Faculty Bibliography

BACKGROUND:Anabolic androgenic steroids (AAS) are synthetic forms of testosterone frequently used as performance enhancing drugs among gay, bisexual, and queer (GBQ) men. Despite widespread use, associated harms, and the likely existence of an AAS use disorder, there is no medical consensus on standards of care for people who use AAS, with most medical providers focusing exclusively on abstinence. Individuals using AAS have developed community-based harm reduction strategies to mitigate these harms. METHODS:This paper is a sub-analysis of qualitative data obtained through semi-structured interviews with GBQ men using AAS for 8 or more weeks recruited through convenience and snowball sampling from clinical sites and LGBTQ + venues in New York City as well as through social media. Interviews were coded with themes developed using reflexive thematic analysis. Data related to harm reduction techniques were then re-analyzed through a prevention strategies framework lens of primary, secondary, and tertiary harm prevention. RESULTS:Thematic saturation was reached at twelve interviews in the primary analysis, with men reporting frequent use of multiple harm reduction techniques. For primary prevention, men avoided oral steroids and simultaneous substance use, tried to obtain AAS from reputable sources, used "cycling" to dose steroids, and practiced sterile injection techniques. Secondary prevention methods included patient-directed lab testing for hematocrit, liver and kidney function, cholesterol, prostate specific antigen, testosterone, and self-performed blood pressure checks. Tertiary prevention included donating blood and the use of medications without a prescription, including aromatase inhibitors, selective estrogen receptor blockers, aspirin, statins, angiotensin receptor blockers, clomiphene, and human chorionic gonadotropin. CONCLUSIONS:Despite many GBQ men experiencing harms from anabolic androgenic steroids, community members have often sought harm reduction techniques in lieu of abstinence. Though many of these techniques embrace clinical reasoning and may be more broadly applicable, additional research is needed to understand the impact of each intervention on the overall health of individuals using AAS.

IMPORTANCE/UNASSIGNED:Anabolic androgenic steroids (AAS) are disproportionately used by sexual minority men, with the physical and mental health implications of AAS use incompletely understood. OBJECTIVE/UNASSIGNED:To understand the reasons for use and health care needs of gay, bisexual, and queer cisgender men using AAS. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This qualitative study was conducted from November 2021 to May 2023 using self-administered questionnaires and semistructured interviews that were transcribed and coded using reflexive thematic analysis. Participants were recruited through convenience and snowball sampling from lesbian, gay, bisexual, transgender, and queer clinical centers in New York, New York, as well as through online platforms. All patients self-identified as cisgender and gay, bisexual, or queer. EXPOSURES/UNASSIGNED:History of nonprescribed AAS use for a minimum of 8 consecutive weeks was required. MAIN OUTCOMES AND MEASURES/UNASSIGNED:The primary outcomes were reasons for and health implications of AAS use and interactions with health care practitioners, as determined through interviews. Interview transcripts were collected and analyzed. RESULTS/UNASSIGNED:Thematic saturation was reached after interviews with 12 male participants (mean [SD] age, 44 [11] years), with the majority of participants identifying as gay (10 participants [83%]), White non-Hispanic (9 participants [75%]), being in their 30s and 40s (9 participants [75%]), holding a bachelor's degree or higher (11 participants [92%]), and having used steroids for a mean (SD) of 7.5 (7.1) years. One participant (8%) self-identified as Black, and 2 (17%) identified as Hispanic. Seven men (58%) met the criteria for muscle dysmorphia on screening. Nine overarching themes were found, including internal and external motivators for initial use, continued use because of effectiveness or fear of losses, intensive personal research, physical and emotional harms experienced from use, using community-based harm reduction techniques, frustration with interactions with the medical community focused on AAS cessation, and concerns around the illegality of AAS. CONCLUSIONS AND RELEVANCE/UNASSIGNED:In this qualitative study, AAS use among cisgender gay, bisexual, and queer men was found to be associated with multifactorial motivators, including a likely AAS use disorder and muscle dysmorphia. Despite all participants experiencing harms from use, men seeking medical help found insufficient support with practitioners insistent on AAS cessation and, thus, developed their own harm reduction techniques. Further research is needed to assess the utility of practitioner education efforts, the safety and efficacy of community-developed harm reduction methods, and the impact of AAS decriminalization on health care outcomes for this patient population.

People with substance use disorders (SUD) who are hospitalized often have worse medical outcomes and face treatment inequity. Individuals from racially and ethnically minoritized groups face structural racism in addition to the general stigma against people with substance use disorders. Outpatient racial disparities in SUD treatment, such as rates of buprenorphine prescription, may be perpetuated if unaddressed during medical hospitalizations. Thus, psychiatric consultation or addiction treatment services have the potential to reduce systemic inequities in access and initiation of evidence-based SUD treatments. We describe best practices that addiction treatment services can follow to move towards equity in treating hospital ized patients with SUDs, particularly for minoritized groups. Areas of improvement include access to addiction consultation services, minimization of patient-directed discharges, buprenorphine initiation, access to harm-reduction resources, incorporation of lived experience, referrals to post-discharge treatment, and education.

