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2024</time></div><h1 class="text-[26px] font-medium leading-8">The Week in Review: February 26-March 1</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/erin-o-brien">Erin O'Brien</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="The Week in Review: February 26-March 1" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg 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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="The Week in Review: February 26-March 1" 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">From personality disorders and common comorbidities to the effects of abortion bans on mental health, here are highlights from the week in Psychiatric Times.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class=""><div style="width:60%;float:center;max-width:525px;margin:0 auto 1rem;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=%271500%27%20height=%27824%27/%3e"/></span><img alt="Chepko Danil_AdobeStock" title="Chepko Danil_AdobeStock" 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="Chepko Danil_AdobeStock" title="Chepko Danil_AdobeStock" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F51d3cd8b64698f18bbaa58a4dd6d2804957c12c0-1500x824.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1920&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F51d3cd8b64698f18bbaa58a4dd6d2804957c12c0-1500x824.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F51d3cd8b64698f18bbaa58a4dd6d2804957c12c0-1500x824.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">Chepko Danil_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/51d3cd8b64698f18bbaa58a4dd6d2804957c12c0-1500x824.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">This week, <em>Psychiatric Times</em>® discussed a wide variety of psychiatric issues and industry updates, from personality disorders and common comorbidities to the effects of abortion bans on mental health.</p><p class="pb-2"></p><p class="pb-2"><strong>FDA Issues CRL for Roluperidone in the Treatment of Negative Symptoms of Schizophrenia</strong></p><div class=""><div style="width:40%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;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=%273840%27%20height=%273869%27/%3e"/></span><img alt="everything bagel_AdobeStock" title="everything bagel_AdobeStock" 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="everything bagel_AdobeStock" title="everything bagel_AdobeStock" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F8e4b544999520320bef1c3e63099377c88e6cec0-3840x3869.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 1x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F8e4b544999520320bef1c3e63099377c88e6cec0-3840x3869.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">everything bagel_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/8e4b544999520320bef1c3e63099377c88e6cec0-3840x3869.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">The US Food & Drug Administration (FDA) has issued a Complete Response Letter (CRL) in follow-up to the New Drug Application (NDA) for roluperidone (MIN-101) as a treatment for negative symptoms of schizophrenia. In the CRL, the FDA cited several clinical areas for improvement necessary for future approval of roluperidone.</p><p class="pb-2">The cited deficiencies include insufficient data to establish that the change in negative symptoms with roluperidone treatment was clinically meaningful, and a lack of data on concomitant administration of antipsychotic drugs in the NDA submission. The FDA also stated that there was an inadequate number of participants exposed to the proposed dose (64 mg) of roluperidone for at least 12 months in the safety database. <a target="_blank" href="https://www.psychiatrictimes.com/view/fda-issues-crl-for-roluperidone-in-the-treatment-of-negative-symptoms-of-schizophrenia"><strong>Continue Reading</strong></a></p><p class="pb-2"></p><p class="pb-2"><strong>An Update on Personality Disorders and Common Comorbidities</strong></p><div class=""><div style="width:40%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;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=%273840%27%20height=%271920%27/%3e"/></span><img alt="Anbuselvan/AdobeStock" title="Anbuselvan/AdobeStock" 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="Anbuselvan/AdobeStock" title="Anbuselvan/AdobeStock" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F10753a11a8c23b5f669206abe0eb2785ed2bccbc-3840x1920.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 1x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F10753a11a8c23b5f669206abe0eb2785ed2bccbc-3840x1920.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">Anbuselvan/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/10753a11a8c23b5f669206abe0eb2785ed2bccbc-3840x1920.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">Descriptions of character and temperament are ancient, found in Chinese and Greek writings from more than 2000 years ago. Hippocrates proposed a humoral theory of temperaments (sanguine, choleric, melancholic, and phlegmatic) in 400 BC. Emil Kraepelin classified patients with manic depression as depressive, hypomanic, or irritable.</p><p class="pb-2">Our current taxonomy of personality disorders derives from Kurt Schneider’s ‘‘psychopathic personalities,’’ which start in childhood and include depressive personality (depressive personality disorder, anankastic personality), obsessive-compulsive personality disorder, attention-seeking personality (histrionic personality disorder, labile personality), borderline personality disorder, and affectionless personality (antisocial and schizoid personality disorders). <a target="_blank" href="https://www.psychiatrictimes.com/view/an-update-on-personality-disorders-and-common-comorbidities"><strong>Continue Reading</strong></a></p><p class="pb-2"></p><p class="pb-2"><strong>Double Binds in Borderline Communication</strong></p><div class=""><div style="width:40%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;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=%273600%27%20height=%271884%27/%3e"/></span><img alt="VectorMine/AdobeStock" title="VectorMine/AdobeStock" 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="VectorMine/AdobeStock" title="VectorMine/AdobeStock" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F577404812d561d94e372223b07007c607ae4cbb3-3600x1884.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 1x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2F577404812d561d94e372223b07007c607ae4cbb3-3600x1884.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">VectorMine/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/577404812d561d94e372223b07007c607ae4cbb3-3600x1884.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">Borderline personality disorder (BPD) is a severe mental disorder characterized, in part, by paradoxical and self-defeating behavior, particularly in the realm of interpersonal relationships. Previously, I have described BPD as fundamentally a disorder of self-contradiction; via the process of cyclical psychodynamics, first described by Paul Wachtel, PhD, the patient with BPD inadvertently elicits precisely what they most fear.</p><p class="pb-2">An underappreciated aspect of BPD is the patient’s characteristic methods of communication. While several classic theorists have attempted to apply game-theoretical concepts to the understanding of psychopathology, such as Eric Berne, MD, and Thomas Szasz, MD, relatively little attention has been paid specifically to the communicative patterns of patients with BPD. <a target="_blank" href="https://www.psychiatrictimes.com/view/double-binds-in-borderline-communication"><strong>Continue Reading</strong></a></p><p class="pb-2"></p><p class="pb-2"><strong>How Abortion Bans Harm Mental Health</strong></p><div class=""><div style="width:40%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;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=%273840%27%20height=%272283%27/%3e"/></span><img alt="Prazis Images/AdobeStock" title="Prazis Images/AdobeStock" 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="Prazis Images/AdobeStock" title="Prazis Images/AdobeStock" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2Fbed69bd52d088fa5fe67dd6d9b64f2212e90e36a-3840x2283.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 1x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fpsychtimes%2Fbed69bd52d088fa5fe67dd6d9b64f2212e90e36a-3840x2283.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">Prazis Images/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/bed69bd52d088fa5fe67dd6d9b64f2212e90e36a-3840x2283.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">Frozen embryos are children, rules Alabama Supreme Court, meanwhile Alabama’s maternal mortality rate is the third highest in the nation. Instead of legislation aimed at reducing pregnancy-related deaths, Alabama’s government banned abortion in 2022 and now paves the way for more restrictions on reproductive care. Pregnant individuals living in states with abortion bans are more likely to die from a pregnancy-related complication than those living in states where abortion is legal. Meanwhile maternal mental health issues are driving an increase in death rates in the United States.</p><p class="pb-2">Lack of abortion access fuels mental illness by exacerbating stress, poverty, and domestic violence. Mental illness is one of the most common health problems in the United States. In fact, more than 1 in 5 individuals in the United States are living with a mental illness. A 2023 Gallup Survey found that 29% of US adults have been diagnosed with depression, an increase from 19.6% in 2015. Rates of depression among US adults tripled in the pandemic, resulting in part from collective trauma and isolation. <a target="_blank" href="https://www.psychiatrictimes.com/view/how-abortion-bans-harm-mental-health"><strong>Continue Reading</strong></a></p><p class="pb-2"></p><p class="pb-2">See more recent coverage from <em>Psychiatric Times </em><a target="_blank" href="https://www.psychiatrictimes.com/">here</a>. And be sure to stay up-to-date by subscribing to the <em>Psychiatric Times </em><a target="_blank" href="https://www.psychiatrictimes.com/view/enews?tfa_2=navbar">E-newsletter</a>.</p><p class="pb-2"></p><p class="pb-2"><em>Do you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? Write to us at <a rel="nofollow" target="_self" href="mailto:PTeditor@mmhgroup.com">PTeditor@mmhgroup.com</a>.