substantial recovery or restoration of function is unlikely in the absence of targeted intervention. In addition to targeted rehabilitation, we can bolster neuroplasticity by using combination therapies, noninvasive neurostimulation, and addressing underrecognized comorbidities such as sleep and neuroendocrine function.\n\n\n\nDr Howell is a senior neuroscientist and Director of Research Integration at the Centre for Neuro Skills. She is a specialist in brain injury rehabilitation, neurodegenerative disease, and clinical research.\n\n\n\nReferences\n\n1. Kelly C, Foxe JJ, Garavan H. Patterns of normal human brain plasticity after practice and their implications for neurorehabilitation. Arch Phys Med Rehabil. 2006;87(12 Suppl 2):S20-29.\n\n2. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 2008;51(1):S225-239.\n\n3. Xing Y, Bai Y. A review of exercise-induced neuroplasticity in ischemic stroke: pathology and mechanisms. Mol Neurobiol. 2020;57(10):4218-4231.\n\n4. Zaninotto AL, El-Hagrassy MM, Green JR, et al. Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: a systematic review. Dement Neuropsychol. 2019;13(2):172-179.\n\n5. Sun L, Zhou H, Cichon J, Yang G. Experience and sleep-dependent synaptic plasticity: from structure to activity. Philos Trans R Soc Lond B Biol Sci. 2020;375(1799):20190234.\n\n6. Radley J, Morilak D, Viau V, Campeau S. Chronic stress and brain plasticity: mechanisms underlying adaptive and maladaptive changes and implications for stress-related CNS disorders. Neurosci Biobehav Rev. 2015;58:79-91.","description":"Improving cognitive function is a primary goal of brain injury rehabilitation and is made possible through the process of neuroplasticity.","author":[{"@type":"Person","name":"Stefanie N. Howell, PhD"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-5V9L5PL" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class="w-full bg-primary flex flex-col items-center justify-center"><div class="container w-[1340px]"><div id="footerInnerWrap" class="bg-primary w-full py-12"><div class="py-4 pl-4 flex flex-row items-center"><div class="flex flex-row flex-wrap w-[55%] h-full"><div class="w-[33%] p-1 my-0 cursor-pointer text-footer-text-color hover:text-footer-text-color/80 hover:underline"><a class="text-md" target="_self" href="/about">About</a></div><div 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Ranging from seizures, paralysis, and pain to learning and memory impairment, disorientation, aggression, impulsivity, and noncompliance. Cognitive function postinjury is considered the most impacted and is also cited as the most important predictor for returning to work or prior living status. Improving these symptoms/functions is a primary goal of brain injury rehabilitation and is made possible through the process of neuroplasticity.","_key":"a1d7774b4db70"}],"upload_doc":null,"uploadAudio":null,"medias":null},{"uploadAudio":null,"medias":null,"style":"normal","_key":"55a1f2d79e62","markDefs":[],"children":[{"text":"","_key":"bfa3fb8a736b0","_type":"span","marks":[]}],"_type":"block","upload_doc":null},{"uploadAudio":null,"medias":null,"children":[{"text":"What Is Neuroplasticity?","_key":"8ff94c1ec6710","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"ccd03ee02734","markDefs":[],"upload_doc":null},{"uploadAudio":null,"medias":null,"_key":"ecde9d7c6997","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/neuroplasticity-and-smart-phones","_key":"c0d8d4f2e306"}],"children":[{"_type":"span","marks":[],"text":"Neuroplasticity is the science of how the brain changes its structure and function in response to input. These changes include creation of new blood vessels, creation of new synapses, dendritic arborization, and creation of new neurons. These changes may occur in response to positive, as well as negative stimuli (maladaptive vs adaptive plasticity). Examples of maladaptive plasticity include neuronal structure/function changes in response to addictive substances, as well as the strengthening of connections and reinforcement of compensatory mechanisms that impede recovery. ","_key":"19517d6884680"},{"marks":["c0d8d4f2e306"],"text":"Neuroplasticity","_key":"3d69fa53b072","_type":"span"},{"marks":[],"text":" can occur at multiple levels, from the molecular and synaptic level to higher order levels of cortical maps and large-scale neuronal networks. Data indicates that the brain continuously restructures neural circuitry, in fact, this is the foundation for encoding new experiences and enabling changes in behavior. Channeling this innate ability of the brain to change is essential to maximizing the benefits of rehabilitation.","_key":"0d7d3d4ddf0b","_type":"span"},{"_type":"span","marks":["superscript"],"text":"1","_key":"6e78fbe18200"},{"_key":"8e73622b068f","_type":"span","marks":[],"text":" Change requires structure, repetition, and consistency by trained and experienced staff. This need for structure, repetition, and consistency is illustrated in a set of principles of neuroplasticity."}],"_type":"block","style":"normal","upload_doc":null},{"medias":null,"_type":"block","style":"normal","_key":"3be956b5e6ac","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7ae187fd50900"}],"upload_doc":null,"uploadAudio":null},{"medias":null,"children":[{"_type":"span","marks":["strong"],"text":"Principles of Neuroplasticity","_key":"70d5aac6de9d0"},{"_type":"span","marks":["strong","superscript"],"text":"2","_key":"1650b65cc187"}],"_type":"block","style":"normal","_key":"0b32d3faa990","markDefs":[],"upload_doc":null,"uploadAudio":null},{"medias":null,"listItem":"number","children":[{"_type":"span","marks":["strong"],"text":"Use it or lose it: ","_key":"dce64add5a560"},{"_type":"span","marks":[],"text":"This principle describes the degradation of neural circuits not actively engaged in task performance for long periods of time. For example, individuals with left side strokes may lose some function on the right side of their bodies. Since tasks with the right side become more difficult, they default to use of the unaffected (left) side. The brain reorganizes and dedicates more “space” to the left motor area, thus limiting recovery potential of the right side.","_key":"dce64add5a561"}],"_type":"block","upload_doc":null,"uploadAudio":null,"style":"normal","_key":"7b115a45c8cc","markDefs":[],"level":1},{"children":[{"_type":"span","marks":["strong"],"text":"Use it and improve it: ","_key":"e8b5e9318bff0"},{"_type":"span","marks":[],"text":"Plasticity can be induced through extended training. In other words, training that drives a specific brain function can lead to enhancement of that function. For example, under the guidance of trained staff, a technique known as constraint-induced movement therapy can be used to restrain the arm on the nonaffected side, so that the patient is compelled to use their affected limb as much as possible, thereby improving its function.","_key":"e8b5e9318bff1"}],"level":1,"_type":"block","style":"normal","_key":"82232e853da0","listItem":"number","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null},{"medias":null,"_type":"block","_key":"6b7a5d015470","upload_doc":null,"uploadAudio":null,"level":1,"style":"normal","listItem":"number","markDefs":[],"children":[{"_key":"4780eaab9b310","_type":"span","marks":["strong"],"text":"Specificity: "},{"_type":"span","marks":[],"text":"From a treatment standpoint, specificity highlights the importance of tailoring an activity or exercise to produce a result in specific circuitry. Research in this area has shown that specific skill acquisition produces greater changes in the brain than unskilled repetitive movements. While physical exercises aimed at strengthening leg muscles will ultimately help patients improve their sit-to-stand from a chair or bed, more significant changes will occur when that specific sit-to-stand skill is practiced.","_key":"4780eaab9b311"}]},{"_type":"block","style":"normal","listItem":"number","upload_doc":null,"uploadAudio":null,"medias":null,"level":1,"_key":"3dae4df43ce8","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Repetition matters: ","_key":"b077b3533a2e0"},{"_type":"span","marks":[],"text":"Patients may often ask, “how long is this going to take?” While it is difficult to give a precise answer, research shows that thousands and even tens of thousands of repetitions are required to generate change. Utilization of combination therapies can be particularly beneficial for increasing repetitions without necessarily increasing time. For example, physical therapists may increase a patient’s steps outside of their therapy session by having them walk between therapy sessions or stand during their other therapy sessions. Likewise, speech therapists could have patients working on memory or pathfinding activities during their PT session.","_key":"b077b3533a2e1"}]},{"_type":"block","style":"normal","listItem":"number","medias":null,"markDefs":[],"children":[{"marks":["strong"],"text":"Intensity matters: ","_key":"ccd66cefbb930","_type":"span"},{"text":"This principle can be thought of as the dosage required to induce change. The intensity, or dosage, is highly dependent upon the therapy goals; however, data shows that the more intense a therapy program, the more likely it is that the program will result in substantial change and the more sustainable those changes will be.","_key":"ccd66cefbb931","_type":"span","marks":[]}],"upload_doc":null,"uploadAudio":null,"level":1,"_key":"77a53f1bb0ac"},{"_type":"block","style":"normal","_key":"7df7dd4fca30","listItem":"number","markDefs":[],"upload_doc":null,"children":[{"text":"Time matters:","_key":"17de8e3538200","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" “Plasticity occurs at different times during recovery.” This is particularly relevant in the context of brain injury recovery, as in the acute phase especially, the brain is actively looking for new ways to rewire to regain function (making the training much easier). Without access to the appropriate training during this phase, the brain will instead develop less desirable compensatory mechanisms (like a stroke patient not using their affected limb to do daily tasks). Early access to treatment helps avoid development of maladaptive behaviors.","_key":"17de8e3538201"}],"level":1,"uploadAudio":null,"medias":null},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Salience matters:","_key":"403f15ef0aef0"},{"_type":"span","marks":[],"text":" Research suggests that emotions play a role in neuroplasticity. It is easier for us to learn things that we are interested in or that excite us. It is important for therapists to know what really matters to their patients in order to improve skill acquisition by targeting relevant and salient tasks.","_key":"403f15ef0aef1"}],"_type":"block","style":"normal","_key":"ffce0a3e8094","listItem":"number","level":1,"upload_doc":null,"uploadAudio":null,"medias":null},{"listItem":"number","children":[{"_type":"span","marks":["strong"],"text":"Age matters:","_key":"d0bd1abd4b550"},{"marks":[],"text":" Our brains are much more adaptable when we are younger, which makes change in structure and function easier to achieve. An aging brain is very capable of neuroplasticity, it simply may take more time and be more difficult, requiring more repetitions and higher intensity.","_key":"d0bd1abd4b551","_type":"span"}],"_type":"block","style":"normal","uploadAudio":null,"markDefs":[],"level":1,"_key":"155d9f2595aa","upload_doc":null,"medias":null},{"style":"normal","medias":null,"level":1,"_type":"block","markDefs":[],"children":[{"text":"Transference or generalization:","_key":"f9152283e7070","_type":"span","marks":["strong"]},{"_key":"f9152283e7071","_type":"span","marks":[],"text":" “Plasticity in response to one training experience can enhance acquisition of similar behaviors.” This principle is best explained in the context of rehabilitation. During therapy, the goal is to get the patient to a level where they can function as independently as possible, meaning that it is important to utilize techniques that can be applied outside of the therapy environment. For example, having a patient reach out to grab an object during PT or OT knowing that they will be able to utilize that same technique to reach for objects at home."}],"upload_doc":null,"uploadAudio":null,"_key":"4eba74e65aad","listItem":"number"},{"uploadAudio":null,"_type":"block","upload_doc":null,"style":"normal","_key":"baaa7d6e2720","listItem":"number","markDefs":[],"children":[{"marks":["strong"],"text":"Interference:","_key":"d92d625411a90","_type":"span"},{"_key":"d92d625411a91","_type":"span","marks":[],"text":" This principle is referencing the development of maladaptive behaviors. When therapy is delayed and maladaptive behaviors surface, therapy is made more challenging by needing to unlearn the maladaptive compensatory mechanisms before real positive change can occur."}],"level":1,"medias":null},{"_key":"0531b96f1e74","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"09121f5a43c90"}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null},{"markDefs":[],"children":[{"_key":"5f4c8f6cf58f0","_type":"span","marks":["strong"],"text":"Methods for Improving Neuroplasticity After Brain Injury"}],"_type":"block","style":"normal","_key":"1c75d4371523","upload_doc":null,"uploadAudio":null,"medias":null},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"3366a31e65f3","markDefs":[],"children":[{"_key":"b4a28dcf1b790","_type":"span","marks":["strong","em"],"text":"Structured Rehabilitation"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Structured rehabilitation is the most direct way to improve neuroplasticity postinjury, especially multidisciplinary programs. Multidisciplinary programs including all therapeutic disciplines (cognitive, physical, occupational, educational, and counseling) allow for the most efficient use of time and the highest amount of carry over by creating well-balanced and coordinated treatment plans that are supported by each department. Progress can then be reassessed across time, and therapy goals redirected as appropriate.","_key":"194c3bdbac530"}],"_type":"block","style":"normal","_key":"59a7e390e621","upload_doc":null,"uploadAudio":null,"medias":null},{"uploadAudio":null,"medias":null,"children":[{"text":"","_key":"f3fabd07ad730","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"929f347204e7","markDefs":[],"upload_doc":null},{"children":[{"_type":"span","marks":["strong","em"],"text":"Physical Exercise and Cognitive Activity","_key":"9272599cc3a60"}],"_type":"block","style":"normal","_key":"e81d68effbb4","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"A large body of evidence tells us that exercise is neuroprotective. Its mechanisms include anti-inflammatory effects, neuro- and angiogenesis, decreasing oxidative stress, promoting long-term strengthening of synapses [long-term potentiation (LTP)], and increasing transcription of genes associated with plasticity.","_key":"21b0037309010"},{"_type":"span","marks":["superscript"],"text":"3","_key":"d8cc02426776"},{"_type":"span","marks":[],"text":" Functionally, this leads to improvements in depressive symptoms, cognitive function, balance, and sleep. By combining the effects of exercise with cognitive training, we are likely to see a substantial impact on neural structure and function.","_key":"4887b8055962"}],"_type":"block","style":"normal","_key":"5261fe4d2c8a","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[]},{"_type":"block","style":"normal","_key":"af10de046451","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_key":"19ef878a03660","_type":"span","marks":[],"text":""}]},{"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Noninvasive Neurostimulation and Rehabilitation","_key":"dd0854940e4d0"}],"_type":"block","style":"normal","_key":"251d4ac63a06","upload_doc":null},{"_type":"block","style":"normal","_key":"c166b093963c","markDefs":[{"_key":"4b5eb7cf7866","nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/spotlight-on-neurostimulation-research-innovation-award"}],"children":[{"_type":"span","marks":[],"text":"There are a number of different methods of noninvasive ","_key":"1fe42f8fe2f10"},{"text":"neurostimulation","_key":"d8a56fd74b12","_type":"span","marks":["4b5eb7cf7866"]},{"marks":[],"text":" (ie, tDCS, TMS, tACS). While these methods of stimulation are not enough to generate action potentials on their own, they produce sub-threshold changes in the firing patterns of already active neurons. By producing these small subthreshold changes, the stimulation may be able to prime the neural circuits so that the brain is more responsive to rehabilitation.","_key":"4d76df0baa85","_type":"span"},{"marks":["superscript"],"text":"4","_key":"7ebe6e3f7395","_type":"span"}],"upload_doc":null,"uploadAudio":null,"medias":null},{"style":"normal","_key":"29b645da6226","markDefs":[],"children":[{"text":"","_key":"fe63c1dbcb780","_type":"span","marks":[]}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block"},{"children":[{"text":"Addressing Underrecognized Comorbidities","_key":"ed46f562fcf40","_type":"span","marks":["strong"]}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"71018dbeba85","markDefs":[]},{"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"0d558ec7ba2b","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Sleep","_key":"b9fce1b5f5b50"}]},{"uploadAudio":null,"medias":null,"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/identifying-and-addressing-sleep-wake-disturbances-post-tbi","_key":"05e79f06915c"}],"children":[{"text":"Sleep-wake disturbances","_key":"1ef8d744d2520","_type":"span","marks":["05e79f06915c"]},{"marks":[],"text":" are common after brain injury, impacting up to 80% of brain injury survivors. These disturbances are often multiple and multifaceted ranging from sleep disordered breathing (sleep apnea) to REM sleep behavior disorders, circadian rhythm disorders, and disruptions in sleep architecture. Sleep has long been established as critical for learning and memory and is now also associated with the ability to suppress memories and unlearn, as well as decrease depressive symptoms. Sleep also impacts various aspects of synaptic strength and structure, including stabilization of dendritic spines and spine pruning, and decreases inflammation.","_key":"164182350735","_type":"span"},{"_type":"span","marks":["superscript"],"text":"5","_key":"7c31428128af"},{"text":" By objectively