On This Day … 07 April

People (Deaths)

  • 1999 – Heinz Lehmann, German-Canadian psychiatrist and academic (b. 1911).

Heinz Lehmann

Heinz Edgar Lehmann, OC FRSC (17 July 17 1911 to 07 April 1999) was a German-born Canadian psychiatrist best known for his use of chlorpromazine for the treatment of schizophrenia in 1950s and “truly the father of modern psychopharmacology.”

Early Life

Born in Berlin, Germany, he was educated at the University of Freiburg, the University of Marburg, the University of Vienna, and the University of Berlin. He emigrated to Canada in 1937.

Hospital Work in Canada

In 1947, he was appointed the clinical director of Montreal’s Douglas Hospital. From 1971 to 1975, he was the chair of the McGill University Department of Psychiatry. He was also a humane lecturer in psychiatry in 1952, and was able to give empathetic lectures on the plight of people suffering from anxiety, depression obsessions, paranoia etc. No one to that time had been able to understand or help schizophrenic patients, who filled mental hospitals around the world, so when chlorpromazine showed some promise he helped to promote it in North America and start the drug revolution. He was ahead of his time in that he supported research in the use of the active ingredient psilocybin to alleviate anxiety.

Le Dain Commission

From 1969 to 1972, he was one of the five members of the Le Dain Commission, a royal commission appointed in Canada to study the non-medical use of drugs. He was an advocate for decriminalisation of marijuana.

DSM Work

In 1973, he was a member of the Nomenclature Committee of the American Psychiatric Association that decided to drop homosexuality from the Diagnostic and Statistical Manual of Mental Disorders, i.e. to depathologise it.

Honours and Awards

In 1970 he was made a Fellow of the Royal Society of Canada and, in 1976, he was made an Officer of the Order of Canada. He was inducted into the Canadian Medical Hall of Fame in 1998.

Heinz Lehmann Award

In 1999, the Canadian College of Neuropsychopharmacology established the Heinz Lehmann Award in his honour, given in recognition of outstanding contributions to research in neuropsychopharmacology in Canada.

Principles for Improving Investment in Translational Neuroscience Aimed at Psychiatric Drug Discovery

Research Paper Title

Time to re-engage psychiatric drug discovery by strengthening confidence in preclinical psychopharmacology.

Background

There is urgent need for new medications for psychiatric disorders. Mental illness is expected to become the leading cause of disability worldwide by 2030. Yet, the last two decades have seen the pharmaceutical industry withdraw from psychiatric drug discovery after costly late-stage trial failures in which clinical efficacy predicted pre-clinically has not materialised, leading to a crisis in confidence in preclinical psychopharmacology.

Methods

Based on a review of the relevant literature, the researchers formulated some principles for improving investment in translational neuroscience aimed at psychiatric drug discovery.

Results

The researchers propose the following 8 principles that could be used, in various combinations, to enhance CNS drug discovery:

  1. Consider incorporating the NIMH Research Domain Criteria (RDoC) approach;
  2. Engage the power of translational and systems neuroscience approaches;
  3. Use disease-relevant experimental perturbations;
  4. Identify molecular targets via genomic analysis and patient-derived pluripotent stem cells;
  5. Embrace holistic neuroscience: a partnership with psychoneuroimmunology;
  6. Use translational measures of neuronal activation;
  7. Validate the reproducibility of findings by independent collaboration; and
  8. Learn and reflect.

They provide recent examples of promising animal-to-human translation of drug discovery projects and highlight some that present re-purposing opportunities.

Conclusions: We hope that this review will re-awaken the pharma industry and mental health advocates to the opportunities for improving psychiatric pharmacotherapy and so restore confidence and justify re-investment in the field.

Reference

Tricklebank, M.D., Robbins, T.W., Simmons, C. & Wong, E.H.F. (2021) Time to re-engage psychiatric drug discovery by strengthening confidence in preclinical psychopharmacology. Psychopharmacology (Berl). doi: 10.1007/s00213-021-05787-x. Online ahead of print.

Book: Case Studies: Stahl’s Essential Psychopharmacology, Volume 02

Book Title:

Case Studies: Stahl’s Essential Psychopharmacology, Volume 02.

Author(s): Stephen M. Stahl.

Year: 2016.

Edition: First (1ed).

Publisher: Cambridge University Press.

Type(s): Paperback.

Synopsis:

Following the success of the first collection of Stahl’s Case Studies, published in 2011, we are pleased to present this completely new selection of clinical stories.

Designed with the distinctive user-friendly presentation readers have become accustomed to and making use of icons, questions/answers and tips, these cases address complex issues in an understandable way and with direct relevance to the everyday experience of clinicians.

Covering a wide-ranging and representative selection of clinical scenarios, each case is followed through the complete clinical encounter, from start to resolution, acknowledging all the complications, issues, decisions, twists and turns along the way.

