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Psychiatric Care When Cure Is No Longer the Goal: A Call for Expansion of Management Options for Treatment-Resistant Mental Illness [Comment]

Ben-Dor, Gabriel A; Alebdy, Duwa; Xu, Yingcheng Elaine
PMID: 38207183
ISSN: 2150-7759
CID: 5626572

Suicidal behavior across a broad range of psychiatric disorders

Xu, Yingcheng E; Barron, Daniel A; Sudol, Katherin; Zisook, Sidney; Oquendo, Maria A
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
PMID: 36653675
ISSN: 1476-5578
CID: 5469662

Revisiting Neuroethics Through the Lens of Buddhist Theory: A Call for Integration [Comment]

Xu, Yingcheng Elaine; Sahota, Puneet; Pradhan, Basant
PMID: 36272167
ISSN: 2150-7759
CID: 5469652

Futility and Terminal Mental Illness: The Conceptual Clarification Continues

Xu, Yingcheng Elaine; Sisti, Dominic
Conceptual parity posits that both medical and mental illness are both simply illness, and thus should be considered as fundamentally the same, especially in health services and policy. Recent controversy over medical assistance in dying (MAID) highlights both the unequal treatment of physical and mental illnesses in end-of-life care and the need for more conceptual clarification of terminal mental illness. This article presents an argument for the necessary elements in terminal mental illness, the value of qualitative assessments, and important areas that require further research and clarity in order for terminal mental illness to be appropriately identified. Given current conceptual limitations, palliative psychiatry, and not MAID, is recommended in severely treatment-resistant cases of mental illness.
PMID: 33746129
ISSN: 1529-8795
CID: 5469642

Physician Aid-in-Dying for Individuals With Serious Mental Illness: Clarifying Decision-Making Capacity and Psychiatric Futility [Comment]

Zhong, Rocksheng; Xu, Yingcheng; Oquendo, Maria A; Sisti, Dominic A
PMID: 31557113
ISSN: 1536-0075
CID: 5469632

Associations of Parent-Adolescent Discrepancies in Family Cohesion and Conflict with Adolescent Impairment

Xu, Yingcheng; Boyd, Rhonda C.; Butler, Laura; Moore, Tyler M.; Benton, Tami D.
ISSN: 1062-1024
CID: 5469672


Xu, Yingcheng; Boyd, Rhonda C.; Butler, Laura; Benton, Tami D.
ISSN: 0890-8567
CID: 5469682

Insulin and AMPK regulate FA translocase/CD36 plasma membrane recruitment in cardiomyocytes via Rab GAP AS160 and Rab8a Rab GTPase

Samovski, Dmitri; Su, Xiong; Xu, Yingcheng; Abumrad, Nada A; Stahl, Philip D
The FA translocase cluster of differentiation 36 (CD36) facilitates FA uptake by the myocardium, and its surface recruitment in cardiomyocytes is induced by insulin, AMP-dependent protein kinase (AMPK), or contraction. Dysfunction of CD36 trafficking contributes to disordered cardiac FA utilization and promotes progression to disease. The Akt substrate 160 (AS160) Rab GTPase-activating protein (GAP) is a key regulator of vesicular trafficking, and its activity is modulated via phosphorylation. Our study documents that AS160 mediates insulin or AMPK-stimulated surface translocation of CD36 in cardiomyocytes. Knock-down of AS160 redistributes CD36 to the surface and abrogates its translocation by insulin or the AMPK agonist 5-aminoimidazole-4-carboxamide-1-beta-d-ribofuranoside (AICAR). Conversely, overexpression of a phosphorylation-deficient AS160 mutant (AS160 4P) suppresses the stimulated membrane recruitment of CD36. The AS160 substrate Rab8a GTPase is shown via overexpression and knock-down studies to be specifically involved in insulin/AICAR-induced CD36 membrane recruitment. Our findings directly demonstrate AS160 regulation of CD36 trafficking. In myocytes, the AS160 pathway also mediates the effect of insulin, AMPK, or contraction on surface recruitment of the glucose transporter GLUT4. Thus, AS160 constitutes a point of convergence for coordinating physiological regulation of CD36 and GLUT4 membrane recruitment.
PMID: 22315395
ISSN: 1539-7262
CID: 5476932