addressing any sleep disturbances, we can weed out the impact of sleep on cognitive and behavioral function, as well as directly improve the capacity for neuroplastic change.","_key":"a47ca6279e97","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"dcb6275bf0bc","upload_doc":null},{"uploadAudio":null,"medias":null,"children":[{"marks":[],"text":"","_key":"77264ff3046d0","_type":"span"}],"_type":"block","style":"normal","_key":"9a4ada6fdb13","markDefs":[],"upload_doc":null},{"_type":"block","style":"normal","_key":"87f79c5b2dad","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":["strong","em"],"text":"Neuroendocrine Function","_key":"c6bd3b0f82f70"}]},{"upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Neuroendocrine dysfunction is not uncommon postinjury and may or may not be associated with sleep disturbances, since sleep impacts hormone function and vice versa. In general, the pituitary gland, which directs neuroendocrine function, is very susceptible to injury due to its size and location. Our neuroendocrine system relies on tightly regulated negative feedback loops to function properly. When the hypothalamus and/or pituitary is injured, these feedback loops breakdown and lead to widespread functional damage. One specific example is the impact of prolonged stress on neuroplasticity. If the brain is not receiving and sending stress signals appropriately, leading to a prolonged response, we can see atrophy and remodeling of neurons, impacts on gene expression, decreases in LTP, and increases in depression and anxiety.","_key":"a770e94e63c70"},{"_type":"span","marks":["superscript"],"text":"6","_key":"6418364a0c26"}],"_type":"block","style":"normal","_key":"80c75d3c8984"},{"uploadAudio":null,"medias":null,"_key":"f9139195b1d1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"92fbe294b03a0"}],"_type":"block","style":"normal","upload_doc":null},{"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"text":"Concluding Thoughts","_key":"d03395acdb330","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"ed33b6cf7d65","upload_doc":null},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Understanding and utilizing neuroplasticity principles is crucial in neurorehabilitation. Early access to multidisciplinary therapy programs with experienced and trained staff will aid in improving a patient’s ability to engage in daily activities and participate in meaningful social roles. In fact, substantial recovery or restoration of function is unlikely in the absence of targeted intervention. In addition to targeted rehabilitation, we can bolster neuroplasticity by using combination therapies, noninvasive neurostimulation, and addressing underrecognized comorbidities such as sleep and neuroendocrine function.","_key":"487ae61450220"}],"_type":"block","style":"normal","_key":"81da9a2c6f40","upload_doc":null,"uploadAudio":null,"medias":null},{"style":"normal","_key":"7e68ec42d620","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"26fc729c069d0"}],"_type":"block"},{"_key":"1b51421d1157","markDefs":[],"children":[{"text":"Dr Howell ","_key":"2e9bcf20dccd0","_type":"span","marks":["strong"]},{"_type":"span","marks":["em"],"text":"is a senior neuroscientist and Director of Research Integration at the Centre for Neuro Skills. She is a specialist in brain injury rehabilitation, neurodegenerative disease, and clinical research.","_key":"2e9bcf20dccd1"}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null},{"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"d9fa3efe6cf8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5006d61a84820"}]},{"uploadAudio":null,"medias":null,"_key":"a5ae57f0444d","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"4e548b7a42000"}],"_type":"block","style":"normal","upload_doc":null},{"style":"normal","_key":"83e16ec48d1e","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/17140876/","_key":"3633efd84c2d"}],"children":[{"_key":"d78deda2e9720","_type":"span","marks":[],"text":"1. Kelly C, Foxe JJ, Garavan H. 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This case highlights the frequent overlap of trauma and psychosis, emphasizing the need for trauma-informed care. Trauma is often overlooked in psychosis assessments, leading to inadequate treatment. Implementing trauma-informed approaches and evidence-based PTSD treatments, such as trauma-focused CBTp, can improve outcomes. 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Hardy, PsyD","_createdAt":"2024-11-11T21:08:13Z","_type":"author","_id":"81b94746-54aa-488a-b0ac-98cfbe85d8ab","biography":[{"children":[{"_type":"span","marks":["strong"],"text":"Dr Hardy","_key":"36792f8aea220"},{"_type":"span","marks":["em"],"text":" is the codirector of the INSPIRE Clinic, the co–section chief of INSPIRE Section, and a clinical professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine.","_key":"4a8e080cb949"}],"_type":"block","style":"normal","_key":"63f723cd2219","markDefs":[]},{"_key":"03fe34e53770","markDefs":[],"children":[{"_type":"span","marks":[],"text":"\n","_key":"bcf77501ed800"}],"_type":"block","style":"normal"}]}],"published":"2024-11-12T16:00:00.000Z","factCheckAuthors":null,"summary":"Traumatic life events are common among individuals who experience psychosis. Here's how best to assess and treat. 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Olson, PhD","url":"nichole-d-olson-phd"},{"displayName":"Kate V. Hardy, PsyD","url":"kate-v-hardy-psyd"}],"body":[{"widthP":52,"_type":"figure","alt":"trauma","alignment":"left","disableTextWrap":false,"asset":{"_ref":"image-3baa097f1742d64c9afda10b2c6f7deda469f1dc-7280x4080-jpg","_type":"reference"},"disableLightBox":true,"imgcaption":[{"markDefs":[],"children":[{"marks":[],"text":"necropos12/AdobeStock","_key":"01fe0f8049d20","_type":"span"}],"_type":"block","style":"normal","_key":"c7587d8ba6a0"}],"_key":"ea3d94bb02c1"},{"_key":"9cfae10a87c3","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Case Vignette ","_key":"3923afc8f8ae"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Sasha” is a 23-year-old nonbinary Asian American individual. Sasha is a survivor of childhood emotional and physical abuse by their parents. In addition, Sasha was physically assaulted when they were a freshman in college as they were walking back to their dorm late at night. Soon after this experience, they started having nightmares and flashbacks about the assault. They became easily startled and hypervigilant and no longer felt safe in lecture halls and on campus, which led them to drop out of college. Sasha also believes that strangers on the street intend to harm them physically, and they let Sasha know this by making eye contact with Sasha or by touching their faces. Sasha also reports seeing shadowy figures that seem threatening and hearing voices—both of their abusers from the past and strangers. These voices say degrading things about Sasha, which they interpret as a sign that there is a larger plot against them. Sasha no longer feels safe leaving the house or socializing, is disengaged from loved ones, is unable to return to college or work, and is currently on a leave of absence from their job at a daycare center. In the context of reduced sleep, concerns about financial stressors, and worsening voices, Sasha presents to the emergency department, where they disclose their voices, the shadowy figures, and fears that others in their neighborhood are threatening them. They are commenced on antipsychotic medication and are connected with their local early psychosis service for follow-up. ","_key":"ae86b87ed1ba"}],"_type":"block","style":"normal","_key":"6f0a120a970f"},{"style":"normal","_key":"19df16d351eb","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Trauma and Psychosis","_key":"2d2c4984cef80"}],"_type":"block"},{"children":[{"_key":"f449939cd7920","_type":"span","marks":[],"text":"Per the Substance Abuse and Mental Health Services Administration (SAMHSA), “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.” "},{"text":"Posttraumatic stress disorder","_key":"f67cd3fc6889","_type":"span","marks":["478472b25997"]},{"_type":"span","marks":[],"text":" (PTSD) refers to a cluster of symptoms often experienced by individuals who have experienced trauma. Whether a person who has experienced a traumatic event will go on to qualify for a diagnosis of PTSD depends on the event, the person’s experience of the event, and the long-lasting adverse effects of the event.","_key":"a3b6e2739dbe"},{"_type":"span","marks":["superscript"],"text":"1","_key":"92582eb60ccd"}],"_type":"block","style":"normal","_key":"68f22e6675d4","markDefs":[{"href":"https://www.psychiatrictimes.com/topics/ptsd","_key":"478472b25997","nofollow":true,"blank":true,"_type":"link"}]},{"markDefs":[],"children":[{"text":"Sasha’s presentation with comorbid symptoms of psychosis and PTSD is not unusual. Individuals experiencing psychosis often have also been exposed to traumatic life events,","_key":"ee6a2b1559200","_type":"span","marks":[]},{"text":"2,3","_key":"a27c7b8ee84a","_type":"span","marks":["superscript"]},{"_key":"dcb93fc61fa0","_type":"span","marks":[],"text":" with some estimates suggesting that all individuals with a psychotic disorder have experienced at least 1 traumatic event."},{"_key":"99c0afb0ecfe","_type":"span","marks":["superscript"],"text":"2"},{"text":" In addition, the experience of psychosis, as well as some aspects of mental health treatment including police involvement in admission, seclusion, and restraint, can also be traumatic.","_key":"dd679da3dd71","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"4","_key":"65573a220790"},{"_key":"212019e0ea47","_type":"span","marks":[],"text":" The rates of PTSD in those experiencing psychosis range from 10% to 30%, and approximately 40% of individuals with PTSD experience psychosis."},{"_type":"span","marks":["superscript"],"text":"3,5-8","_key":"5097ee08e0cc"},{"marks":[],"text":" Psychosis-related PTSD, or PTSD directly related to having a psychotic episode, varies from 14% to 47%.","_key":"360632143304","_type":"span"},{"text":"9","_key":"3ffe271492c2","_type":"span","marks":["superscript"]},{"text":" Comorbid PTSD/psychosis is associated with increased health care use and worse clinical outcomes.","_key":"e02108a5ca10","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"8,10","_key":"797dc58322e8"},{"_type":"span","marks":[],"text":" Hence, when planning for effective care, it is important to assess for trauma and PTSD in anyone presenting with symptoms of psychosis.","_key":"69351212f915"}],"_type":"block","style":"normal","_key":"863374d0a5fa"},{"markDefs":[],"children":[{"text":"Clinical Pearl:","_key":"56654ffc90760","_type":"span","marks":["strong","em"]},{"_type":"span","marks":["strong"],"text":" ","_key":"8c35cc633a2d"},{"_type":"span","marks":[],"text":"Traumatic experiences are very common for those who report symptoms of psychosis. Trauma may be a result of early childhood experiences or later traumatic experiences linked to psychosis symptoms or treatment for psychosis. Psychosis symptoms can also occur in the context of PTSD and posttraumatic stress. ","_key":"12f9523c581a"}],"_type":"block","style":"normal","_key":"ecb3ce78093d"},{"style":"normal","_key":"31d6921130a7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2a2bedb339b7"}],"_type":"block"},{"style":"normal","_key":"68cd91cd5237","markDefs":[],"children":[{"_key":"d92720c7ab3b0","_type":"span","marks":["strong"],"text":"Assessment of Trauma in Individuals Experiencing Psychosis"}],"_type":"block"},{"style":"normal","_key":"10d1823d4bc6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Trauma is often overlooked in individuals with psychosis, resulting in an inadequate assessment of traumatic or adverse life events and, therefore, limited access to gold standard, evidence-based trauma treatments. Assessing for trauma should occur routinely, and access to these treatments should be made available for all individuals as needed. If Sasha is asked specific questions assessing past traumas, they will likely report childhood abuse and the more recent physical assault. Structured assessments commonly used to assess PTSD symptoms include the PTSD Checklist for DSM-5 (PCL-5),","_key":"85ece899cd910"},{"_type":"span","marks":["superscript"],"text":"11 ","_key":"9741bccf172c"},{"text":"PTSD Symptom Scale – Interview for DSM-5 (PSS-I-5),","_key":"719f8a0d30ef","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"12","_key":"a8dfabe13e7d"},{"_type":"span","marks":[],"text":" and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).","_key":"e2d96d86b540"},{"_type":"span","marks":["superscript"],"text":"13","_key":"1fc5c376246c"},{"_type":"span","marks":[],"text":" During an initial assessment, it is vital for clinicians assessing potential traumatic experiences to gather only the information necessary to determine whether a trauma history is present and whether trauma interventions are appropriate, which does not require a full account of traumatic experiences. Requiring individuals to disclose a detailed account of their trauma history during the initial assessment poses a risk for retraumatization and may limit what the individual feels comfortable sharing. PTSD assessments only ask clients to, at most, share a brief description of the traumatic event and PTSD symptoms.","_key":"942804615eb4"}],"_type":"block"},{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/schizophrenia","_key":"d8214a5a9350"}],"children":[{"marks":[],"text":"Assessment is an essential component of understanding, and addressing, trauma as part of a psychosis presentation. In our clinical example, if Sasha is only assessed for psychosis and not asked questions about past traumas, they will likely receive a diagnosis of a psychotic disorder (such as ","_key":"a3c19acd92eb0","_type":"span"},{"marks":["d8214a5a9350"],"text":"schizophrenia","_key":"77604a39a007","_type":"span"},{"text":") and be prescribed antipsychotic medications to reduce the occurrence of the voices and shadowy figures. Sasha may also be offered supportive psychotherapy and case management. If the clinic has trained staff, Sasha may be offered an evidence-based psychotherapeutic intervention such as cognitive behavioral therapy for psychosis (CBTp). However, the traumatic experiences would go untreated, thus limiting the potential for recovery.","_key":"3559fd194365","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"a6b8aeb9f68e"},{"_type":"block","style":"normal","_key":"21cd01287ce4","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Clinical Pearl: ","_key":"fd9eb8545e9c0"},{"text":"As clients do not often report trauma experiences unless asked about them explicitly, assessment of trauma in individuals presenting with psychosis symptoms is essential. Assessing for the types of trauma experienced and PTSD symptoms, as opposed to a full account of traumatic events, is sufficient at this stage of care.","_key":"ecfb99764e01","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"33f834148e7a"}],"_type":"block","style":"normal","_key":"9c9613896724"},{"children":[{"_type":"span","marks":["strong"],"text":"Trauma-Informed Care","_key":"9765ab1dd28b0"}],"_type":"block","style":"normal","_key":"d1e421b5bec3","markDefs":[]},{"_type":"block","style":"normal","_key":"7e446c9a1681","markDefs":[],"children":[{"_type":"span","marks":[],"text":"SAMHSA recommends that all treatment programs take a trauma-informed approach.","_key":"b67d570f20860"},{"_type":"span","marks":["superscript"],"text":"1","_key":"8d86306d3ac6"},{"_type":"span","marks":[],"text":" This incorporates key principles into the organizational culture of the program. These include acknowledging the widespread impact of trauma and the path to recovery, recognizing the signs of trauma in individuals, and responding by making sure policies and practices are geared toward not retraumatizing the individual. A trauma-informed approach may or may not include trauma-specific treatments. Some fundamental principles in a trauma-informed approach are ensuring a sense of physical and psychological safety for all served; building and maintaining individuals’ trust in the program by those accessing services and their families; welcoming mutual self-help from those with lived experience of trauma and recovery from trauma; adopting a nonhierarchical, collaborative stance where the expertise of individuals accessing services is understood and respected; keeping individuals accessing services front and center, and believing in their resilience and ability to recover from trauma; and providing care that actively moves away from stereotypes and biases.","_key":"ba8723c5431d"}]},{"_type":"block","style":"normal","_key":"d6b894b68ec2","markDefs":[],"children":[{"marks":["strong","em"],"text":"Clinical Pearl: ","_key":"22aeea7450c00","_type":"span"},{"text":"Programs should consider how to implement trauma-informed care and ensure staff are trained in this approach to best meet the needs of individuals accessing services.","_key":"4cb2122c8799","_type":"span","marks":[]}]},{"style":"normal","_key":"a1504d8d40cc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6ad611286096"}],"_type":"block"},{"_type":"block","style":"normal","_key":"e9c37a269cc3","markDefs":[],"children":[{"text":"Addressing Trauma","_key":"88f3e6fa02c30","_type":"span","marks":["strong"]}]},{"_key":"bf19bb1c869d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Clinicians are often concerned about the increased sensitivity to stress in those experiencing psychosis and can be hesitant to use evidence-based treatments for PTSD.","_key":"f20c8abcc6470"},{"marks":["superscript"],"text":"14,15","_key":"d2744bce97f2","_type":"span"},{"_type":"span","marks":[],"text":" As a result, evidence-based trauma treatments are not offered routinely to individuals seeking treatment for psychosis in the United States.","_key":"3701106caee7"},{"_key":"35b05d027c71","_type":"span","marks":["superscript"],"text":"16"},{"text":" However, Grubaugh et al, in a meta-analysis of PTSD treatments for individuals diagnosed with PTSD and a “severe and persistent comorbid mental illness,” which included psychotic spectrum disorders or mood disorders, found that PTSD treatment can be used safely in this population.","_key":"1444440872d4","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"5","_key":"2fd90c84cf85"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"87c3e1c1e9d9","markDefs":[],"children":[{"text":"In