</em></p><p class="pb-2"></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" style="scroll-snap-align:center;text-decoration:none" href="/view/potential-novel-schizophrenia-treatments"><div class="w-full shadow-md shadow-gray-800 overflow-hidden relative bg-white aspect-video"><span style="box-sizing:border-box;display:block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:absolute;top:0;left:0;bottom:0;right:0"><img alt="Erin Crown, PA-C, CAQ-Psychiatry, and John M. 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Steven Moffic, MD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/on-being-grateful?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 gap-x-4"><a class="jsx-ad50481d5ee26850" href="/view/beyond-dopamine-muscarinic-solutions-bring-new-hope-for-schizophrenia?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/psychtimes/15620d5296df4215dfbf6a510820b123d360e256-4630x2595.jpg?fit=crop&auto=format" alt="schizophrenia brain" width="288" class="jsx-ad50481d5ee26850 lg:w-[110px] lg:h-[100px] xl:w-[135px] xl:h-[125px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full xl:w-[70%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 20th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/beyond-dopamine-muscarinic-solutions-bring-new-hope-for-schizophrenia?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent">Beyond Dopamine: Muscarinic Solutions Bring New Hope for Schizophrenia</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/khutaija-noor-mbbs-fcr">Khutaija Noor, MBBS, FCR</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/beyond-dopamine-muscarinic-solutions-bring-new-hope-for-schizophrenia?utm_source=www.psychiatrictimes.com&utm_medium=relatedContent"></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"The Week in Review: February 26-March 1","datePublished":"2024-03-02T14:00:00.000Z","dateModified":"2024-03-01T17:56:26Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/psychtimes/51d3cd8b64698f18bbaa58a4dd6d2804957c12c0-1500x824.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.psychiatrictimes.com/view/the-week-in-review-february-26-march-1"},"publisher":{"@type":"Organization","name":"Psychiatric Times","logo":{"@type":"ImageObject","url":"https://www.psychiatrictimes.com/PsychiatricTimesLogo.png"}},"articleBody":"\n\nThis week, Psychiatric Times® discussed a wide variety of psychiatric issues and industry updates, from personality disorders and common comorbidities to the effects of abortion bans on mental health.\n\n\n\nFDA Issues CRL for Roluperidone in the Treatment of Negative Symptoms of Schizophrenia\n\n\n\nThe US Food & Drug Administration (FDA) has issued a Complete Response Letter (CRL) in follow-up to the New Drug Application (NDA) for roluperidone (MIN-101) as a treatment for negative symptoms of schizophrenia. In the CRL, the FDA cited several clinical areas for improvement necessary for future approval of roluperidone.\n\nThe cited deficiencies include insufficient data to establish that the change in negative symptoms with roluperidone treatment was clinically meaningful, and a lack of data on concomitant administration of antipsychotic drugs in the NDA submission. The FDA also stated that there was an inadequate number of participants exposed to the proposed dose (64 mg) of roluperidone for at least 12 months in the safety database. Continue Reading\n\n\n\nAn Update on Personality Disorders and Common Comorbidities\n\n\n\nDescriptions of character and temperament are ancient, found in Chinese and Greek writings from more than 2000 years ago. Hippocrates proposed a humoral theory of temperaments (sanguine, choleric, melancholic, and phlegmatic) in 400 BC. Emil Kraepelin classified patients with manic depression as depressive, hypomanic, or irritable.\n\nOur current taxonomy of personality disorders derives from Kurt Schneider’s ‘‘psychopathic personalities,’’ which start in childhood and include depressive personality (depressive personality disorder, anankastic personality), obsessive-compulsive personality disorder, attention-seeking personality (histrionic personality disorder, labile personality), borderline personality disorder, and affectionless personality (antisocial and schizoid personality disorders). Continue Reading\n\n\n\nDouble Binds in Borderline Communication\n\n\n\nBorderline personality disorder (BPD) is a severe mental disorder characterized, in part, by paradoxical and self-defeating behavior, particularly in the realm of interpersonal relationships. Previously, I have described BPD as fundamentally a disorder of self-contradiction; via the process of cyclical psychodynamics, first described by Paul Wachtel, PhD, the patient with BPD inadvertently elicits precisely what they most fear.\n\nAn underappreciated aspect of BPD is the patient’s characteristic methods of communication. While several classic theorists have attempted to apply game-theoretical concepts to the understanding of psychopathology, such as Eric Berne, MD, and Thomas Szasz, MD, relatively little attention has been paid specifically to the communicative patterns of patients with BPD. Continue Reading\n\n\n\nHow Abortion Bans Harm Mental Health\n\n\n\nFrozen embryos are children, rules Alabama Supreme Court, meanwhile Alabama’s maternal mortality rate is the third highest in the nation. Instead of legislation aimed at reducing pregnancy-related deaths, Alabama’s government banned abortion in 2022 and now paves the way for more restrictions on reproductive care. Pregnant individuals living in states with abortion bans are more likely to die from a pregnancy-related complication than those living in states where abortion is legal. Meanwhile maternal mental health issues are driving an increase in death rates in the United States.\n\nLack of abortion access fuels mental illness by exacerbating stress, poverty, and domestic violence. Mental illness is one of the most common health problems in the United States. In fact, more than 1 in 5 individuals in the United States are living with a mental illness. A 2023 Gallup Survey found that 29% of US adults have been diagnosed with depression, an increase from 19.6% in 2015. Rates of depression among US adults tripled in the pandemic, resulting in part from collective trauma and isolation. Continue Reading\n\n\n\nSee more recent coverage from Psychiatric Times here. And be sure to stay up-to-date by subscribing to the Psychiatric Times E-newsletter.\n\n\n\nDo you have a comment on any of these or other articles? Have a good idea for an article and want to write? Interested in sharing your perspectives? 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"},{"_type":"span","marks":["9b56e9523bf3","strong"],"text":"Continue Reading","_key":"465d0d014d951"}],"_type":"block","style":"normal","_key":"b945872778cf"},{"style":"normal","_key":"1a5fe2685cd3","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"6c63e01e9488"}],"_type":"block"},{"_key":"545e7eb05ddd","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"An Update on Personality Disorders and Common Comorbidities","_key":"ba41b1bdedd80"}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block","style":"normal"},{"imgcaption":[{"_type":"block","style":"normal","_key":"035f25343039","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Anbuselvan/AdobeStock","_key":"5c0c470bdbff0"}]}],"alignment":"right","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"909ae9946786","asset":{"_ref":"image-10753a11a8c23b5f669206abe0eb2785ed2bccbc-3840x1920-jpg","_type":"reference"},"widthP":40,"_type":"figure"},{"_type":"block","style":"normal","_key":"87e8cfc7e336","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Descriptions of character and temperament are ancient, found in Chinese and Greek writings from more than 2000 years ago. Hippocrates proposed a humoral theory of temperaments (sanguine, choleric, melancholic, and phlegmatic) in 400 BC. Emil Kraepelin classified patients with manic depression as depressive, hypomanic, or irritable.","_key":"a7df17d87c5a0"}],"upload_doc":null,"uploadAudio":null,"medias":null},{"medias":null,"_type":"block","style":"normal","_key":"15dd03ecba8d","markDefs":[{"href":"https://www.psychiatrictimes.com/view/an-update-on-personality-disorders-and-common-comorbidities","_key":"b9b0143e8f57","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"Our current taxonomy of personality disorders derives from Kurt Schneider’s ‘‘psychopathic personalities,’’ which start in childhood and include depressive personality (depressive personality disorder, anankastic personality), obsessive-compulsive personality disorder, attention-seeking personality (histrionic personality disorder, labile personality), borderline personality disorder, and affectionless personality (antisocial and schizoid personality disorders). ","_key":"3f12bcecbbe30"},{"_key":"3f12bcecbbe31","_type":"span","marks":["b9b0143e8f57","strong"],"text":"Continue Reading"}],"upload_doc":null,"uploadAudio":null},{"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"a3bcda36cf24"}],"_type":"block","style":"normal","_key":"810c42f5234f","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"Double Binds in Borderline Communication","_key":"d3d3954cdae30"}],"_type":"block","style":"normal","_key":"4966bd4d7a28","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[]},{"asset":{"_ref":"image-577404812d561d94e372223b07007c607ae4cbb3-3600x1884-jpg","_type":"reference"},"widthP":40,"uploadAudio":null,"_type":"figure","imgcaption":[{"children":[{"_type":"span","marks":[],"text":"VectorMine/AdobeStock","_key":"cbeac892c0a40"}],"_type":"block","style":"normal","_key":"9d24d7a2a029","markDefs":[]}],"_key":"1a2f650e30b6","alignment":"right","upload_doc":null,"medias":null},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Borderline personality disorder (BPD) is a severe mental disorder characterized, in part, by paradoxical and self-defeating behavior, particularly in the realm of interpersonal relationships. Previously, I have described BPD as fundamentally a disorder of self-contradiction; via the process of cyclical psychodynamics, first described by Paul Wachtel, PhD, the patient with BPD inadvertently elicits precisely what they most fear.","_key":"c90ca9a09dba0"}],"_type":"block","style":"normal","_key":"dcfa8f8abb62","upload_doc":null,"uploadAudio":null,"medias":null},{"upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/double-binds-in-borderline-communication","_key":"dfab9b8773d4"}],"children":[{"_type":"span","marks":[],"text":"An underappreciated aspect of BPD is the patient’s characteristic methods of communication. While several classic theorists have attempted to apply game-theoretical concepts to the understanding of psychopathology, such as Eric Berne, MD, and Thomas Szasz, MD, relatively little attention has been paid specifically to the communicative patterns of patients with BPD. 