The book is about living through the treatments that work, the treatments that fail, and the mistakes made along the journey. This is psychiatry in real life – these are the patients from your waiting room – this book will reassure, inform and guide better clinical decision making.

Book: Case Studies: Stahl’s Essential Psychopharmacology

Book Title:

Case Studies: Stahl’s Essential Psychopharmacology

Author(s): Stephen M. Stahl (Author), Debbi A. Morrisette (Editor), and Nancy Muntner (Illustrator).

Year: 2011.

Edition: First (1ed).

Publisher: Cambridge University Press.

Type(s): Paperback.

Synopsis:

Designed with the distinctive, user-friendly presentation Dr Stahl’s audience know and love, this new stream of Stahl books capitalise on Dr Stahl’s greatest strength – the ability to address complex issues in an understandable way and with direct relevance to the everyday experience of clinicians.

The book describes a wide-ranging and representative selection of clinical scenarios, making use of icons, questions/answers and tips. It follows these cases through the complete clinical encounter, from start to resolution, acknowledging all the complications, issues, decisions, twists and turns along the way.

The book is about living through the treatments that work, the treatments that fail, and the mistakes made along the journey. This is psychiatry in real life – these are the patients from your waiting room – this book will reassure, inform and guide better clinical decision making.

Find Volume 02 here.

On This Day … 15 February

People (Births)

  • 1856 – Emil Kraepelin, German psychiatrist and academic (d. 1926).
  • 1940 – Vaino Vahing, Estonian psychiatrist, author, and playwright (d. 2008).

Emil Kraepelin

Emil Wilhelm Georg Magnus Kraepelin (15 February 1856 to 7 October 1926) was a German psychiatrist. H. J. Eysenck’s Encyclopaedia of Psychology identifies him as the founder of modern scientific psychiatry, psychopharmacology and psychiatric genetics.

Kraepelin believed the chief origin of psychiatric disease to be biological and genetic malfunction. His theories dominated psychiatry at the start of the 20th century and, despite the later psychodynamic influence of Sigmund Freud and his disciples, enjoyed a revival at century’s end. While he proclaimed his own high clinical standards of gathering information “by means of expert analysis of individual cases”, he also drew on reported observations of officials not trained in psychiatry.

His textbooks do not contain detailed case histories of individuals but mosaic-like compilations of typical statements and behaviours from patients with a specific diagnosis. He has been described as “a scientific manager” and “a political operator”, who developed “a large-scale, clinically oriented, epidemiological research programme”.

Vaino Bahing

Vaino Vahing (15 February 1940 to 23 March 2008), was an Estonian writer, prosaist, psychiatrist and playwright. Starting from 1973, he was a member of Estonian Writers Union.

Vaino Vahing has written many articles about psychiatry, but also literature – novels, books and plays with psychiatric and autobiographical influence. He has played in several Estonian films.

Book: Psychiatric and Mental Health Nursing: The craft of caring

Book Title:

Psychiatric and Mental Health Nursing: The Craft of Caring.

Author(s): Mary Chambers.

Year: 2017.

Edition: Third (3rd).

Publisher: Routledge.

Type(s): Hardcover, Paperback and Kindle.

Synopsis:

This new edition of a bestselling, evidence-based textbook provides a comprehensive overview of psychiatric and mental health nursing. Keeping service users and their recovery at the centre of care, the holistic approach will help nurses to gain the tools and understanding required to work in this complex area.

Extensively updated for this new edition, the text looks at:

  • Aspects of mental health nursing: covering topics such as ethics, developing therapeutic relationships and supervision.
  • The foundations of mental health nursing: discussing diagnosis, assessment and risk.
  • Caring for those experiencing mental health distress: looking at wide range of troubles including anxiety, bipolar disorder, eating disorders and issues around sexuality and gender.
  • Care planning and approaches to therapeutic practice: exploring ideas, pathways and treatments such as recovery, CBT, psychodynamic therapies and psychopharmacology.
  • Services and support for those with mental health distress: covering topics such as collaborative work, involvement of service users and their families and carers, and a range of different mental healthcare settings.
  • Mental health nursing in the twenty-first century: highlighting emerging and future trends including the political landscape, physical health and health promotion, and technological advances.

This accessible and comprehensive textbook integrates service user perspectives throughout and includes student-friendly features such as learning outcomes, key points summaries, reflection points and further reading sections. It is an essential resource for all mental health nursing students, as well as an invaluable reference for practising nurses.

Book: Psychopharmacology: A mental health professional’s guide to commonly used medications (Nursing)

Book Title:

Psychopharmacology: A mental health professional’s guide to commonly used medications (Nursing).

Author(s): Herbert Mwebe.

Year: 2018.