addition, a growing evidence base suggests that standard protocols for trauma treatments in psychosis are effective.","_key":"af52c57198d70","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"17","_key":"844c511b2b18"},{"_type":"span","marks":[],"text":" These treatment protocols include trauma-focused CBTp,","_key":"b806af46327e"},{"text":"18","_key":"961c7f1dc092","_type":"span","marks":["superscript"]},{"text":" prolonged exposure,","_key":"761eaf8e1bed","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"19","_key":"533e62e1f515"},{"_type":"span","marks":[],"text":" and eye movement desensitization reprocessing.","_key":"bd1e88d694b7"},{"_type":"span","marks":["superscript"],"text":"20","_key":"a40fb0106e08"},{"_type":"span","marks":[],"text":" However, adapting these protocols may be necessary to ensure the needs of an individual experiencing psychosis symptoms are thoroughly addressed; for example, ensuring the individual has sufficient coping skills in place to tolerate the trauma intervention while not prolonging access to exposure-based therapies (“as much as needed, but as little as necessary”) and supporting the individual around psychosis symptoms if these are intrusive and may impact the trauma treatment. Developing an initial formulation to understand the trauma timeline, subsequent symptoms (both trauma and psychosis focused), and impact of these on core beliefs will aid the clinician in determining where to focus psychosocial interventions.","_key":"b559930bfda4"}]},{"_type":"block","style":"normal","_key":"3d54d81ab544","markDefs":[],"children":[{"_key":"b5b3e14824a50","_type":"span","marks":["strong","em"],"text":"Clinical Pearl:"},{"_type":"span","marks":[],"text":" Treatment options and pacing are guided by the immediate needs of the individual and should support the reduction of distress and movement toward meaningful goals.","_key":"09df86fc96fc"}]},{"_type":"block","style":"normal","_key":"c6ba35812f68","markDefs":[],"children":[{"_key":"ceadb6aed9cd","_type":"span","marks":[],"text":""}]},{"_type":"block","style":"normal","_key":"04c89206a160","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Concluding Thoughts","_key":"6c96206f90d20"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Traumatic life events are common among individuals who experience psychosis. Often, when an individual presents with psychosis, past traumas are not assessed. This could be due to the individual’s hesitancy to talk about these events or the clinician’s fear that asking about trauma will exacerbate symptoms. We now know that trauma-informed care leads to better outcomes. This systemwide approach begins with creating safe spaces for individuals to speak about past experiences in a way that is not retraumatizing and incorporates the impact of these experiences into a formulation that guides treatment. Evidence-based trauma interventions have been shown to be effective in addressing trauma in individuals experiencing psychosis and should be made routinely available. Further research on effective trauma intervention adaptations for individuals with psychosis would be meaningful. We encourage all clinicians who support individuals experiencing psychosis to provide trauma- informed care across treatment settings.","_key":"a5ecb30f9ece0"}],"_type":"block","style":"normal","_key":"54ee64fccb50"},{"style":"normal","_key":"5e4006ea3d7d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2f2dc6a7b49d"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Chari","_key":"58e1667f91790"},{"_type":"span","marks":[],"text":" ","_key":"5cf65405f242"},{"_type":"span","marks":["em"],"text":"is the assistant psychosocial director and didactic lead of the INSPIRE Clinic and a clinical associate professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine in California. ","_key":"e866b43f1ed2"},{"_type":"span","marks":["strong"],"text":"Dr Lee","_key":"ccb4f0afd429"},{"_type":"span","marks":[],"text":" ","_key":"2f0e11fb3a7f"},{"_key":"7b4d350db1c9","_type":"span","marks":["em"],"text":"is a clinical assistant professor and a California-licensed clinical psychologist in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine."},{"marks":["em","strong"],"text":" ","_key":"354ee8181f6a","_type":"span"},{"_key":"00a55572510f","_type":"span","marks":["strong"],"text":"Dr Olson"},{"text":" is a clinical associate professor and licensed psychologist in the INSPIRE Clinic and dialectical behavior therapy program at Stanford University.","_key":"064317cd6de7","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" ","_key":"e5ddf42511aa"},{"_type":"span","marks":["strong"],"text":"Dr Hardy","_key":"361261b71957"},{"_type":"span","marks":["em"],"text":" is the codirector of the INSPIRE Clinic, the co–section chief of INSPIRE Section, and a clinical professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine.","_key":"2ae2be231aa1"}],"_type":"block","style":"normal","_key":"6d6dd3a97886"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"","_key":"571f1168fb33"}],"_type":"block","style":"normal","_key":"005a3e2c28bd"},{"style":"normal","_key":"8d33c20439ca","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"78ff24c7b93a0"}],"_type":"block"},{"children":[{"text":"1. Substance Abuse and Mental Health Services Administration. ","_key":"4cd7d88fbc060","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach","_key":"4cd7d88fbc061"},{"_type":"span","marks":[],"text":". Substance Abuse and Mental Health Services Administration; 2014. HHS Publication No. (SMA) 14-4884. Accessed September 25, 2024. ","_key":"4cd7d88fbc062"},{"_type":"span","marks":["0ce96c8b2d16"],"text":"https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf","_key":"4cd7d88fbc063"}],"_type":"block","style":"normal","_key":"65064370f438","markDefs":[{"_key":"0ce96c8b2d16","blank":true,"_type":"link","href":"https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf"}]},{"_type":"block","style":"normal","_key":"fd9a524350bb","markDefs":[{"_key":"1fe6fbca1660","blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/16023620/"}],"children":[{"marks":[],"text":"2. Kessler RC, Birnbaum H, Demler O, et al. ","_key":"024ba5700fc90","_type":"span"},{"text":"The prevalence and correlates of nonaffective psychosis in the National Comorbidity Survey Replication (NCS-R).","_key":"024ba5700fc91","_type":"span","marks":["1fe6fbca1660"]},{"_type":"span","marks":[],"text":" ","_key":"7c5b46a5e614"},{"marks":["em"],"text":"Biol Psychiatry","_key":"024ba5700fc92","_type":"span"},{"_type":"span","marks":[],"text":". 2005;58(8)668-676.","_key":"024ba5700fc93"}]},{"_type":"block","style":"normal","_key":"a7cdf1dd1c8d","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/19959704/","_key":"2f4dd8eb6b96"}],"children":[{"_type":"span","marks":[],"text":"3. Achim AM, Maziade M, Raymond E, et al. ","_key":"7d61c21346920"},{"_type":"span","marks":["2f4dd8eb6b96"],"text":"How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association.","_key":"7d61c21346921"},{"_type":"span","marks":[],"text":" ","_key":"7d61c21346922"},{"_key":"7d61c21346923","_type":"span","marks":["em"],"text":"Schizophr Bull"},{"marks":[],"text":". 2011;37(4):811-821.","_key":"7d61c21346924","_type":"span"}]},{"_key":"16fc36532644","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/29163239/","_key":"3e2bbe429683"}],"children":[{"text":"4. Hardy KV, Mueser KT. Editorial: ","_key":"382ce079fc510","_type":"span","marks":[]},{"_type":"span","marks":["3e2bbe429683"],"text":"trauma, psychosis and posttraumatic stress disorder.","_key":"382ce079fc511"},{"marks":[],"text":" ","_key":"382ce079fc512","_type":"span"},{"_type":"span","marks":["em"],"text":"Front Psychiatry","_key":"382ce079fc513"},{"_type":"span","marks":[],"text":". 2017;8:220.","_key":"382ce079fc514"}],"_type":"block","style":"normal"},{"markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/34033709/","_key":"100f436f7a08","blank":true}],"children":[{"_key":"71d6e96019f20","_type":"span","marks":[],"text":"5. Grubaugh AL, Brown WJ, Wojtalik JA, et al. "},{"_type":"span","marks":["100f436f7a08"],"text":"Meta-analysis of the treatment of posttraumatic stress disorder in adults with comorbid severe mental illness.","_key":"71d6e96019f21"},{"_type":"span","marks":[],"text":" ","_key":"9e662b34ae06"},{"_type":"span","marks":["em"],"text":"J Clin Psychiatry","_key":"71d6e96019f22"},{"_type":"span","marks":[],"text":". 2021;82(3):20r13584.","_key":"71d6e96019f23"}],"_type":"block","style":"normal","_key":"687bdce9942f"},{"style":"normal","_key":"854f54831f43","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/25792693/","_key":"710a5f067805"}],"children":[{"_type":"span","marks":[],"text":"6. de Bont PAJM, van den Berg DPG, van der Vleugel BM, et al. ","_key":"b4f37a2c6ff80"},{"_type":"span","marks":["710a5f067805"],"text":"Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. ","_key":"b4f37a2c6ff81"},{"marks":["em"],"text":"Br J Psychiatry","_key":"b4f37a2c6ff82","_type":"span"},{"text":". 2015;206(5):408-416.","_key":"b4f37a2c6ff83","_type":"span","marks":[]}],"_type":"block"},{"_key":"9b2e4010f051","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/9642887/","_key":"30eb8c3dff4a"}],"children":[{"marks":[],"text":"7. Mueser KT, Goodman LB, Trumbetta SL, et al. 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"},{"_type":"span","marks":["ec0887bd9e68"],"text":"The effect of lifetime adversities on resistance to antipsychotic treatment in schizophrenia patients.","_key":"642c17a5970e1"},{"marks":["em"],"text":" Schizophr Res.","_key":"642c17a5970e2","_type":"span"},{"_type":"span","marks":[],"text":" 2015;161(2-3):496-500.","_key":"642c17a5970e3"}],"_type":"block","style":"normal","_key":"460abbbeb4ab"},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/26606250/","_key":"02b13d2554f0"}],"children":[{"_key":"10bd4feadaf40","_type":"span","marks":[],"text":"11. Blevins CA, Weathers FW, Davis MT, et al. 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","_key":"cd7c5782451d1","_type":"span","marks":["92e862af4fa4"]},{"_type":"span","marks":["em"],"text":"Psychol Assess","_key":"cd7c5782451d2"},{"_type":"span","marks":[],"text":". 2016;28(10):1159-1165.","_key":"cd7c5782451d3"}]},{"markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/28493729/","_key":"2939d0321406"}],"children":[{"text":"13. Weathers FW, Bovin MJ, Lee DJ, et al. 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","_key":"536d6c14f3eb0"},{"text":"Increased stress reactivity: a mechanism specifically associated with the positive symptoms of psychotic disorder.","_key":"536d6c14f3eb1","_type":"span","marks":["f5a903d62e18"]},{"_type":"span","marks":[],"text":" ","_key":"536d6c14f3eb2"},{"marks":["em"],"text":"Psychol Med","_key":"536d6c14f3eb3","_type":"span"},{"text":". 2013;43(7):1389-1400.","_key":"536d6c14f3eb4","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"b433caef6e5b"},{"style":"normal","_key":"beeed05c8bbf","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/24530499/","_key":"c63fb91a88b0"}],"children":[{"_type":"span","marks":[],"text":"15. Meyer JM, Farrell NR, Kemp JJ, et al. ","_key":"96be82f048170"},{"_type":"span","marks":["c63fb91a88b0"],"text":"Why do clinicians exclude anxious clients from exposure therapy?","_key":"96be82f048171"},{"_type":"span","marks":[],"text":" ","_key":"96be82f048172"},{"_type":"span","marks":["em"],"text":"Behav Res Ther","_key":"96be82f048173"},{"_key":"96be82f048174","_type":"span","marks":[],"text":". 2014;54:49-53."}],"_type":"block"},{"style":"normal","_key":"b2b72c87a4d0","markDefs":[{"_key":"b0163f07bbd8","blank":true,"_type":"link","href":"https://www.researchgate.net/publication/224856492_Emotional_expression_perceptions_of_therapy_and_help-seeking_intentions_in_men_attending_therapy_services"}],"children":[{"text":"16. Cusack J, Deane FP, Wilson CJ, Ciarrochi J. ","_key":"12472d1f9d2d0","_type":"span","marks":[]},{"text":"Emotional expression, perceptions of therapy, and help-seeking intentions in men attending therapy services.","_key":"12472d1f9d2d1","_type":"span","marks":["b0163f07bbd8"]},{"_type":"span","marks":[],"text":" ","_key":"12472d1f9d2d2"},{"text":"Psychol Men Masc","_key":"12472d1f9d2d3","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2006;7(2):1-14.","_key":"12472d1f9d2d4"}],"_type":"block"},{"style":"normal","_key":"2bb7b1a3336d","markDefs":[{"_key":"0caadd16bb26","blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/28352239/"}],"children":[{"_type":"span","marks":[],"text":"17. Swan S, Keen N, Reynolds N, Onwumere J. 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Yet I also recognized, perhaps for the first time, the burden of a greater labor, a toil with traumatic roots, that I call trauma labor.","_key":"474277d08232"}],"_type":"block","style":"normal","_key":"40012645157f","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"cfb5fd734cb00"}],"_type":"block","style":"normal","_key":"3f876b910082"},{"style":"normal","_key":"41a985d2fc7d","markDefs":[],"children":[{"marks":[],"text":"In the beginning of my career, I had viewed exposure to abuse in the workplace as coming with the territory of psychiatry. This is not because individuals living with mental illness are inherently dangerous, rather I knew that when humans are psychotic, suicidal, homicidal, or under the influence of drugs or alcohol, they may behave in belligerent ways. To safeguard against this, I have always taken precautions: every office I occupy undergoes a furniture reshuffle, with my chair closest to the door; I am trained in managing disruptive behavior and after long shifts, I walk to my vehicle clutching a panic alarm. In terms of personal attire, necklaces and scarves are banished from my wardrobe, and I rarely wear shoes in which I cannot run.","_key":"7f90538604020","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"25aa8ed06f090"}],"_type":"block","style":"normal","_key":"a2a693ca855c"},{"markDefs":[],"children":[{"text":"By the time I was deep into my first decade of doctoring, 1 thing was abundantly clear: believing that violence at work was comprised of isolated incidents was wishful thinking. Workplace violence (which includes verbal abuse, hostility, and harassment) is a ","_key":"904c388397590","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"systemic","_key":"904c388397591"},{"_type":"span","marks":[],"text":" issue in health care, with a 2015 OSHA report showing incidents of serious workplace violence were 4 times more common in health care than in private industry and that possible sources of violence went beyond patients to encompass family members, intruders, and even coworkers.","_key":"904c388397592"},{"_type":"span","marks":["superscript"],"text":"3","_key":"2ccd18fcc81d"}],"_type":"block","style":"normal","_key":"6f8b6c1e0235"},{"style":"normal","_key":"0409d52aa899","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"699b2abe557e0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"While workplace violence affects all health care workers, women are disproportionately impacted.","_key":"95c085865ede0"},{"marks":["superscript"],"text":"4","_key":"eb0985a350cd","_type":"span"},{"_key":"1ab40ff92688","_type":"span","marks":[],"text":" On March 9th, 2018, at the Pathway Home program for returning veterans in Yountville, 3 women—Christine Loeber, a social worker; Dr Jennifer Gonzales, a psychologist who was 6 months pregnant; and Dr Jennifer Golick, the program’s clinical director—were murdered by a former patient."},{"_type":"span","marks":["superscript"],"text":"5","_key":"fd293b3bc3f9"},{"_type":"span","marks":[],"text":" This horrific tragedy shook me to my core and, in the aftermath, many intense conversations with female colleagues ensued which made me realize I was not alone and many of us were feeling the toll of years of exposure to abuse and hostility at work. These conversations raised many questions: Were women subjected to more abuse at work because we live in a world where violence, against women, is pervasive?","_key":"de38cf9a3e9c"},{"_type":"span","marks":["superscript"],"text":"6","_key":"4b0bc2d10752"},{"_type":"span","marks":[],"text":" Are women more disproportionately burdened with the stress of workplace abuse because we are programmed to be more afraid for our physical safety when compared with our male colleagues? Are women more at risk because we are overrepresented on the frontlines in healthcare and underrepresented in the leadership of health care institutions (where policies surrounding health care violence are set)?","_key":"c5f8a035d642"},{"_type":"span","marks":["superscript"],"text":"7","_key":"fe6564dea54d"},{"text":" These discussions also reminded me of the even greater vulnerabilities of women health care workers with less education, less pay, and job security, who often find themselves working in particularly precarious and unsafe settings.","_key":"d9a56f81a0fc","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d1892aa44139"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"789ac4321fb50","_type":"span"}],"_type":"block","style":"normal","_key":"1ed26259e293"},{"style":"normal","_key":"93b3e4c6a788","markDefs":[],"children":[{"text":"I believe we need to go beyond the concept of emotional labor and consider the notion of trauma labor, a toil that employees have to endure that has historical roots embedded in traumatic social constructs such as misogyny. Trauma labor requires me to manage my emotions and fulfill my workplace duties when my ","_key":"f0dc8453c92b0","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"identity","_key":"f0dc8453c92b1"},{"_type":"span","marks":[],"text":" may be contributing to why I am being mistreated in the first place. ","_key":"f0dc8453c92b2"},{"_type":"span","marks":["em"],"text":"Would my inebriated patient have told me to f*** off if I was male?","_key":"f0dc8453c92b3"},{"_type":"span","marks":[],"text":" Of course, I will never know the answer to that question, so I am left with only a hunch that my identity is related to such hostile workplace incidents. In this way, trauma labor becomes further complicated by a discomforting ambiguity because even if the abuse is unrelated to misogyny, it still imposes this burden of consideration. I believe trauma labor impacts clinicians from all groups that have been historically marginalized. They are inherently vulnerable