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Instead of legislation aimed at reducing pregnancy-related deaths, Alabama’s government banned abortion in 2022 and now paves the way for more restrictions on reproductive care. Pregnant individuals living in states with abortion bans are more likely to die from a pregnancy-related complication than those living in states where abortion is legal. Meanwhile maternal mental health issues are driving an increase in death rates in the United States."}],"_type":"block","style":"normal","_key":"cab2ab36e0b1","upload_doc":null,"uploadAudio":null,"medias":null},{"uploadAudio":null,"medias":null,"markDefs":[{"_key":"cbf243dbdc9e","blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/how-abortion-bans-harm-mental-health"}],"children":[{"_type":"span","marks":[],"text":"Lack of abortion access fuels mental illness by exacerbating stress, poverty, and domestic violence. Mental illness is one of the most common health problems in the United States. In fact, more than 1 in 5 individuals in the United States are living with a mental illness. A 2023 Gallup Survey found that 29% of US adults have been diagnosed with depression, an increase from 19.6% in 2015. Rates of depression among US adults tripled in the pandemic, resulting in part from collective trauma and isolation. 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psychiatry takes a dangerous turn when discussions lead to advocacy for assisted suicide policies for mental illness.","_updatedAt":"2024-11-18T18:54:09Z","title":"“Palliative Psychiatry” and Assisted Suicide: Compassion? 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Or Something Far Worse?","_createdAt":"2024-11-18T18:54:04Z","authors":[{"displayName":"Karandeep Sonu Gaind, MD","url":"karandeep-sonu-gaind-md"}],"factCheckAuthorMapping":null,"audioUrl":"https://s3.us-east-1.amazonaws.com/ai-generated-audios/www.psychiatrictimes.com/d4539d56-8c75-4ea6-a4d3-3ed1acb6535a_1731956045714.0964bf31-cce2-4d10-85a6-fee41f983292.mp3","articleType":"Commentary","_id":"d4539d56-8c75-4ea6-a4d3-3ed1acb6535a","documentGroup":null,"_type":"article","url":"palliative-psychiatry-and-assisted-suicide-compassion-abandonment-or-something-far-worse","ExcludeFromPubMedXML":false,"documentGroupMapping":null,"authorMapping":[{"_createdAt":"2024-11-18T17:24:48Z","biography":[{"_key":"5e6d3d345730","markDefs":[],"children":[{"_key":"a0ec3a53c9600","_type":"span","marks":["strong"],"text":"Dr Gaind"},{"_type":"span","marks":["em"],"text":" is a professor and governor at the University of Toronto, Chief of Psychiatry at Sunnybrook Health Sciences Centre, Honorary Member of the World Psychiatric Association and former president (but no longer member) of the Canadian Psychiatric Association. He is not a “conscientious objector” to PAD and previously was physician chair of his former hospital’s assisted dying team. 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The real issue is that palliative psychiatry takes a dangerous turn when discussions invariably lead to advocacy for assisted suicide policies for mental illness, which reflect neither palliative medicine, nor psychiatric care.","_key":"05701dbc2555","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2bf4456e29b4","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"(A note on terminology: Although Canada coined the term ","_key":"cb1454ac45be0"},{"text":"medical assistance in dying","_key":"cb1454ac45be1","_type":"span","marks":["em"]},{"_key":"cb1454ac45be2","_type":"span","marks":[],"text":" or "},{"_type":"span","marks":["em"],"text":"MAiD","_key":"cb1454ac45be3"},{"text":" in 2016, this author believes the term is a misnomer when providing death to individuals who are not otherwise in the process of dying. Instead, this paper will use the term ","_key":"cb1454ac45be4","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"physician-assisted death","_key":"cb1454ac45be5"},{"_type":"span","marks":[],"text":" [PAD].)","_key":"cb1454ac45be6"}],"_type":"block","style":"normal","_key":"f2e87092cae7","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"79bb11b79ec80"}],"_type":"block","style":"normal","_key":"7161f4495061","markDefs":[]},{"_key":"264dac2438aa","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Those in favor of PAD for mental illness cite the fact that some individuals die from their mental illness and propose that those with end stage psychiatric disorder should be able to apply for PAD. This rationale naively ignores the obvious distinction between whether some individuals die (we all die, life is a terminal condition) vs the real point of whether we can predict which individuals will not get better. Advocates propose making such predictions based on review of the patient’s historical course, but worldwide evidence shows that we remain unable to predict which individuals will recover, and which will have an irremediable mental illness.","_key":"ca3e23e9aa900"},{"_key":"da01324dffe4","_type":"span","marks":["superscript"],"text":"2"},{"text":" Even precision modeling of treatment-resistant depression suggests such attempted predictions are wrong over half the time.","_key":"17ef6ccf81b9","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"3","_key":"364d13947554"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"655a81d726dd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1ab6c80288ba0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"By ignoring this issue, while couching it as offering compassionate escape from unresolvable suffering, PAD providers would actually be providing death under false pretenses to many individuals who would have improved. In essence, the white lab coat will have colluded with the patient’s symptoms of despair in telling the patient (incorrectly most of the time) that they will never get better. PAD expansion advocates claim patient autonomy and competence are undermined if patients are not able to choose PAD for mental illness, but the reality is much starker—despite some believing otherwise, it is we as clinicians who are not competent to determine irremediability of mental illness, which is the fundamental premise of all PAD laws. Bypassing this core safeguard with unscientific and false predictions of irremediability, with individual practitioners conferring a medical credibility that does not exist, renders other potential safeguards meaningless.","_key":"aa6bfceb1c4d0"}],"_type":"block","style":"normal","_key":"6f2eafc1ee57"},{"style":"normal","_key":"9cb7d4ea3374","markDefs":[],"children":[{"text":"","_key":"807dd58be3bd0","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Concerningly in this debate, expansion advocates frequently mischaracterize that cautions against PAD for mental illness “have been based on religious, historical, and cultural arguments.”","_key":"e675149bbaa50"},{"_type":"span","marks":["superscript"],"text":"1","_key":"a04326234ee4"},{"_type":"span","marks":[],"text":" This belittles the evidence-based cautions that have been raised and dismisses widespread evidence demonstrating that expanding PAD beyond end-of-life conditions risks marginalized populations. Advocates cite data showing that privileged populations access PAD for end-of-life conditions to support arguments to expand PAD to mental illness, yet ignore the inconvenient truth that, unlike end-of-life PAD, psychiatric euthanasia is associated with unresolved social suffering and a 2:1 gender gap of twice as many women as men being provided death for their mental illness","_key":"64e04c1cb53e"},{"_type":"span","marks":["superscript"],"text":"4","_key":"58c3b6f675fb"},{"_key":"fe238adb91d0","_type":"span","marks":[],"text":" (which parallels the 2:1 ratio of women to men who attempt suicide when mentally ill, most of whom do not die by suicide and do not try again). Rather than being concerned about this gender gap, despite Canada not even requiring past access to treatment before providing PAD, the activists charged with establishing Canadian safeguards for psychiatric euthanasia concluded death by PAD could be provided for mental illness “without adding new legislative safeguards.”"},{"marks":["superscript"],"text":"5","_key":"c879ce8fbe59","_type":"span"},{"_type":"span","marks":[],"text":" The chair of the same federal panel openly stated the gender gap of twice as many women getting psychiatric euthanasia “does not concern” her since she doesn’t think “anybody knows what it means.”","_key":"4d0e9a190d38"},{"_type":"span","marks":["superscript"],"text":"6","_key":"a3212c0b3bf8"},{"_type":"span","marks":[],"text":" Advocates similarly ignore evidence showing overlapping characteristics of traditionally suicidal populations, who may benefit from suicide prevention, with those receiving PAD for mental illness.","_key":"98c1253311c1"},{"_type":"span","marks":["superscript"],"text":"7","_key":"f8efdc789898"},{"text":" Instead, similar to providing false reassurances of being able to predict irremediability, advocates make evidence-free claims they can separate suicidality from other motivations for psychiatric PAD requests. Essentially PAD assessors are taught it is “suicidality” if the patient is impulsive and acting on their own, but a different (and acceptable) motivation for PAD if they are instead coming to the assessor for a nonimpulsive PAD request.","_key":"cc834107bf53","_type":"span","marks":[]},{"marks":["superscript"],"text":"8","_key":"80ab099691fc","_type":"span"},{"_type":"span","marks":[],"text":" These so-called distinctions are based on a fallacy, evidence shows most suicides in North America are nonimpulsive.","_key":"11c53d8b4461"},{"text":"7","_key":"39d734c7552b","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal","_key":"666cae7c74b5"},{"_type":"block","style":"normal","_key":"cb3c541435d8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a3afb17ab8820"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"This raises the question of what our role as a profession is. At a recent American Psychiatric Association (APA) symposium on assisted dying hosted by the Council on Psychiatry and Law on September 23, panelists suggested it is not our role to set policy, but to follow shifting public views towards more expansive PAD policies. This bypasses a key role we, as medical experts, are charged with, which is ensuring that public views and policy are informed by medical evidence. Canada, which now provides more PAD than any other country and has seen the sharpest rise of PAD rates on the planet, is set to further expand PAD