As psychedelic-assisted therapy research and clinical trials continue to grow, there is a positive outlook on the future, but also concerns about who will benefit. Most research shows that there is an obvious deficit of racial and ethnically minoritized populations, defined within the article, enrolling in studies. The objectives of this paper are (1) to provide a history of psychedelics and its resurgence over the last two decades; (2) to present an understanding of the racialization of psychedelics in the treatment of psychiatric disorders; (3) to showcase the current inequity of psychedelic medicine; and (4) to operationalize an antiracism framework for racial equity to decolonize psychedelic research, or remove the historically pervasive White power dynamic in hopes of shifting power back to the originating indigenous cultures. The psychedelic movement is in a rare place to optimize inclusion and this article aims to demonstrate how. [Psychiatr Ann. 2022;52(12):494-499.].

Burnout and moral injury within medicine have steadily increased over the last decades, especially among those providing care during the COVID-19 pandemic. The term burnout has been used to describe clinician distress and a syndrome of emotional exhaustion, a diminished sense of personal accomplishment, and depersonalization. Burnout has a significant impact on both job performance and patient care. Moral injury occurs when external circumstances interact with a person's cherished beliefs and standards. When the tension between them cannot be reconciled, the felt integrity of the individual is disrupted and the person experiences distress. The consultative aspect in consultation-liaison psychiatry (CLP) presents challenges that may predispose the young clinician to burnout and moral injury, especially during fellowship training. CLP psychiatrists also have a liaison role that could catalyze systemlevel change to enhance the mental well-being of their colleagues. This article reviews clinically relevant psychodynamic aspects of burnout and moral injury during CLP training. In addition, the authors propose strategies to enhance career growth and prevent and address moral injury during training to generate fulfilling professional development.

Increasing attention to systemic racism in the United States in all aspects of life has sharpened focus on its effects on the health outcomes of Black, Latinx, and Indigenous populations. Racial disparities in substance use disorders remain a significant public health problem in mental health, and psychiatrists require sufficient knowledge and awareness to help address these disparities. First, this article reviews evidence of racial disparities in substance use disorders. We then discuss the historical and legal foundations of systemic racism and substance use disorder disparities and explore research examining the role of systemic racism in substance use disorder outcomes on structural and individual levels. Finally, we discuss recommendations for providing substance use disorder care in a more racially equitable manner.

OBJECTIVE:The primary purpose of the study was to develop and implement a psychiatry mnemonic PSYCH-PASS for transitions of care in residency training programs. METHODS:The authors examined areas of improvement in the handoff system with residency training administration, service directors, and psychiatry residents to create PSYCH-PASS, a novel mnemonic that could be integrated in the electronic medical record (EMR). The components of PSYCH-PASS are Patient summary, Situational awareness, "whY" is the patient here, Comorbidities, Hemodynamics, Pharmacology/PRNs, Action list, Specifics, and Synthesis. The authors developed a 14 question pre- and post-survey with a 4-point Likert scale measuring five categories. RESULTS:Pre-survey and post-surveys completed by post-graduate year 2 and 3 residents at Montefiore Medical Center (n = 24) noted increased satisfaction, handoff efficiency, handoff efficiency, accessibility, accuracy, communication, awareness, and adherence to PSYCH-PASS, along with a decrease in frequency of errors. CONCLUSIONS:With promising results across a range of metrics indicating resident-reported positive impacts on patient care, further research on the implementation of PSYCH-PASS and its integration into EMR systems is merited. Future directions include gathering objective data from Epic and expansion of the initiative to other psychiatric services and institutions.

The intrinsic properties of tonically firing neurons in the cochlear nucleus contribute to representing average sound intensity by favoring synaptic integration across auditory nerve inputs, reducing phase locking to fine temporal acoustic structure and enhancing envelope locking. To determine whether tonically firing neurons of the avian cochlear nucleus angularis (NA) resemble ideal integrators, we investigated their firing responses to noisy current injections during whole cell patch-clamp recordings in brain slices. One subclass of neurons (36% of tonically firing neurons, mainly subtype tonic III) showed no significant changes in firing rate with noise fluctuations, acting like pure integrators. In contrast, many tonically firing neurons (>60%, mainly subtype tonic I or II) showed a robust sensitivity to noisy current fluctuations, increasing their firing rates with increased fluctuation amplitudes. For noise-sensitive tonic neurons, the firing rate vs. average current curves with noise had larger maximal firing rates, lower gains, and wider dynamic ranges compared with FI curves for current steps without noise. All NA neurons showed fluctuation-driven patterning of spikes with a high degree of temporal reliability and millisecond spike time precision. Single-spiking neurons in NA also responded to noisy currents with higher firing rates and reliable spike trains, although less precisely than nucleus magnocellularis neurons. Thus some NA neurons function as integrators by encoding average input levels over wide dynamic ranges regardless of current fluctuations, others detect the degree of coherence in the inputs, and most encode the temporal patterns contained in their inputs with a high degree of precision.