to identity-based mistreatment as they go about their day-to-day work. The labor requires that they stay professional despite the toll the mistreatment takes on their personal well-being. My anecdotal experience leads me to believe, that like emotional labor, this “trauma labor” is playing a hidden role in the clinician burnout epidemic that is gripping our profession. This predicament in further exacerbated by the fact that violence at work remains underreported, by health care workers, for many reasons including lack of clearcut policies, navigating reporting systems is onerous, lack of faith in the effectiveness of such systems, and a fear of retaliation.","_key":"f0dc8453c92b4"},{"_type":"span","marks":["superscript"],"text":"3","_key":"5b6581bbe6d6"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"dcb73a0052e10"}],"_type":"block","style":"normal","_key":"f3c2b827aaca"},{"children":[{"_type":"span","marks":["strong"],"text":"Toward Alleviating the Toll of Workplace Verbal Abuse and Hostility","_key":"121f17682a9b0"}],"_type":"block","style":"normal","_key":"d608849e96e7","markDefs":[]},{"_key":"1358a76b8f95","markDefs":[],"children":[{"text":"The following suggestions are not a solution but a start to addressing the problem of trauma labor and workplace violence and mistreatment. They represent small steps on a path toward ensuring career longevity and prosperity in our wild world.","_key":"c700c6c7da5f0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"style":"normal","_key":"37b03925ddf3","markDefs":[],"children":[{"_key":"1134f4f499b20","_type":"span","marks":["strong"],"text":"For individual clinicians:"}],"_type":"block"},{"_key":"84f09df20873","markDefs":[],"children":[{"text":"1. The attitude of “","_key":"c3befaf5a1c00","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"it is your job to take it","_key":"c3befaf5a1c01"},{"_type":"span","marks":[],"text":"” currently embedded in health care ethos needs to be eradicated. If you have internalized this ethos now may be the time to reexamine it. If you tend to want to be a hero or a martyr, keep that in check. That trait will not serve you well under such circumstances.","_key":"c3befaf5a1c02"}],"_type":"block","style":"normal"},{"style":"normal","_key":"0e53b27b29fb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"2. The statistics suggest you are not alone. Do not suffer in silence when such incidents occur. Access the support and validation of trusted colleagues and reach out to mentors and supervisors for guidance on how to process or navigate such incidents.","_key":"1fdd05fe7717"}],"_type":"block"},{"style":"normal","_key":"2dbbe2e94dde","markDefs":[],"children":[{"marks":[],"text":"3. If you have faith in your workplace reporting system of such incidents, then use it. Better still, volunteer to serve as a clinician member on any related committees and get ready to speak truth to power.","_key":"56402496be42","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"efb2c3949dd00","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"51e715d75166"},{"_type":"block","style":"normal","_key":"c06c8374a552","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"For colleagues and coworkers:","_key":"a0317924343e0"}]},{"_key":"690ec87f1ac6","markDefs":[],"children":[{"text":"4. Tolerance for verbal abuse and hostility toward health care professionals should became antithetical to the collective values of","_key":"b56d522eebb40","_type":"span","marks":[]},{"marks":["em"],"text":" all","_key":"b56d522eebb41","_type":"span"},{"_type":"span","marks":[],"text":" health care professionals.","_key":"b56d522eebb42"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"746afe82d3650","_type":"span"}],"_type":"block","style":"normal","_key":"e7d72058241e"},{"style":"normal","_key":"063a6fc222cd","markDefs":[],"children":[{"_key":"05742f23a9570","_type":"span","marks":["strong"],"text":"For health care leaders:"}],"_type":"block"},{"_type":"block","style":"normal","_key":"bd12f7cb4ac0","markDefs":[],"children":[{"_type":"span","marks":[],"text":"5. Recognize that violence against female clinicians in the workplace undermines their abilities to progress in careers or be promoted to leadership positions from which they could bring a diverse viewpoint to effectively addressing workplace violence prevention policies.","_key":"2e7cc6bdc5170"},{"_type":"span","marks":["superscript"],"text":"4","_key":"ca7920ce5c91"}]},{"style":"normal","_key":"3f187719d670","markDefs":[],"children":[{"_type":"span","marks":[],"text":"6. Violence at work leads to burnout and moral distress and absenteeism and attrition and leadership failure to address this issue will likely contribute to the global shortfall of health care workers.","_key":"1b416f70a25c"},{"_type":"span","marks":["superscript"],"text":"4","_key":"975d7e32b384"}],"_type":"block"},{"_type":"block","style":"normal","_key":"d01f27a394aa","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"cf0d7f3a46520"}]},{"markDefs":[],"children":[{"marks":["strong"],"text":"For institutional leaders:","_key":"d2e3ae9c5cb50","_type":"span"}],"_type":"block","style":"normal","_key":"104f7b7da6d8"},{"_type":"block","style":"normal","_key":"de4ecca527b9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"7. Health care institutions need to take a top down and zero-tolerance stance toward identity-based attacks on frontline clinicians. Zero tolerance should go beyond rhetoric to actual safeguards and enforceable policies that become seamlessly and tightly woven into organizational culture.","_key":"1561d46a956e0"}]},{"children":[{"_type":"span","marks":[],"text":"8. Violence reporting systems of the hospitals should be clinician centered and accessible and not pose an undue burden on the clinician victim.","_key":"6e6f086e58f4"}],"_type":"block","style":"normal","_key":"3acdfb1da3b0","markDefs":[]},{"_key":"aad82856d773","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ce42f17afe240"}],"_type":"block","style":"normal"},{"style":"normal","_key":"0c9f7e18cf68","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Jain ","_key":"bc46f3631c8a0"},{"_type":"span","marks":["em"],"text":"is a board-certified general psychiatrist, with specialty expertise in PTSD, primary and mental health integrated care, and women’s health psychiatry. From 2012-2020, she served as Medical Director for Integrated Care at the VA Palo Alto Healthcare System and is also a former health services researcher, affiliated with the National Center for PTSD. She is an adjunct clinical professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine and a distinguished fellow of the American Psychiatric Association and the author of ","_key":"bc46f3631c8a1"},{"_type":"span","marks":[],"text":"The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science","_key":"bc46f3631c8a2"},{"_key":"bc46f3631c8a3","_type":"span","marks":["em"],"text":" (Harper, 2019)."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"\n","_key":"bc46f3631c8a4"},{"_key":"bc46f3631c8a5","_type":"span","marks":["em"],"text":"The views expressed are those of the author and do not necessarily reflect the official policy or position of the organizations with which she is affiliated."}],"_type":"block","style":"normal","_key":"377fbf1caeca"},{"style":"normal","_key":"bb25f2d5b450","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3c481bfa48d40"}],"_type":"block"},{"children":[{"text":"References","_key":"2555f847a09b0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"d99c6a469aba","markDefs":[]},{"_key":"aa1212ed09f6","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Hochschild AR. ","_key":"998c51207ca40"},{"_type":"span","marks":["em"],"text":"The Managed Heart: Commercialization of Human Feeling.","_key":"998c51207ca41"},{"_type":"span","marks":[],"text":" University of California Press; 2012.","_key":"998c51207ca42"}],"_type":"block","style":"normal"},{"_key":"eeaa3e458b93","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/29436185/","_key":"340abf7a2c9a"}],"children":[{"_key":"84d7016e18fe0","_type":"span","marks":[],"text":"2. Jeung DY, Kim C, Chang SJ. "},{"_type":"span","marks":["340abf7a2c9a"],"text":"Emotional labor and burnout: a review of the literature.","_key":"84d7016e18fe1"},{"_type":"span","marks":[],"text":" ","_key":"b1a1314e540a"},{"text":"Yonsei Med J","_key":"84d7016e18fe2","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2018;59(2):187-193.","_key":"84d7016e18fe3"}],"_type":"block","style":"normal"},{"children":[{"marks":[],"text":"3. Workplace Violence in Healthcare: Understanding the Challenge. Occupational Safety and Health Administration. Accessed October 25, 2024. ","_key":"562f21a467cc0","_type":"span"},{"_type":"span","marks":["6913061160ae"],"text":"https://www.osha.gov/sites/default/files/OSHA3826.pdf","_key":"562f21a467cc1"}],"_type":"block","style":"normal","_key":"bd9b1791d703","markDefs":[{"blank":true,"_type":"link","href":"https://www.osha.gov/sites/default/files/OSHA3826.pdf","_key":"6913061160ae"}]},{"_type":"block","style":"normal","_key":"1ca727e556f0","markDefs":[{"_type":"link","href":"https://www.bmj.com/content/371/bmj.m3546","_key":"eacebc4f3c90","blank":true}],"children":[{"_key":"66ffc5a694420","_type":"span","marks":[],"text":"4. George AS, McConville FE, de Vries S, et al. "},{"_key":"66ffc5a694421","_type":"span","marks":["eacebc4f3c90"],"text":"Violence against female health workers is tip of iceberg of gender power imbalances."},{"_type":"span","marks":[],"text":" ","_key":"471d88489653"},{"marks":["em"],"text":"BMJ.","_key":"66ffc5a694422","_type":"span"},{"_type":"span","marks":[],"text":" 2020;371:m3546.","_key":"66ffc5a694423"}]},{"style":"normal","_key":"cf7de2ff5a64","markDefs":[{"href":"https://www.cnn.com/2018/03/10/us/california-veterans-home-shooting-victims/index.html","_key":"7fe6aceb5139","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"5. Vera A. Victims of California veterans home shooting lived ‘to serve others.’ CNN. March 11, 2018. Accessed October 25, 2024. ","_key":"7eea357514180"},{"_type":"span","marks":["7fe6aceb5139"],"text":"https://www.cnn.com/2018/03/10/us/california-veterans-home-shooting-victims/index.html","_key":"7eea357514181"}],"_type":"block"},{"_type":"block","style":"normal","_key":"08aadb6bc137","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/12429433/","_key":"7365eb2a4151"}],"children":[{"_type":"span","marks":[],"text":"6. Heise L, Ellsberg M, Gottmoeller M. ","_key":"3d7dfb6be1490"},{"_type":"span","marks":["7365eb2a4151"],"text":"A global overview of gender-based violence.","_key":"3d7dfb6be1491"},{"text":" Int J Gynaecol Obstet","_key":"3d7dfb6be1492","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". 2002;78 Suppl 1:S5–S14.","_key":"3d7dfb6be1493"}]},{"_key":"0ea67e99ccaf","markDefs":[{"_type":"link","href":"https://womeningh.org/wp-content/uploads/2023/03/The-State-of-Women-and-Leadership-in-Global-Health.pdf","_key":"f260811eabba","blank":true}],"children":[{"_type":"span","marks":[],"text":"7. The state of women and leadership in global health. Women in Global Health. March 16, 2023. Accessed October 25, 2024. ","_key":"e37e2fa5d4dc0"},{"_type":"span","marks":["f260811eabba"],"text":"https://womeningh.org/wp-content/uploads/2023/03/The-State-of-Women-and-Leadership-in-Global-Health.pdf","_key":"e37e2fa5d4dc1"}],"_type":"block","style":"normal"}],"_createdAt":"2024-10-28T16:40:40Z","gptSummary":"Healthcare professionals, particularly women, face significant workplace violence, including verbal abuse and hostility, which contributes to burnout and moral distress. This issue, termed \"trauma labor,\" is rooted in systemic issues like misogyny and identity-based mistreatment. Despite the prevalence, such violence often goes unreported due to inadequate systems and fear of retaliation. Addressing this requires a cultural shift in healthcare, with zero-tolerance policies and supportive reporting systems. Empowering clinicians and promoting diverse leadership can help mitigate these challenges and improve career longevity and well-being.","authors":[{"displayName":"Shaili Jain, MD","url":"shaili-jain-md"}],"documentGroupMapping":null,"url":"beyond-emotional-labor-exploring-how-trauma-becomes-an-occupational-hazard-for-clinicians","_id":"34676ed9-a190-4db5-88f7-b10d4e58e480","ExcludeFromPubMedXML":false,"factCheckAuthors":null,"_type":"article","contentCategory":{"_id":"8bdaa7fc-960a-4b57-b076-75fdce3741bb","_updatedAt":"2020-02-25T09:35:56Z","_createdAt":"2020-02-06T09:15:47Z","_rev":"snQqhhB4O8T5bi1viURsgs","_type":"contentCategory","name":"Articles"},"is_visible":true,"articleType":"Blog","authorMapping":[{"address2":"Suite 300","displayName":"Shaili Jain, MD","_id":"pst_author_332243","biography":[{"_type":"block","style":"normal","_key":"6398bce19c4d","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Jain ","_key":"1ac57d99cdd20"},{"_type":"span","marks":["em"],"text":"is a board certified psychiatrist, with specialty expertise in PTSD, primary and mental health integrated care, and women’s health psychiatry. She is a former health services researcher, affiliated with the National Center for PTSD, and from 2012-2020, she served as Medical Director for Integrated Care at the VA Palo Alto Healthcare System. She is an adjunct clinical professor of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine and a distinguished fellow of the American Psychiatric Association and the author of ","_key":"1ac57d99cdd21"},{"_type":"span","marks":[],"text":"The Unspeakable Mind: Stories of Trauma and Healing from the Frontlines of PTSD Science","_key":"1ac57d99cdd22"},{"_type":"span","marks":["em"],"text":" (Harper, 2019).","_key":"1ac57d99cdd23"}]}],"_updatedAt":"2024-07-10T19:58:41Z","address1":"901 E. 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The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of Physicians’ Education Resource, LLC.","_key":"73dcac9b18440"}]},{"style":"normal","_key":"cfadccb2a8c5","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"FACULTY, STAFF, AND PLANNERS’ DISCLOSURES AND CONFLICT OF INTEREST (COI) MITIGATION","_key":"c56952fc4d210"}],"_type":"block"},{"_key":"9903bcc1f362","markDefs":[],"children":[{"_type":"span","marks":[],"text":"None of the staff of Physicians’ Education Resource, LLC, or Psychiatric Times or the planners or the authors of this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing health care products used by or on patients.","_key":"4b2c08f48f750"}],"_type":"block","style":"normal"},{"_key":"5ca15f3c7441","markDefs":[{"_key":"46656a5c2d41","_type":"emailAddress","href":"PTEditor@mmhgroup.com"},{"_type":"emailAddress","href":"info@gotoper.com","_key":"4203ab4f714c"}],"children":[{"_type":"span","marks":[],"text":"For content-related questions, email us at ","_key":"5bcef021e7350"},{"_type":"span","marks":["46656a5c2d41"],"text":"PTEditor@mmhgroup.com","_key":"7d08bb58da15"},{"text":"; for questions concerning the accreditation of this CME activity or how to claim credit, please contact ","_key":"e5483f4f8495","_type":"span","marks":[]},{"text":"info@gotoper.com","_key":"feee5bdc74fd","_type":"span","marks":["4203ab4f714c"]},{"_key":"1b30057e5919","_type":"span","marks":[],"text":" and include \""},{"marks":["strong"],"text":"Evaluating Brexpiprazole for the Management of Behavioral and Psychological Symptoms of Dementia","_key":"6dcc0fcb85fb","_type":"span"},{"_key":"b4d7280838c2","_type":"span","marks":[],"text":"\" in the subject line."}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"517a963c3787","markDefs":[],"children":[{"_key":"bbf055ee998c0","_type":"span","marks":["strong"],"text":"HOW TO CLAIM CREDIT"}]},{"markDefs":[{"_type":"link","href":"https://education.gotoper.com/activity/ptcme24oct24","_key":"5917a78676cf","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"Once you have read the article, please use the following URL to evaluate and request credit: ","_key":"587b3f55bebb0"},{"_key":"b435e3554a49","_type":"span","marks":["5917a78676cf"],"text":"https://education.gotoper.com/activity/ptcme24oct24"},{"_type":"span","marks":[],"text":". If you do not already have an account with PER,® you will be prompted to create one. You must have an account to evaluate and request credit for this activity.","_key":"69e8562883d8"}],"_type":"block","style":"normal","_key":"b05d9bb8be94"},{"_type":"brtag","_key":"f19387903afc"},{"_type":"block","style":"normal","_key":"a8a2c445e737","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The term ","_key":"b5bad3d031f90"},{"_type":"span","marks":["em"],"text":"behavioral and psychological symptoms of dementia ","_key":"1bed94973632"},{"_type":"span","marks":[],"text":"(BPSD) describes a constellation of symptoms and behaviors that occur in more than 90% of individuals with dementia.","_key":"2c244ede1751"},{"_type":"span","marks":["superscript"],"text":"1","_key":"36949b72440f"},{"_type":"span","marks":[],"text":" BPSD is associated with a faster decline in cognition and function among individuals with dementia and contributes significantly to the greater rates of morbidity and mortality among those with dementia.","_key":"f66fb40e80e2"}]},{"style":"normal","_key":"545bd326fe5a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Brexpiprazole is an atypical antipsychotic that is approved by the US Food and Drug Administration (FDA) as monotherapy treatment for schizophrenia and as an adjunctive treatment to antidepressants for major depressive disorder.","_key":"15cd1404ff3f0"},{"marks":["superscript"],"text":"2","_key":"77f234fe882d","_type":"span"},{"_type":"span","marks":[],"text":" Brexpiprazole is a partial agonist at the serotonin 5-hydroxytryptamine","_key":"4b9aa6c1de6e"},{"text":"1A","_key":"e70b4af3076d","_type":"span","marks":["subscript"]},{"_type":"span","marks":[],"text":" and dopamine D","_key":"418808447a57"},{"_key":"1ac545446407","_type":"span","marks":["subscript"],"text":"2"},{"text":" receptors and an antagonist at serotonin 5-hydroxytryptamine","_key":"6366f985a2ee","_type":"span","marks":[]},{"_key":"f565654603b5","_type":"span","marks":["subscript"],"text":"2A"},{"_type":"span","marks":[],"text":"; noradrenergic α","_key":"fb0801e7f6e0"},{"marks":["subscript"],"text":"1B","_key":"f64ec31a92e1","_type":"span"},{"marks":[],"text":", and noradrenergic α","_key":"2adcdfff5b5c","_type":"span"},{"_type":"span","marks":["subscript"],"text":"2C","_key":"432b666dc30e"},{"_type":"span","marks":[],"text":" receptors.","_key":"91db9d0b8a51"},{"marks":["superscript"],"text":"3","_key":"5f43fc01afee","_type":"span"},{"_key":"d43833d53b04","_type":"span","marks":[],"text":" In May 2023, the FDA provided supplemental approval for brexpiprazole oral tablets for the treatment of agitation associated with dementia due to Alzheimer disease (AD), making it the first FDA-approved treatment option for this indication."