to mental illness by 2027, and our profession abdicated that role. A former Ontario Medical Association President has described our PAD processes as having fallen victim to regulatory capture, whereby a small but influential group of nonrepresentative individuals drives the policy process.","_key":"ee4fac7dd68f0"},{"_type":"span","marks":["superscript"],"text":"9","_key":"a5bbb3594c04"}],"_type":"block","style":"normal","_key":"67021bdc637e"},{"_type":"block","style":"normal","_key":"4aaf7ba683ca","markDefs":[],"children":[{"text":"","_key":"2d98bdd81e6b0","_type":"span","marks":[]}]},{"_key":"5aab81964bc7","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/suicide","_key":"6c16b56269d8"}],"children":[{"_type":"span","marks":[],"text":"As a past president of the Canadian Psychiatric Association (CPA), I have seen this in my own former association. During the consultations leading to Bill C-7 and the sunset clause, which is what led to Canada’s decision to expand PAD to mental illness, in all its written and oral submissions and input, CPA leadership never once mentioned suicide risks associated with mental illness or marginalization, nor spoke to the importance of suicide prevention.","_key":"04985532d44c0"},{"text":"10","_key":"632a55f5a5e5","_type":"span","marks":["superscript"]},{"text":" Indeed, the CPA never used the words “","_key":"ac088c07dd2c","_type":"span","marks":[]},{"_type":"span","marks":["6c16b56269d8"],"text":"suicide","_key":"2d90a168ce74"},{"marks":[],"text":",” “suicidal,” or any variant in any of these consultations on death seeking and mental illness. Imagine a respirologist association refusing to mention smoking as a risk factor for lung disease in public consultations on lung health. While feigning official “neutrality,” CPA leadership was publicly acknowledged as supporting psychiatric euthanasia by repeatedly claiming it would be discriminatory not to offer PAD for mental illness,","_key":"0625f789fe3e","_type":"span"},{"_type":"span","marks":["superscript"],"text":"11,12","_key":"8e50720b3398"},{"_type":"span","marks":[],"text":" this despite offering no evidence on how or whether irremediability could be predicted. And while making legalistic claims about discrimination, it openly declined offering medical evidence—when asked in Senate hearings whether the CPA agreed with other experts that more research was needed prior to providing PAD for mental illness, the CPA President replied “I guess that is a legislative decision.”","_key":"69ee3b1823bc"},{"_type":"span","marks":["superscript"],"text":"13","_key":"89668204e091"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d89c4f3d4f0e0"}],"_type":"block","style":"normal","_key":"85fb86075a53"},{"_key":"3465f882e6cd","markDefs":[],"children":[{"_key":"56aaf577e1d50","_type":"span","marks":[],"text":"Abdicating responsibility for providing evidence-based medical expertise regarding irremediability and suicidality, while uncritically facilitating expansion of PAD policies, represents a profound failure in Canada. Now we are seeing such blind spots emerge in US discussions as well. At the aforementioned APA Psychiatry and Law symposium, which was billed as discussing “Canadian challenges,” no panelist presented details of concerning data already emerging, even before Canada’s planned expansion of PAD to mental illness, that demonstrate some of our most vulnerable Canadians are being provided death for reasons associated with traditional suicidality. Of the over 13,000 Canadians euthanized by PAD in 2022, over one third cited feeling a burden and nearly one fifth cited loneliness as sources of suffering fueling their PAD requests."},{"_type":"span","marks":["superscript"],"text":"14","_key":"92c12bba3785"},{"_type":"span","marks":[],"text":" On the recently introduced “Track 2,” that allows PAD for nonterminal conditions to adults with any disability, including for nebulous conditions of frailty and hearing loss, gender gaps are emerging of a disproportionate number of women receiving PAD.","_key":"1976d0a8b3fa"},{"_type":"span","marks":["superscript"],"text":"14","_key":"ca71495e12d7"},{"_type":"span","marks":[],"text":" And the Ontario Chief Coroner, representing Canada’s most populous province, recently concluded that “individuals whose deaths were Track 2 (nonterminal) were much more likely to live in neighbourhoods with higher levels of residential instability, higher material deprivation, and greater dependency than those in Track 1 (end-of-life).”","_key":"46d868d0d36b"},{"marks":["superscript"],"text":"15","_key":"b31778e824ee","_type":"span"},{"_type":"span","marks":[],"text":" Yet none of this critical evidence entered the panelists’ discussions, which focussed instead on whether psychiatry should label some patients as having “terminal” psychiatric conditions to qualify these otherwise nondying individuals for PAD (which, as stated previously, would be based on nonscientific assessments wrongly predicting irremediability).","_key":"355011d5fcbf"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e4ae215b83540"}],"_type":"block","style":"normal","_key":"37f74b2a1e6a"},{"style":"normal","_key":"4244d23e57bf","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In Canada, again even before PAD expansion to mental illness, we are seeing individuals receiving PAD driven not by illness suffering, but by social suffering including poverty, housing insecurity, isolation, and lack of access to care.","_key":"28a745b40d140"},{"_type":"span","marks":["superscript"],"text":"16","_key":"a799cce79590"},{"_type":"span","marks":[],"text":" This does not mean that everyone getting PAD in these situations is driven by social suffering, but are we to ignore that these PAD expansions risk the marginalized seeking PAD not to avoid a painful death but to escape a painful life? The privileged perspective of some advocates does precisely that. Despite individuals who died by PAD themselves articulating that “it was not a disease that took me out, it was a system,”","_key":"c2c51d0d98eb"},{"_type":"span","marks":["superscript"],"text":"17","_key":"ab0686b98070"},{"_type":"span","marks":[],"text":" well-funded advocacy groups like Dying With Dignity","_key":"580b7185a3dc"},{"_type":"span","marks":["superscript"],"text":"18","_key":"e1a62edef7ea"},{"_type":"span","marks":[],"text":" boldly maintain that it is a “myth” that “vulnerable populations can be eligible (for PAD) if they are suffering from inadequate social supports, including housing”","_key":"1317072d3b50"},{"_key":"03cd900cbd15","_type":"span","marks":["superscript"],"text":"19"},{"marks":[],"text":" as they lobby those in power who have shaped PAD policies.","_key":"8397452eefe4","_type":"span"},{"_type":"span","marks":["superscript"],"text":"20","_key":"e871bafe8d3a"},{"_key":"11e095b91e7a","_type":"span","marks":[],"text":" Meanwhile, those in power rarely mention the cost savings of “death with dignity” compared with costly medical and social supports required for a life with dignity for those with disabilities."}],"_type":"block"},{"markDefs":[],"children":[{"text":"","_key":"a55a4c7392b10","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"bdaeb1429257"},{"_type":"block","style":"normal","_key":"c1db4defe52e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In this context, the failure of the profession to provide crucial evidence, while wrongly reassuring that assessors can predict irremediability and separate suicidality from PAD requests, is even more troubling. This failure entrenches an illusion falsely medicalizing and legitimizing that PAD is always provided to alleviate unresolvable illness suffering, when in reality the most marginalized are being provided death not to escape illness but to escape social suffering. Scholars are now emphasizing how, rather than being “cloaked as medical care,” assisted suicide is not only outside the field of palliative care, it should be outside the house of medicine.","_key":"152c0389c9c30"},{"_type":"span","marks":["superscript"],"text":"21","_key":"0730cf1e767b"}]},{"_key":"e0fe50729261","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b1c6b8af07690"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"82769b4f5b5b","markDefs":[],"children":[{"text":"The United Nations Office of the High Commissioner for Human Rights has recognized the risks of providing assisted suicide to marginalized nondying individuals, entreating that “disability should never be a ground or justification to end someone’s life directly or indirectly,” and concluding that “these assumptions, which are grounded in ableism and associated stereotypes, have been decisively rejected by the Convention on the Rights of Persons with Disabilities. Under no circumstance should the law provide that it could be a well-reasoned decision for a person with a disabling condition who is not dying to terminate their life with the support of the State.”","_key":"9ca56e5a7b090","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"22","_key":"ccf6ca2b778d"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"ab93765027b00"}],"_type":"block","style":"normal","_key":"bd41ff27d50e","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The concept of “terminal psychiatric illness,” as it relates to predicting who will never improve for purposes of qualifying for PAD, may reflect an ideology or a worldview, but it does not reflect evidence. It is not compassionate to collude with a patient’s mental illness symptoms and tell them they will never get better, when evidence shows us our predictions will be wrong over half the time. It is beyond abandonment to provide nondying, marginalized individuals death under false pretenses.","_key":"4746a7cd3c8e0"}],"_type":"block","style":"normal","_key":"d28b3a89d5da"},{"children":[{"_type":"span","marks":[],"text":"","_key":"e1e36319e7060"}],"_type":"block","style":"normal","_key":"be0083e9a711","markDefs":[]},{"_key":"cc04a7691b2b","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/topics/covid-19","_key":"021de72f2c0f"}],"children":[{"marks":[],"text":"During the ","_key":"3919aba077730","_type":"span"},{"_type":"span","marks":["021de72f2c0f"],"text":"COVID-19","_key":"a27fa96cf6bd"},{"_type":"span","marks":[],"text":" pandemic, concerns emerged that social policies jeopardizing marginalized lives were enabling “social murder,”","_key":"7c1f99e6069d"},{"_type":"span","marks":["superscript"],"text":"23","_key":"4ffc153430cb"},{"_key":"2e48dd3b0160","_type":"span","marks":[],"text":" a term coined by Friedrich Engels in the 19th century describing policies leading to working conditions causing the premature deaths of workers that Engels