Edition: First (1st).

Publisher: Critical Publishing Ltd.

Type(s): Paperback and Kindle.

Synopsis:

This jargon-free guide is suitable for all trainee and registered health professionals who require knowledge and understanding of drugs used in the treatment of mental health conditions for prescribing or administering purposes. A life-saving pocketbook that you can easily carry anywhere you go!

Introductory material provides a background on psychotropic drugs, the aetiology of mental illness, some of the commonly used drugs in practice and brief notes on common non-pharmacological interventional options. It also examines biochemical and neurodevelopmental theories and the link to the pathophysiology of mental illness as well as clinical decision making.

The central chapters of the book provide comprehensive coverage of all the major medications used in mental health. Each focuses on a specific class of drug, detailing the most commonly used medicines, including side effects, average doses, contra-indications and clinical management interventions that may be required. At the end of each chapter a series of review questions enable readers to review their learning, and theory is clearly related to practice throughout.

Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development.

Research Paper Title

Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development.

Background

Environmental contexts that are reliably associated with the use of pharmacologically active substances are hypothesized to contribute to substance use disorders.

In this review, the researchers provide an updated summary of parallel pre-clinical and human studies that support this hypothesis.

Methods

Research conducted in rats shows that environmental contexts that are reliably paired with drug use can renew extinguished drug-seeking behaviour and amplify responding elicited by discrete, drug-predictive cues.

Akin to drug-associated contexts, interoceptive drug stimuli produced by the psychopharmacological effects of drugs can also influence learning and memory processes that play a role in substance use disorders.

Results

Findings from human laboratory studies show that drug-associated contexts, including social stimuli, can have profound effects on cue reactivity, drug use, and drug-related cognitive expectancies.

This translationally relevant research supports the idea that treatments for substance use disorders could be improved by considering drug-associated contexts as a factor in treatment interventions.

The researchers conclude this review with ideas for how to integrate drug-associated contexts into treatment-oriented research based on 4 approaches:

  • Pharmacology;
  • Brain stimulation;
  • Mindfulness-based relapse prevention; and
  • Cognitive behavioural group therapy.

Throughout, the researchers focus on alcohol- and tobacco-related research, which are two of the most prevalent and commonly misused drugs worldwide for which there are known treatments.

Reference

LeCocq, M.R., Randall, P.A., Besheer, J. & Chaudhri, N. (2020) Considering Drug-Associated Contexts in Substance Use Disorders and Treatment Development. Neurotherapeutics. 17(1), pp.43-54. doi: 10.1007/s13311-019-00824-2.

Review of Physical Health Monitoring after Rapid Tranquilisation for Acute Behavioural Disturbance

Research Paper Title

Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services.

Background

The researchers aimed to assess the quality of physical health monitoring following rapid tranquillisation (RT) for acute behavioural disturbance in UK mental health services.

Methods

The Prescribing Observatory for Mental Health (POMH-UK) initiated an audit-based quality improvement programme addressing the pharmacological treatment of acute behavioural disturbance in mental health services in the UK.

Results

Data relating to a total of 2454 episodes of RT were submitted by 66 mental health services.

Post-RT physical health monitoring did not reach the minimum recommended level in 1933 (79%) episodes.

Patients were more likely to be monitored (OR 1.78, 95% CI 1.39-2.29, p < 0.001) if there was actual or threatened self-harm, and less likely to be monitored if the episode occurred in the evening (OR 0.79, 95% CI 0.62-1.0, p < 0.001) or overnight (OR 0.57, 95% CI 0.44-0.75, p < 0.001).

Risk factors such as recent substance use, RT resulting in the patient falling asleep, or receiving high-dose antipsychotic medication on the day of the episode, did not predict whether or not the minimum recommended level of post-RT monitoring was documented.

Conclusions

The minimum recommended level of physical health monitoring was reported for only one in five RT episodes.

The findings also suggest a lack of targeting of at-risk patients for post-RT monitoring.

Possible explanations are that clinicians consider such monitoring too demanding to implement in routine clinical practice or not appropriate in every clinical situation.

For example, physical health measures requiring direct contact with a patient may be difficult to undertake, or counter-productive, if RT has failed.

These findings prompt speculation that post-RT monitoring practice would be improved by the implementation of guidance that integrated and refined the currently separate systems for undertaking and recording physical health observations post-RT, determining nursing observation schedules and detecting acute deterioration in physical health.

The effectiveness and clinical utility of such an approach would be worth testing.

Reference

Paton, C., Adams, C.E., Dye, S., Delgado, O., Okocha, C. & Barnes, T.R.E. (2019) Physical health monitoring after rapid tranquillisation: clinical practice in UK mental health services. Therapeutic Advances in Psychopharmacology. doi: 10.1177/2045125319895839. eCollection 2019.