},{"_type":"span","marks":["superscript"],"text":"4","_key":"a7ac084dfd5a"},{"marks":[],"text":" The FDA, however, retained the boxed warning for brexpiprazole that is included for medications in this class indicating that older adults with dementia-related psychosis are at an increased risk of death when treated with antipsychotic medications, with the rewording in the Boxed Warning that it did not apply if the primary diagnosis was agitation associated with dementia due to AD, even if psychosis was present. Significantly, brexpiprazole is not FDA-approved as an as-needed medication.","_key":"026ff4feb364","_type":"span"}],"_type":"block"},{"disableTextWrap":false,"_key":"5c74a6d32a40","disableLightBox":true,"imgcaption":[{"style":"normal","_key":"157b08109470","markDefs":[],"children":[{"marks":["strong"],"text":"Table 1. ","_key":"9059efbf947c0","_type":"span"},{"_key":"bac5dd16a6ff","_type":"span","marks":[],"text":"Study Characteristics"}],"_type":"block"}],"asset":{"_ref":"image-dc966b812f520348026b9b645bd7357cd8661f84-1654x740-png","_type":"reference"},"alt":"TABLE 1. Study Characteristics","alignment":"right","blank":true,"_type":"figure","widthP":60},{"style":"normal","_key":"b2527ac1a102","markDefs":[{"_key":"fa9ca4f0930d","nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2Fdc966b812f520348026b9b645bd7357cd8661f84-1654x740.png%3Ffit%3Dcrop%26auto%3Dformat\u0026w=3840\u0026q=75"},{"_key":"c7f1027f4eb6","nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2Fb3b9d572b7ab95db78897c9ea112e531c35f9b4c-1050x1338.png%3Ffit%3Dcrop%26auto%3Dformat\u0026w=3840\u0026q=75"},{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F2d79db98fa385b16d49a4e22995e48021d9b4206-1612x552.png%3Ffit%3Dcrop%26auto%3Dformat\u0026w=3840\u0026q=75","_key":"b4673211b4ae"}],"children":[{"_type":"span","marks":[],"text":"Three 12-week randomized controlled trials (RCTs) that evaluated the efficacy, safety, and tolerability of brexpiprazole among individuals with BPSD and AD were reviewed. One article by Grossberg et al included data from 2 RCTs.","_key":"c4a36fdcf7300"},{"_type":"span","marks":["superscript"],"text":"5","_key":"88409cc13c3d"},{"_type":"span","marks":[],"text":" We also used data from the recently published version of the third study.","_key":"2ec6a95b1923"},{"_key":"fee9657045d9","_type":"span","marks":["superscript"],"text":"6"},{"text":" The trials were of good quality and were rated as a 5/5 on the Jadad scale.","_key":"d2809e5936dd","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"7","_key":"5a59370c35aa"},{"_type":"span","marks":[],"text":" ","_key":"1efdbd1d2480"},{"_type":"span","marks":["strong","fa9ca4f0930d"],"text":"Table 1","_key":"bcd5daf869c5"},{"_type":"span","marks":[],"text":" discusses the characteristics of the included studies, ","_key":"e706defff648"},{"_type":"span","marks":["strong","c7f1027f4eb6"],"text":"Table 2","_key":"89268f199115"},{"_key":"3e23684600eb","_type":"span","marks":[],"text":" describes study results, and "},{"_type":"span","marks":["strong","b4673211b4ae"],"text":"Table 3","_key":"587b8b4a8bb4"},{"text":" reviews the quality of included studies.","_key":"4f2eca6ff0e8","_type":"span","marks":[]},{"marks":["superscript"],"text":"7","_key":"9d0da3f63161","_type":"span"}],"_type":"block"},{"_key":"0c9b795e64fa","markDefs":[],"children":[{"marks":["strong"],"text":"Exploring Efficacy","_key":"40802ebb31a60","_type":"span"}],"_type":"block","style":"normal"},{"widthP":60,"blank":true,"_type":"figure","alt":"TABLE 2. Study Results","alignment":"right","disableTextWrap":false,"imgcaption":[{"markDefs":[],"children":[{"_key":"ebe80cc0dd410","_type":"span","marks":["strong"],"text":"Table 2. "},{"_type":"span","marks":[],"text":"Study Results","_key":"bb09db9843bc"}],"_type":"block","style":"normal","_key":"8d01bcb7fd7f"}],"_key":"c19f6da244e5","disableLightBox":true,"asset":{"_ref":"image-b3b9d572b7ab95db78897c9ea112e531c35f9b4c-1050x1338-png","_type":"reference"}},{"markDefs":[],"children":[{"_key":"c3f3b9933fc20","_type":"span","marks":["strong"],"text":"Study 1"}],"_type":"block","style":"normal","_key":"4d7804ebcab8"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In this multicenter, randomized, double-blind, placebo-controlled, parallel-arm study, 433 participants were randomized to receive brexpiprazole 2 mg/day (n = 140), brexpiprazole 1 mg/day (n = 137), brexpiprazole 0.5 mg/day (n = 20), or placebo (n = 136) for 12 weeks.5 The 0.5-mg/day brexpiprazole arm was removed early in the study when information from other ongoing and completed studies demonstrated that 0.5 mg was a nonefficacious dose. Although these patients were not included in the efficacy analyses because there were not many of them, these individuals were pooled with the 1 mg/day arm in the safety analyses (ie, the Sheehan Suicidality Tracking Scale, Mini Mental State Examination [MMSE], and extrapyramidal symptoms scales [EPS; the Simpson-Angus Scale, the Abnormal Involuntary Movement Scale, and Barnes Akathisia Rating Scale]).","_key":"0358ad3ef4a20"}],"_type":"block","style":"normal","_key":"5385f4958c5b"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Participants were randomized to receive brexpiprazole doses or placebo in a 1:1:1 fashion. The medication was titrated over a period of 2 to 4 weeks (days 1-3, 0.25 mg/day; days 4-14, 0.5 mg/day; days 15-28, 1 mg/day; day 29 onward, assigned dose). Participants who were not able to tolerate their assigned dose of drug (or matching placebo) had to discontinue the trial. Baseline characteristics were similar across the brexpiprazole 2-mg/day and 1-mg/day and placebo groups.","_key":"a1181241925d0"}],"_type":"block","style":"normal","_key":"d73efa65d69e"},{"markDefs":[],"children":[{"text":"A majority (79.6%) of the participants had received treatment for agitation in AD (AAD) and psychosis prior to the study, with the most common medications being risperidone (17.4%), quetiapine (15.5%), lorazepam (14.1%), and haloperidol (11.1%). During the study period, 74.8% of participants used 1 or more medications for AD including memantine (45.1%), donepezil (27.8%), and rivastigmine (11.8%). The study was completed by 122 patients (87.1%) in the brexpiprazole 2-mg/day group, 121 (88.3%) in the brexpiprazole 1-mg/day group, 13 (65.0%) in the brexpiprazole 0.5-mg/day group, and 121 (89.0%) in the placebo group.","_key":"c0caa13ae8610","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2f1d28e6f4c0"},{"alignment":"right","_key":"0bc844e486c5","alt":"TABLE 3. Quality of Included Studies","asset":{"_ref":"image-2d79db98fa385b16d49a4e22995e48021d9b4206-1612x552-png","_type":"reference"},"blank":true,"disableTextWrap":false,"disableLightBox":true,"imgcaption":[{"_type":"block","style":"normal","_key":"11764cfddc38","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Table 3. ","_key":"41b30f0eee280"},{"_type":"span","marks":[],"text":"Quality of Included Studies","_key":"00b8ffcf8227"}]}],"widthP":60,"_type":"figure"},{"markDefs":[],"children":[{"_key":"616376afa5980","_type":"span","marks":[],"text":"The brexpiprazole 2-mg/day group showed statistically significant improvements on the primary efficacy end point (Cohen-Mansfield Agitation Inventory [CMAI] Total score), when compared with placebo (Cohen d effect size = -0.25, "},{"text":"P","_key":"6a916295bab3","_type":"span","marks":["em"]},{"text":" = .040). Brexpiprazole 2 mg/day also demonstrated improvements, although not statistically significant results on the key secondary efficacy end point (Clinical Global Impressions-Severity of illness [CGI-S]) as related to agitation (Cohen d effect size = -0.17, ","_key":"9f3c4474b0d0","_type":"span","marks":[]},{"_key":"5f10c4d1a074","_type":"span","marks":["em"],"text":"P"},{"_type":"span","marks":[],"text":" = .16), as well as on the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH) Agitation/Aggression domain (Cohen d effect size = -0.19, ","_key":"34486caf8dc8"},{"_type":"span","marks":["em"],"text":"P","_key":"fa08fe343866"},{"marks":[],"text":" = .12). No benefits were noted for the brexpiprazole 1 mg/day dosing when compared with placebo on either the primary efficacy end point (CMAI Total score; Cohen d effect size = 0.02, ","_key":"029546f0d0dc","_type":"span"},{"_type":"span","marks":["em"],"text":"P","_key":"f35972cbcf46"},{"_type":"span","marks":[],"text":" = .90), or key secondary end points (CGI-S as related to agitation; Cohen d effect size = 0.09, ","_key":"e1e1b08715e9"},{"_type":"span","marks":["em"],"text":"P","_key":"b70019f8cd55"},{"_type":"span","marks":[],"text":" = .44); (NPI-NH Agitation/Aggression domain; Cohen d effect size = -0.03, ","_key":"a989f28d9f58"},{"_key":"43477b039458","_type":"span","marks":["em"],"text":"P"},{"_type":"span","marks":[],"text":" = .78).","_key":"d00fce148d08"}],"_type":"block","style":"normal","_key":"fade0fdd3667"},{"children":[{"_key":"8f42bc5503e70","_type":"span","marks":["strong"],"text":"Study 2"}],"_type":"block","style":"normal","_key":"8dd5645b40b0","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In this study, which was not used by the FDA for analysis for approval, participants (n = 270) were randomized to receive brexpiprazole 0.5-2 mg/day (n = 133) or placebo (n = 137).","_key":"66c20ff6eaeb0"},{"_type":"span","marks":["superscript"],"text":"5","_key":"362a493dcba9"},{"_type":"span","marks":[],"text":" Eligible participants were randomly assigned in a 1:1 proportion to receive either flexible doses of brexpiprazole 0.5-2 mg/day or placebo for 12 weeks. Brexpiprazole treatment commenced at 0.25 mg/day (days 1-3), was raised to 0.5 mg/day (days 4-14), and subsequently escalated to a targeted dose of 1 mg/day (days 15-28, with the option to revert to 0.5 mg/day). Starting from day 29 (week 4 visit), an additional escalation to 2 mg/day was possible. Beyond week 4, dose adjustments (increases or decreases) could occur at any point during scheduled or unscheduled visits, guided by the investigator’s assessment of the participant’s response and tolerability. Participants who were unable to tolerate brexpiprazole 0.5 mg/day or corresponding placebo were discontinued from the trial. Patients (n = 270) were randomized to receive brexpiprazole 0.5-2 mg/day (n = 133) or placebo (n = 137) for 12 weeks.","_key":"25ee672a9edd"},{"_key":"bde23da44fb7","_type":"span","marks":["superscript"],"text":"1"}],"_type":"block","style":"normal","_key":"3aec34f96dd1"},{"markDefs":[],"children":[{"_key":"1b37f3d9f2140","_type":"span","marks":[],"text":"Baseline characteristics were similar between the brexpiprazole and the placebo groups. About half (66.5%) of participants had received treatment for AAD and psychosis, with common prior medications being risperidone (14.5%), chlorprothixene (14.1%), haloperidol (11.5%), and quetiapine (10%). During the study, 83.3% of participants used 1 or more medications for AD, with memantine (51.7%) and donepezil (31.2%) being common."}],"_type":"block","style":"normal","_key":"96c78815007c"},{"_key":"169824ef0de4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The study was completed by 117 participants (88.0%) in the brexpiprazole group and 121 (88.3%) in the placebo group. The brexpiprazole 0.5-2 mg/day group did not achieve statistical superiority on the primary efficacy end point (CMAI Total score) when compared with placebo (Cohen d effect size = -0.18, ","_key":"9439d8e1c2ea0"},{"_type":"span","marks":["em"],"text":"P","_key":"df2d0687f2d6"},{"text":" = .15). However, benefit was noted for brexpiprazole 0.5-2 mg/day on the key secondary end points of CGI-S as related to agitation (Cohen d effect size = -0.30, ","_key":"f5ad9e5484f1","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"P","_key":"a678cc258af6"},{"_type":"span","marks":[],"text":" = .016) and the NPI-NH Agitation/Aggression domain (Cohen d effect size = -0.34, ","_key":"330b41fe03df"},{"_type":"span","marks":["em"],"text":"P","_key":"b0e1c9de4e4c"},{"_type":"span","marks":[],"text":" = .0068). The post hoc analyses showed that the subgroup of individuals who were titrated to the maximum dose of brexpiprazole at 2 mg/day at week 4 demonstrated improvements on the CMAI Total score when compared with individuals who were titrated similarly on placebo (Cohen d effect size = -0.41, ","_key":"5afe44106c93"},{"_type":"span","marks":["em"],"text":"P","_key":"563179952655"},{"_type":"span","marks":[],"text":" = .012). These individuals also demonstrated improvements on CGI-S as related to agitation (Cohen d effect size = −0.59, ","_key":"de9f5344a76d"},{"_type":"span","marks":["em"],"text":"P ","_key":"6c0b05b78f33"},{"marks":[],"text":"\u003c.001).","_key":"7a8512f6fd72","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"233394a0cda1","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Study 3","_key":"213827ac0df50"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Lee et al conducted a multicenter, randomized, double-blind, placebo-controlled, parallel-arm trial of brexpiprazole among 345 individuals with AAD who were randomized to receive either brexpiprazole (n = 228) or placebo (n = 117) for 12-weeks.","_key":"48f1cfd924390"},{"_key":"b07f2bcf2045","_type":"span","marks":["superscript"],"text":"6"},{"text":" Participants in the brexpiprazole group were further randomized 1:2 to receive brexpiprazole fixed doses of 2 or 3 mg/day. The dose titration for brexpiprazole was as follows; first week, 0.5 mg/day; second week, 1 mg/day; third and fourth weeks, 2 mg/day; beyond fourth week, 2 or 3 mg/day (fixed doses). The primary efficacy end point was a change from baseline to week 12 on the CMAI Total score. Secondary efficacy measures were the CGI-S and the Clinical Global Impressions-Improvement (CGI-I) scales, specifically applied to agitation, and the NPI-NH Agitation/Aggression domain. In contrast to the other 2 trials, the participants in this trial needed to meet the International Psychogeriatric Association definition of agitation to be eligible for participation in the study.","_key":"b0d9b83521ef","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"59dff3fa7286"},{"_type":"block","style":"normal","_key":"4ecf7a3f6f6b","markDefs":[],"children":[{"_key":"408982bfa4510","_type":"span","marks":[],"text":"The baseline demographic and clinical characteristics between the 2 groups were generally similar. A total of 184 (81.4%) individuals in the brexpiprazole group and 95 (81.9%) individuals in the placebo received standard medications for AD, mainly memantine or donepezil."}]},{"style":"normal","_key":"11c302ef4892","markDefs":[],"children":[{"_key":"1ef376a2c8a40","_type":"span","marks":[],"text":"The study was completed by 198 (86.8%) individuals in the brexpiprazole groups and 104 (88.9%) individuals in the placebo group. On the CMAI Total score, individuals receiving brexpiprazole 2 or 3 mg/day showed statistically significant improvements when compared with placebo (Cohen d effect size = 0.35, "},{"_key":"9e03c153f8bf","_type":"span","marks":["em"],"text":"P"},{"_key":"52129552f72a","_type":"span","marks":[],"text":" = .003). Additionally, benefits were noted for the brexpiprazole 2 or 3 mg/day group on the CGI-S score as related to agitation (Cohen d effect size = 0.31, "},{"_key":"6418e9a8b9a2","_type":"span","marks":["em"],"text":"P"},{"_type":"span","marks":[],"text":" = .008). Furthermore, benefits were also noted for the brexpiprazole 2 or 3 mg/day group on the following exploratory end points: CMAI factor 1: aggressive behavior score (Cohen d effect size = 0.33, ","_key":"10ed5e2f549e"},{"_type":"span","marks":["em"],"text":"P","_key":"876a53f49e4e"},{"marks":[],"text":" = .004); CMAI factor 2: physically nonaggressive behavior score (Cohen d effect size = 0.25, ","_key":"c8a6837f1319","_type":"span"},{"_type":"span","marks":["em"],"text":"P","_key":"801eb7610ceb"},{"_type":"span","marks":[],"text":" = .03) and the CMAI factor 3: verbally agitated behavior score (Cohen d effect size = 0.29, ","_key":"5b3fc3daf35c"},{"text":"P","_key":"ffbabb36bddf","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" = .01) and the CGI-I score (","_key":"97e1f5147f38"},{"_type":"span","marks":["em"],"text":"P","_key":"8abf59ccec3a"},{"_type":"span","marks":[],"text":" = .007). Additionally, on the NPI-NH Total score, the brexpiprazole 2 or 3 mg/day group did better than placebo (Cohen d effect size = 0.39, ","_key":"d2bfefb352c0"},{"_type":"span","marks":["em"],"text":"P","_key":"c85c931a5a02"},{"_type":"span","marks":[],"text":" = .001).","_key":"1159c0e7e371"}],"_type":"block"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Safety and Tolerability","_key":"2621d754cb850","_type":"span"}],"_type":"block","style":"normal","_key":"c8348842cb40"},{"children":[{"_type":"span","marks":["strong"],"text":"Study 1","_key":"87cb0828e6330"}],"_type":"block","style":"normal","_key":"a52f026e9818","markDefs":[]},{"style":"normal","_key":"caf1b6b0c079","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The incidence rates of treatment-emergent adverse events (TEAEs) were 65.0% for brexpiprazole 2 mg/day, 49.0% for 0.5-1 mg/day, and 45.9% for placebo.","_key":"0e739e6929f20"},{"_type":"span","marks":["superscript"],"text":"5 ","_key":"ddd6d404f95d"},{"_type":"span","marks":[],"text":"Most of the TEAEs were rated as being mild or moderate. Serious TEAEs were seen in about 10% of the brexpiprazole groups and about 5% of the placebo group. Agitation in a participant on brexpiprazole 0.5 mg/day was the only TEAE that was considered related to the study drug.","_key":"54f78161ec2a"}],"_type":"block"},{"_key":"0cb9fee14ccf","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Discontinuation rates due to TEAEs were 4.3% for brexpiprazole 2 mg/day, 8.9% for brexpiprazole 0.5-1 mg/day, and 5.2% for placebo. Agitation (4 vs 1) and QTc interval prolongation (2 vs 0) led to discontinuation from the study in the brexpiprazole vs placebo groups. The investigators did not find any significant differences between the