felt those in power were responsible for. As I point out in a recent "},{"text":"BMJ","_key":"3919aba077731","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" rapid response, “what more fitting term [than social murder] could there be to describe policies actively providing death to non-dying marginalized individuals, who seek readily available state facilitated suicide since society failed to offer opportunities to relieve social suffering?”","_key":"3919aba077732"},{"text":"24","_key":"3db351c59bc7","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"9d893e6f475c","markDefs":[],"children":[{"_key":"fcd90a81d94c0","_type":"span","marks":[],"text":""}]},{"style":"normal","_key":"b90d65a5c086","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Whatever our personal worldviews, the integrity of our profession demands that we ensure relevant evidence guides public policies, especially those literally involving life or death—the cost of complicity otherwise is just too high.","_key":"ffe7a891cb2e0"}],"_type":"block"},{"style":"normal","_key":"b3e54e9f7dd4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"90a23247916f0"}],"_type":"block"},{"style":"normal","_key":"acb62c4eacc9","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Gaind","_key":"faebca90e8c60"},{"_type":"span","marks":["em"],"text":" is a professor and governor at the University of Toronto, Chief of Psychiatry at Sunnybrook Health Sciences Centre, Honorary Member of the World Psychiatric Association and former president (but no longer member) of the Canadian Psychiatric Association. He is not a “conscientious objector” to PAD and previously was physician chair of his former hospital’s assisted dying team. Views expressed are his own and not meant to represent any group he works with.","_key":"faebca90e8c61"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"56f19257b8c90"}],"_type":"block","style":"normal","_key":"9a119182b1f8"},{"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"4b02365499ec0"}],"_type":"block","style":"normal","_key":"fb3434684f94","markDefs":[]},{"markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/end-of-life-care-for-patients-with-psychiatric-disorders","_key":"51614978fc10"}],"children":[{"text":"1. Yager J, Treem J, Strouse T. ","_key":"6c567cebd4f70","_type":"span","marks":[]},{"marks":["51614978fc10"],"text":"End-of-life care for patients with psychiatric disorders.","_key":"6c567cebd4f71","_type":"span"},{"_type":"span","marks":[],"text":" ","_key":"9072da371708"},{"_key":"6c567cebd4f72","_type":"span","marks":["em"],"text":"Psychiatric Times"},{"_type":"span","marks":[],"text":". 2024;41(9).","_key":"6c567cebd4f73"}],"_type":"block","style":"normal","_key":"f0e62ebe871c"},{"_type":"block","style":"normal","_key":"6c564763c78c","markDefs":[{"blank":true,"_type":"link","href":"https://www.eagMAID.org/report","_key":"6308481bc700"}],"children":[{"_type":"span","marks":[],"text":"2. Expert Advisory Group on Medical Assistance in Dying. Canada at a crossroads: recommendations on medical assistance in dying and persons with a mental disorder. An evidence-based critique of the Halifax Group IRPP Report. February 13, 2020. Accessed November 12, 2024. ","_key":"92ab42ec62970"},{"_type":"span","marks":["6308481bc700"],"text":"https://www.eagMAID.org/report","_key":"92ab42ec62971"}]},{"children":[{"_type":"span","marks":[],"text":"3. Nicolini ME, Jardas EJ, Zarae CA Jr, et al. ","_key":"ce8bb95a877c0"},{"_type":"span","marks":["e19cea5621a7"],"text":"Irremediability in psychiatric euthanasia: examining the objective standard.","_key":"ce8bb95a877c1"},{"_type":"span","marks":[],"text":" ","_key":"483f08ff3ade"},{"_key":"ce8bb95a877c2","_type":"span","marks":["em"],"text":"Psychol Med"},{"_type":"span","marks":[],"text":". 2022;53(12):5729-5747.","_key":"ce8bb95a877c3"}],"_type":"block","style":"normal","_key":"a2d274d879f5","markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/36305567/","_key":"e19cea5621a7","blank":true,"_type":"link"}]},{"style":"normal","_key":"811820fd1d01","markDefs":[{"blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/26864709/","_key":"25230693bf63"}],"children":[{"_key":"b90af549ea7a0","_type":"span","marks":[],"text":"4. Kim SY, De Vries RG, Peteet JR. "},{"text":"Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014.","_key":"b90af549ea7a1","_type":"span","marks":["25230693bf63"]},{"_type":"span","marks":[],"text":" ","_key":"9cad73110357"},{"text":"JAMA Psychiatry.","_key":"b90af549ea7a2","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" 2016;73(4):362-368.","_key":"b90af549ea7a3"}],"_type":"block"},{"markDefs":[{"href":"https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html","_key":"934bb3c04540","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"5. Final Report of the Expert Panel on MAID and Mental Illness. Health Canada. May 2022. Accessed November 12, 2024. ","_key":"683d2a0564900"},{"_type":"span","marks":["934bb3c04540"],"text":"https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html","_key":"683d2a0564901"}],"_type":"block","style":"normal","_key":"d674ba0f8200"},{"_type":"block","style":"normal","_key":"a2cba2a25413","markDefs":[{"blank":true,"_type":"link","href":"https://www.parl.ca/documentviewer/en/44-1/AMAD/meeting-38/evidence","_key":"c5797d23a253"}],"children":[{"_type":"span","marks":[],"text":"6. Meeting of the Special Joint Committee on Medical Assistance in Dying – Evidence, 44th Parliament, 1st Session. November 7, 2023. Accessed November 12, 2024. ","_key":"7a80b76545940"},{"text":"https://www.parl.ca/documentviewer/en/44-1/AMAD/meeting-38/evidence","_key":"7a80b76545941","_type":"span","marks":["c5797d23a253"]}]},{"style":"normal","_key":"5883cad02bcd","markDefs":[{"_key":"47cc8913895b","blank":true,"_type":"link","href":"https://cca-reports.ca/wp-content/uploads/2018/12/The-State-of-Knowledge-on-Medical-Assistance-in-Dying-Where-a-Mental-Disorder-is-the-Sole-Underlying-Medical-Condition.pdf"}],"children":[{"text":"7. Council of Canadian Academies. The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition. The Expert Panel Working Group on MAID Where a Mental Disorder Is the Sole Underlying Medical Condition. 2018. Accessed November 12, 2024. ","_key":"80294180340f0","_type":"span","marks":[]},{"text":"https://cca-reports.ca/wp-content/uploads/2018/12/The-State-of-Knowledge-on-Medical-Assistance-in-Dying-Where-a-Mental-Disorder-is-the-Sole-Underlying-Medical-Condition.pdf","_key":"80294180340f1","_type":"span","marks":["47cc8913895b"]}],"_type":"block"},{"markDefs":[{"blank":true,"_type":"link","href":"https://www.parl.ca/documentviewer/en/44-1/AMAD/meeting-40/evidence","_key":"c986f88c414d"}],"children":[{"_type":"span","marks":[],"text":"8. Meeting of the Special Joint Committee on Medical Assistance in Dying – Evidence, 44th Parliament, 1st Session. November 28, 2023. Accessed November 12, 2024. ","_key":"684824ffca010"},{"_type":"span","marks":["c986f88c414d"],"text":"https://www.parl.ca/documentviewer/en/44-1/AMAD/meeting-40/evidence","_key":"684824ffca011"}],"_type":"block","style":"normal","_key":"0c5072fffc49"},{"_type":"block","style":"normal","_key":"60f7fe513778","markDefs":[{"blank":true,"_type":"link","href":"https://macdonaldlaurier.ca/assisted-suicide-activists-should-not-be-running-our-maid-program-shawn-whatley-in-the-national-post/","_key":"0789154dbc6d"}],"children":[{"text":"9. Whatley S. Assisted suicide activists should not be running our MAiD program. ","_key":"2f36a5273bcb0","_type":"span","marks":[]},{"marks":["em"],"text":"National Post","_key":"2f36a5273bcb1","_type":"span"},{"_type":"span","marks":[],"text":". December 28, 2023. Accessed November 12, 2024. 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It is a religious moment also, and here is the danger . . . The public yearning for Order will invite many stubborn uncompromising persons to impose it. The sadness of the zoo will fall upon society.”","_key":"6f680a54385b0","_type":"span","marks":[]}],"_type":"block","style":"blockquote","_key":"d7e6a5ec21f1"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1e04df0565f90"}],"_type":"block","style":"normal","_key":"163106ddcdd1"},{"markDefs":[],"children":[{"marks":[],"text":"As Maria Popova discusses in her recent November 17, 2024, post, “Leonard Cohen on the Antidote to Anger,”","_key":"e761f4678cb50","_type":"span"},{"_type":"span","marks":["superscript"],"text":"2","_key":"c5f1b971c3db"},{"marks":[],"text":" it is human nature to look to authority figures in times of helplessness and uncertainty. However, when the helping hand is metaphorically in a clenched fist, it is likely a false messiah. When it is the shape of an open hand, it is more likely to be a reflection of the love we find in the best of religion, spirituality, and community.","_key":"9b956b0769ff","_type":"span"}],"_type":"block","style":"normal","_key":"3f8c7b7611f5"},{"children":[{"_type":"span","marks":[],"text":"","_key":"f9c1ec3ce62b0"}],"_type":"block","style":"normal","_key":"7b6da3edbd6f","markDefs":[]},{"_type":"block","style":"normal","_key":"4fedeef15098","markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/paradoxical-therapy-and-politics","_key":"cc8efa2cd581"}],"children":[{"_type":"span","marks":[],"text":"This antidote of love may not be obvious, but even paradoxical in the sense of our ","_key":"d44ffb8ffe750"},{"text":"last column","_key":"d44ffb8ffe751","_type":"span","marks":["cc8efa2cd581"]},{"_type":"span","marks":[],"text":". So Cohen ends another poem in that book, “SOS 1995,” with the implication of the second coming of an emergency call for help that we now have a generation later","_key":"d44ffb8ffe752"},{"text":"1","_key":"2e198c109227","_type":"span","marks":["superscript"]},{"text":":","_key":"77a28117704e","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_key":"1cd887638d900","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"b0fc833866af"},{"_type":"block","style":"normal","_key":"3a349be42da5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“the Devil tempting me","_key":"3695f368bf2c0"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"To turn way from alarming you,","_key":"0cda07599d910"}],"_type":"block","style":"normal","_key":"185687f5608b"},{"children":[{"_type":"span","marks":[],"text":"","_key":"b0d4d42bca540"}],"_type":"block","style":"normal","_key":"53d09ae161ac","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"So I must say it quickly","_key":"97e904d003d60"}],"_type":"block","style":"normal","_key":"367def27860e","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"Whoever is in your