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Chris Aiken, MD @chrisaikenmd.bsky.social · 3h

Around 1 in 3 with chronic #bipolar, #depression, or #schizophrenia (even higher there) have fatty liver.

Chris Aiken, MD @chrisaikenmd.bsky.social · 3h

/Evidence grade: Low (5/10) (it is an observational study, but a high quality one utilizing Mendellian randomization, which mimicks a randomized controlled trial by using randomly inherited genes to control for confounders):
chrisaikenmd.com/ebm/

EBM - Chris Aiken, MD

Grading Evidence This is a simple way to rate the quality of clinical trials from 1-10. Most randomized trials land […]

chrisaikenmd.com

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Chris Aiken, MD @chrisaikenmd.bsky.social · 5h

Should we test for fatty liver in #psychiatry? Rates are double in chronic mental illnesses, and new study suggests depression plays a causative role, possibly through effects on metabolic health:
www.ncbi.nlm.nih.gov/pubmed/41031...

Tips for liver health:
chrisaikenmd.com/fattyliver

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Chris Aiken, MD @chrisaikenmd.bsky.social · 1d

Memantine improved social impairments in youth with #autism in small randomized trial (20 mg):
www.ncbi.nlm.nih.gov/pubmed/41032...

Improvements correlated with baseline glutamate levels, in line with the mechanism.

Evidence grade: Moderate (8/10):
chrisaikenmd.com/ebm

#psychiatry #pmhnp

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Chris Aiken, MD @chrisaikenmd.bsky.social · 2d

Single dose IM #ketamine improved treatment resistant #PTSD in small, short-term RCT, opioid as control:
pubmed.ncbi.nlm.nih.gov/41030011/

Caution: Reports of PTSD worsening after ketamine, like
www.psychiatrist.com/jcp/how-do-w...

Evidence grade: Moderate (6/10)
chrisaikenmd.com/ebm

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Chris Aiken, MD @chrisaikenmd.bsky.social · 3d

Rx for benzos and z-drugs raised the risk of alcohol/drug use disorders 2-3 fold in large, prospective, 14-year study of people compared to their twins or to matched controls:
pubmed.ncbi.nlm.nih.gov/41035208

Evidence grade: Moderate 6/10 (high quality observational study, can't prove causation)

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Chris Aiken, MD @chrisaikenmd.bsky.social · 4d

Update on food/sleep, from
pubmed.ncbi.nlm.nih.gov/40988908

▪ More sugar = worse sleep quality
▪ Eat at night = delay sleep by 30 min
▪ Skip breakfast = worse sleep quality/cognition
▪ Sleep deprivation causes weight gain (as do 3 above)

#psychiatry #neurology #nutrition #pmhnp #therapy #diet

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Chris Aiken, MD @chrisaikenmd.bsky.social · 5d

Brain fog is common in #longCOVID. Track it with this newly validated rating scale:
chrisaikenmd.com/brainfogscale
pubmed.ncbi.nlm.nih.gov/40987251

First step = Exercise, good sleep, healthy diet, stress reduction (eg, mindfulness).

What have you found helpful for it?

#covid #pmhnp #psychiatry

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Chris Aiken, MD @chrisaikenmd.bsky.social · 6d

Which med is most effective for binge eating?

1st: Topiramate or lisdexamfetamine (Vyvanse)
2nd: Bupropion-naltrexone combo (reduced weight but not binging)

Concludes new analysis of 12 trials:
pubmed.ncbi.nlm.nih.gov/40984657

But 1st line = therapy (and eating more protein/fiber)

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Chris Aiken, MD @chrisaikenmd.bsky.social · 6d

Today #Medicare reverted to pre-pandemic telehealth coverage, requiring an in-person visit before telehealth, and in-person at least every 6 months:
telehealthresourcecenter.org/resources/th...

The abrupt reversal is a side effect of the government shutdown.

The Telehealth Policy Cliff: Preparing for October 1, 2025 | National Consortium of Telehealth Resource Centers

Photo credit: https://www.flickr.com/photos/chad_k/3767365155https://creativecommons.org/licenses/by/2.0/ (no changes were made) Introduction Without Congressional action, key telehealth…

telehealthresourcecenter.org

Chris Aiken, MD @chrisaikenmd.bsky.social · 7d

Probiotics improved cognition after 3 months in meta-analysis of 21 RCTs, mainly in:
▪ Older adults
▪ Children
▪ Depression

Benefits in processing speed, memory, and spatial ability
pubmed.ncbi.nlm.nih.gov/40983638

How to use #probiotics:
chrisaikenmd.com/supplements

#naturalhealth #mentalhealth

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Chris Aiken, MD @chrisaikenmd.bsky.social · 8d

New trial compares two FDA-approved meds (risperidone/aripiprazole) for irritability in #autism.