groups on suicidality, EPS, QTc interval, body weight, metabolic parameters, and cognitive dysfunction. Although 5 participants in the brexpiprazole groups died during the study, none of the deaths were attributable to the medication. There were no reported deaths in the placebo group.","_key":"be6db983a5ba0"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":["strong"],"text":"Study 2","_key":"9f72dbc091130"}],"_type":"block","style":"normal","_key":"24b0a5d7e9b8","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"TEAE incidence was similar between brexpiprazole 0.5-2-mg/day (56.8%) and placebo (58.4%) groups,6 and most were rated as being mild to moderate.","_key":"1fb902fb9fe70"},{"_type":"span","marks":["superscript"],"text":"5","_key":"f2818d461f35"},{"marks":[],"text":" Serious TEAEs were similar for both groups (occurring in 5.3% of the brexpiprazole 0.5-2 mg/day group and 4.4% of the placebo group, respectively). A total of 6.8% of the individuals in the brexpiprazole group discontinued the study due to TEAEs compared with 0.7% of the individuals in the placebo group. Post hoc analysis showed no TEAE differences for participants titrated to 2 mg/day brexpiprazole at week 4 vs placebo. No clinically meaningful between-group differences were observed in other safety assessments, including suicidality, EPS, QTc interval, body weight, metabolic parameters, and cognitive dysfunction. Two patients died during the study and the deaths were considered unrelated to the study drug.","_key":"1c42d4fbf864","_type":"span"}],"_type":"block","style":"normal","_key":"9d6171580747"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Study 3","_key":"d6f70331934c0"}],"_type":"block","style":"normal","_key":"8c788c9fe861"},{"_key":"fafe4cf121d6","markDefs":[],"children":[{"text":"Approximately 40.7% of the individuals in the brexpiprazole groups reported TEAEs, compared with 31.0% in the placebo group.","_key":"b36ea17eaeda0","_type":"span","marks":[]},{"text":"6","_key":"7e7f592c37be","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Other TEAEs (brexpiprazole vs placebo groups) were headache, 6.6% vs 6.9%; cardiovascular events, 0.9% vs 0.9%; any EPS, 3.5% vs 0%; somnolence/sedation, 4.0% vs 0.9%; accident or injury TEAE, including fall, 2.2% vs 3.4%; and metabolism and nutrition disorder, 1.3% vs 1.7%. The investigators rated the majority of TEAEs as being of mild or moderate severity; 5.3% and 4.3% of brexpiprazole and placebo groups, respectively, discontinued the study due to AEs. There was 1 death in the brexpiprazole group, but it was thought to be unrelated to the drug.","_key":"03d30ffa3a48"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The mean standard deviation increase in body weight from baseline to week 12 was 0.3 kg in the brexpiprazole group. Weight gain of 7% or more from baseline to week 12 was experienced by 1.5% of individuals in the brexpiprazole group, and 0% of the individuals in the placebo group. From baseline to week 12, weight loss of 7% or more was noted in 1.0% of participants in both groups. None of the participants in either group reported suicidal ideation or behavior as a TEAE. On the MMSE score, the mean change from baseline to week 12 was 0.7 for the brexpiprazole group and 0.4 in the placebo group. The investigators reported that there were no clinically meaningful differences noted on the laboratory test results, vital signs, or electrocardiograms between the brexpiprazole and placebo groups. In addition, the EPS rating scale score changes were also rated as being minimal.","_key":"da59abd68fa80"}],"_type":"block","style":"normal","_key":"0e67e180ea4f"},{"_type":"block","style":"normal","_key":"2de19dfe5c98","markDefs":[],"children":[{"_type":"span","marks":["em"],"text":"(It is important to note that the primary outcome of the aforementioned 3 brexpiprazole studies was limited to agitation [as assessed by the Cohen-Mansfield Agitation Inventory], which is just one of the many symptoms that are included in the list of BPSD. Additionally, the studies did not require the presence of psychosis, nor did they evaluate any symptoms of psychosis. Because there is a paucity of published literature looking only at improvement in agitation in dementia, it limits direct comparisons with other studies. Meanwhile, the following 2 meta-analyses by Yunusa et al","_key":"004f1788df170"},{"_type":"span","marks":["superscript","em"],"text":"7,8","_key":"aa0371ed879b"},{"_type":"span","marks":["em"],"text":" allow for some degree of comparison with brexpiprazole, albeit in a very general manner.—Ed)","_key":"b454472d8861"}]},{"children":[{"_key":"b3b0e58e01b90","_type":"span","marks":["strong"],"text":"Making Sense of the Data"}],"_type":"block","style":"normal","_key":"b7b543a9b207","markDefs":[]},{"style":"normal","_key":"cd055850c4b1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Brexpiprazole titrated to 2 or 3 mg/day over 2 to 4 weeks provides statistically significant, although modest benefits among individuals with AD who present with agitation. Additionally, brexpiprazole appears to be well tolerated compared with placebo. No significant differences were noted between brexpiprazole and placebo on rates of suicidality, EPS, QTc interval, body weight, metabolic parameters, and cognitive dysfunction. There were no cerebrovascular events (CVAEs) noted in the studies, and the deaths in the study population were deemed as not being attributable to brexpiprazole.","_key":"aaf87335029c0"}],"_type":"block"},{"_key":"d528a4e4465e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A previous meta-analysis looked at the use of other atypical antipsychotic medications among individuals with BPSD; interestingly, the data for brexpiprazole appear similar (standardized mean difference [SMD] = effect size). The meta-analysis from Yunusa et al found benefits for aripiprazole among individuals with BPSD when compared with placebo on the NPI (SMD = −0.17), the Brief Psychiatric Rating Scale (BPRS, SMD = −0.20), and on the CMAI (SMD = −0.30).","_key":"917bd11768240"},{"text":"8","_key":"bca848f2dc61","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Benefits were noted for quetiapine on the BPRS (SMD = −0.24), and risperidone on the CMAI (SMD = −0.26) when compared with placebo. In another meta-analysis, Yunusa et al found that aripiprazole (SMD = −0.12) and olanzapine (SMD = −0.17) demonstrated small although nonsignificant numerical improvements in NPI-NH psychosis scores, compared with placebo.9 However, quetiapine (SMD = 0.04) did not show any benefits among individuals with dementia-related psychosis.","_key":"5ea91ed82df1"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"The tolerability of brexpiprazole in individuals with BPSD appears to be favorable when compared with other atypical antipsychotics.","_key":"2772e5067ec60","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"5,6","_key":"1a787c7082dc"},{"_type":"span","marks":[],"text":" There were no CVAEs noted and none of the deaths were attributable to brexpiprazole. Additionally, there was no cognitive decline noted with the use of brexpiprazole. Sedation may be an adverse effect to watch for when using brexpiprazole among individuals with BPSD.","_key":"9e78e33398af"}],"_type":"block","style":"normal","_key":"65d9b701589f"},{"children":[{"_type":"span","marks":[],"text":"When looking at other antipsychotics, Yunusa et al noted that the risk for CVAEs was greater with olanzapine (OR = 4.28) and risperidone (OR = 3.85) when compared with placebo.","_key":"c5c19558744f0"},{"_type":"span","marks":["superscript"],"text":"8","_key":"7a2bc1cfec45"},{"marks":[],"text":" Additionally, the investigators noted that risperidone (OR = 2.23) produced greater risk of EPS. Furthermore, somnolence was greater with aripiprazole (OR = 3.14), olanzapine (OR = 4.08), quetiapine (OR = 4.47), and risperidone (OR = 2.57). When compared with placebo, quetiapine (OR = 2.11) was associated with increased urinary incontinence or urinary tract infections. In their second meta-analysis, Yunusa et al found that mortality was noted to be higher for aripiprazole (OR = 1.58), olanzapine (OR = 2.21), quetiapine (OR = 1.68), and risperidone (OR = 1.63).","_key":"9b431c909245","_type":"span"},{"_type":"span","marks":["superscript"],"text":"9","_key":"d1fe05d35458"},{"_key":"0bd4e2061d84","_type":"span","marks":[],"text":" Additionally, risperidone (OR = 3.68) and olanzapine (OR = 4.47) appeared to increase the risk of CVAEs."}],"_type":"block","style":"normal","_key":"7cd119724df5","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"The investigators noted that the odds of mortality were numerically higher in the brexpiprazole group when compared with the placebo group (OR = 2.22, 95% CI, 0.3-16.56).","_key":"faebf502e1400"},{"text":"8","_key":"879f7589a47e","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" These data differ from the data that we obtained from the 3 brexpiprazole studies that are reviewed in this article. There were no brexpiprazole-related deaths identified in these studies. This difference in data is probably due to pooling of data from the 2 individual studies for the meta-analysis by Yunusa et al.","_key":"d04bbf1ba9a9"},{"marks":["superscript"],"text":"8","_key":"c8e5c8f01deb","_type":"span"}],"_type":"block","style":"normal","_key":"25e505c3b9ce","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Strengths and Limitations","_key":"a0d0e0668bfc0"}],"_type":"block","style":"normal","_key":"20741bd7e5af"},{"markDefs":[],"children":[{"text":"There are several strengths of the 3 included studies: They were well conducted, multicenter RCTs (Jadad 5/5) that included 1000 or more participants with AAD; also, they used varying doses of brexpiprazole (0.5-3 mg/day). However, there are limitations: mostly Caucasian participants, limited to 12 weeks in duration, concomitant therapies were restricted, and functioning was not assessed. Moreover, they included more participants from care facilities and those participants who had comorbidities. Additionally, these trials were designed primarily to study the efficacy, safety, and tolerability of brexpiprazole for the management of AAD. Together, these issues limit its generalizability, including the use of brexpiprazole among other BPSD symptoms (ie, apathy, anxiety, psychosis, etc), and among individuals with dementia due to other etiologies (eg, vascular disease, frontotemporal dementia, dementia with Lewy bodies, and Parkinson disease dementia). Brexpiprazole is also not indicated for as-needed dosing for treating agitation among individuals with AD dementia. Brexpiprazole is only available in an oral formulation, so it cannot be used in situations where intramuscular (IM) or intravenous dosing is required to manage emergent agitation among individuals with dementia.","_key":"37025fb1d17e0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"30ced6f3d489"},{"_type":"block","style":"normal","_key":"332dca487ca9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Treatment algorithms provide additional insights. A Canadian algorithm recommends sequential trials of risperidone, aripiprazole, quetiapine, carbamazepine, citalopram, gabapentin, and prazosin after completion of a baseline assessment and discontinuation of medications that potentially exacerbate BPSD.","_key":"32baf30073930"},{"_type":"span","marks":["superscript"],"text":"10","_key":"e3d004271d81"},{"_type":"span","marks":[],"text":" A Harvard South Shore program proposes 3 separate algorithms in emergent, urgent, and nonurgent settings.","_key":"13a170bfd1e6"},{"_type":"span","marks":["superscript"],"text":"11","_key":"aee7f253b815"},{"_type":"span","marks":[],"text":" IM olanzapine is recommended as first-line treatment for emergent BPSD. Haloperidol injection is the recommended second choice, followed by a possible consideration for IM benzodiazepine. Oral second-generation antipsychotics (SGAs) aripiprazole and risperidone are recommended as first-line treatment in an urgent setting. Prazosin is recommended as a possible next option, and electroconvulsive therapy could be a final treatment option. The authors recommend the following order of medications: trazodone, donepezil and memantine, antidepressants such as escitalopram and sertraline, SGAs, prazosin, and finally carbamazepine for nonemergent agitation.","_key":"7816bf503c26"}]},{"_type":"block","style":"normal","_key":"a797ef7daea3","markDefs":[],"children":[{"_key":"0714c2bbe1290","_type":"span","marks":[],"text":"Based on available evidence, brexpiprazole can possibly be placed along with aripiprazole and risperidone in the Canadian algorithm for sequential medication trials. In the Harvard South Shore algorithm, it can possibly be a first-line treatment option in the urgent setting along with aripiprazole and risperidone."}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We recommend using nonpharmacological management strategies as first-line treatment. Given the consistent lack of efficacy of brexpiprazole doses at 1 mg and below in the clinical trials, additional studies and time will be needed to determine if lower doses can be effective in a subset of agitated patients with dementia due to AD. We are only beginning to learn about brexpiprazole; current data supports its use in minimizing future episodes of agitation in patients with AD whose agitation symptoms have become dangerous or damaging despite the use of nonpharmacological treatments. Thus, we recommend pharmacological management strategies including brexpiprazole at the lowest effective doses and for the shortest time. Medications should only be trialed for partially responsive or refractory symptoms of BPSD, and should be done in conjunction with nonpharmacological treatments to optimize outcomes.","_key":"8a203f808f130"}],"_type":"block","style":"normal","_key":"df88accf3395"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Concluding Thoughts","_key":"63c2b654cbbc0"}],"_type":"block","style":"normal","_key":"aa0e387b6c51"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Available evidence from 3 high-quality RCTs indicated that brexpiprazole at 2-3 mg/day is more efficacious than placebo at reducing agitation among individuals with AD dementia. Brexpiprazole at these doses is well tolerated among individuals with AD, with no evidence for CVAEs or deaths attributed to the drug.","_key":"15a92125be870"}],"_type":"block","style":"normal","_key":"cef5c1c78e88"},{"style":"normal","_key":"49e8d5a08142","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Robust data from multiple additional high-quality trials of longer duration using brexpiprazole among individuals with different etiologies for dementia and targeting different BPSD symptoms are needed to cement its place as definitive first-line treatment for the management of BPSD. Otherwise, the use of brexpiprazole will be limited to just the management of agitation among individuals with AD dementia.","_key":"c46c8ecc7f290"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Bachu","_key":"2da3dbc7c07c0"},{"_key":"99b260cc933c","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"is a psychiatrist at Baptist Health Behavioral Health Clinic in North Little Rock, AR. Dr Subhedar is a clinical extern at Saint Elizabeths Hospital in Washington, DC.","_key":"56a3b998b329"},{"marks":[],"text":" ","_key":"82a164e8ee66","_type":"span"},{"_type":"span","marks":["strong"],"text":"Dr Ansari","_key":"e8e6884027bf"},{"text":" ","_key":"93946113e072","_type":"span","marks":[]},{"marks":["em"],"text":"is a psychiatrist at Pramukhswami Medical College in Anand, Gujarat, India. ","_key":"ad6ac13a3b37","_type":"span"},{"marks":["strong"],"text":"Dr Manoharan","_key":"a3e1d9ca47f4","_type":"span"},{"_type":"span","marks":[],"text":" ","_key":"95ce136643ee"},{"_type":"span","marks":["em"],"text":"is a psychiatrist at Creighton University School of Medicine in Omaha, NE.","_key":"52badc03d9f9"},{"_type":"span","marks":[],"text":" ","_key":"4bb23a716e68"},{"_type":"span","marks":["strong"],"text":"Dr Tampi","_key":"5aa102a7535a"},{"_type":"span","marks":[],"text":" ","_key":"85b6088183e7"},{"_type":"span","marks":["em"],"text":"is professor and chairman of the Department of Psychiatry at Creighton University School of Medicine and Catholic Health Initiatives (CHI) Health Behavioral Health Services. He is also an adjunct professor of psychiatry at Yale School of Medicine in New Haven, CT, and a member of the ","_key":"99259a4fca9e"},{"text":"Psychiatric Times","_key":"44e3a02a350d","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":" editorial board.","_key":"81df4f7ac0f2"}],"_type":"block","style":"normal","_key":"e740ecdfb6ad"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"1438ff78608e0"}],"_type":"block","style":"normal","_key":"7ded5394932d"},{"_key":"ed632c70cb10","markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/35921394/","_key":"9ec91e967fc6","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"1. Tampi RR, Jeste DV. ","_key":"c5643da41b6d0"},{"_type":"span","marks":["9ec91e967fc6"],"text":"Dementia is more than memory loss: neuropsychiatric symptoms of dementia and their nonpharmacological and pharmacological management.","_key":"03f6f70a1100"},{"_type":"span","marks":[],"text":" ","_key":"d5fb1effbac6"},{"_type":"span","marks":["em"],"text":"Am J Psychiatry","_key":"c0d1a0bc7890"},{"_type":"span","marks":[],"text":". 2022;179(8):528-543.","_key":"6e81444ee09b"}],"_type":"block","style":"normal"},{"style":"normal","_key":"70447fdf5398","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/29955525/","_key":"e4078ce120e5"}],"children":[{"_type":"span","marks":[],"text":"2. Diefenderfer LA, Iuppa C. ","_key":"a54d2b13344a0"},{"_type":"span","marks":["e4078ce120e5"],"text":"Brexpiprazole: a review of a new treatment option for schizophrenia and major depressive disorder.","_key":"62536aab7cfd"},{"_type":"span","marks":[],"text":" ","_key":"cf851d52f6aa"},{"_type":"span","marks":["em"],"text":"Ment Health Clin.","_key":"c9711d6b242e"},{"text":" 2018;7(5):207-212.","_key":"8ab0b19bbf4d","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/34092824/","_key":"856eb9637875","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"3. Edinoff AN, Wu NW, Maxey BS, et al. ","_key":"1981e2d8f3ed0"},{"_type":"span","marks":["856eb9637875"],"text":"Brexpiprazole for the treatment of schizophrenia and major depressive disorder: a comprehensive review of pharmacological considerations in clinical practice.","_key":"ebc1052bbc82"},{"_type":"span","marks":["em"],"text":" Psychopharmacol Bull","_key":"506d9f9c48c8"},{"_type":"span","marks":[],"text":". 