life,","_key":"828960a87e100","_type":"span"}],"_type":"block","style":"normal","_key":"324f9cb06eea"},{"_type":"block","style":"normal","_key":"e89736b6d214","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Those who harm you,","_key":"b41a42a6d8c10"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Those who help you;","_key":"b03e7d6aaca60"}],"_type":"block","style":"normal","_key":"1d702e4e9c41"},{"children":[{"_type":"span","marks":[],"text":"Those whom you know","_key":"98a6799b04230"}],"_type":"block","style":"normal","_key":"514235615ccc","markDefs":[]},{"style":"normal","_key":"383d2fd64320","markDefs":[],"children":[{"text":"And those whom you do not know -","_key":"2f2cd275db9a0","_type":"span","marks":[]}],"_type":"block"},{"style":"normal","_key":"7c5afaddadfd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Let them off the hook,","_key":"93b0f648fa7a0"}],"_type":"block"},{"style":"normal","_key":"05a48c33a46b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Help them off the hook.","_key":"bb23612f429b0"}],"_type":"block"},{"_type":"block","style":"normal","_key":"5f0bb810a0c6","markDefs":[],"children":[{"text":"You are listening to Radio Resistance.”","_key":"58cded1f26570","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5df48d68a13f0"}],"_type":"block","style":"normal","_key":"0293b89b76f4"},{"children":[{"text":"A similar message occurred in the directly connected second coming and reelection of President Lincoln, who was a moderate Republican of his time. He conveyed a related sacred liturgy in his Second Inaugural Address:","_key":"d96fc58bc82e0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2af1f4dc5b04","markDefs":[]},{"_type":"block","style":"normal","_key":"cc3891f6aeff","markDefs":[],"children":[{"text":"","_key":"2dfb03109db40","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“With malice toward none; with charity for all; with firmness in the right, as God gives us to see the right, let us drive on to finish the work; . . . to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.”","_key":"9ea65002beac0"}],"_type":"block","style":"blockquote","_key":"789e6e08b975"},{"markDefs":[],"children":[{"text":"","_key":"84df31c896580","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c6392aa68e9d"},{"_type":"block","style":"normal","_key":"fdf7c2ba14aa","markDefs":[{"blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/paradoxical-therapy-and-politics","_key":"9e90c1f04312"}],"children":[{"_key":"8528fbf7485d0","_type":"span","marks":[],"text":"I suppose that both Cohen’s and Lincoln’s connecting and compassionate statements might seem naive and quaint nowadays. Perhaps a "},{"_type":"span","marks":["9e90c1f04312"],"text":"paradox","_key":"8528fbf7485d1"},{"_type":"span","marks":[],"text":"?\n\n","_key":"8528fbf7485d2"}]},{"_type":"block","style":"normal","_key":"7a795d44232e","markDefs":[{"_key":"6c391f2d7795","blank":true,"_type":"link","href":"https://www.psychiatrictimes.com/view/what-about-love-in-the-workplace"}],"children":[{"_type":"span","marks":[],"text":"In psychiatry, and on the way to this second coming,","_key":"6c1b9fcb719b0"},{"_key":"5470fa3f7365","_type":"span","marks":["superscript"],"text":"3"},{"_type":"span","marks":[],"text":" we know that there has been a general increase in mental disorders and disturbances on all political and religious sides over years. There is a saying to “look for the helpers,” and we will do so in our next column. But we should also “look for the lovers” in our current time of major conflict. These are not the passionate sexually-drawn lovers and scandals, but as I tried to describe in our November 3, 2021, video “","_key":"ae9e8f723e90"},{"marks":["6c391f2d7795"],"text":"What About Love in the Workplace","_key":"6c1b9fcb719b1","_type":"span"},{"_type":"span","marks":[],"text":",” the kind of caring and humanitarian love in the spirit of connecting religion and psychiatry, and in the best of clinical and administrative psychiatric work.","_key":"6c1b9fcb719b2"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"10272c24b1900"}],"_type":"block","style":"normal","_key":"a1093c2b43b1"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Moffic","_key":"5b1dfcc9977c0"},{"_type":"span","marks":[],"text":" ","_key":"5b1dfcc9977c1"},{"_type":"span","marks":["em"],"text":"is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry \u0026 Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. 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","_key":"8aa24313bb1b0"},{"text":"Book of Longing.","_key":"8aa24313bb1b1","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" Ecco; 2006.","_key":"8aa24313bb1b2"}]},{"markDefs":[{"_type":"link","href":"https://www.themarginalian.org/2024/07/18/leonard-cohen-anger-resistance/","_key":"07b7cb0988b3","blank":true}],"children":[{"marks":[],"text":"2. Popova M. Leonard Cohen on the antidote to anger. The Marginalian. Accessed November 21, 2024. ","_key":"55340de25c380","_type":"span"},{"_type":"span","marks":["07b7cb0988b3"],"text":"https://www.themarginalian.org/2024/07/18/leonard-cohen-anger-resistance/","_key":"55340de25c381"}],"_type":"block","style":"normal","_key":"1db8248ea3e0"},{"markDefs":[{"_type":"link","href":"https://www.nybooks.com/articles/2024/12/05/the-second-coming-fintan-otoole/?srsltid=AfmBOoou2L_P5K6YB0ofcxjeK-SGjM-sphTEChPymPY1Q8hXaUMNHjHD","_key":"03da96b81265","blank":true}],"children":[{"text":"3. O’Toole F. The second coming. 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His writings reflect on societal bewilderment and the human tendency to seek authoritative figures during uncertainty. Cohen's message, akin to Lincoln's, emphasizes compassion and love as antidotes to anger and societal discord. The article underscores the importance of humanitarian love in psychiatry, especially amidst rising mental health issues. Dr. Moffic, a retired psychiatrist, continues to advocate for mental health and societal issues.","ExcludeFromPubMedXML":false,"_createdAt":"2024-11-21T14:16:39Z","summary":"There has been a general increase in mental disorders and disturbances on all political and religious sides over years. ","documentGroup":{"identifier":{"current":"psychiatric-views-on-the-daily-news","_type":"slug"},"_createdAt":"2021-10-28T16:33:24Z","name":"Psychiatric Views on the Daily News","_id":"a839f9ba-d69f-4a5a-a330-d0e6b8d9fce9","isShow":true,"parent":{"_updatedAt":"2021-10-08T09:12:25Z","identifier":{"_type":"slug","current":"series"},"_createdAt":"2020-03-26T06:12:02Z","_rev":"xOG5peVv8n6C7S2w86PQEH","parent":null,"_type":"documentGroup","name":"Series","_id":"pst_documentGroup_53204_series"},"isSeries":false,"_updatedAt":"2023-01-06T21:35:44Z","pixelTrackingCode":null,"_rev":"Nb8LeHROZGYg4NHdvjPMeS","_type":"documentGroup","published":"2021-10-28T16:33:00.000Z","isGated":false},"factCheckAuthors":null,"documentGroupMapping":null,"_id":"8070d730-5174-4319-bf68-92e718c97ad4","is_visible":true,"taxonomyMapping":[{"parent":null,"identifier":"commentary","name":"Commentary","_updatedAt":"2021-10-07T14:44:33Z","_id":"pst_taxonomy_54_commentary","pixelTrackingCode":null,"_createdAt":"2020-03-26T06:11:21Z","_rev":"CT8kz40NBv9JvHKzAk1arA","_type":"taxonomy"}],"articleType":"Blog","drugMentions":"{\"drug_mentions\": []}","authors":[{"displayName":"H. Steven Moffic, MD","url":"h-steven-moffic-md"}],"factCheckAuthorMapping":null,"authorMapping":[{"_rev":"geYrsaD3ijmzedpw6GnES1","_type":"author","_id":"pst_author_322595","biography":[{"children":[{"_type":"span","marks":["strong"],"text":"Dr Moffic","_key":"ada5b7a9b843"},{"_type":"span","marks":[],"text":" ","_key":"207bec418af2"},{"_type":"span","marks":["em"],"text":"(he/himhis)","_key":"9766b78b3fdb"},{"_key":"5d0b1559606f","_type":"span","marks":[],"text":" "},{"_type":"span","marks":["em"],"text":"is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry, and is now in retirement and refirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry \u0026 Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now","_key":"4f58f875b316"},{"_key":"4a00caaa2c0a","_type":"span","marks":[],"text":" The Eastern Religions, and Spirituality"},{"_key":"4f26d5e6d022","_type":"span","marks":["em"],"text":". He serves on the Editorial Board of"},{"_type":"span","marks":[],"text":" Psychiatric Times","_key":"8df506c4a3c3"},{"_type":"span","marks":["em"],"text":".","_key":"f84ef6d63c25"}],"_type":"block","style":"normal","_key":"db4cf1b0a36a","markDefs":[]}],"_updatedAt":"2023-11-06T15:02:13Z","url":{"current":"h-steven-moffic-md","_type":"slug"},"displayName":"H. Steven Moffic, MD","_createdAt":"2020-02-21T11:23:21Z"}],"_rev":"A6PliCZ1q3f327pdIE7osi","gptTakeaways":"• Leonard Cohen found solace in Buddhism and Judaism, reflecting on societal bewilderment and the search for authoritative figures during uncertainty.\n\n• Cohen and Lincoln both emphasized compassion and love as antidotes to anger and societal discord.\n\n• Humanitarian love is crucial in psychiatry, especially amidst rising mental health issues across political and religious divides.\n\n• Dr. Moffic, a retired psychiatrist, advocates for mental health and societal issues, emphasizing the connection between religion and psychiatry.","title":"A Second Coming: Leonard Cohen on Real and False Religion in Dark Times","_type":"article","thumbnail":{"_type":"mainImage","alt":"candles","caption":"stokkete/AdobeStock","asset":{"_ref":"image-62db06179561ad7205e6501c30e492a6c09642e3-5600x3737-jpg","_type":"reference"}},"targeting":{"content_placement":["commentary"],"document_url":["a-second-coming-leonard-cohen-on-real-and-false-religion-in-dark-times"],"document_group":{"identifier":{"current":"psychiatric-views-on-the-daily-news","_type":"slug"},"_createdAt":"2021-10-28T16:33:24Z","name":"Psychiatric Views on the Daily News","_id":"a839f9ba-d69f-4a5a-a330-d0e6b8d9fce9","isShow":true,"parent":{"_updatedAt":"2021-10-08T09:12:25Z","identifier":{"_type":"slug","current":"series"},"_createdAt":"2020-03-26T06:12:02Z","_rev":"xOG5peVv8n6C7S2w86PQEH","parent":null,"_type":"documentGroup","name":"Series","_id":"pst_documentGroup_53204_series"},"isSeries":false,"_updatedAt":"2023-01-06T21:35:44Z","pixelTrackingCode":null,"_rev":"Nb8LeHROZGYg4NHdvjPMeS","_type":"documentGroup","published":"2021-10-28T16:33:00.000Z","isGated":false},"rootDocumentGroup":["series"],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"Hineni: Looking for the Healers and Healing in Our Presidential Transition","url":{"current":"hineni-looking-for-the-healers-and-healing-in-our-presidential-transition","_type":"slug"},"thumbnail":{"asset":{"_type":"reference","_ref":"image-a3ad7cbf519b6805ff3500e425f90d54dbf78803-3648x3178-jpg"},"_type":"mainImage","alt":"politics","caption":"Syda Productions/AdobeStock"},"published":"2024-11-22T13:40:10.897Z"},{"title":"A Second Coming: Leonard Cohen on Real and False Religion in Dark Times","url":{"current":"a-second-coming-leonard-cohen-on-real-and-false-religion-in-dark-times","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"candles","caption":"stokkete/AdobeStock","asset":{"_ref":"image-62db06179561ad7205e6501c30e492a6c09642e3-5600x3737-jpg","_type":"reference"}},"published":"2024-11-21T14:16:46.239Z"},{"title":"On Being Grateful","url":{"current":"on-being-grateful","_type":"slug"},"thumbnail":{"_type":"mainImage","alt":"grateful","caption":"Marinela/AdobeStock","asset":{"_ref":"image-7b0eb22790865dbef56ec32e61a01eaedaf41627-6000x4000-jpg","_type":"reference"}},"published":"2024-11-20T21:00:07.881Z"},{"title":"“Our Capes Are Killing Us”: How Do We Support Men’s Mental Health Month? 