Similar benefits, but aripiprazole caused less prolactinemia:
pubmed.ncbi.nlm.nih.gov/41004875

Evidence grade: Moderate (7/10)

However, I recommend omega-3 first-line for its safety profile

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Chris Aiken, MD @chrisaikenmd.bsky.social · 9d

Sodas raise #depression risk, in part by disrupting gut microbiome:
pubmed.ncbi.nlm.nih.gov/40991280

Diet soda may be worse: Artificial sweeteners cause hippocampal damage and cognitive problems in mice:
pubmed.ncbi.nlm.nih.gov/39382230

Evidence: 4/10 (correlation, not causation)

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Chris Aiken, MD @chrisaikenmd.bsky.social · 10d

What keeps people active in retirement?

A sense of purpose, concludes new prospective cohort study:
www.ncbi.nlm.nih.gov/pubmed/40919...

Evidence grade: Moderate (5/10)
chrisaikenmd.com/ebm/

#psychiatry #pmhnp #therapy #mentalhealth #psychology

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Chris Aiken, MD @chrisaikenmd.bsky.social · 10d

New Carlat #Psychiatry Podcast covers meds that require special skill to start:

> Trazodone
> Carbamazepine
> Lithium
> Bupropion
> Pramipexole
> Valproate
> Topiramate

Plus a research update on #antidepressant withdrawal:
www.thecarlatreport.com/blogs/2-the-...

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Chris Aiken, MD @chrisaikenmd.bsky.social · 10d

"Don't put antisocials in group therapy. They'll just learn how to be more antisocial!"

But new trial of group + individual mentalization-based therapy refuts that:
pubmed.ncbi.nlm.nih.gov/39978982

It reduced aggressive behavior with a large effect size compared to controls on parole.

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Chris Aiken, MD @chrisaikenmd.bsky.social · 12d

The ketogenic diet reduced #depression 60% in this open-label study that followed 24 young adults with MDD over 3 months. Unfortunately drop-outs = 34%:
www.ncbi.nlm.nih.gov/pubmed/40925...

It also was neuroprotective (BDNF)

Evidence grade: Very low (2/10)
chrisaikenmd.com/ebm

#psychiatry #pmhnp

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Chris Aiken, MD @chrisaikenmd.bsky.social · 13d

Do non-or low-alcohol beers* and cocktails help people reduce #alcohol use? Yes, if the reason for drinking is social conformity, concludes cross-sectional UK study:
www.ncbi.nlm.nih.gov/pubmed/40937...

Low: < 1.2%; Non: < 0.5% alcohol
QUIZ: This bit of trivia in life-saving for which patients?

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Chris Aiken, MD @chrisaikenmd.bsky.social · 14d

Is #ketamine neurotoxic? Review concludes
▪ Not in antidepressant doses, even with long-term use
▪ Yes in high doses

www.ncbi.nlm.nih.gov/pubmed/40926...
▪ How do they know? Cognitive testing in humans and histopathology in animals
▪ Some more vulnerable to toxicity? Possibly children and elderly

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Chris Aiken, MD @chrisaikenmd.bsky.social · 14d

Trial: www.ncbi.nlm.nih.gov/pubmed/40932...

Low-Dose Propranolol versus Amitriptyline for Episodic Migraine Prophylaxis: A Randomized Controlled Trial Assessing Efficacy, Safety, and Cost-Effectiveness - PubMed

Clinical Trial Registry-India (Date: 27 October 2020; registration no.: CTRI/2020/01/022972).

www.ncbi.nlm.nih.gov

Chris Aiken, MD @chrisaikenmd.bsky.social · 15d

Propranolol and low-dose amitriptyline are both useful for #migraines, and this small RCT suggests propranolol is the better option for prevention (80 mg daily)

Evidence grade: Moderate (6/10)
chrisaikenmd.com/ebm

More on migraines in #psychiatry:
www.thecarlatreport.com/articles/454...

#pmhnp

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Chris Aiken, MD @chrisaikenmd.bsky.social · 16d

Among children prescribed a stimulant:

▪ 1/30 develop psychosis
▪ 1/30 develop #bipolar
▪ Amphetamines riskier than methylphenidate:
www.ncbi.nlm.nih.gov/pubmed/40900...

From pooled analysis of 288,199 patients, avg age 13.

Evidence grade 5/10
chrisaikenmd.com/ebm
Art J Clark

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Chris Aiken, MD @chrisaikenmd.bsky.social · 17d

Patients recover faster when you measure symptoms, concludes RCT of #depression:
www.ncbi.nlm.nih.gov/pubmed/40892...

What rating scale do you find useful? My patients have comorbidities so I use a broad scale:
chrisaikenmd.com/treatmentupd...

Evidence grade: High (10/10)
chrisaikenmd.com/ebm

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Chris Aiken, MD @chrisaikenmd.bsky.social · 18d

GLP-1 agonist semaglutide reduced diabetes risk (HbA1c) and weight (20 lb) in new RCT of people with #schizophrenia, prediabetes, and obesity:
www.ncbi.nlm.nih.gov/pubmed/40900...

Evidence grade: High (10/10)
chrisaikenmd.com/ebm/

How to use GLP-1’s:
www.thecarlatreport.com/articles/535...

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Chris Aiken, MD @chrisaikenmd.bsky.social · 18d

/typo: reincarceration

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