2021;51(2):69-95.","_key":"4ce0d44d5e86"}],"_type":"block","style":"normal","_key":"5066641b30eb"},{"_type":"block","style":"normal","_key":"f56f9ac29915","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease","_key":"ce30ba679a7d"}],"children":[{"_type":"span","marks":[],"text":"4. FDA approves first drug to treat agitation symptoms associated with dementia due to Alzheimer’s disease. US Food \u0026 Drug Administration. Press release. May 11, 2023. Accessed April 3, 2024. ","_key":"b7e2fe1a2a980"},{"text":"https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease","_key":"d7b55895414a","_type":"span","marks":["ce30ba679a7d"]}]},{"_type":"block","style":"normal","_key":"e848af3a205c","markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/31708380/","_key":"8ae520d0de6d","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"5. Grossberg GT, Kohegyi E, Mergel V, et al. ","_key":"4da410b3b06d0"},{"marks":["8ae520d0de6d"],"text":"Efficacy and safety of brexpiprazole for the treatment of agitation in Alzheimer’s dementia: two 12-week, randomized, double-blind, placebo-controlled trials.","_key":"4a5124447790","_type":"span"},{"text":" ","_key":"8e2f026f9e13","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"Am J Geriatr Psychiatry","_key":"42d13cbbdc64"},{"_type":"span","marks":[],"text":". 2020;28(4):383-400.","_key":"c0c00df9ade3"}]},{"children":[{"_type":"span","marks":[],"text":"6. Lee D, Slomkowski M, Hefting N, et al. ","_key":"711e3ae9f3c30"},{"_type":"span","marks":["ec64d731b179"],"text":"Brexpiprazole for the treatment of agitation in Alzheimer dementia: a randomized clinical trial.","_key":"c63b4af6df62"},{"_type":"span","marks":[],"text":" ","_key":"d20da80ea137"},{"_type":"span","marks":["em"],"text":"JAMA Neurol","_key":"390835511ebc"},{"_type":"span","marks":[],"text":". 2023;80(12):1307-1316.","_key":"0fa5f7fd4b0c"}],"_type":"block","style":"normal","_key":"0d3785460b30","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://jamanetwork.com/journals/jamaneurology/fullarticle/2811629","_key":"ec64d731b179"}]},{"style":"normal","_key":"d0a25d19658b","markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/8721797/","_key":"10658a13260f","nofollow":true,"blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"7. Jadad AR, Moore RA, Carroll D, et al. ","_key":"5481e1c52f9c0"},{"_type":"span","marks":["10658a13260f"],"text":"Assessing the quality of reports of randomized clinical trials: is blinding necessary?","_key":"87e1ea98dc9f"},{"text":" ","_key":"506732cbf831","_type":"span","marks":[]},{"_key":"972a02422b55","_type":"span","marks":["em"],"text":"Control Clin Trials"},{"_type":"span","marks":[],"text":". 1996;17(1):1-12.","_key":"df0cafc950ca"}],"_type":"block"},{"_type":"block","style":"normal","_key":"40afbea8a867","markDefs":[{"blank":true,"_type":"link","href":"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2728618","_key":"59e46b87fc32","nofollow":true}],"children":[{"marks":[],"text":"8. Yunusa I, Alsumali A, Garba AE, et al. ","_key":"96e985100db60","_type":"span"},{"_type":"span","marks":["59e46b87fc32"],"text":"Assessment of reported comparative effectiveness and safety of atypical antipsychotics in the treatment of behavioral and psychological symptoms of dementia: a network meta-analysis.","_key":"9e02c80f84cf"},{"marks":[],"text":" ","_key":"98aaa7f4c2d7","_type":"span"},{"_type":"span","marks":["em"],"text":"JAMA Netw Open","_key":"a0d1cfdaba82"},{"_type":"span","marks":[],"text":". 2019;2(3):e190828.","_key":"eda401098f94"}]},{"children":[{"_type":"span","marks":[],"text":"9. Yunusa I, Rashid N, Demos GN, et al. ","_key":"ac528ddd08740"},{"_key":"75aacb3c8103","_type":"span","marks":["9c206455af0e"],"text":"Comparative outcomes of commonly used off-label atypical antipsychotics in the treatment of dementia-related psychosis: a network meta-analysis."},{"_type":"span","marks":[],"text":" ","_key":"9e41fe3ad064"},{"marks":["em"],"text":"Adv Ther","_key":"821313852e98","_type":"span"},{"_type":"span","marks":[],"text":". 2022;39(5):1993-2008.","_key":"0c542a5179b0"}],"_type":"block","style":"normal","_key":"c68b182df68e","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/35247186/","_key":"9c206455af0e"}]},{"markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/29338602/","_key":"45cc696482cc","nofollow":true,"blank":true}],"children":[{"marks":[],"text":"10. Davies SJ, Burhan AM, Kim D, et al. ","_key":"ca428f4780140","_type":"span"},{"_type":"span","marks":["45cc696482cc"],"text":"Sequential drug treatment algorithm for agitation and aggression in Alzheimer’s and mixed dementia.","_key":"082452e2a348"},{"_key":"3ec7d2e04936","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"J Psychopharmacol","_key":"a66cf69498ce"},{"_type":"span","marks":[],"text":". 2018;32(5):509-523.","_key":"e3aaa5a42e02"}],"_type":"block","style":"normal","_key":"8ecec8d381f5"},{"children":[{"text":"11. Chen A, Copeli F, Metzger E, et al. ","_key":"795e3b89be4b0","_type":"span","marks":[]},{"_type":"span","marks":["72106f31acc2"],"text":"The Psychopharmacology Algorithm Project at the Harvard South Shore Program: an update on management of behavioral and psychological symptoms in dementia.","_key":"539c1bed9667"},{"_type":"span","marks":[],"text":" ","_key":"679e50e8f703"},{"marks":["em"],"text":"Psychiatry Res","_key":"d33721e8d866","_type":"span"},{"_type":"span","marks":[],"text":". 2021;295:113641. \n\n","_key":"da77218c7691"}],"_type":"block","style":"normal","_key":"1d709bc6c3e6","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/33340800/","_key":"72106f31acc2"}]},{"_type":"block","style":"normal","_key":"4feb3e442dcb","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"","_key":"a499d4186842"}]}],"issueGroup":{"_ref":"5a9163da-f212-4c01-a207-8ab23dbd2246","_type":"reference"},"gptTakeaways":"• Brexpiprazole is FDA-approved for agitation in Alzheimer's dementia, showing efficacy at 2-3 mg/day in RCTs.\n• Trials reported no significant differences in suicidality, EPS, QTc interval, body weight, or cognitive dysfunction between brexpiprazole and placebo.\n• The studies were limited to 12 weeks and primarily involved Caucasian participants, restricting generalizability to other dementia types and symptoms.\n• Brexpiprazole is not indicated for as-needed dosing and is only available in oral formulation, limiting its use in emergent situations.","summary":"In this CME article, learn more about the efficacy and tolerability of brexpiprazole for the treatment of agitation among individuals with Alzheimer disease dementia. ","_id":"1e864d2a-05d8-40c0-9a0d-a994f89ac80a","_rev":"q15rgr9KO9mLI3ePQQTiy7","thumbnail":{"_type":"mainImage","alt":"dementia","caption":"GordonGrand/AdobeStock","asset":{"_ref":"image-32cef1d30b31a8a9054644b3895cd6d7285bd198-4256x2832-jpg","_type":"reference"}},"targeting":{"content_placement":["topics/dementia","topics/neuropsychiatry","continuing-education","topics/alzheimer-disease"],"document_url":["evaluating-brexpiprazole-for-the-management-of-behavioral-and-psychological-symptoms-of-dementia"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Multidisciplinary Inpatient Care for Medically Compromised Youth and Young Adults With Eating Disorders","url":{"current":"multidisciplinary-inpatient-care-for-medically-compromised-youth-and-young-adults-with-eating-disorders","_type":"slug"},"thumbnail":{"asset":{"_ref":"image-75e054327354fd399f1c1b0d16066577da5800d1-5000x3500-jpg","_type":"reference"},"_type":"mainImage","alt":"eating disorders","caption":"Wanlee/AdobeStock"},"published":"2024-11-22T17:00:00.488Z"},{"title":"Earn CME Credit With Psychiatric Times ","url":{"current":"earn-cme-credit-with-psychiatric-times","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"Earn CME credit with Psychiatric Times","asset":{"_type":"reference","_ref":"image-882aff5a48d7f9876df87a590bc633f70a11954b-960x540-jpg"}},"published":"2024-10-29T19:04:59.678Z"},{"title":"TMS for the Treatment of OCD","url":{"current":"tms-for-the-treatment-of-ocd","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"brain lightbulb","caption":"Dilok/AdobeStock","asset":{"_ref":"image-6e7deea1c577db789477d44ab9518072785d31ee-6000x4000-jpg","_type":"reference"}},"published":"2024-10-25T15:00:00.000Z"},{"title":"Evaluating Brexpiprazole for the Management of Behavioral and Psychological Symptoms of Dementia","url":{"current":"evaluating-brexpiprazole-for-the-management-of-behavioral-and-psychological-symptoms-of-dementia","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"dementia","caption":"GordonGrand/AdobeStock","asset":{"_ref":"image-32cef1d30b31a8a9054644b3895cd6d7285bd198-4256x2832-jpg","_type":"reference"}},"published":"2024-10-23T16:00:00.000Z"},{"title":"Climate Change, Vector Range, and Alpha-Gal in Psychiatric Practice","url":{"current":"climate-change-vector-range-and-alpha-gal-in-psychiatric-practice","_type":"slug"},"thumbnail":{"caption":"ondreicka/AdobeStock","asset":{"_ref":"image-4d334999fcf64afe7e821bce3a9230aae30a5918-5998x3999-jpg","_type":"reference"},"_type":"mainImage","alt":"tick"},"published":"2024-10-22T16:00:00.000Z"},{"title":"Electroconvulsive Therapy for the Treatment of Dementia Symptoms","url":{"current":"electroconvulsive-therapy-for-the-treatment-of-dementia-symptoms","_type":"slug"},"thumbnail":{"alt":"dementia","caption":"SJM Photos/AdobeStock","asset":{"_ref":"image-2172f65e37645ccf10b6977cbddcfd470b116efb-4961x3508-jpg","_type":"reference"},"_type":"mainImage"},"published":"2024-10-14T15:00:06.211Z"}]},{"url":"climate-change-vector-range-and-alpha-gal-in-psychiatric-practice","thumbnail":{"_type":"mainImage","alt":"tick","caption":"ondreicka/AdobeStock","asset":{"_type":"reference","_ref":"image-4d334999fcf64afe7e821bce3a9230aae30a5918-5998x3999-jpg"}},"_type":"article","gptTakeaways":"• AGS is triggered by lone star tick bites, causing delayed allergic reactions to mammalian products. Symptoms include urticaria, gastrointestinal distress, and anaphylaxis.\n\n• Diagnosis is challenging due to the lack of standardized testing and the rarity of the condition, often leading to delayed identification.\n\n• AGS impacts mental health, causing dietary restrictions, social isolation, and financial stress, necessitating interdisciplinary care.\n\n• Climate change may increase AGS prevalence by expanding the range of lone star ticks, complicating management and diagnosis.\n\n• Effective management involves allergists, psychiatrists, and pharmacists to address both physical and psychological aspects of AGS.","factCheckAuthors":null,"_id":"8f14bcad-bf99-4751-b19b-d4d5f852b397","is_visible":true,"factCheckAuthorMapping":null,"title":"Climate Change, Vector Range, and Alpha-Gal in Psychiatric Practice","taxonomyMapping":[{"parent":{"identifier":"topics","isMainTopic":true,"_createdAt":"2020-03-26T06:11:21Z","_rev":"uvXJooXtzvjNOyx50HTt8m","name":"Topics","_id":"pst_taxonomy_53202_clinical","_type":"taxonomy","_updatedAt":"2023-03-31T19:15:59Z","parent":null},"_rev":"77mZ7PORfofI3dBGfWcsCF","perKeywordMapping":["Psychiatry","Neurology"],"_createdAt":"2020-03-26T06:11:21Z","name":"Neuropsychiatry","_id":"pst_taxonomy_35_neuropsychiatry","cmeType":"per","_type":"taxonomy","_updatedAt":"2023-03-31T19:19:55Z","identifier":"topics/neuropsychiatry","pixelTrackingCode":null}],"articleType":"News","_updatedAt":"2024-10-21T18:16:24Z","gptSummary":"Alpha-gal syndrome (AGS) is a delayed allergic reaction to the oligosaccharide alpha-gal, commonly triggered by lone star tick bites. Symptoms vary and can include urticaria, gastrointestinal distress, and anaphylaxis. AGS poses significant diagnostic challenges due to its rarity and the lack of standardized testing. The syndrome's impact extends to mental health, as patients face dietary restrictions and potential social isolation. Climate change may expand AGS prevalence. Effective management requires interdisciplinary care, including allergists, psychiatrists, and pharmacists, to address both physical and psychological aspects of the condition.","authorMapping":[{"_createdAt":"2024-10-21T17:41:43Z","biography":[{"_key":"22f2fb64f850","markDefs":[],"children":[{"text":"Mr Babineau","_key":"87a4ad98326e0","_type":"span","marks":["strong"]},{"_key":"87a4ad98326e1","_type":"span","marks":["em"],"text":" is a medical student at Virginia Commonwealth University School of Medicine."}],"_type":"block","style":"normal"}],"profileImage":{"_type":"mainImage","asset":{"_ref":"image-455fd5a645f878d7500074d4c822bbc3004f08ef-800x800-jpg","_type":"reference"}},"url":{"current":"ryan-babineau","_type":"slug"},"displayName":"Ryan Babineau","_rev":"iwIk0EhdBdoIVjJwZZF7My","_type":"author","_id":"27ff1210-98f8-4719-bf79-c5ee2239de87","_updatedAt":"2024-10-21T17:52:22Z"},{"_createdAt":"2024-10-21T17:43:17Z","biography":[{"_type":"block","style":"normal","_key":"5b2dc5e7f88e","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Daily ","_key":"957e5e844f480"},{"_type":"span","marks":["em"],"text":"is adjunct faculty at the Oklahoma State University School of Osteopathic Medicine at The Cherokee Nation.","_key":"957e5e844f481"}]}],"profileImage":{"asset":{"_ref":"image-28565033521595bbe60fa20c0624e2c2778153cd-320x320-jpg","_type":"reference"},"_type":"mainImage"},"_id":"597e3e31-4eac-4cf6-b9a2-3b53e6878ea0","_updatedAt":"2024-10-21T17:52:48Z","url":{"current":"rebecca-susan-daily-md-dlfapa-dfaacap","_type":"slug"},"displayName":"Rebecca Susan Daily, MD, DLFAPA, DFAACAP","_rev":"piyJAhpB4yoL7s3CRcqGYa","_type":"author"}],"published":"2024-10-22T16:00:00.000Z","body":[{"asset":{"_ref":"image-4d334999fcf64afe7e821bce3a9230aae30a5918-5998x3999-jpg","_type":"reference"},"disableLightBox":true,"imgcaption":[{"markDefs":[],"children":[{"text":"ondreicka/AdobeStock","_key":"bf8c44d2eaf30","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d790799c6b8b"}],"_type":"figure","alt":"tick","alignment":"left","widthP":50,"disableTextWrap":false,"_key":"d4c284b59b6e"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Alpha-gal syndrome (AGS) arises via delayed allergic (IgE) reaction to galactose-alpha-1,3–galactose (alpha-gal), which is an oligosaccharide molecule found in mammalian products such as meat, milk, and mammalian byproducts, including medications and medical devices.","_key":"e2fc311168c00"},{"marks":["superscript"],"text":"1","_key":"77e8581c52bc","_type":"span"},{"text":" Bites from the lone star tick are the most common cause of AGS, sensitizing individuals to the alpha-gal molecule on subsequent exposure to mammalian products; however, globally there may be other explanatory vectors. Symptoms present hours to days after exposure and include urticaria, gastrointestinal distress, angioedema, and possibly anaphylaxis, with significant variability among individuals. The psychological impacts of AGS are broad, and this vector-borne disease may cause patients to seek or be referred to psychiatric care.","_key":"e53d8b434bb7","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"4afef286faa0"},{"_key":"d99a297fa557","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"f9e481c308a60"}],"_type":"block","style":"normal"},{"style":"normal","_key":"5a890d1283b4","markDefs":[],"children":[{"_key":"ca1de9a3248c0","_type":"span","marks":["strong"],"text":"Case Example"}],"_type":"block"},{"style":"normal","_key":"42d89574bc61","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Ben” is an 11-year-old boy referred to the psychiatric clinic by his pediatrician after experiencing years of gastrointestinal symptoms, including nausea, diarrhea, and episodic stomach pains. Workup including upper gastrointestinal endoscopy and colonoscopy was unrevealing and conservative management has failed. He has been missing school due to his symptoms and the school district is concerned about truancy. He lives in rural Missouri with his family who manages a tight budget, saving money by purchasing half of a steer or a whole hog at a time to feed the family. Ben is a picky eater, preferring meat with most meals.","_key":"3c8316ddd4660"}],"_type":"block"},{"style":"normal","_key":"d3e46cfaea56","markDefs":[],"children":[{"text":"","_key":"a581f0ed38490","_type":"span","marks":[]}],"_type":"block"},{"_type":"block","style":"normal","_key":"874a0dcb082d","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Psychiatric Concerns","_key":"7c557dad5d8d0"}]},{"_type":"block","style":"normal","_key":"8ee4e996549e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"AGS lies at the intersection of physical and mental health. This case emphasizes some of the principal psychiatric concerns originating from AGS. This syndrome, which can arrive unannounced, may be triggered by foods and medications the patient has consumed their entire life. Suddenly, individuals with AGS may be limited in the types of food they eat, which can ostracize them from their family and culture, as well as place undue financial and administrative stressors on the individual and family. Of the top 20 pharmaceutical companies, only 60% were able to accurately provide information on whether there were animal products in their formulation. Of those respondents, many required repeated calls and prompting to coax out this information.","_key":"9551113830620"},{"marks":["superscript"],"text":"2 ","_key":"744a36f9d3bf","_type":"span"},{"_type":"span","marks":[],"text":"Climate change applies additional pressure onto mental health concerns, from increased AGS range to changes in food choice/availability, and even potential disruptions to supply chains for medication.","_key":"842be518b3f7"}]},{"_key":"034688161565","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"8639a3e38abb0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"25ab86fab149","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The prevalence of AGS is greatest in the United States, where the link between tick bites and AGS was initially identified by an Australian group in 2009. Subsequently, an American group discovered that cetuximab reactions overlapped with Rocky Mountain Spotted fever, a Rickettsial infection transmitted by the lone star tick (Amblyomma americanum).","_key":"c0483753cd1b0"},{"_type":"span","marks":["superscript"],"text":"1","_key":"33261792e545"},{"_type":"span","marks":[],"text":" Recent data showed 18,885 positive tests in the United States in 2021, rising from 13,371 in 2017 with geographic preference for the Midwest, Southern, and Mid-Atlantic regions, which not so coincidentally mirrors the distribution of the lone star tick.","_key":"e31024bb0d6c"},{"_type":"span","marks":["superscript"],"text":"3","_key":"85bca20fcb02"},{"marks":[],"text":" Without established surveillance for AGS, its exact prevalence is largely unknown. A survey from the same Centers for Disease Control and Prevention (CDC) weekly morbidity and mortality report highlights the lack of provider knowledge on AGS and its underdiagnosis.","_key":"8599def10961","_type":"span"},{"_type":"span","marks":["superscript"],"text":"4","_key":"8211256330fe"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"52468ef0c6650"}],"_type":"block","style":"normal","_key":"e6e3f871d64f"},{"children":[{"marks":[],"text":"Changing climates alter regions suitable for ticks, and the range of AGS will likely follow such migrations.1 The northward expansion of lone star ticks and AGS is amplified by the acceleration of the tick life cycle from climate impacts. One study identified that milder northeastern winters facilitated increased survival of the lone star tick, where patients with AGS may appear in the clinic of unsuspecting clinicians.5","_key":"534a792fb45f0","_type":"span"}],"_type":"block","style":"normal","_key":"db781f6bde69","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"4e67beec185a0"}],"_type":"block","style":"normal","_key":"2d00dc4ae40b","markDefs":[]},{"_type":"block","style":"normal","_key":"5599e8c0e152","markDefs":[],"children":[{"text":"Diagnosis","_key":"6fe0c939ad000","_type":"span","marks":["strong"]}]},{"children":[{"_key":"69786a7dfcc90","_type":"span","marks":[],"text":"This condition poses a challenge for many physicians. There is no consensus diagnostic threshold of IgE to alpha-gal molecules, as testing itself is relatively new. Likewise, there are no curative treatments for this condition, which can be life-threatening."