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Affecting roughly 20 million individuals worldwide, ","_key":"c6451866522a0","_type":"span","marks":[]},{"_type":"span","marks":["16c025d77354"],"text":"schizophrenia","_key":"3daf560f7909"},{"text":" robs individuals of cognitive clarity, emotional stability, and social connection.","_key":"48c8d200ed41","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"1","_key":"083d52d370aa"},{"_type":"span","marks":[],"text":" Though antipsychotic medications have transformed the prognosis for many, they often come with harsh physical and social costs: movement disorders, metabolic disturbances, weight gain, and sedation. Today, however, a revolutionary approach may be unfolding through the study of muscarinic receptors, which could allow patients to manage symptoms without the burdens of traditional dopamine-based therapies. This groundbreaking work offers hope not just for symptom relief but for a life unburdened by the adverse effects and stigma that come with current treatment.","_key":"831de9cb77ee"}],"_type":"block","style":"normal","_key":"aa72289db71d"},{"_type":"block","style":"normal","_key":"68005142df58","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"95e19c2552700"}]},{"_type":"block","style":"normal","_key":"a271675c9a46","markDefs":[],"children":[{"_type":"span","marks":[],"text":"As research on muscarinic receptor modulation advances, the potential to transform psychiatry—and possibly other fields of medicine—becomes ever more real. By shifting from dopamine antagonism to muscarinic modulation, we could be on the brink of a paradigm shift that extends far beyond schizophrenia treatment.","_key":"e222f8d019a70"}]},{"children":[{"_key":"d3a28709dc0d0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"63dea5b439fd","markDefs":[]},{"_key":"9998754368a5","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"The Quest for a Comprehensive Approach: Beyond Dopamine","_key":"428d64ef99460"}],"_type":"block","style":"normal"},{"_key":"fc0a9fe8add2","markDefs":[{"_type":"link","href":"https://www.psychiatrictimes.com/topics/tardive-dyskinesia","_key":"704e96ed84ea","nofollow":true,"blank":true}],"children":[{"_type":"span","marks":[],"text":"Dopamine-blocking drugs have been the primary therapy for schizophrenia since the 1950s,","_key":"f8e8ae4bfe2f0"},{"_type":"span","marks":["superscript"],"text":"2","_key":"831630002f82"},{"marks":[],"text":" achieving effectiveness in reducing hallucinations and delusions. 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In a survey capturing the lived experiences of individuals with schizophrenia on antipsychotic medications, 27% of participants reported that antipsychotics had done “more harm than good.”","_key":"253db6dbffb4"},{"text":"3","_key":"55b4a3a29f61","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"3244de49ff180"}],"_type":"block","style":"normal","_key":"6a7ffb9655d0"},{"_type":"block","style":"normal","_key":"41dac818b7dd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Furthermore, current antipsychotics often fail to address cognitive deficits and negative symptoms, leaving many patients with impaired memory, motivation, and social engagement. Without improvements in these areas, a gap remains in symptom management, preventing truly comprehensive treatment.","_key":"bc044db8f6440"}]},{"style":"normal","_key":"b00ea089b0b2","markDefs":[],"children":[{"text":"","_key":"81b8c5aaac510","_type":"span","marks":[]}],"_type":"block"},{"_key":"ca2031ed6d94","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Muscarinic Receptors: A Breakthrough Pathway","_key":"bcbb2264f47c0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Recent years have brought us to a pivotal discovery: the muscarinic cholinergic system, specifically the M1 and M4 receptor subtypes, offers a promising alternative target in schizophrenia treatment.","_key":"788178e22adf0"},{"_type":"span","marks":["superscript"],"text":"4","_key":"cb2db38edde0"},{"_type":"span","marks":[],"text":" Unlike dopamine receptors, which are directly antagonized in traditional treatments, muscarinic receptors modulate neurotransmission in a way that can regulate dopamine indirectly, without the associated adverse effects. Muscarinic receptors are distributed in regions of the brain essential for cognition, mood, and behavioral regulation, aligning well with the core symptoms of schizophrenia.","_key":"8608cf860694"}],"_type":"block","style":"normal","_key":"90d85671b4f1"},{"markDefs":[],"children":[{"marks":[],"text":"","_key":"347172f9ca120","_type":"span"}],"_type":"block","style":"normal","_key":"c888ccb914ac"},{"markDefs":[],"children":[{"_key":"9a1f68c63f590","_type":"span","marks":[],"text":"The muscarinic hypothesis of schizophrenia suggests that dysfunction in cholinergic pathways may contribute to psychosis, cognitive impairments, and emotional dysregulation. By modulating these receptors, researchers have opened an exciting frontier: a pathway that could simultaneously improve cognitive performance, motivation, and mood without triggering metabolic or movement-related adverse effects."},{"marks":["superscript"],"text":"5","_key":"6382329b5a50","_type":"span"}],"_type":"block","style":"normal","_key":"8748dcd1b354"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2631422eff2f0"}],"_type":"block","style":"normal","_key":"e61f852a34fe"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Xanomeline: A New Hope for Adverse-Effect-Free Treatment","_key":"c7d964afb9950"}],"_type":"block","style":"normal","_key":"f19f37a56cfc"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Xanomeline, is FDA approved, selective M1/M4 muscarinic receptor agonist,","_key":"74e706b8d5720"},{"_type":"span","marks":["superscript"],"text":"6","_key":"79267986e10b"},{"marks":[],"text":" is one of the most promising agents in this new class of treatments. Originally studied for Alzheimer disease, xanomeline demonstrated strong efficacy in managing psychotic symptoms and enhancing cognitive function.","_key":"6411d469e536","_type":"span"},{"_type":"span","marks":["superscript"],"text":"7","_key":"61286e7a7364"},{"_type":"span","marks":[],"text":" When repurposed for schizophrenia, clinical trials revealed that xanomeline could reduce both positive and negative symptoms—without the weight gain, sedation, or motor adverse effects that plague dopamine blockers.","_key":"da85833f15e4"},{"text":"6","_key":"f76777ad513a","_type":"span","marks":["superscript"]}],"_type":"block","style":"normal","_key":"605c1ee35ba4"},{"_key":"7550ec083239","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"aa5fec27ff2d0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"6877bed469b4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For patients, this means more than just relief from psychotic symptoms; it offers a pathway to reclaiming cognitive function, social engagement, and physical health. Such improvements address the full spectrum of schizophrenia’s impact, enhancing quality of life on every level. Early results from xanomeline trials show that patients experience significant efficacy in reducing symptoms of acute psychosis in individuals","_key":"0517cb71390a0"},{"_key":"e1a4ad93008e","_type":"span","marks":["superscript"],"text":"8"},{"_type":"span","marks":[],"text":" and fewer adverse effects, stay more socially active, and feel more motivated—a combination that has long been out of reach with dopamine-based medications.","_key":"90a47485bd9f"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"ae5f8832f03d0"}],"_type":"block","style":"normal","_key":"7bdc00f0bec6","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Reducing Adverse Effects, Reducing Stigma","_key":"1f0d5b07ae020"}],"_type":"block","style":"normal","_key":"379379d26ba0"},{"children":[{"_type":"span","marks":[],"text":"Perhaps one of the most transformative implications of muscarinic modulation lies in its potential to reduce the visible, stigmatizing adverse effects of antipsychotics. Physical changes like weight gain and movement issues not only impact self-image and health but also reinforce societal stigma, isolating patients from family, friends, and work. Muscarinic receptor therapies, with their reduced adverse effect profile, present an opportunity to lift this dual burden, allowing patients to reintegrate socially and engage with their communities. In this way, muscarinic receptor research not only holds the promise of symptom relief; it offers patients a chance at dignity, inclusion, and a life free from the physical and social costs of traditional treatment.","_key":"3291cc142fb40"}],"_type":"block","style":"normal","_key":"017df005e638","markDefs":[]},{"_type":"block","style":"normal","_key":"68b9554a20be","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"46c3e274f8520"}]},{"_key":"41526a1bf1a7","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Challenges on the Path to Innovation","_key":"82cb461b8dfb0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"b876f78aa3ee","markDefs":[],"children":[{"_key":"47b9bc58659b0","_type":"span","marks":[],"text":"While the muscarinic pathway offers hope, it also presents unique scientific challenges. Muscarinic receptors are widely distributed throughout the body, and achieving selective targeting within the central nervous system requires precision. Efforts are currently underway to develop compounds that act exclusively on the M1 and M4 receptors in the brain, minimizing peripheral adverse effects such as gastrointestinal or cardiovascular issues. The long-term safety profile of muscarinic modulators also needs to be thoroughly evaluated to confirm their efficacy and tolerability over time."