},{"_type":"span","marks":["superscript"],"text":"1,4","_key":"17d88e251d9b"},{"marks":[],"text":" A 28-person survey from 2016 found an average time to diagnosis of 7 years, requiring repeat visits, workups, and independent research, with roughly 3 out of 4 patients self-diagnosing their unique presentation of this presently rare condition.","_key":"0a16e27e0c01","_type":"span"},{"_type":"span","marks":["superscript"],"text":"6","_key":"954d0fa84ca6"},{"text":" This increased time to diagnosis for a chronic condition with a risk of repeated symptom flares can have an immense psychological impact. Core aspects of people’s lives now have the potential to induce a reaction, making you think twice about pets, eating out, apparel choices (leather), and personal care products. Unlabeled food and drug products pose a hazard to patients seeking to manage their condition chronically. Products containing alpha-gal moieties are ubiquitous—even when excluding red meat. Currently, the US Food and Drug Administration does not require labeling products this way, which is an added daily stressor for patients, seeding doubt, anxiety, and isolation even after a drawn-out diagnosis. The costs for health care, prescriptions including EpiPens, social impacts, and ambiguity when seeking information about the syndrome compound. The distress felt by patients and families navigating AGS can be immense. Supportive communities and resources with appropriate therapy can help manage this condition.","_key":"b203efbb8dd5","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"0a66578f3872","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b163c44ff9100"}],"_type":"block","style":"normal","_key":"f16bc9bd24bd"},{"_type":"block","style":"normal","_key":"26ee1d09128c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For the practicing psychiatrist, there are obstacles to medical management for many psychiatric conditions. Gelatin capsules and animal-derived stabilizers, including lactose and other mammalian products, frequently occupy selective serotonin reuptake inhibitors, serotonin–norepinephrine reuptake inhibitors, tricyclic antidepressants, 1st and 2nd generation antipsychotics, mood stabilizers (lithium, anticonvulsants), and anxiolytic (benzodiazepine and nonbenzodiazepine) medications. These were found just from a cursory glance online, because not even the CDC has a comprehensive list, deferring to the patient’s provider.","_key":"6a2663c2fd720"},{"_type":"span","marks":["superscript"],"text":"7-10","_key":"7209baa560a0"},{"marks":[],"text":" A column from the American Academy of Allergy, Asthma, and Immunology takes a similar stance to the CDC, where a blanket response defers patient risk, treatment consent, and care decisions to the institution, as there is no standardized reporting of product ingredients.","_key":"d4a4ee5a1493","_type":"span"},{"_type":"span","marks":["superscript"],"text":"11","_key":"75e818277f9e"},{"_type":"span","marks":[],"text":" This significantly impinges on the therapeutic latitude available for patients with AGS and psychiatric concerns, with elevated risks in acute management. Pharmacies themselves may only receive information from the manufacturer, who may be rather lax in their reporting. A case report on initiating psychotropic treatment in the setting of AGS emphasized the necessity of interdisciplinary care for initiating appropriate treatment, and that generic manufacturers may use different ingredients, so generalizing alpha-gal content from one formulation to another is not possible.","_key":"007f48955e0a"},{"_type":"span","marks":["superscript"],"text":"7","_key":"7795510a69ce"},{"_type":"span","marks":[],"text":" For some patients, multiple trials of medication may be needed for effective treatment. Chronic illness is related to psychiatric comorbidities such as depression and anxiety.","_key":"182dcc36152f"},{"_type":"span","marks":["superscript"],"text":"12","_key":"c0ebe67ada21"},{"text":" Addressing mental health alongside organic disease should be pursued in patients with AGS if applicable, as this diagnosis can be life-altering.","_key":"e27e31cc1a3d","_type":"span","marks":[]}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"2a0ff53db8eb0"}],"_type":"block","style":"normal","_key":"4ced177c21f4","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"Challenges in managing patients with AGS have been documented across many specialties. In the emergency department, AGS should be on the differential for anaphylaxis of unknown origin, as well as an adverse drug reaction in an unknown patient.","_key":"c507bf5a8bcf0"},{"_type":"span","marks":["superscript"],"text":"13","_key":"ecf7dead1967"},{"_type":"span","marks":[],"text":" In the operative setting, porcine valves, certain types of sutures, and common drugs including heparin and oxycodone are off-limits.","_key":"fb9e68fc8dd5"},{"_type":"span","marks":["superscript"],"text":"14","_key":"1b81a57dddaa"},{"text":" Once outpatient, compounding pharmacies with custom medication formulations can provide an answer to the uncertainty of living with AGS, but these are often more expensive than traditional pharmacies. Rural patients may not have access to this, or other options if there are no pharmacies in their area with the available prescriptions to turn to when first-line meds contain the alpha-gal epitope. Prescription medications are something individuals living with AGS become hyperaware of, as common entities can cause flares in symptoms. In a recent survey, half of patients with AGS have had an anaphylactic reaction to a health product.","_key":"f55985f62d27","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"8","_key":"90455d642d80"},{"text":" ","_key":"ecdea9ab7859","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2b69ccd692c6","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"a7d632936f750"}],"_type":"block","style":"normal","_key":"a663545e9b82","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Treatment of AGS involves avoiding allergens and having rescue medications available if a reaction occurs.","_key":"4ce16a225e570"},{"_type":"span","marks":["superscript"],"text":"15","_key":"80728d891b61"},{"_key":"b7c2ce9ed69c","_type":"span","marks":[],"text":" On first presentation, if suspicious for AGS physicians should encourage mammalian meat and product avoidance, provide an EpiPen and antihistamine prescription, and refer the patient to an allergist."},{"text":"13","_key":"69f543f4065b","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" Once diagnosed, significant patient education surrounding lifestyle changes is needed to help avoid reactions, though complete avoidance is next to impossible. After reviewing the broad swath of everyday products where we encounter alpha-gal, education on label reading can help mitigate encountering the antigen. Advocating for more information about medical treatments like vaccines and prescriptions is key to reducing iatrogenic risks, and tick avoidance remains essential in preventing disease onset or worsening. Psychiatrists have an important role in the interdisciplinary treatment of patients with AGS to address psychological sequelae. Collaboration with pharmacists and registered dietitians helps in providing comprehensive care to people with AGS, too.","_key":"e0f5f446d26b"},{"marks":["superscript"],"text":"15","_key":"c3f493b30d0a","_type":"span"},{"_type":"span","marks":[],"text":" As with many of the rarer chronic diseases receiving insufficient attention from research, there seems to be a robust, supportive online community for those living with AGS. With accelerating climate change, the reality of AGS becoming more prevalent and significant for practicing physicians including psychiatrists, provides another incentive to allocate more energy towards the diagnosis and management of AGS. Through gene editing, an alpha-gal free porcine products are on the horizon, but increasing awareness on the part of physicians to identify and adequately treat people with AGS would yield substantial benefit to those unfortunate enough to be sensitized to the oligosaccharide.","_key":"65860d1ace65"}],"_type":"block","style":"normal","_key":"105c6a841ee2"},{"_key":"0d43acdc779f","markDefs":[],"children":[{"text":"","_key":"4b6841a22e5a0","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"Concluding Thoughts","_key":"15986115b0660","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"fa6443acdb2f"},{"_type":"block","style":"normal","_key":"84421899e092","markDefs":[],"children":[{"_type":"span","marks":[],"text":"AGS is a chronic disease affecting an increasing number of Americans and is difficult for physicians to identify. Its physical and psychological impact on patients is significant, and providers should have a plan in place in their practice for addressing the needs of these patients. Mandated reporting of all drug ingredients would go a long way in managing their care and alleviating stress for both patients and their providers. Future efforts to evaluate the burden of this disease, clear guidelines for AGS diagnosis, and improved labeling would have substantial benefits to those learning to live with alpha-gal.","_key":"5fe5b1a69d430"}]},{"_type":"block","style":"normal","_key":"6b9904a7c1c9","markDefs":[],"children":[{"marks":[],"text":"","_key":"6d2cb61f3f640","_type":"span"}]},{"markDefs":[],"children":[{"marks":["strong"],"text":"List of Resources for Patients and Providers","_key":"4428d062ea5b0","_type":"span"}],"_type":"block","style":"normal","_key":"563785eb05e8"},{"_key":"fe058bcf379d","listItem":"bullet","markDefs":[{"blank":true,"_type":"link","href":"https://alphagalinformation.org/","_key":"29424b7fc5c6"}],"children":[{"_type":"span","marks":["29424b7fc5c6"],"text":"https://alphagalinformation.org/","_key":"b3f1c558d7670"}],"level":1,"_type":"block","style":"normal"},{"style":"normal","_key":"47aee12221bd","listItem":"bullet","markDefs":[{"blank":true,"_type":"link","href":"https://www.aaaai.org/allergist-resources/ask-the-expert/answers/2023/alpha-gal","_key":"c8950079b449","nofollow":true}],"children":[{"_type":"span","marks":["c8950079b449"],"text":"https://www.aaaai.org/allergist-resources/ask-the-expert/answers/2023/alpha-gal","_key":"9611b5be5b470"}],"level":1,"_type":"block"},{"listItem":"bullet","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.twoalphagals.com/blog/psychological-impacts","_key":"c63ffdef68fc"}],"children":[{"marks":["c63ffdef68fc"],"text":"https://www.twoalphagals.com/blog/psychological-impacts","_key":"5211e11b9a2d0","_type":"span"}],"level":1,"_type":"block","style":"normal","_key":"9acc93d5bc0f"},{"markDefs":[{"_type":"link","href":"https://tickedoffmastcells.org/?p=181","_key":"9fe0589279f1","blank":true}],"children":[{"_key":"adcc8fc5a32a0","_type":"span","marks":["9fe0589279f1"],"text":"https://tickedoffmastcells.org/?p=181"}],"level":1,"_type":"block","style":"normal","_key":"5fce3ec7828e","listItem":"bullet"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"6db5fd9260740"}],"_type":"block","style":"normal","_key":"2df59ce2f29a"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Mr Babineau","_key":"5137e130d91e0","_type":"span"},{"_type":"span","marks":["em"],"text":" is a medical student at Virginia Commonwealth University School of Medicine.","_key":"5137e130d91e1"},{"marks":["strong"],"text":" Dr Daily ","_key":"5137e130d91e2","_type":"span"},{"_key":"5137e130d91e3","_type":"span","marks":["em"],"text":"is adjunct faculty at the Oklahoma State University School of Osteopathic Medicine at The Cherokee Nation."}],"_type":"block","style":"normal","_key":"34afbb545661"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"62e571d0e3e40"}],"_type":"block","style":"normal","_key":"03fec2e8aee6"},{"_key":"698ff2433a57","markDefs":[],"children":[{"text":"References","_key":"3cd8d9a429b30","_type":"span","marks":["strong"]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"193c96aa1af9","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/33529984/","_key":"193b3b722a33"}],"children":[{"_type":"span","marks":[],"text":"1. Young I, Prematunge C, Pussegoda K, et al. ","_key":"a2cb27ccf39a0"},{"_key":"a2cb27ccf39a1","_type":"span","marks":["193b3b722a33"],"text":"Tick exposures and alpha-gal syndrome: a systematic review of the evidence. "},{"_type":"span","marks":["em"],"text":"Ticks Tick Borne Dis","_key":"a2cb27ccf39a2"},{"_type":"span","marks":[],"text":". 2021;12(3):101674.","_key":"a2cb27ccf39a3"}]},{"markDefs":[{"blank":true,"_type":"link","href":"https://meridian.allenpress.com/jcphp/article/70/2a/8/493818/Patient-Experience-With-Pharmaceutical-Medical","_key":"e11920380e75"}],"children":[{"_key":"67652bd44db90","_type":"span","marks":[],"text":"2. Son FS, Wolfe A, Nguyen YT, Uchi J. "},{"_type":"span","marks":["e11920380e75"],"text":"Patient experience with pharmaceutical medical information centers to identify animal-free medications. ","_key":"67652bd44db91"},{"text":"J Contemp Pharm Prac.","_key":"67652bd44db92","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" 2023;70(2a):8-11.","_key":"67652bd44db93"}],"_type":"block","style":"normal","_key":"8315a6cfa29b"},{"markDefs":[{"_key":"ebf377e342a3","blank":true,"_type":"link","href":"https://www.cdc.gov/mmwr/volumes/72/wr/mm7230a2.htm"}],"children":[{"marks":[],"text":"3. Thompson JM, Carpenter A, Kersh GJ, et al. ","_key":"4b8362756b790","_type":"span"},{"_type":"span","marks":["ebf377e342a3"],"text":"Geographic distribution of suspected alpha-gal syndrome cases - United States, January 2017-December 2022. ","_key":"4b8362756b791"},{"_type":"span","marks":["em"],"text":"MMWR Morb Mortal Wkly Rep","_key":"4b8362756b792"},{"_key":"4b8362756b793","_type":"span","marks":[],"text":". 2023;72(30):815-820."}],"_type":"block","style":"normal","_key":"991ae18be404"},{"_key":"235a5469b343","markDefs":[{"blank":true,"_type":"link","href":"https://www.cdc.gov/mmwr/volumes/72/wr/mm7230a1.htm","_key":"f7b6ca3bceb7"}],"children":[{"_type":"span","marks":[],"text":"4. Carpenter A, Drexler NA, McCormick DW, et al. ","_key":"71abcd9baece0"},{"_key":"71abcd9baece1","_type":"span","marks":["f7b6ca3bceb7"],"text":"Health care provider knowledge regarding alpha-gal syndrome - United States, March-May 2022. "},{"_type":"span","marks":["em"],"text":"MMWR Morb Mortal Wkly Rep","_key":"71abcd9baece2"},{"_type":"span","marks":[],"text":". 2023;72(30):809-814.","_key":"71abcd9baece3"}],"_type":"block","style":"normal"},{"style":"normal","_key":"82cfb8255ce2","markDefs":[{"blank":true,"_type":"link","href":"https://www.mdpi.com/2075-4450/11/1/13","_key":"1c85ba9c9b30"}],"children":[{"_type":"span","marks":[],"text":"5. Linske MA, Williams SC, Stafford KC 3rd, et al. ","_key":"0280da0b4af10"},{"_key":"0280da0b4af11","_type":"span","marks":["1c85ba9c9b30"],"text":"Determining effects of winter weather conditions on adult "},{"_key":"0280da0b4af12","_type":"span","marks":["1c85ba9c9b30","em"],"text":"Amblyomma americanum"},{"_key":"0280da0b4af13","_type":"span","marks":["1c85ba9c9b30"],"text":" (Acari: Ixodidae) survival in Connecticut and Maine, USA. "},{"marks":["em"],"text":"Insects","_key":"0280da0b4af14","_type":"span"},{"_key":"0280da0b4af15","_type":"span","marks":[],"text":". 2019;11(1):13."}],"_type":"block"},{"markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/28447914/","_key":"1a65756f8ac1","blank":true}],"children":[{"text":"6. Flaherty MG, Kaplan SJ, Jerath MR. 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","_key":"33550e8344e11","_type":"span"},{"_type":"span","marks":["em"],"text":"Cureus","_key":"33550e8344e12"},{"_type":"span","marks":[],"text":". 2022;14(8):e28443.","_key":"33550e8344e13"}],"_type":"block","style":"normal","_key":"1bd092ced1cf"},{"_key":"f58174bd73d0","markDefs":[{"blank":true,"_type":"link","href":"https://optiorx.com/wp-content/uploads/2023/11/POSTER_Understanding-Health-Related-Challenges-in-Patients-with-Alpha-Gal-Syndrome-Jasmine-Uchi.pdf","_key":"24a6a79041e6"}],"children":[{"_type":"span","marks":[],"text":"8. Uchi J. Understanding health-related challenges in patients with alpha-gal syndrome. Poster presented at the DIA Global Annual Meeting 2023 in Boston, MA. Accessed October 4, 2024. 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