}]},{"style":"normal","_key":"fd9777e4fe52","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e4eb53c0090a0"}],"_type":"block"},{"children":[{"_key":"75002f2046cf0","_type":"span","marks":[],"text":"Nonetheless, the scientific and therapeutic potential is clear. Muscarinic modulation is more than a symptom-management strategy—it represents a paradigm shift that prioritizes patients’ mental and physical well-being."}],"_type":"block","style":"normal","_key":"f419aa43589a","markDefs":[]},{"_type":"block","style":"normal","_key":"be1c4f9a31f4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a152092e38130"}]},{"markDefs":[],"children":[{"_key":"5a13db1db2250","_type":"span","marks":["strong"],"text":"Broad Implications for Psychiatry and Medicine"}],"_type":"block","style":"normal","_key":"1b9fa576dab7"},{"children":[{"_type":"span","marks":[],"text":"The implications of muscarinic modulation could extend well beyond schizophrenia. Given that muscarinic receptors are involved in regulating cognition, mood, and memory, this line of research could have applications in other neuropsychiatric and neurodegenerative disorders. Cognitive and mood-related impairments in conditions like bipolar disorder, depression, and Alzheimer disease share characteristics with schizophrenia’s negative and cognitive symptoms, suggesting that muscarinic modulation might offer benefits across diagnostic categories.","_key":"bfa8c662f5aa0"}],"_type":"block","style":"normal","_key":"8903d80c7aa4","markDefs":[]},{"_key":"f06aa3a71e49","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b77e61617d190"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"As psychiatry moves toward a more personalized and comprehensive approach, muscarinic receptor research exemplifies the kind of innovation that could transform not just treatment but the philosophy of care itself. By addressing root mechanisms in cognition, mood, and motivation, muscarinic therapies have the potential to address multiple symptoms simultaneously, creating a holistic effect that aligns closely with real-world patient needs.","_key":"41fd801587720"}],"_type":"block","style":"normal","_key":"3c62dbad62a5"},{"style":"normal","_key":"5e3ff8c917a5","markDefs":[],"children":[{"_key":"e568326949bd0","_type":"span","marks":[],"text":""}],"_type":"block"},{"_type":"block","style":"normal","_key":"966a7177f8fe","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"The Future of Schizophrenia Treatment: A Vision Realized","_key":"34b08d3bf01b0"}]},{"style":"normal","_key":"1edd561d3963","markDefs":[],"children":[{"text":"Muscarinic receptor modulation is not simply an alternative to dopamine-based treatment; it represents a long-awaited shift in the treatment of schizophrenia and possibly the field of psychiatry at large. By exploring a new pathway that minimizes adverse effects, this research aligns with a future in which patients do not have to choose between symptom relief and overall health. For those living with schizophrenia, muscarinic therapies could mean regaining control over their lives—free from the physical and social burdens imposed by current medications.","_key":"a24f6f9aab6b0","_type":"span","marks":[]}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"868fc3f6449a0"}],"_type":"block","style":"normal","_key":"76becf9d20eb"},{"style":"normal","_key":"3c5122447a24","markDefs":[],"children":[{"_type":"span","marks":[],"text":"As we stand on the cusp of this breakthrough, it is worth reflecting on the impact such therapies could have. Imagine a world in which patients can achieve sustained symptom relief without sacrificing their physical health or social well-being. Imagine a treatment model that prioritizes quality of life as much as it does symptom reduction. This is the future that muscarinic receptor research promises, not only for patients with schizophrenia but for the countless individuals whose lives could be improved by this visionary approach.","_key":"b7993b93839d0"}],"_type":"block"},{"_type":"block","style":"normal","_key":"34e64f80c556","markDefs":[],"children":[{"_key":"e5951281ac840","_type":"span","marks":[],"text":""}]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Concluding Thoughts","_key":"1d786a73e61f0"}],"_type":"block","style":"normal","_key":"81cd92beb550"},{"_type":"block","style":"normal","_key":"7ae6c29e0909","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The journey toward muscarinic modulation as a primary treatment approach in schizophrenia marks one of the most promising advancements in psychiatry. By balancing symptom control with physical and social well-being, this research embodies the potential to redefine the patient experience and make strides toward a life of dignity, inclusion, and health. If successful, muscarinic receptor therapies could transform psychiatry, ushering in a new era of treatment that respects the holistic needs of patients and offers a true path to recovery.","_key":"4bb9490be9ad0"}]},{"_type":"block","style":"normal","_key":"a17175fb5194","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"ead65d2d4d3f0"}]},{"_key":"baf2b1c6d26c","markDefs":[],"children":[{"_key":"2e386df8cf880","_type":"span","marks":[],"text":"For patients, families, and clinicians alike, muscarinic receptor modulation is more than a scientific breakthrough—it is the realization of a hope that has driven psychiatric research for decades."}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"50f327c0f38e0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"ee1600e165ae"},{"style":"normal","_key":"5b45bf257ceb","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Dr Noor ","_key":"63c79c8cf2ee0"},{"_key":"63c79c8cf2ee1","_type":"span","marks":["em"],"text":"is a clinical researcher, and a research liaison for the American Association of Physician of Indian Origin."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"322a202449010"}],"_type":"block","style":"normal","_key":"a9463550cfd9"},{"children":[{"_key":"9e3537f8e5880","_type":"span","marks":["em"],"text":"The author declares no funding, sponsorship, or financial interests related to this article. There are no conflicts of interest to disclose."}],"_type":"block","style":"normal","_key":"4673a5a883c0","markDefs":[]},{"_type":"block","style":"normal","_key":"5621660303d8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"9b584c3dc94c0"}]},{"_type":"block","style":"normal","_key":"7ec093e71937","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"7b4d699c6c980"}]},{"children":[{"_type":"span","marks":[],"text":"1. Schizophrenia. World Health Organization. January 10, 2022. Accessed October 30, 2024. ","_key":"5d0e0f457bac0"},{"_type":"span","marks":["f07d465f0679"],"text":"https://www.who.int/news-room/fact-sheets/detail/schizophrenia","_key":"5d0e0f457bac1"},{"text":".","_key":"5d0e0f457bac2","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"82b799fac3e9","markDefs":[{"_key":"f07d465f0679","blank":true,"_type":"link","href":"https://www.who.int/news-room/fact-sheets/detail/schizophrenia"}]},{"_key":"245a7dc47b84","markDefs":[{"_key":"bc44d729afe9","blank":true,"_type":"link","href":"https://www.webmd.com/schizophrenia/first-second-generation-antipsychotics"}],"children":[{"marks":[],"text":"2. Robinson KM. First and second-generation antipsychotics for schizophrenia. WebMD. June 18, 2024. Accessed October 30, 2024. ","_key":"d8cc08c3b7ab0","_type":"span"},{"_type":"span","marks":["bc44d729afe9"],"text":"https://www.webmd.com/schizophrenia/first-second-generation-antipsychotics","_key":"d8cc08c3b7ab1"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"3. Doane MJ, Sajatovic M, Weiden PJ, et al. ","_key":"89c1edc6ad6c0"},{"_key":"89c1edc6ad6c1","_type":"span","marks":["8b3b1c236c52"],"text":"Antipsychotic treatment experiences of people with schizophrenia: patient perspectives from an online survey."},{"_type":"span","marks":[],"text":" ","_key":"89c1edc6ad6c2"},{"_type":"span","marks":["em"],"text":"Patient Prefer Adherence","_key":"89c1edc6ad6c3"},{"_type":"span","marks":[],"text":". 2020;14:2043-2054.","_key":"89c1edc6ad6c4"}],"_type":"block","style":"normal","_key":"ed3d00ec129f","markDefs":[{"blank":true,"_type":"link","href":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7604247/","_key":"8b3b1c236c52"}]},{"_type":"block","style":"normal","_key":"e1f1628c3502","markDefs":[{"_key":"78a45972809e","blank":true,"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/35758639/"}],"children":[{"text":"4. Paul SM, Yohn SE, Popiolek M, et al. ","_key":"0b8e52d91f0a0","_type":"span","marks":[]},{"_type":"span","marks":["78a45972809e"],"text":"Muscarinic acetylcholine receptor agonists as novel treatments for schizophrenia.","_key":"0b8e52d91f0a1"},{"_type":"span","marks":[],"text":" ","_key":"0b8e52d91f0a2"},{"_key":"0b8e52d91f0a3","_type":"span","marks":["em"],"text":"Am J Psychiatry"},{"text":". 2022;179(9):611-627.","_key":"0b8e52d91f0a4","_type":"span","marks":[]}]},{"style":"normal","_key":"eddbbb9b3df0","markDefs":[{"href":"https://pubmed.ncbi.nlm.nih.gov/33647377/","_key":"a7f822ede8d6","blank":true,"_type":"link"}],"children":[{"_key":"9e18e97fdf240","_type":"span","marks":[],"text":"5. Foster DJ, Bryant ZK, Conn PJ. "},{"_type":"span","marks":["a7f822ede8d6"],"text":"Targeting muscarinic receptors to treat schizophrenia","_key":"9e18e97fdf241"},{"_type":"span","marks":[],"text":". ","_key":"9e18e97fdf242"},{"_type":"span","marks":["em"],"text":"Behav Brain Res","_key":"9e18e97fdf243"},{"text":". 2021;405:113201.","_key":"9e18e97fdf244","_type":"span","marks":[]}],"_type":"block"},{"_key":"971748b04b1b","markDefs":[{"blank":true,"_type":"link","href":"https://www.ajmc.com/view/first-schizophrenia-treatment-approved-in-decades-targets-cholinergic-receptors","_key":"6304f4454767"}],"children":[{"_type":"span","marks":[],"text":"6. Grossi G. First schizophrenia treatment approved in decades targets cholinergic receptors. ","_key":"74d0c3e70f2c0"},{"text":"American Journal of Managed Care. ","_key":"74d0c3e70f2c1","_type":"span","marks":["em"]},{"text":"September 27, 2024. Accessed October 30, 2024. ","_key":"74d0c3e70f2c2","_type":"span","marks":[]},{"_type":"span","marks":["6304f4454767"],"text":"https://www.ajmc.com/view/first-schizophrenia-treatment-approved-in-decades-targets-cholinergic-receptors","_key":"74d0c3e70f2c3"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"aeba3dbd358b","markDefs":[{"href":"https://profiles.wustl.edu/en/publications/the-selective-muscarinic-agonist-xanomeline-improves-both-the-cog","_key":"babe466f35fe","blank":true,"_type":"link"}],"children":[{"_type":"span","marks":[],"text":"7. Bodick NC, Offen WW, Shannon HE, et al. 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